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Washington, Jun 9: When epidemiologists talked about "flattening the curve," they probably didn't mean it this way: the US hit its peak coronavirus caseload in April, but since that time the graph has been on a seemingly unending plateau.

That's unlike several other hard-hit countries which have successfully pushed down their numbers of new cases, including Spain and Italy, which now have bell-shaped curves.

Experts say the prolonged nature of the US epidemic is the result of the cumulative impact of regional outbreaks, as the virus that started out primarily on the coasts and in major cities moves inward.

Layered on top of that are the effects of lifting lockdowns in parts of the country that are experiencing rising cases, as well as a lapse in compliance with social distancing guidelines because of economic hardship, and in some cases a belief that the threat is overstated.

"The US is a large country both in geography and population, and the virus is at very different stages in different parts of the country," Tom Frieden, a former director of the Centers for Disease Control and Prevention told AFP.

The US saw more than 35,000 new cases for several days in April. While that figure has declined, it has still been exceeding 20,000 regularly in recent days.

By contrast, Italy was regularly hitting more than 5,000 cases per day in March but is currently experiencing figures in the low hundreds.

"We did not act quickly and robustly enough to stop the virus spreading initially, and data indicate that it travelled from initial hotspots along major transport routes into other urban and rural areas," added Frieden, now CEO of the non-profit Resolve to Save Lives.

To wit: the East Coast states of New York, New Jersey and Massachusetts accounted for about 50 percent of all cases until about a month or so ago -- but now the geographic footprint of the US epidemic has shifted to the Midwest and southeast, including Florida.

Another key problem, said Jennifer Nuzzo, an epidemiologist at Johns Hopkins, is that the United States is still not doing enough testing, contact tracing and isolation.

After coming late to the testing party -- for reasons ranging from technical issues to regulatory hurdles -- the US has now conducted more COVID-19 tests than any other country.

It even has one of the highest per capita rates per country of 62 per 1,000 people, according to the website ourworldindata.org -- better than Germany (52 per 1,000) and South Korea (20 per 1,000).

But according to Nuzzo, these numbers are misleading, because "the amount of testing that a country should do should be scaled to the size of its epidemic.

"The United States has the largest epidemic in the world so obviously we need to do a lot more testing than any other country."

For Johns Hopkins, the more important metric is the positivity rate -- that is, out of all tests conducted, how many came back positive for COVID-19.

As of June 7, the United States had an average daily positivity rate of 14 percent, well above the World Health Organization guideline of 5 percent over two weeks before social distancing guidelines should be relaxed.

By contrast, Germany, which has tested far fewer people in relation to its population, has a positivity rate of 5 percent.

Even if testing were scaled up, carrying out tests in of itself does very little good without the next steps -- finding out who was exposed and then asking them to isolate.

Here also, too many US states are lagging woefully behind.

Texas, which is experiencing a surge in cases after relaxing its lockdown, is a case in point. The state targeted hiring a modest 4,000 tracers by June, but according to local reports is still more than a thousand shy of even that goal.

Opt-in app based efforts have also been slow to get off the ground.

Then there is the fact that some people are growing tired of lockdowns, while others don't have the economic luxury of being able to stay home for prolonged periods.

The government sent some 160 million Americans a single stimulus check of up to $1,200 back in April but it's not clear whether more will be forthcoming.

Still others, particularly in so-called red states under Republican leadership, have chafed under restrictions and mask-wearing guidelines that they see as an affront to their personal freedom.

"The US is kind of on the extreme of the individual liberty side," Sten Vermund, dean of the Yale School of Public Health, told AFP.

Part of this has to do with mixed messaging from Republican leaders, including President Donald Trump, said Nuzzo.

"We have had at the highest political level an assertion that this is a situation that's been overblown, and that maybe certain protective behaviors are not necessary," she said.

More recently, tens of thousands of people across the country have taken to the streets to protest the killing on an unarmed black man by police, risking coronavirus infection to demonstrate against the public health threat of racialized state violence.

Paris, May 10: The number of coronavirus cases worldwide topped four million as some of the hardest-hit countries readied Sunday to lift lockdown restrictions despite concern about a second wave of infections.

Governments around the world are trying to stop the spread of the deadly disease while scrambling for ways to relieve pressure on their economies, which are facing a historic downturn with millions pushed into unemployment.

Despite the intense political pressure to reopen, nations are also keen to avoid second waves of infections that could overwhelm healthcare systems, with reminders over the weekend of the threat posed by the virus.

In the United States, media reported Saturday that the nation's top infectious disease expert, Anthony Fauci, was among three members of the White House coronavirus task force who will self-isolate after potential exposure.

And in South Korea, the capital Seoul shut all bars and clubs on Saturday as more than 50 cases were linked to a man who tested positive after spending time in one of the city's busiest nightlife districts.

Despite the risks, some governments in hard-hit Europe have said are signs of progress that justify cautious steps towards normality.

Officials in France on Saturday said the day's death toll of 80 was the lowest since early April, while nursing home fatalities also fell sharply as the nation prepared to relax curbs on public movement imposed eight weeks ago.

The easing, to begin Monday, has brought mixed reactions.

"I've been scared to death" about the reopening, said Maya Flandin, a bookshop manager from Lyon. "It's a big responsibility to have to protect my staff and my customers."

French health officials have warned that social distancing must be kept up even as restrictions are eased.

In Spain, about half the population will be allowed out on Monday for limited socialisation, and restaurants will be able to offer some outdoor service as the country begins a phased transition set to last through June.

With lingering fears of a resurgence, authorities excluded Madrid and Barcelona -- two COVID-19 hotspots -- from the first phase.

Belgium is also easing some restrictions on Monday, and in some parts of Germany, bars and restaurants reopened on Saturday with further easing set for Monday.

In Britain, Prime Minister Boris Johnson is expected Sunday to lay out a plan for the nation to emerge out of its current lockdown.

Media reports have suggested that Britain may introduce a mandatory 14-day quarantine for international arrivals to stop the spread of the virus.

Global economic figures are pointing to the most acute downturn in nearly a century, with businesses forced to shut and supply lines badly disrupted, and pressure is growing on leaders around the world to find a way out as the worldwide death toll topped 277,000 and infections crossed four million.

In the United States, the country with the highest death toll and where more than 20 million people have lost their jobs, President Donald Trump has insisted that next year would be "phenomenal" for the economy, urging reopening despite the virus still claiming well over 1,000 lives daily in the country.

The scale of the challenge was brought in sharp focus over the weekend as US media reported that top disease expert Anthony Fauci, who has become the trusted face of the government response to the pandemic, is going to self-isolate after possible exposure to an infected White House staffer.

Fauci told CNN that he will undergo a "modified quarantine" as he had not been in close proximity to the staffer, the network reported. He will remain at home teleworking, and will wear a mask for two weeks.

Robert Redfield, the director of the Centers for Disease Control and Prevention, and Stephen Hahn, the commissioner of the Food and Drug Administration, will also self-isolate, CNN added.

All three will still testify at Tuesday's Senate coronavirus hearing, with Redfield and Hahn participating via video link, according to Senator Lamar Alexander, chairman of the chamber's health committee.

It is believed Fauci will attend wearing a mask, CNN reported.

President Trump has faced sharp criticism from his predecessor Barack Obama, who said on a leaked tape that Trump's handling of the crisis was an "absolute chaotic disaster".

With people wearying of being indoors and under economic pressure, anti-lockdown protests have been held in a number of countries in recent weeks, with some demonstrators arguing that such restrictions violate their rights and others promoting conspiracy theories about the pandemic.

Ten people were arrested and a police officer injured in Melbourne, Australia, on Sunday in the latest such protest, where around 150 people gathered to demand an end to the shutdown.

Participants were promoting a number of conspiracy theories, such as linking 5G cellular communications to the disease.

Australian chief medical officer Brendan Murphy said there was "a lot of very silly misinformation out there", including the 5G allegation.

"I have unfortunately received a lot of communication from these conspiracy theorists myself," he said.

"It is complete nonsense. 5G has got nothing at all to do with coronavirus."