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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.

Jan 23: Hundreds of Central Americans trying to reach the United States were stuck at the Mexico-Guatemala border on Wednesday after the Mexican government beefed up security to meet US demands to contain migrant flows.

Under sustained pressure from President Donald Trump, Mexico's government has adopted tougher measures to reduce the number of people heading towards the U.S. border.

Migrants in Tecun Uman, on the Guatemalan side of the border, were taken by surprise.

"We thought we'd be allowed through just like with the October caravan when they reached Tijuana," said Honduran migrant Ritzy Anabel, who did not give her surname.

"People from Mexico and Guatemala treated them well. But now it's changed because Mexicans don't want (us) to enter."

Many Central Americans migrants heading north are fleeing economic hardship and violence at home. A large caravan of migrants crossed into Mexico and went north in October 2018. Migrants crossing into Mexico earlier this week faced tear gas from security forces, who delivered a firmer response than in previous mass movements at the border.

Even so, about 1,000 migrants, most of them from Honduras, managed to reach Mexican soil on Tuesday. Mexican Foreign Minister Marcelo Ebrard said several hundred of the new arrivals were immediately deported on planes and buses.

On Wednesday, Mexican authorities said that 460 Honduran migrants were deported throughout the day. Other migrants from the group, including families traveling with children, were pondering their next moves.

Honduran Carlos Amador said that while some of his compatriots were returning home, others were hoping for positive news.

Trump has repeatedly threatened to punish Mexico and Central American countries if they fail to clamp down on the migrant flows. That has resulted in a series of agreements aimed at delivering on Trump's campaign promises to curb immigration.

Department of Homeland Security Acting Secretary Chad Wolf called the measures put in place by the Mexican National Guard "effective", adding that dozens of his personnel was on the ground in Central America assisting local immigration and security officials. Trump tweeted: "Sorry, if you come you will be immediately sent back!"

Jun 11: The total death toll in the US from the novel coronavirus pandemic could hit the grim figure of 200,000 by September and expecting a dramatic decrease in COVID-19 cases in the country will be a "wishful thinking , an eminent Indian-American professor has warned.

Ashish Jha, the head of Harvard's Global Health Institute, told CNN on Wednesday that he is not trying to scare people to stay at home rather urged everyone to wear masks, adhere to the social distancing rules and called for ramping up testing and tracing infrastructure.

Anybody who's expecting a dramatic decrease in cases is almost surely engaging in wishful thinking. And if it (COVID numbers) stays just flat for the next three months, we're going to hit 200,000 deaths sometime in September and that is just awful, Jha said.

Jha said the 200,000 death toll is not just a guess . Currently 800-1000 people are dying daily in America from the virus and all data suggest that the situation is going to get worse.

We're gonna have increases, but even if we assume that it's going to be flat all summer, that nothing is going to get worse... even if we pick that low number of 800 a day, that is 25,000 (deaths) a month in three and a half months. We're going to add another 88,000 people and we will hit 200,000 sometime in September, Jha said.

The United States is by far the hardest-hit country in the global pandemic, in terms of both confirmed infections and deaths.

According to data by the Johns Hopkins University, the number of coronavirus cases in the US currently is nearly two million and about 112,900 people have died in the country, the most in the world.

When asked about an improvement in states like New York, which had been the epicenter of the COVID19 pandemic in the US, Jha said while coronavirus cases are declining in New York, New Jersey, Connecticut and Massachusetts, the numbers are increasing in states such as Arizona, Florida, Texas, North and South Carolina while the country as a whole is pretty flat.

He said, people should take measures as that will help suppress the virus and ensure people could get back outside safely but he voiced concern that this was not the situation in reality.

We're not doing that and so we're going to unfortunately have another 25,000 deaths a month until September, and then it'll keep going. It's not going to magically disappear. We've got a turn around. This is not the future I want, he said.

Jha said he had expected the situation to improve in the summer months but on the contrary the numbers have continued to rise even in the warm weather.

Summer was supposed to be our better months - warmer weather, people outside, a little less transmission. This is not the time (summer) I was expecting a lot more cases. We're seeing a lot more cases, especially in states like Arizona where the numbers look really scary, he said.

Jha added that he was hopeful that maybe the summer months would give us more of a break. I think I may have been too optimistic on that.