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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.

Feb 12: China on Wednesday reported another drop in the number of new cases of a viral infection and 97 more deaths, pushing the total dead past 1,100 as postal services worldwide said delivery was being affected by the cancellation of many flights to China.

The National Health Commission said 2,015 new cases had been reported over the last 24 hours, declining for a second day. The total number of cases in mainland China reached 44,653, although many experts say a large number of others infected have gone uncounted.

The additional deaths raised the mainland toll to 1,113. Two people have died elsewhere, one in Hong Kong and one in the Philippines.

In the port city of Tianjin, just southeast of Beijing, a cluster of cases has been traced to a department store in Baodi district. One-third of Tianjin’s 104 confirmed cases are in Baodi, the Xinhua state news agency reported.

A salesperson working in the store’s small home appliance section became the first individual in the cluster to be diagnosed on Jan. 31, Xinhua said. The store was already closed at that point, then disinfected on Feb. 1. Nevertheless, several more diagnoses soon followed.

The next to have their infections confirmed were also salespeople at the store. They had not visited Wuhan recently and, with the exception of one married couple, the patients worked in different sections of the store and did not know one another, according to Xinhua.

Japan’s Health Ministry said that 39 new cases have been confirmed on a cruise ship quarantined at Yokohama, bringing the total to 174 on the Diamond Princess.

The U.S. Postal Service said that it was “experiencing significant difficulties” in dispatching letters, parcels and express mail to China, including Hong Kong and Macau.

Both the U.S. and Singapore Post said in notes to their global counterparts that they are no longer accepting items destined for China, “until sufficient transport capacity becomes available.”

The Chinese mail service, China Post, said it was disinfecting postal offices, processing centers and vehicles to ensure the virus doesn’t spread via the mail and to protect staff.

It said the crisis is also impacting mail that transits China to other destinations including North Korea, Kazakhstan, Kyrgyzstan, Mongolia, Tajikistan, Turkmenistan, Uzbekistan and Vietnam.

The World Health Organization has named the disease caused by the virus as COVID-19, avoiding any animal or geographic designation to avoid stigmatization and to show the illness comes from a new coronavirus discovered in 2019.

The illness was first reported in December and connected to a food market in the central Chinese city of Wuhan, where the outbreak has largely been concentrated.

Zhong Nanshan, a leading Chinese epidemiologist, said that while the virus outbreak in China may peak this month, the situation at the center of the crisis remains more challenging.

“We still need more time of hard working in Wuhan,” he said, describing the isolation of infected patients there a priority.

“We have to stop more people from being infected,” he said. “The problem of human-to-human transmission has not yet been resolved.”

Without enough facilities to handle the number of cases, Wuhan has been building prefabricated hospitals and converting a gym and other large spaces to house patients and try to isolate them from others.

China’s official media reported Tuesday that the top health officials in Hubei province, of which Wuhan is the capital, have been relieved of their duties. No reasons were given, although the province’s initial response was deemed slow and ineffective. Speculation that higher-level officials could be sacked has simmered, but doing so could spark political infighting and be a tacit admission of responsibility.

The virus outbreak has become the latest political challenge for the party and its leader, Xi Jinping, who despite accruing more political power than any Chinese leader since Mao Zedong, has struggled to handle crises on multiple fronts. These include a sharply slowing domestic economy, the trade war with the U.S. and pushback on China’s increasingly aggressive foreign policies.

China is struggling to restart its economy after the annual Lunar New Year holiday was extended to try to curb the spread of the virus. About 60 million people are under virtual quarantine and many others are still working at home.

In Hong Kong, the diagnosis of four people living in an apartment building prompted worried comparisons with the deadly SARS pandemic of 17 years ago.

More than 100 people were evacuated from the building after a 62-year-old woman diagnosed with the virus was found living 10 floors directly below a man who was earlier confirmed with the virus.

Health officials called it a precautionary measure and sought to assuage fears of an epidemic, dismissing similarities to the SARS community outbreak at the Amoy Gardens housing estate in 2003.

London/Milan, Jun 2: World Health Organization experts and a range of other scientists said on Monday there was no evidence to support an assertion by a high profile Italian doctor that the coronavirus causing the COVID-19 pandemic has been losing potency.

Professor Alberto Zangrillo, head of intensive care at Italy's San Raffaele Hospital in Lombardy, which bore the brunt of Italy's COVID-19 epidemic, on Sunday told state television that the new coronavirus "clinically no longer exists".

But WHO epidemiologist Maria Van Kerkhove, as well as several other experts on viruses and infectious diseases, said Zangrillo's comments were not supported by scientific evidence.

There is no data to show the new coronavirus is changing significantly, either in its form of transmission or in the severity of the disease it causes, they said.

"In terms of transmissibility, that has not changed, in terms of severity, that has not changed," Van Kerkhove told reporters.

It is not unusual for viruses to mutate and adapt as they spread, and the debate on Monday highlights how scientists are monitoring and tracking the new virus. The COVID-19 pandemic has so far killed more than 370,000 people and infected more than 6 million.

Martin Hibberd, a professor of emerging infectious disease at the London School of Hygiene & Tropical Medicine, said major studies looking at genetic changes in the SARS-CoV-2 virus that causes COVID-19 did not support the idea that it was becoming less potent, or weakening in any way.

"With data from more than 35,000 whole virus genomes, there is currently no evidence that there is any significant difference relating to severity," he said in an emailed comment.

Zangrillo, well known in Italy as the personal doctor of former Prime Minister Silvio Berlusconi, said his comments were backed up by a study conducted by a fellow scientist, Massimo Clementi, which Zangrillo said would be published next week.

Zangrillo told Reuters: "We have never said that the virus has changed, we said that the interaction between the virus and the host has definitely changed."

He said this could be due either to different characteristics of the virus, which he said they had not yet identified, or different characteristics in those infected.

The study by Clementi, who is director of the microbiology and virology laboratory of San Raffaele, compared virus samples from COVID-19 patients at the Milan-based hospital in March with samples from patients with the disease in May.

"The result was unambiguous: an extremely significant difference between the viral load of patients admitted in March compared to" those admitted last month, Zangrillo said.

Oscar MacLean, an expert at the University of Glasgow's Centre for Virus Research, said suggestions that the virus was weakening were "not supported by anything in the scientific literature and also seem fairly implausible on genetic grounds."