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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.

UN, May 26: Countries could see a "second peak" of coronavirus cases during the first wave of the pandemic if lockdown restrictions were lifted too soon, the World Health Organization (WHO) has warned.

Mike Ryan, the WHO's head of emergencies, told a briefing on Monday that the world was "right in the middle of the first wave", the BBC reported.

He said because the disease was "still on the way up", countries need to be aware that "the disease can jump up at any time".

"We cannot make assumptions that just because the disease is on the way down now that it's going to keep going down," Ryan said.

There would be a number of months to prepare for a second peak, he added.

The stark warning comes as countries around the world start to gradually ease lockdown restrictions, allowing shops to reopen and larger groups of people to gather.

Experts have said that without a vaccine to give people immunity, infections could increase again when social-distancing measures are relaxed.

Ryan said countries where cases are declining should be using this time to develop effective trace-and-test regimes to "ensure that we continue on a downwards trajectory and we don't have an immediate second peak".

Also on Monday, Tedros Adhanom Ghebreyesus, WHO Director-General, said that a clinical trial of hydroxychloroquine (HCQ) on COVID-19 patients has come to "a temporary pause", while the safety data of the the anti-malaria drug was being reviewed.

According to the WHO chief, The Lancet medical journal on May 22 had published an observational study on HCQ and chloroquine and its effects on COVID-19 patients that have been hospitalized, reports Xinhua news agency.

The authors of the study reported that among patients receiving the drug, when used alone or with a macrolide, they estimated a higher mortality rate.

"The Executive Group of the Solidarity Trial, representing 10 of the participating countries, met on Saturday (May 23) and has agreed to review a comprehensive analysis and critical appraisal of all evidence available globally," Tedros said in a virtual press conference.

The developments come as the total number of global COVID-19 cases has increased to 5,508,904, with 346,508 deaths, according to the Johns Hopkins University.

Beijing, Feb 24: The lockdown of Guo Jing's neighbourhood in Wuhan -- the city at the heart of China's new coronavirus epidemic -- came suddenly and without warning.

Unable to go out, the 29-year-old is now sealed inside her compound where she has to depend on online group-buying services to get food.

"Living for at least another month isn't an issue," Guo told news agency, explaining that she had her own stash of pickled vegetables and salted eggs.

But what scares her most is the lack of control -- first, the entire city was sealed off, and then residents were limited to exiting their compound once every three days.

Now even that has been taken away.

Guo is among some 11 million residents in Wuhan, a city in central Hubei province that has been under effective quarantine since January 23 as Chinese authorities race to contain the epidemic.

Since then, its people have faced a number of tightening controls over daily life as the death toll from the virus swelled to over 2,500 in China alone.

But the new rules this month barring residents from leaving their neighbourhoods are the most restrictive yet -- and for some, threaten their livelihoods.

"I still don't know where to buy things once we've finished eating what we have at home," said Pan Hongsheng, who lives with his wife and two children.

Some neighbourhoods have organised group-buying services, where supermarkets deliver orders in bulk.

But in Pan's community, "no one cares".

"The three-year-old doesn't even have any milk powder left," Pan told news agency, adding that he has been unable to send medicine to his in-laws -- both in their eighties -- as they live in a different area.

"I feel like a refugee."

The "closed management of neighbourhoods is bound to bring some inconvenience to the lives of the people", Qian Yuankun, vice secretary of Hubei's Communist Party committee, said at a press briefing last week.

Authorities on Monday allowed healthy non-residents of the city to leave if they never had contact with patients, but restrictions remained on those who live in Wuhan.

Demand for group-buying food delivery services has rocketed with the new restrictions, with supermarkets and neighbourhood committees scrambling to fill orders.

Most group-buying services operate through Chinese messaging app WeChat, which has ad-hoc chat groups for meat, vegetables, milk -- even "hot dry noodles", a famous Wuhan dish.

More sophisticated shops and compounds have their own mini-app inside WeChat, where residents can choose packages priced by weight before orders are sent in bulk to grocery stores.

In Guo's neighbourhood, for instance, a 6.5-kilogramme (14.3-pound) set of five vegetables, including potatoes and baby cabbage, costs 50 yuan ($7.11).

"You have no way to choose what you like to eat," Guo said. "You cannot have personal preferences anymore."

The group-buying model is also more difficult for smaller communities to adopt, as supermarkets have minimum order requirements for delivery.

"To be honest, there's nothing we can do," said Yang Nan, manager of Lao Cun Zhang supermarket, which requires a minimum of 30 orders.

"We only have four cars," she said, explaining that the store did not have the staff to handle smaller orders.

Another supermarket told AFP it capped its daily delivery load to 1,000 orders per day.

"Hiring staff is difficult," said Wang Xiuwen, who works at the store's logistics division, adding that they are wary about hiring too many outsiders for fear of infection.

Closing off communities has split the city into silos, with different neighbourhoods rolling out controls of varying intensity.

In some compounds, residents have easier access to food -- albeit a smaller selection than normal -- and one woman said her family pays delivery drivers to run grocery errands.

Her compound has not been sealed off either, the 24-year-old told AFP under condition of anonymity, though they are limited to one person leaving at a time.

Some districts have implemented their own rules, such as prohibiting supermarkets from selling to individuals, forcing neighbourhoods to buy in bulk or not at all.

"In the neighbourhood where I live, the reality is really terrible," said David Dai, who is based on the outskirts of Wuhan.

Though his apartment complex has organised group-buying, Dai said residents were unhappy with price and quality.

"A lot of tomatoes, a lot of onions -- they were already rotten," he told , estimating over a third of the food had to be thrown away.

His family must "totally depend" on themselves, added the 49-year-old, who has resorted to saving and drying turnip skins to add nutrients to future meals.

The uncertainty of not knowing when the controls will be lifted is also frustrating, said Ma Chen, a man in his 30s who lives alone.

"I have no way of knowing how much (food) I should buy."