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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.

Washington, May 20: The United States recorded another 1,536 coronavirus deaths over the past 24 hours, the Johns Hopkins University tracker said.

That figure, tallied as of 8:30 pm (0030 GMT), raises to 91,845 the total number of COVID-19 deaths in the US.

The US tops the global rankings both for the highest death toll and the highest number of infections, with more than 1.5 million cases.

Wuhan, Apr 15: In the six days after top Chinese officials secretly determined they likely were facing a pandemic from a new coronavirus, the city of Wuhan at the epicenter of the disease hosted a mass banquet for tens of thousands of people; millions began traveling through for Lunar New Year celebrations.

President Xi Jinping warned the public on the seventh day, Janaury 20. But by that time, more than 3,000 people had been infected during almost a week of public silence, according to internal documents obtained by The Associated Press and expert estimates based on retrospective infection data.

That delay from Jan 14 to Jan. 20 was neither the first mistake made by Chinese officials at all levels in confronting the outbreak, nor the longest lag, as governments around the world have dragged their feet for weeks and even months in addressing the virus.

But the delay by the first country to face the new coronavirus came at a critical time — the beginning of the outbreak. China's attempt to walk a line between alerting the public and avoiding panic set the stage for a pandemic that has infected almost 2 million people and taken more than 126,000 lives.

A This is tremendous, a said Zuo-Feng Zhang, an epidemiologist at the University of California, Los Angeles. If they took action six days earlier, there would have been much fewer patients and medical facilities would have been sufficient. We might have avoided the collapse of Wuhan's medical system.

Other experts noted that the Chinese government may have waited on warning the public to stave off hysteria, and that it did act quickly in private during that time.

But the six-day delay by China's leaders in Beijing came on top of almost two weeks during which the national Center for Disease Control did not register any cases from local officials, internal bulletins obtained by the AP confirm. Yet during that time, from Jan 5 to Jan 17, hundreds of patients were appearing in hospitals not just in Wuhan but across the country.

It's uncertain whether it was local officials who failed to report cases or national officials who failed to record them. It's also not clear exactly what officials knew at the time in Wuhan, which only opened back up last week with restrictions after its quarantine.

But what is clear, experts say, is that China's rigid controls on information, bureaucratic hurdles and a reluctance to send bad news up the chain of command muffled early warnings. The punishment of eight doctors for rumor-mongering, broadcast on national television on Jan. 2, sent a chill through the city's hospitals.

Doctors in Wuhan were afraid, said Dali Yang, a professor of Chinese politics at the University of Chicago. It was truly intimidation of an entire profession. Without these internal reports, it took the first case outside China, in Thailand on Jan 13, to galvanize leaders in Beijing into recognising the possible pandemic before them. It was only then that they launched a nationwide plan to find cases distributing CDC-sanctioned test kits, easing the criteria for confirming cases and ordering health officials to screen patients, all without telling the public.

The Chinese government has repeatedly denied suppressing information in the early days, saying it immediately reported the outbreak to the World Health Organization.

Allegations of a cover-up or lack of transparency in China are groundless, said foreign ministry spokesman Zhao Lijian at a Thursday press conference.

The documents show that the head of China's National Health Commission, Ma Xiaowei, laid out a grim assessment of the situation on Jan. 14 in a confidential teleconference with provincial health officials.

A memo states that the teleconference was held to convey instructions on the coronavirus from President Xi Jinping, Premier Li Keqiang and Vice Premier Sun Chunlan, but does not specify what those instructions were.

The epidemic situation is still severe and complex, the most severe challenge since SARS in 2003, and is likely to develop into a major public health event, the memo cites Ma as saying.

The National Health Commission is the top medical agency in the country. In a faxed statement, the Commission said it had organised the teleconference because of the case reported in Thailand and the possibility of the virus spreading during New Year travel. It added that China had published information on the outbreak in an open, transparent, responsible and timely manner," in accordance with important instructions repeatedly issued by President Xi.

The documents come from an anonymous source in the medical field who did not want to be named for fear of retribution. The AP confirmed the contents with two other sources in public health familiar with the teleconference. Some of the memo's contents also appeared in a public notice about the teleconference, stripped of key details and published in February.

Under a section titled sober understanding of the situation, the memo said that clustered cases suggest that human-to-human transmission is possible. It singled out the case in Thailand, saying that the situation had changed significantly because of the possible spread of the virus abroad.

With the coming of the Spring Festival, many people will be traveling, and the risk of transmission and spread is high, the memo continued.