--:-- Sean Rameswaram: Support for Today Explained comes from BetterHelp. Let me tell you a true story. Last weekend, I got an email from a listener who wanted to discuss their problems with me. And I said, look, I don't think that this is about me personally. At least I hope it's not. Why don't you try BetterHelp.com slash Explained? Absolute truth. As the largest online therapy provider in the world, BetterHelp can provide access to mental health professionals with a diverse variety of expertise. Find the one with BetterHelp. The one is not me, guys. Our listeners get 10% off their first month at BetterHelp.com slash explain. That's BetterHelp.com slash explained.
--:-- Sean Rameswaram: Remember the pandemic? With all the news about protests and police reform and racial justice, you may have forgotten about it a bit, but it has not forgotten about you. The United States of America just hit another grim milestone, two million confirmed cases of COVID-19. And as the old song goes, that's an undercount. It's really important to remember that even as summer arrives and people are at the beach and families are getting together again, we lost 1,300 countrymen to COVID-19 on Tuesday alone. And a bunch of states are seeing their biggest yet spikes in new cases right now. On today's show, we're going to try and make sense of the latest numbers and what they mean, and how to keep ourselves safe while the entire country moves on. Vox healthcare reporter Dylan Scott is here to help.
--:-- Dylan Scott: Thanks for having me on the show.
--:-- Sean Rameswaram: Let's start with the spikes. Where are we seeing the biggest spikes in COVID cases right now?
--:-- Dylan Scott: So I asked a bunch of public health experts yesterday which states they're most worried about, and a lot of them had pretty much the same list. It was Arizona, North Carolina, South Carolina, Texas, Utah, Arkansas, Florida, and Tennessee. Those are the states that have some of the most troubling patterns in their COVID-19 outbreaks right now.
--:-- Sean Rameswaram: And are these states that are like seeing a first surge, or is this like a second surge, or what?
--:-- Dylan Scott: I think in most of these places, this is really a first surge. You know, obviously, when the coronavirus first arrived in the U.S., it was concentrated in New York, New Jersey, Connecticut. It obviously popped up in Washington and California. Those were the places that endured, you know, the worst of the first wave here in the United States. And because we went into social distancing back in mid-March, a lot of the rest of the country, you know, had a much slower progression in their COVID-19 outbreaks.
--:-- Sean Rameswaram: But what's concerning is now that we've started to ease social distancing in some of these places, now that businesses are starting to open back up and people are starting to go about their daily lives in a little more normal way again, these are the places where hospitalizations are going up. And even though we're testing a lot more, the rate at which those tests are coming back positive is increasing, which suggests to health experts that it's not just that we're testing more and picking up on more cases, it's that the virus is actually spreading further again in these states.
--:-- Dylan Scott: Just plain old-fashioned community spread. Good old-fashioned community spread, exactly.
--:-- Sean Rameswaram: So tell us how much we really know about what's going on in Arizona, Arkansas, the Carolinas, Florida, Utah, Texas, and Tennessee. What are the details?
--:-- Dylan Scott: So the common feature of almost all of those states that I listed at the top is that their hospitalizations are going up and their positive test rates are going up. So in Arizona, just to give one example, back on May 16th, when they lifted their stay at home order, they had about 800 people in the hospital because of COVID-19. Currently, as of just a couple of days ago, they now have nearly 1300 people in the hospital because of COVID-19. And so that is a meaningful increase in how many people are developing serious COVID-19 cases.
--:-- Sean Rameswaram: And a couple of weeks ago, it was about 8% and now it's about 13%. So all of those things combined to give experts the impression that the outbreak is actually starting to spread again.
--:-- Dylan Scott: And it's difficult to ignore the fact that this is coming a couple of weeks after states started to reopen which is about when we would expect any change in the outbreak from that change in policy to reveal itself.
--:-- Sean Rameswaram: How are these states equipped to deal with this? Do they have sufficient testing supplies? Do they have sufficient PPE? Do they have sufficient ICU beds?
--:-- Dylan Scott: So I think the last one, hospital capacity, is the thing that people are most worried about. The biggest hospital system in Arizona sent out a tweet earlier this week saying they were concerned about how many of their beds are taken up with COVID-19 patients and particularly how many ICU units they have available to handle a surge in COVID-19 cases.
--:-- Sean Rameswaram: Because again, this takes a while to reveal itself. So like right now we're seeing the positive test rate go up. About 30% of ICU beds are available. But if spread is continuing and if more people are getting infected, you know, eventually some of those people are going to need to go to the hospital and that 30% hospital capacity can disappear pretty quickly.
--:-- Dylan Scott: And so the state health department in Arizona has urged hospitals to start activating their emergency plans. You know, whatever they can do to increase some more capacity, now is the time to do it. Because if spread is underway again, you're going to soon have more hospitalizations. And there's not necessarily a ton of capacity right now.
--:-- Sean Rameswaram: And another thing that's complicating this is as part of reopening, hospitals are starting to do elective surgeries again. And they've started to resume business as normal, just like everybody else. And I was talking to somebody in Tennessee who said that one of the reasons he was worried is not just because COVID-19 hospitalizations are increasing, but because their hospitals have also kind of gone back up to their normal capacity, setting aside the coronavirus.
--:-- Dylan Scott: And so any little spikes in COVID-19 cases and the accompanying increase in hospitalizations can be really problematic for these hospitals if they've already started to bring in all their usual patients as well.
--:-- Sean Rameswaram: And so I don't think any of these places are at a crisis mode quite yet, based on the conversations I've had with folks. But the signs are worrying. They're already starting to see an increase in cases. You would expect a surge in hospitalizations to come soon after that. And so the time to prepare for that is now rather than when it's too late.
--:-- Dylan Scott: And at the same time, there's a protest movement coursing its way through this entire country right now? When are we going to see the results of that?
--:-- Sean Rameswaram: That's a good question. I think everybody's waiting with bated breath to see any changes in the trends from the protests. You know, I gave the example of it's been like a month, give or take, since a lot of these states lifted their stay-at-home orders or started reopening businesses. And we're probably just now really starting to see the effect of those policy changes. So I think the same will end up being true of the protests.
--:-- Dylan Scott: You know, they really started picking up about two weeks ago. You know, we would probably just now be on the front end of any new trends in COVID-19 because of the protests starting to reveal themselves.
--:-- Sean Rameswaram: I know I saw yesterday that at least so far, there hasn't been any noticeable uptick in Minneapolis. But I think a lot of the cities where we had substantial protests because of the George Floyd killing will be watched closely.
--:-- Dylan Scott: And it'll be here over these next couple weeks where, you know, if there are new outbreaks because of the protests, we're going to find out.
--:-- Sean Rameswaram: Something that's important to keep in mind is it is probably safe to say that it's too early for us to be seeing an effect of the protests.
--:-- Dylan Scott: And that's why I think experts are more looking at both the policy changes, lifting stay-at-home orders, as well as the attitudinal changes, people just starting to act a little more freely.
--:-- Sean Rameswaram: You know, we're a couple weeks out from Memorial Day when a lot of people might have decided to venture out for the first time. And so this seems to be right now a story about what happens when we start to reopen.
--:-- Dylan Scott: We'll find out here in the next week or two what happened as a result of the protests.
--:-- Sean Rameswaram: More with Dylan after a quick break. I'm Sean Rameswaram. This is Today Explained.
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--:-- Dylan Scott: Dylan, you mentioned these states that are seeing these big surges right now. Arizona, Arkansas, the Carolinas, Florida, Texas, Tennessee, Utah. These are states that are seeing big first surges. It's not a second surge or a so-called second wave. How exactly do we determine when it's a second wave for the country, though?
--:-- Sean Rameswaram: What's tricky about this is that, like, every place, every city, every state is going through its own coronavirus outbreak. Like, sure, they're interconnected and people travel from one place to another. But like the outbreak in New York City is on a completely different timeline, a completely different trajectory than the outbreak in Phoenix or Salt Lake City or Little Rock.
--:-- Dylan Scott: And so as much as I know people have come to think about things in terms of waves, it's important to remember that we have a bunch of discrete different waves ebbing and flowing all the time. And we can see that right now.
--:-- Sean Rameswaram: You know, these days, the cases and deaths in New York City have been on a substantial decline for quite a while now. You know, they've seen the worst of the coronavirus, whereas somewhere like Arizona that wasn't hit as hard the first time is now, to your point, seeing for the first time a big surge in cases as the lockdown starts to get lifted.
--:-- Dylan Scott: The virus hasn't gone away. COVID-19 is going to spread. People are going to get sick and some people are going to die. And it becomes a decision for politics and for society to figure out how much new COVID-19 spread is worth the economic reopening.
--:-- Sean Rameswaram: What will be concerning is if we see a place like New York or Seattle or some of these places that have already endured a first wave, if they start to see a big surge as they start their reopening process, that's when we're going to know that a second wave is really underway.
--:-- Dylan Scott: And of course, both of those cities have seen huge protests take over their streets with tear gas and coughing and sneezing amongst cops and protesters alike.
--:-- Sean Rameswaram: Yeah. So if we start to see increases there, it's going to be a lot easier to say, well, this is a result of the protests. As opposed to places like Arizona and North Carolina and Florida, where reopening has already been underway for a couple weeks.
--:-- Dylan Scott: And so, you know, if anything, the protests might accelerate trends that were already underway as a result of reopening.
--:-- Sean Rameswaram: This is kind of the new reality for all of us. Any resumption of normal activity before a vaccine is online or before we have a truly effective treatment means a risk of more spread.
--:-- Dylan Scott: It already seemed like President Trump was sort of done talking about COVID-19 and wanted to reopen the country. But how have these protests changed the politics of COVID-19? I mean, is there still as much serious attention being paid to this crisis at the federal level?
--:-- Sean Rameswaram: That's a great question. And I think, I mean, I think it's evident that the White House is not at least publicly talking about the coronavirus nearly as much as they were before.
--:-- Dylan Scott: You know, our daily briefings are now a thing of the past. If you look at the president's Twitter feed, it certainly doesn't seem to be the first thing at the top of his mind on any given day.
--:-- Sean Rameswaram: The next coronavirus stimulus relief package seems to be stuck for the time being. And there seems to be nearly as much urgency about getting that done.
--:-- Dylan Scott: And it really complicated to try to understand what's happening with any given state coronavirus outbreak.
--:-- Sean Rameswaram: A pattern I noticed as I was looking into each one of these places is that the political leaders would usually say like, well, yes, cases are going up, hospitalizations are going up, but that's not because of reopening.
--:-- Dylan Scott: As you see an increase in testing, we've been consistent in saying you will see an increase in cases. The virus is widespread. It's in every county and every state in our nation.
--:-- Sean Rameswaram: And that's why this metric that I've mentioned before about positive test rates is so important, because that is not a reflection of just more testing. It's a reflection of more spread.
--:-- Dylan Scott: And the fact that the political leaders in these states don't seem to be taking that trend and why it's so worrisome seriously, I think is a real cause for concern.
--:-- Sean Rameswaram: And the more we let our attention drift away from it, the more we are really just laying the seeds for the virus to come back in a big way.
--:-- Dylan Scott: So I take your point that this isn't a second wave for the country because we have, you know, 50 different approaches and 50 different waves.
--:-- Sean Rameswaram: But what can the United States learn from other countries who maybe had one big wave and then, you know, one sort of uniform second wave?
--:-- Dylan Scott: I think there are a couple things. One is, it is important, even if we're relaxing lockdowns, people need to take precautions on their own. If you're going out in public, you know, wear a mask. If you're going to see people, try to see people outside.
--:-- Sean Rameswaram: Just because a lockdown is over doesn't mean that social distancing should be over.
--:-- Dylan Scott: Another, and maybe the most concerning thing for the U.S., a lot of these other places, especially like South Korea, have instituted really robust contact tracing programs.
--:-- Sean Rameswaram: If somebody gets sick, they interview that person, find out everybody that they've been in contact with, they get in touch with those people and tell them about their exposure and ask them to isolate themselves.
--:-- Dylan Scott: It's a really good way to try to clamp down on new outbreaks. But here in the U.S., we haven't put nearly as much money behind contact tracing as experts think we should.
--:-- Sean Rameswaram: These apps that Apple and Google have tried to facilitate through their Bluetooth technology, most states aren't even making them.
--:-- Dylan Scott: There hasn't been a ton of uptake in the states that have. And even if they did, most Americans have said they don't want to use that kind of app.
--:-- Sean Rameswaram: And so that limits our ability to leverage technology to make contact tracing easier, which then means we need to rely more on traditional contact tracing, which is like an individual person gets hired by the government. They do interviews with people who have tested positive for COVID-19, get in touch with all the people who they've been in contact with.
--:-- Dylan Scott: But even that, like we don't have enough people to do it. We don't have enough money to hire people and to train people to do it.
--:-- Sean Rameswaram: And so I do think there's this sort of almost scary bit of fatalism that the United States seems to be adopting towards COVID, which is just like, We've locked down for a couple months. We did what we could. And now we're just going to kind of move on and accept it.
--:-- Dylan Scott: Yeah, it sounds like we've gone from we're all in this together to very much so being at the point where it's like, you're on your own, kid. Good luck.
--:-- Sean Rameswaram: Yeah. Something that's important to keep in mind is even though the governments might be relaxing their policies, I do think there's a lot of evidence in public opinion surveys and that kind of thing that individual Americans do still take the coronavirus threat seriously.
--:-- Dylan Scott: They are going to be cautious about going to restaurants, seeing their friends. And hopefully a lot of us will still be willing to take the very easy precautions that we know from science do a lot to tamp down on transmissions.
--:-- Sean Rameswaram: There is a lot that's within each of our individual power to do to try to keep the coronavirus under control, no matter how the government policies have changed.
--:-- Dylan Scott: That's an undercount.
