Nearly two months ago, a health-care adviser to two U.S. presidents burst out in frustration when asked whether Americans would see a quick spike in new COVID-19 cases as states reopened.
Zeke Emanuel, who served in the Obama White House and has informally advised President Donald Trump, expressed exasperation that people kept looking for an immediate effect.
Launching into a sermon about the mathematical realities of exponential growth rates, Emanuel said the disastrous consequences of reopening too early would only emerge around early summer.
“Two months, not two weeks,” Emanuel said in early May. “That’s likely when you’ll see the effects of what we’re doing today. … That’s when people will recognize, ‘Wow, now we’ve got 1,000 cases today, 3,000 cases tomorrow, 6,000 the next day.'”
He predicted the country would awaken to the disaster around mid-July.
It’s happening ahead of schedule.
Few people wear masks as they walk on the beach pier in Oceanside, California, on Monday, despite rising COVID-19 case numbers in the state. (Mike Blake/Reuters)
The U.S. has surpassed 127,000 deaths and case counts are rising rapidly in numerous states, mainly in the south. An alarming surge has forced Texas to pause its reopening plans. Hospitalizations have hit record highs in Arizona and in California.
Florida has backpedaled on its reopening bullishness. A governor who recently accused the media of fear-mongering over COVID-19 — wagging his finger at reporters over what he characterized as “black helicopter” conspiracy theories — was forced to announce Friday that bars would close again as Florida experienced an astronomical spike in positive tests.
“This is what happens when you reduce social distancing measures and you have community transmission ongoing and those two things collide and it just spreads,” said Jason Kindrachuk, an assistant professor of viral pathogenesis at the University of Manitoba in Winnipeg and Canada Research Chair of emerging viruses.
Kindrachuk said that Canadians would be well-advised to take lessons from the American response to the pandemic.
“We can take that information and posit here in Canada that as we reduce social distancing, especially in regions that are more population-dense, we’re likely going to see a resurgence in cases, because ultimately the virus is still in our communities and it’s still able to spread.”
U.S. South hard-hit
On Friday, the troubling trendline in the U.S. prompted the White House to resume its previously suspended coronavirus press conferences. Vice-President Mike Pence maintained the country is largely better off than a few weeks ago, but said 16 states have rising case totals and, more worryingly, a rising percentage of positive test rates.
While this virus is an evolving phenomenon, rendering any broad conclusions risky, here’s what we know about the places in the U.S. experiencing outbreaks: they’re mostly in the south; mostly in states that reopened early and aggressively and resisted the widespread use of masks; and mostly run by Republicans, unlike an earlier wave that primarily struck northern, Democrat-led states.
The rapid increase in cases and hospitalizations is due to the push to reopen states without first establishing proper systems of tracking and treating cases, said Dr. Amesh Adalja, an infectious disease physician and senior scholar at the Johns Hopkins Center for Health Security.
“It’s never been a question whether or not we would get more cases when people started to socially interact,” he said. “The question always was, could we keep those cases occurring at a pace that was manageable?”
Adalja said, “clearly in those states that are under stress right now, there hadn’t been enough preparation for these cases.”
He said states facing a strain on their health-care systems squandered opportunities during lockdowns to expand their capacity and prepare for a spike in cases.
People line up to get tested for COVID-19 at a drive through testing site in Phoenix, Ariz. on June 20. (Matt York/Associated Press)
“From the very beginning, this outbreak has really been mismanaged in terms of what the government response should have been,” he said. “People thought that they could get away with going back to the norm – not realizing the virus was still there.”
Adalja said some parts of the U.S. that were spared large outbreaks of COVID-19 early in the pandemic wrongly assumed they wouldn’t be hit hard after lifting lockdown measures — or that they could adequately handle the number of new cases.
He said that’s the main takeaway for Canada as provinces hit hard by COVID-19, like Ontario and Quebec, move to lift lockdown measures.
“What you can learn is that the virus hasn’t disappeared, that social interaction is going to drive new cases,” Adalja said. “The key thing is: Can you handle those new cases?”
U.S. testing more, finding more cases
The initial debacle over the lack of testing in the U.S. is well-documented, as are Trump’s boasts about the amount of testing and his later suggestions that the government should reduce tests, because they only reveal more positive cases.
Another story about U.S. testing is less well-known. It’s that the U.S. has surged ahead of Canada in testing per capita, thanks to public-private partnerships.
In Canada, all COVID-19 testing is done through the health-care system at hospitals or designated testing sites. But in the U.S., different people have different access to tests.
For example, Washington, D.C., resident Carlos Sabatino said he got a test in 20 minutes. Feeling some symptoms, he went to a drive-thru at a CVS Pharmacy, was handed a kit, told how to perform a nasal swab, cleaned the kit with sanitary wipes and gave it back.
Three days later, he went online and got the results, which declared him COVID-free. His health insurance covered the cost. “The whole experience, door to door, took 45 minutes,” he said. “I was surprised how efficient it is.… Frankly, I was impressed.”
Sabatino learned about the pharmacy’s testing after giving up trying to get a test from the city government. He was deterred by the brutally long lines and the news that he would only get results by mail, in a week.
But Sabatino is one of the lucky ones. Disparities in U.S. health care are a constant problem.
Some Americans have access issues, while others describe ghastly insurance bills. Video from some locations in the U.S. south shows huge lineups.
WATCH | Large lineups at U.S. testing sites:
Traffic is seen at a standstill as drivers wait at drive-thru COVID-19 test sites in the U.S. 1:11
This pandemic has exposed deep inequalities in U.S. health care, with Black Americans less likely to access care and far likelier to become critically sick.
This week, a former U.S. health-insurance executive said the system had failed and he apologized for previously disparaging Canadian public health care.
Amid America’s <a href=”https://twitter.com/hashtag/COVID19?src=hash&ref_src=twsrc%5Etfw”>#COVID19</a> disaster, I must come clean about a lie I spread as a health insurance exec: We spent big $$ to push the idea that Canada’s single-payer system was awful & the U.S. system much better. It was a lie & the nations’ COVID responses prove it. The truth: (1/6)
Testing capacity was slow to ramp up in the U.S. early in the pandemic, leaving the virus ample time to spread across the country before it could be exposed. Even now, testing shortages are being reported in the latest hot spots.
That’s why experts say the percentage of tests turning up positive results in the U.S. is drastically higher per capita than in Canada. If you test early and often, you identify cases quickly. If you test late, early cases will be missed and the positivity rate will be higher.
For each positive case in Canada, an average of 110 people are being tested. In the U.S., that number currently sits at about one for every 17 tests.
“When I look at the U.S. scenario, it’s … almost like watching a train wreck in slow motion, because a lot of it is quite predictable, mostly because they were really, really behind on getting testing started,” said Dr. Lynora Saxinger, an infectious disease physician at the University of Alberta.
“They’re expanding their testing now, but the percent positivity of their test is still going up, which is horrifyingly scary.”
A month after DeSantis said this, the Florida Department of Health reports 8,942 new cases of Covid-19 today: the highest single day of reporting. <br><br> <a href=”https://t.co/soXHGFK2cZ”>pic.twitter.com/soXHGFK2cZ</a>
Saxinger said that leaves only one tool to address the rising case numbers in the U.S. – reinstating lockdown measures, which is what Texas and Florida have done.
“The problem that I see coming is if you open when you don’t have the capacity to control things, it’s really hard to get the genie back in the bottle, because the populace is not down with that,” Saxinger said.
“I don’t know how well the reinstitution of public health measures will go if a place has had the more stringent measures, releases them and then goes back.”
In U.S., masks turn political
One difference between the Canadian and American experience is that partisan politics has infected the U.S. response.
Seemingly every aspect of this pandemic has taken on a partisan tinge, from social distancing to medicine — for instance, being for or against hydroxychloroquine, once thought to be an effective COVID-19 treatment, became a proxy for whether Americans were pro- or anti-Trump.
Masks have also become something of a political status symbol.
Even masks have become political. Joe Biden, left, always wears one in public. Trump, right, has mocked Biden and a reporter for wearing them. (Jim Bourg/Reuters, Drew Angerer/Getty Images)
“There is a sense of, ‘This is the US of A and I can do whatever I damn well please,'” said Dr. Linsey Marr, an expert in the transmission of viruses by aerosol at Virginia Tech. There are “certain segments [of the population] that are very anti-government, that don’t want to be told what to do.”
That much was acknowledged by the country’s largest movie chain: AMC Theatres said masks had become politicized and would not be mandated for moviegoers. In the ensuing public uproar, it reversed course.
A Pew survey this month found a 23-percentage-point gap between Democrat and Republican voters on whether they claim to wear masks in stores all or most of the time.
WATCH: Trump holds controversial rally in Tulsa, Okla.:
U.S. President Donald Trump’s first campaign rally in months didn’t have the attendance he bragged about, but the Tulsa, Okla., event was a glimpse at what animates supporters and at Trump’s playbook for re-election. 2:27
The president’s own statements helped shape that conversation. They include early predictions that COVID-19 would quickly disappear, mockery of politicians and reporters for wearing masks and his repeated demands that states reopen faster than recommended by the White House’s own guidelines.
Coronavirus deaths are way down. Mortality rate is one of the lowest in the World. Our Economy is roaring back and will NOT be shut down. “Embers” or flare ups will be put out, as necessary!
In battling the spread of COVID-19, masks may be a game-changer. An investigation by the Philadelphia Inquirer found a strong correlation between a state’s mask rules and its recent case rate.
“The irony here is that if everyone were willing to put on a mask, I think we could get back closer to normal without having this huge spike in cases,” said Marr. “Otherwise, we’re all going to be restricted in our movements and the economy.”
Trump rally exposes divide
When it comes to masks, staunch Trump supporters made their feelings clear at a recent indoor rally in Tulsa, Okla.
A minuscule percentage of the crowd wore masks — this despite a surge in cases in that state and news that a handful of Trump campaign staffers had tested positive.
Event organizers were even handing out masks. Most attendees took one. Few put them on.
U.S. President Donald Trump held a campaign rally at the BOK Center in Tulsa, Okla. on June 20 while infection rates in the state continue to rise. (Win McNamee/Getty Images)
“Science [has come] out to show this coronavirus is a lot less deadly than people thought it was going to be,” said rallygoer Jason Yeadon. “I think the numbers are overblown and data will show that in the end.”
He blamed the “supposed professionals” for pressuring elected officials to shut down the economy and insisted governments overreacted in the first place.
‘I’m not a prophet’
The current spike in cases across the U.S. comes as no surprise to Zeke Emanuel, the former Obama health-care adviser.
“Anybody who’s studied two weeks of epidemiology could have predicted this,” he said in a follow-up interview this week. “I’m not a prophet — this was entirely predictable.”
Saxinger said given the high percentage of the population in both the U.S. and Canada still susceptible to COVID-19 infection, neither country is out of the “line of fire” when it comes to major outbreaks of the disease.
“Although we might be feeling like we dodged that bullet, that bullet is still possible in a lot of places in Canada,” she said.
“People are just so hungry for everything to be normal and so they’re acting like it is – but it clearly is not. The virus is not gone and as soon as you start mingling, it starts going up.”
PHOENIX (AP) — Arizona voters have approved a constitutional amendment guaranteeing abortion access up to fetal viability, typically after 21 weeks — a major win for advocates of the measure in the presidential battleground state who have been seeking to expand access beyond the current 15-week limit.
Arizona was one of nine states with abortion on the ballot. Democrats have centered abortion rights in their campaigns since the U.S. Supreme Court overturned Roe v. Wade in 2022. Abortion-rights supporters prevailed in all seven abortion ballot questions in 2022 and 2023, including in conservative-leaning states.
Arizona for Abortion Access, the coalition leading the state campaign, gathered well over the 383,923 signatures required to put it on the ballot, and the secretary of state’s office verified that enough were valid. The coalition far outpaced the opposition campaign, It Goes Too Far, in fundraising. The opposing campaign argued the measure was too far-reaching and cited its own polling in saying a majority of Arizonans support the 15-week limit. The measure allows post-viability abortions if they are necessary to protect the life or physical or mental health of the mother.
Access to abortion has been a cloudy issue in Arizona. In April, the state Supreme Court cleared the way for the enforcement of a long-dormant 1864 law banning nearly all abortions. The state Legislature swiftly repealed it.
Voters in Arizona are divided on abortion. Maddy Pennell, a junior at Arizona State University, said the possibility of a near-total abortion ban made her “depressed” and strengthened her desire to vote for the abortion ballot measure.
“I feel very strongly about having access to abortion,” she said.
Kyle Lee, an independent Arizona voter, does not support the abortion ballot measure.
“All abortion is pretty much, in my opinion, murder from beginning to end,” Lee said.
The Civil War-era ban also shaped the contours of tight legislative races. State Sen. Shawnna Bolick and state Rep. Matt Gress are among the handful of vulnerable Republican incumbents in competitive districts who crossed party lines to give the repeal vote the final push — a vote that will be tested as both parties vie for control of the narrowly GOP-held state Legislature.
Both of the Phoenix-area lawmakers were rebuked by some of their Republican colleagues for siding with Democrats. Gress made a motion on the House floor to initiate the repeal of the 1864 law. Bolick, explaining her repeal vote to her Senate colleagues, gave a 20-minute floor speech describing her three difficult pregnancies.
While Gress was first elected to his seat in 2022, Bolick is facing voters for the first time. She was appointed by the Maricopa County Board of Supervisors to fill a seat vacancy in 2023. She has not emphasized her role in the repeal vote as she has campaigned, instead playing up traditional conservative issues — one of her signs reads “Bolick Backs the Blue.”
Voters rejected a measure to eliminate retention elections for state Superior Court judges and Supreme Court justices.
The measure was put on the ballot by Republican legislators hoping to protect two conservative justices up for a routine retention vote who favored allowing the Civil War-era ban to be enforced — Shawnna Bolick’s husband, Supreme Court Justice Clint Bolick, and Justice Kathryn Hackett King. Since the measure did not pass, both are still vulnerable to voter ouster, though those races hadn’t been decided by early Wednesday morning.
Under the existing system, voters decide every four to six years whether judges and justices should remain on the bench. The proposed measure would have allowed the judges and justices to stay on the bench without a popular vote unless one is triggered by felony convictions, crimes involving fraud and dishonesty, personal bankruptcy or mortgage foreclosure.
OMAHA, Neb. (AP) — Nebraska voters supported a measure Tuesday that enshrines the state’s current ban on abortions after the 12th week of pregnancy in the state constitution, and they rejected a competing measure that sought to expand abortion rights. Nebraska was the first state to have competing abortion amendments on the same ballot since the U.S. Supreme Court overturned Roe v. Wade in 2022, ending the nationwide right to abortion and allowing states to decide for themselves. The dueling measures were among a record number of petition-initiated measures on Nebraska’s ballot Tuesday.
What were the competing abortion measures?
A majority of voters supported a measure enshrining the state’s current ban on abortion after the first 12 weeks of pregnancy in the state constitution. The measure will also allow for further restrictions. Last year, the Legislature passed the 12-week ban, which includes exceptions for cases of rape and incest and to protect the life of the pregnant woman.
Voters rejected the other abortion measure. If they had passed it by a larger number of “for” votes than the 12-week measure, it would have amended the constitution to guarantee the right to have an abortion until viability — the standard under Roe that is the point at which a fetus might survive outside the womb. Some babies can survive with medical help after 21 weeks of gestation.
Abortion was on the ballot in several other states, as well. Coming into the election, voters in all seven states that had decided on abortion-related ballot measures since the reversal of Roe had favored abortion rights, including in some conservative states.
Who is behind the Nebraska abortion measures?
The 12-week ban measure was bankrolled by some of Nebraska’s wealthiest people, including Republican Sen. Pete Ricketts, who previously served as governor and donated more than $1.1 million. His mother, Marlene Ricketts, gave $4 million to the cause. Members of the Peed family, which owns publishing company Sandhills Global, also gave $1 million.
The effort was organized under the name Protect Women and Children and was heavily backed by religious organizations, including the Nebraska Catholic Conference, a lobbying group that has organized rallies, phone banks and community townhalls to drum up support for the measure.
The effort to enshrine viability as the standard was called Protect Our Rights Nebraska and had the backing of several medical, advocacy and social justice groups. Planned Parenthood donated nearly $1 million to the cause, with the American Civil Liberties Union, I Be Black Girl, Nebraska Appleseed and the Women’s Fund of Omaha also contributing significantly to the roughly $3.7 million raised by Protect Our Rights.
What other initiatives were on Nebraska’s ballot?
Nebraska voters approved two measures Tuesday that will create a system for the use and manufacture of medical marijuana, if the measures survive an ongoing legal challenge.
The measures legalize the possession and use of medical marijuana, and allow for the manufacture, distribution and delivery of the drug. One would let patients and caregivers possess up to 5 ounces (142 grams) of marijuana if recommended by a doctor. The other would create the Nebraska Medical Cannabis Commission, which would oversee the private groups that would manufacture and dispense the drug.
Those initiatives were challenged over allegations that the petition campaign that put them on the ballot broke election rules. Nebraska’s attorney general said supporters of the measures may have submitted several thousand invalid signatures, and one man has been charged in connection with 164 allegedly fraudulent signatures. That means a judge could still invalidate the measures.
Voters also opted Tuesday to repeal a new conservative-backed law that allocates millions of dollars in taxpayer money to fund private school tuition.
Finally, they approved a measure that will require all Nebraska employers to provide at least 40 hours of paid sick leave to their employees.
WASHINGTON (AP) — Voters in Missouri cleared the way to undo one of the nation’s most restrictive abortion bans in one of seven victories for abortion rights advocates, while Florida, Nebraska and South Dakota defeated similar constitutional amendments, leaving bans in place.
Abortion rights amendments also passed in Arizona, Colorado, Maryland and Montana. Nevada voters also approved an amendment, but they’ll need to pass it again it 2026 for it to take effect. Another that bans discrimination on the basis of “pregnancy outcomes” prevailed in New York.
The results include firsts for the abortion landscape, which underwent a seismic shift in 2022 when the U.S. Supreme Court overturned Roe v. Wade, a ruling that ended a nationwide right to abortion and cleared the way for bans to take effect in most Republican-controlled states.
They also came in the same election that Republican Donald Trump won the presidency. Among his inconsistent positions on abortion has been an insistence that it’s an issue best left to the states. Still, the president can have a major impact on abortion policy through executive action.
In the meantime, Missouri is positioned to be the first state where a vote will undo a ban on abortion at all stages of pregnancy, with an amendment that would allow lawmakers to restrict abortions only past the point of a fetus’ viability — usually considered after 21 weeks, although there’s no exact defined time frame.
But the ban, and other restrictive laws, are not automatically repealed. Advocates now have to ask courts to overturn laws to square with the new amendment.
“Today, Missourians made history and sent a clear message: decisions around pregnancy, including abortion, birth control, and miscarriage care are personal and private and should be left up to patients and their families, not politicians,” Rachel Sweet, campaign manager of Missourians for Constitutional Freedom, said in a statement.
Roughly half of Missouri’s voters said abortion should be legal in all or most cases, according to AP VoteCast, a survey of more than 2,200 of the state’s voters. But only about 1 in 10 said abortion should be illegal in all cases; nearly 4 in 10 said abortion should be illegal in most cases.
Bans remain in place in three states after votes
Florida, Nebraska and South Dakota became the first states since Roe was overturned where abortion opponents prevailed on a ballot measure. Most voters supported the Florida measure, but it fell short of the required 60% to pass constitutional amendments in the state. Most states require a simple majority.
The result was a political win for Gov. Ron DeSantis, a Republican with a national profile, who had steered state GOP funds to the cause. His administration has weighed in, too, with a campaign against the measure, investigators questioning people who signed petitions to add it to the ballot and threats to TV stations that aired one commercial supporting it.
Marjorie Dannenfelser, president of the national anti-abortion group SBA Pro-Life America, said in a statement that the result is “a momentous victory for life in Florida and for our entire country,” praising DeSantis for leading the charge against the measure.
The defeat makes permanent a shift in the Southern abortion landscape that began when the state’s six-week ban took effect in May. That removed Florida as a destination for abortion for many women from nearby states with deeper bans and also led to far more women from the state traveling to obtain abortion. The nearest states with looser restrictions are North Carolina and Virginia — hundreds of miles away.
“The reality is because of Florida’s constitution a minority of Florida voters have decided Amendment 4 will not be adopted,” said Lauren Brenzel, campaign director for the Yes on 4 Campaign said while wiping away tears. “The reality is a majority of Floridians just voted to end Florida’s abortion ban.”
In South Dakota, another state with a ban on abortion throughout pregnancy with some exceptions, the defeat of an abortion measure was more decisive. It would have allowed some regulations related to the health of the woman after 12 weeks. Because of that wrinkle, most national abortion-rights groups did not support it.
Voters in Nebraska adopted a measure that allows more abortion restrictions and enshrines the state’s current 12-week ban and rejected a competing measure that would have ensured abortion rights.
Other states guaranteed abortion rights
Arizona’s amendment will mean replacing the current law that bans abortion after the first 15 weeks of pregnancy. The new measure ensures abortion access until viability. A ballot measure there gained momentum after a state Supreme Court ruling in April found that the state could enforce a strict abortion ban adopted in 1864. Some GOP lawmakers joined with Democrats to repeal the law before it could be enforced.
In Maryland, the abortion rights amendment is a legal change that won’t make an immediate difference to abortion access in a state that already allows it.
It’s a similar situation in Montana, where abortion is already legal until viability.
The Colorado measure exceeded the 55% of support required to pass. Besides enshrining access, it also undoes an earlier amendment that barred using state and local government funding for abortion, opening the possibility of state Medicaid and government employee insurance plans covering care.
A New York equal rights law that abortion rights group say will bolster abortion rights also passed. It doesn’t contain the word “abortion” but rather bans discrimination on the basis of “pregnancy outcomes, and reproductive healthcare and autonomy.” Sasha Ahuja, campaign director of New Yorkers for Equal Rights, called the result “a monumental victory for all New Yorkers” and a vote against opponents who she says used misleading parental rights and anti-trans messages to thwart the measure.
The results end a win streak for abortion-rights advocates
Until Tuesday, abortion rights advocates had prevailed on all seven measures that have appeared on statewide ballots since the fall of Roe.
The abortion rights campaigns have a big fundraising advantage this year. Their opponents’ efforts are focused on portraying the amendments as too extreme rather than abortion as immoral.
Currently, 13 states are enforcing bans at all stages of pregnancy, with some exceptions. Four more bar abortion in most cases after about six weeks of pregnancy — before women often realize they’re pregnant. Despite the bans, the number of monthly abortions in the U.S. has risen slightly, because of the growing use of abortion pills and organized efforts to help women travel for abortion. Still, advocates say the bans have reduced access, especially for lower-income and minority residents of the states with bans.
The issue is resonating with voters. About one-fourth said abortion policy was the single most important factor for their vote, according to AP VoteCast, a sweeping survey of more than 110,000 voters nationwide. Close to half said it was an important factor, but not the most important. Just over 1 in 10 said it was a minor factor.
The outcomes of ballot initiatives that sought to overturn strict abortion bans in Florida and Missouri were very important to a majority of voters in the states. More than half of Florida voters identified the result of the amendment as very important, while roughly 6 in 10 of Missouri’s voters said the same, the survey found.
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Associated Press reporters Hannah Fingerhut and Amanda Seitz contributed to this article.
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This article has been corrected to reflect in the ‘other states’ section that Montana, not Missouri, currently allows abortion until viability.
