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.

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. 

“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:

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. 

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.”

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. 

“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.:

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.

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.

“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.”

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