COVID-19 cases and hospital visits are spiking in cities and towns from coast to coast, especially in the South and West, throwing sand in the gears of America's grand reopening and prompting frustrated governors to extend lockdowns or threaten penalties amid President Trump's "transition to greatness."
All 50 states are relaxing some of the coronavirus-related restrictions, but numbers have started creeping back up in states such as Arizona, Texas and North Carolina.
"We continue to be concerned with our percentage of positive tests and our hospitalizations," said North Carolina Gov. Roy Cooper, a Democrat. "We are watching these numbers closely to monitor for hospital beds as well as ICU capacity.
"Right now, our hospitals do have bed capacity, and that's good," he said, though he added, "That could change really quickly."
In New York, which is suddenly on a better track than much of the rest of the country, Gov. Andrew Cuomo, a Democrat, told local leaders to enforce social distancing rules so he doesn't have to hit "pause" on his reopening plans.
Leaders in Oregon, Utah and Nashville, Tennessee, have halted their reopenings for a time, and Harris County, Texas — in the Houston area — established a color-coded warning system to guide public actions as it contends with an uptick in COVID-19 cases and hospitalizations.
The challenges of defeating the wily virus were on display where it was discovered, in China. Beijing was forced to lock down a portion of the capital because of a flare-up traced back to a food market.
Chinese authorities traced the cases, the first reported instances of local transmission in Beijing in 56 days, to the Xinfadi food market.
"Certainly in China, when you've spent over 50 days without having any significant local transmission, a cluster like this is a concern and it needs to be investigated and controlled, and that's exactly what the Chinese authorities are doing. So in that sense, it is big news," said Mike Ryan, director of emergency programs at the World Health Organization.
Stocks on Wall Street tumbled in early trading amid fears of a spike in transmission before rebounding into positive territory Monday after the Federal Reserve said it would buy corporate bonds from individual companies. The Dow Jones Industrial Average closed up 157 points, or 0.6%, to 25,763, while the S&P 500 gained 0.8% and the Nasdaq Composite finished up 1.4%.
Still, the nationwide death toll from COVID-19 climbed past 116,000, putting it on par with total U.S. fatalities in World War I.
Arizona is reporting well over 1,000 cases per day compared with numbers that flirted with 500 in mid-May. Florida reported just over 800 cases on May 14, only to have well over 2,000 on Sunday as part of a broader spike.
Mr. Trump said the U.S. has more confirmed cases because it is testing far more than other countries.
"Without testing, or weak testing, we would be showing almost no cases. Testing is a double edged sword — Makes us look bad, but good to have!!" he tweeted Monday.
Health experts say the problem extends beyond the fact that tests that are widespread enough to catch mild or asymptomatic cases. Hospitals and intensive care units in Sun Belt states are filling up because of serious infections.
"It is not just a result of an increase in testing. We're seeing an increase in hospitalizations," said Michael Mina, assistant professor of epidemiology at the Harvard T.H. Chan School of Public Health. "It's no surprise that the states that have opened up the quickest, that have opened up with the most force, and the states that maybe didn't even put in the same amount of restrictions and social distancing — those are the states where we're seeing the greatest numbers of cases increasing."
Arizona has 28% of its ICU space available, while Florida is at 37% and Texas is at 33%, putting each in "low availability range" according to CovidExitStrategy.org, a web tracker that crunches federal data.
A Texas COVID-19 dashboard said the Houston area was down to 252 ICU beds in a trauma service area serving 6.3 million people.
States such as New York and New Jersey, which bore the brunt of the U.S. outbreak earlier this year, now have nearly half of their ICU capacity available, putting them in "normal" range. The percentage of people testing positive in those states has declined.
"It's a dramatic national turnaround. We are the exception here in New York. God bless us, but we are the exception," Mr. Cuomo said at his daily briefing on COVID-19. "We don't want the same plight of these other states. Talk about a great irony. One of our concerns now in New York is that people from the other states that have a high rate of increase of COVID virus may start traveling to New York."
Earlier this year, leaders in Florida said snowbird travelers from New York were a big problem.
Mr. Cuomo said he is worried that his state will squander its gains by getting too lax. He said he had received 25,000 complaints about social distancing violations, typically from patrons trying to follow the rules.
"I made a few phone calls and said to restaurant owners, bar owners, 'What are you doing?' We have the guidelines," Mr. Cuomo said. "Look, the state is going to enforce the rules."
Utah Gov. Gary Herbert, a Republican, last week said he was pausing reopening plans amid worsening trends because he didn't "want to go forward and then take a step backward." Oregon Gov. Kate Brown, a Democrat, paused county reopenings for a week, dubbing it a statewide "yellow light."
In North Carolina, Mr. Cooper said further reopening are "not off the table" despite the uptick in cases.
Mr. Trump urged Americans to work and learn at home and avoid large gatherings from mid-March through the end of April, but administration officials say shutting down the nation again isn't an option.
"The president is absolutely disinclined to shut down the economy, as is the vice president. I think shutting down the economy could be worse for our health than not shutting it down," White House economic adviser Larry Kudlow said Monday on Fox News.
Also Monday, the Food and Drug Administration revoked an emergency authorization for the use of two malaria drugs championed by Mr. Trump — hydroxychloroquine and chloroquine phosphate — because they were "unlikely to be effective in treating COVID-19."
"Additionally, in light of ongoing serious cardiac adverse events and other potential serious side effects, the known and potential benefits of chloroquine and hydroxychloroquine no longer outweigh the known and potential risks for the authorized use," the agency said.
Mr. Trump promoted the drugs as potential game-changers and even took a course of hydroxychloroquine after he was potentially exposed to the virus through White House staff.
Monday's decision applied to hospitalized COVID-19 patients and drugs donated to the Strategic National Stockpile. Doctors can still prescribe it for off-label use.
"It certainly didn't hurt me," the president said.
⦁ David Sherfinski contributed to this report.