Arizona, Texas see more COVID-19 hospitalizations in shifting of U.S. hot spots

Coronavirus cases are rising in nearly half of U.S. states, according to an Associated Press analysis, a worrying trend that could intensify as people return to work and venture out during the summer.

There is no single reason for the surges. In some cases, more testing has revealed more cases. In others, local outbreaks are big enough to push statewide tallies higher. But experts think at least some are due to lifting stay-at-home orders, school and business closuresand other restrictions put in place during the spring to stem the coronavirus's spread.

The virus, which has killed over 113,000 Americans according to the latest estimate from the coronavirus resource centre at Johns Hopkins University, is also gradually fanning out.

"It is a disaster that spreads," said Dr. Jay Butler, who oversees coronavirus response work at the U.S. national Centers for Disease Control and Prevention. "It's not like there's an entire continental seismic shift and everyone feels the shaking all at once."

For months, the epicentre was in northeastern states. More recently, the biggest increases have been in the South and the West.

The AP analyzed data compiled by the COVID Tracking Project, a volunteer organization that collects coronavirus testing data in the United States. The analysis found that in 21 states as of Monday, the rolling seven-day average of new cases per capita was higher than the average seven days earlier.

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Some worry the situation may get worse as physicaldistancing restrictions lift and more people gather. One concern is that large recent racial justice protests across the country might spark at least some spread of the virus.

President Donald Trump this week said he's planning to hold rallies in Arizona, Florida, Oklahomaand Texas, all of which are among the states with rising cases.

Here is what's driving increases in some states:

Arizona

Republican Gov. Doug Ducey ended Arizona's stay-at-home order on May 15 and eased restrictions on businesses. Arizona residents who were cooped up for six weeks flooded Phoenix-area bar districts, ignoring physicaldistancing guidelines.

The state began seeing a surge of new cases and hospitalizations about 10 days later.

"It seems pretty clear to me that what we're seeing is directly related to the end of the stay-at-home order," said Will Humble, executive director of the Arizona Public Health Association.

There are no requirements to wear face masks, no major increases in contact tracing to spot and stop evolving outbreaksand no scale-up of infection control at nursing homes, Humble said.

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The AP analysis found Arizona had a rolling average of fewer than 400 new cases a day at the time the shutdown was lifted, but it shot up two weeks later and surpassed 1,000 new cases a day by early this week. Hospitalizations have also risen dramatically, hitting the 1,200 mark last week.

The state also passed another grim milestone last week, recording its 1,000th death.

Meanwhile, Arizona hospitals reported they were at 83 per cent of capacity Tuesday, which could force the cancellation of elective surgeries.

Texas

Hospitalizations in the state surged past 2,100 on Wednesday for the first time during the pandemic. That's a 42 per cent increase in patients since Memorial Day weekend, when beachgoers swarmed the coastlineand a water park near Houston opened to big crowds in defiance of Republican Gov. Greg Abbott's orders.

Texas's percentage of tests coming back positive has also jumped to levels that are among the nation's highest. State officials point to hot spots at meatpacking plants and prisons in rural counties, where thousands of new cases have cropped upbut have not offered explanations for a rise in numbers elsewhere.

Abbott, who has recently begun wearing a mask in public, has shown no intention of pumping the brake on reopening a state where protesters in May pressured him to speed up the timeline on getting hair salons back in business.

On Friday, Texas is set to lift even more restrictions and let restaurant dining rooms reopen at nearly full capacity.

Alabama

In Alabama, outbreaks in nursing homes and poultry plants helped drive state numbers upward, though there was a drop more recently.

But hospital intensive care units in Montgomery are as busy as during flu season.

"I can assure you that Montgomery's cases are not going down, and if our community does not take this seriously, the virus will continue to spread, and at some point, our medical capacity will reach its limit," Dr. David Thrasher, director of respiratory therapy at Jackson Hospital, said in a statement.

Arkansas

Arkansas has also seen increasesin cases, hospitalizations and the percentage of tests that come back positive. But the state's situation is a complicated story of different outbreaks at different times, said Dr. Nate Smith, director of the Arkansas Department of Health.

After a peak in April, levels were low until spikes began about three weeks ago mainly in the cities of Rogers and Springdale in the northwest and in De Queen farther south. The cases have been concentrated among Hispanics and those who work in chicken production facilities, which never were closed.

Republican Gov. Asa Hutchinson has said the state will move into a new phase of reopening on Monday.