The U.S. has reported more than 3 million coronavirus cases as of Wednesday morning, with all but a handful of states struggling to control outbreaks of COVID-19. One million of those cases have been confirmed over the past month — part of a wave of infection that began after many states started to reopen their economies in May.
The total number of cases also includes nearly 1 million people declared to have recovered. But more than 130,000 Americans have died from COVID-19 – roughly twice the death toll of any other country, according to a tracker from Johns Hopkins University. Most experts believe those numbers vastly underestimate the disease's true toll.
"I did not expect it to grow this quickly" in the U.S., says Bob Bednarczyk, assistant professor of global health and epidemiology at the Rollins School of Public Health at Emory University in Atlanta.
"Any time we hit some milestone number, like 3 million, it draws a lot of attention," he says. "I hope that as people see how quickly this is continuing to grow, they will pay more attention to experts calling for continued mask wearing, physical distancing, and hand washing."
The U.S. effort to fight the virus has been undermined by problems ranging from flawed tests early on to resistance among many Americans — and in some cases, outright refusal — to wear a face mask or take other precautions recommended by health experts.
While some early hot spots such as New York state have been able to tamp down new cases, COVID-19 has exploded elsewhere, with record case numbers and hospitalizations in states such as Florida, Arizona, Texas and California.
"I think one major hurdle is our patchwork response across the states," Bednarczyk says. "In a federal system, we will have different responses in different states. And that has shown itself in the range of successes in controlling the impact of COVID-19 we have seen."
He says the current situation in the U.S. should be viewed as a "series of smaller outbreaks" and emerging hot spots.
Nine U.S. states — New York, California, Texas, Florida, New Jersey, Illinois, Massachusetts, Arizona and Georgia — are now reporting more than 100,000 cases. Worldwide, only 20 countries other than the U.S. have hit that number.
At least eight states — Louisiana, Idaho, Georgia, Florida, Nevada, Tennessee, Kansas and Delaware — have seen their average daily number of new cases double this week, compared with just two weeks ago.
The highest per capita rate is currently in Arizona, which has been averaging 53 cases per 100,000 people this week. Florida, Louisiana and South Carolina all have per capita rates higher than 30 cases per 100,000 people.
Arizona officials say they are seeing a rush of hospitalizations, forcing administrators in Pima County to send some patients elsewhere, even to another state, to receive care.
"Every week, our numbers are doubling," Neva Farmer, a nurse who is working in the COVID-19 ICU at a Phoenix-area hospital, told member station KJZZ.
"We've seen a really large increase in patients in the 30-to-40 age group, which we had not seen that in the beginning," Farmer said. "Most of the time in the beginning, it was a lot of the elderly population, but we're actually seeing that number decrease, and we're seeing younger individuals struggling with COVID now. So it's harder."
The crisis forced Arizona Gov. Doug Ducey to reverse some reopening orders last week, with bars, gyms and movie theaters told to close for about a month.
In Texas, reopening has been put on pause and face coverings made mandatory for people out in public in counties with 20 or more COVID-19 cases. "COVID-19 is not going away. In fact, it's getting worse," Gov. Greg Abbott said in announcing the mask rule just ahead of the July Fourth weekend.
COVID-19 is not affecting all states equally. For example, both North Carolina and Michigan are reporting more than 70,000 cases, but Michigan's death toll is more than four times higher — 6,251 deaths, compared with 1,446 in North Carolina.
New York state, once the epicenter of new U.S. coronavirus cases, has now gone a month since it last reported 1,000 or more new daily cases. But at least eight other states are now routinely surpassing that mark.
New York is now requiring a 14-day quarantine for people who travel from 19 other states, after Gov. Andrew Cuomo added Delaware, Kansas and Oklahoma to a travel advisory list on Tuesday.
Despite the continued rise in cases, President Trump says he will pressure all states to reopen their schools fully this fall. Many schools have been in limbo or planning to hold classes online, after their academic years were cut short by the pandemic in March.
Florida is among the states planning to reopen brick-and-mortar schools next month. Education Commissioner Richard Corcoran has issued an emergency order requiring that "all school boards and charter school governing boards must open brick-and-mortar schools at least five days per week for all students."
Since the outbreak began, widespread shutdown measures have been credited with slowing key U.S. coronavirus metrics such as the rate of new cases, hospitalizations and deaths. But instead of falling off, those figures merely plateaued in most states — and when many restrictions were lifted, the numbers began to climb anew.
On a global level, the U.S. has by far the most confirmed cases in the COVID-19 pandemic. The country has less than 5% of the world's population, but it has about 25% of the world's coronavirus cases — a proportion that has changed little since U.S. case totals began to skyrocket in the spring.
Predictive models have found that if more people in the U.S. covered their faces to prevent spreading the coronavirus, tens of thousands of deaths from COVID-19 could be prevented between July and Oct. 1. But some Americans — from Massachusetts to Florida to Washington state — have fought against state or county mandates that require face masks.
The pandemic has exposed problems that experts say have long existed within the U.S. health system.
"The biggest issue I see is a lack of emphasis on public health across the U.S.," Bednarczyk says. "State and local health departments have been underfunded for a long time, and many of their activities – health promotion campaigns, vaccination programs, disease surveillance systems – have been seen as either not important or just 'overhead' that has to be done.
"What we're seeing now is a perfect example of what happens when we do not support our public health infrastructure and public health workers."
The dire circumstances in the U.S. resulted in the European Union leaving the country off its list of 15 travel partners last week, a roster that includes South Korea, Japan and, with a caveat, China. The EU says it will accept tourists and other nonessential travelers from countries where the epidemiological situation is equal to or better than the EU's.
The EU also requires reciprocal easing of travel bans — and the U.S. currently bars most travelers from European countries.