BOSTON -- Fourth of July gatherings, graduation parties, no-mask weddings, crowded bars, protests -- there are reasons the U.S. has racked up more than 156,000 coronavirus deaths, the most of any country, and is approaching 5 million confirmed infections.
Many Americans have resisted wearing masks and social distancing, calling such precautions an overreaction or an infringement on their liberty. Public health experts say the problem has been compounded by confusing and inconsistent guidance from politicians and a patchwork quilt of approaches to containing the scourge by county, state and federal governments.
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"The thing that's maddening is country after country and state after state have shown us how we can contain the virus," said Dr. Jonathan Quick of the Duke Global Health Institute. "It's not like we don't know what works. We do."
Confirmed infections in the U.S. have topped 4.7 million, with new cases running at more than 60,000 a day. While that's down from a peak of well over 70,000 in the second half of July, cases are on the rise in 26 states, many in the South and West, and deaths are climbing in 35 states.
On average, the number of covid-19 deaths per day in the U.S. over the past two weeks has gone from about 780 to 1,056, according to an Associated Press analysis.
In Massachusetts, health officials are investigating at least a half-dozen new clusters of cases connected to such events as a lifeguard party, a high school graduation party, a prom party, an unsanctioned football camp and a packed harbor cruise trip.
One recent house party on Cape Cod attended by as many as 60 people led to more than a dozen new cases and prompted some restaurants to close or limit service at the height of tourist season.
Hot spots around the U.S. are popping up in what once seemed like ideal places to ride out the outbreak: rural, less populated and with lots of outdoor space. In South Dakota, a spike was reported at a Christian youth summer camp in the Black Hills, with cases growing to 96 among 328 people who attended.
"We're at a point where there's enough spread of covid-19 that people throughout the U.S. are at an increased likelihood of encountering the virus and getting exposed," University of Florida epidemiologist Dr. Cindy Prins said.
She added: "This is a behavioral disease right now for a lot of people." Prevention means "changing our behavior, and it's so hard for humans to do. We're social creatures."
In Mississippi, Republican Gov. Tate Reeves reversed course and announced a statewide order requiring the wearing of masks because of a resurgence of the virus.
"Wearing a mask -- as irritating as it can be, and I promise you I hate it more than anyone watching today -- is critical," he said.
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Reeves also said he will sign an order mandating that all adults and students wear masks in schools, unless there's a medical reason that prevents them from doing so.
He is delaying the start of school for grades 7-12 in eight counties that have more than 200 cases and 500 cases per 100,000 residents. The counties are Bolivar, Coahoma, Forrest, George, Hinds, Panola, Sunflower and Washington.
Reeves said he firmly believes that his decision gives local schools "options to do what is best for kids."
"I'm hopeful that those who cannot open safely will delay the reopening of their schools until at least Aug. 17," Reeves said. "A week from now, my advice might be not to open until August the 24th."
At the same media briefing, Mississippi State Health Officer Dr. Thomas Dobbs said starting traditional school in the near future is "nuts" and an "unmitigated risk."
The Health Department said Tuesday that Mississippi, which has a population of about 3 million, has had at least 62,199 reported cases and at least 1,753 deaths from covid-19 as of Monday evening. That's an increase of 1,074 confirmed cases and 42 deaths from numbers reported the day before.
VIRGINIA SURGE
In Virginia, cases have surged so much in cities like Norfolk and Virginia Beach that Democratic Gov. Ralph Northam placed limits there last week on alcohol sales and gatherings of more than 50 people. Northam, the nation's only governor who is a doctor, cited rising infections among young people and said the problem is that "too many people are selfish."
"We all know that alcohol changes your judgment," he said.
Dr. Demetria Lindsay, the Virginia Department of Health's district director for Virginia Beach and Norfolk, said there has been a pronounced spike among people ages 20-29. She said the factors behind the surge include gatherings of people not wearing masks or maintaining safe distances.
In Brandon, S.D., thousands of car racing fans packed the 9,000-seat Huset's Speedway over the weekend. Many did not cover their faces or stay away from others.
"We're kind of over this whole covid thing. I won't wear a mask unless I absolutely have to," 21-year-old Veronica Fritz said. She added: "I am a very strong Christian and I know where I'm going, and I believe God will take me when I'm supposed to go. So if I get covid and I die from covid, it's not my decision."
Research has shown that people can spread the virus before they feel sick. Experts say masks lower the likelihood of their respiratory droplets reaching other people.
Josie Machovec, a mother of three who is suing over a mask ordinance in Palm Beach County, Florida, said she doesn't believe the government has the right to require people to wear medical devices, and she hasn't seen clear evidence that masks stop transmission of the virus.
"I'm someone who has looked into this extensively and don't feel that it's the right thing for me and my kids. If we are healthy, we don't need to be wearing them," she said, "and if we're not healthy, if we're sick, then we stay home."
In Minnesota, a group of voters sued Gov. Tim Walz and other officials Tuesday to try to block a requirement that voters wear masks at polling places.
WISCONSIN SPIKE
Nearly a quarter of Wisconsin's more than 55,000 cases had been confirmed over the past 14 days. Much of the spike has occurred in the state's densely urban southeastern corner, but the disease has also spread quickly in rural and sparsely populated northern Wisconsin.
Despite the trend, health industry software provider Epic Systems is requiring its 9,000-plus employees to return to work in person at its sprawling campus outside of Madison by Sept. 21. Workers decried the order, but company CEO Judy Faulkner defended the decision, saying better work is done on campus than from home.
Zona Wick, a spokeswoman and contact tracer for the health department in Wisconsin's Iron County, attributed the dramatic rise in cases to July Fourth gatherings, birthday and graduation parties, out-of-county visitors and people crowding into bars.
"The Fourth of July was tough on us," Wick said. "People had a bit of quarantine fatigue, is what I'm calling it. People got a bit tired of staying in. People just got together like they have for years on the Fourth of July and spread it to one another."
The wedding industry likewise is seeing no-mask receptions with busy dance floors and no social distancing.
Wedding planner Lynne Goldberg has a December wedding scheduled for 200 guests at the home of the bride's parents in upstate New York.
"They have emphatically shared that this pandemic is not going to get in the way of their wedding plans and that there will be no masks handed out and no signs promoting social distancing at their wedding," she said. "The bride has said that when she shows her children her wedding video, she doesn't want it to be a documentary of the 2020 pandemic."
In Louisiana, Gov. John Bel Edwards announced Tuesday that he'll continue the statewide mask mandate and business restrictions he enacted to combat the outbreak for at least three more weeks, despite lawsuits seeking to upend the orders.
The rules were set to expire Friday, but the Democratic governor said he will extend them through Aug. 28 as the state continues to have one of the nation's highest per capita virus infection rates in the past two weeks. Edwards said the state has "made early fragile gains" in slowing the virus spread but couldn't risk lifting the restrictions yet.
"By no means are we out of the woods," said Dr. Alex Billioux, the governor's chief public health adviser.
Billioux estimated that Louisiana still has at least 50,000 active coronavirus cases where people can shed the virus to others.
The regulations limit restaurants to 50% capacity for in-person dining, restrict bars to takeout and delivery only, and place occupancy limits on gyms, salons and other businesses deemed nonessential. Face coverings are required for anyone age 8 and older, with medical exceptions. Indoor gatherings above 50 people are banned.
Meanwhile, Louisiana's agriculture department Tuesday announced the state's first confirmed covid-19 infection in an animal, a dog found to be positive through a nasal swab test. Agriculture Commissioner Mike Strain said no evidence suggests that pets help to spread the virus, and he urged people not to abandon their pets because of worry.
TRUMP COMMENTS
Separately, President Donald Trump says the coronavirus pandemic is "under control as much as you can control it" in the U.S.
In an interview with "Axios on HBO" taped last week, the president said that "right now it's under control," when pressed about the fact that 1,000 Americans are dying each day.
"They are dying, that's true. And you have -- it is what it is," he said. "But that doesn't mean we aren't doing everything we can. It's under control as much as you can control it. This is a horrible plague."
Meanwhile, New York City's health commissioner, Dr. Oxiris Barbot, resigned Tuesday to protest her "deep disappointment" with Mayor Bill de Blasio's handling of the pandemic, renewing scrutiny of his leadership during the crisis just as the city faces pressing decisions about how quickly to reopen schools and businesses.
Her departure came after escalating tensions between City Hall and top city health department officials, which had begun at the start of the coronavirus outbreak in March, burst into public view and raised concerns that the feuding was undermining crucial public health policies.
De Blasio immediately announced a replacement for Barbot.
"I leave my post today with deep disappointment that during the most critical public health crisis in our lifetime, that the health department's incomparable disease control expertise was not used to the degree it could have been," Barbot said in her resignation email sent to de Blasio, a copy of which was shared with The New York Times.
"Our experts are world renowned for their epidemiology, surveillance and response work. The city would be well served by having them at the strategic center of the response not in the background."
At a hastily called news conference after her resignation, de Blasio defended his handling of the outbreak, saying the city had made "extraordinary progress."
The mayor announced the appointment of a new health commissioner, Dr. Dave Chokshi, a former senior leader at Health + Hospitals, the city's public hospital system.
Still, former city health officials said the mayor should have done more to listen to and support Barbot.
"It's a bad day for the city. She's a very qualified commissioner of health," said Lilliam Barrios-Paoli, a former deputy mayor of health under de Blasio who worked with Barbot. "There's another woman of color that goes down. I think it's a really regrettable thing.
"This is not a position you can put anybody in just because. It's the premier public health agency in the country," Barrios-Paoli added. "It's just a shame that she did not feel that she was supported by the mayor."
Information for this article was contributed by Suman Naishadham, Carla K. Johnson, Melinda Deslatte, Leah Willingham, Emily Wagster Pettus and Philip Marcelo of The Associated Press; by Ryan Teague Beckwith of Bloomberg News; and by J. David Goodman of The New York Times.
