Environmental & Occupational Health

Governors last month started to “press pause” on the next phases of their reopenings as Covid-19 cases picked back up. Now, in certain hot spots, they are starting to roll back some of the allowances they’d granted: no more elective medical procedures in some Texas counties. Bars, only reopened for a short time, are shuttered again in parts of California. And on Monday, Arizona’s governor ordered a new wave of gym, bar, and movie theater closures for at least the next month.

These are measured retreats — a far cry from the lockdowns that much of the country burrowed into starting in March. But leaders are desperately hoping that the incremental approach can make a dent in the spread of the virus at a time when another round of lockdowns — and their accompanying disruptions to education, the economy, and the public psyche — seems beyond unpalatable, both politically and socially.

Not every state that reopened early is facing an outbreak on the scale of those in Arizona, Texas, and Florida. Colorado started to peek out from its shelter-in-place restrictions in late April, without a corresponding surge in cases.

It’s hard to pinpoint any one reason that explains the difference. Colorado had an initial wave of cases, so perhaps residents — who, as a whole, are among the country’s healthiest — take more precautions. The state also reopened as case counts were declining, whereas others lifted restrictions as cases were plateauing or even increasing. Its governor, Jared Polis, stressed mask-wearing starting in April.

But cases in recent days have started increasing.

“We are on the razor’s edge,” said epidemiologist Elizabeth Carlton of the Colorado School of Public Health. “We have seen this steady decline in hospitalizations since the beginning of April, and that’s great news. But we are starting to see an uptick in cases.”

Carlton noted that accelerating transmission in Arizona and Utah raises the possibility that cases could spill over into Colorado, where there’s not “some magic wand to protect us.” The reproduction number in the state — the average number of cases that come from each case — is about one, she said, which means that its epidemic, while not worsening, is not improving.

“Equilibrium can be good, but it can also be quite nerve-wracking,” Carlton said. “It doesn’t take much to restart the wildfire.”

Read the full story at STAT News.