with Paulina Firozi

This summer, the fight against the novel coronavirus will be a local one.

Despite the country's bungled response to the pandemic, coronavirus cases and deaths nationally are trending downward as Americans emerge from months of widespread lockdowns. Major U.S. cities with the biggest outbreaks — New York, Detroit, New Orleans — are flattening and even lowering their curves. The nation’s testing capacity has dramatically improved, and a larger share of cases are being caught.

Yet as the virus continues flaring in some rural and suburban areas, tamping it down will be a county-by-county project, dependent on the ability of local health officials to spot new cases and contain them. While life could look close to normal in some communities, others will have to stay vigilant with social distancing procedures to ensure these mini-flares don’t become regional or statewide outbreaks.

“There isn’t going to be one curve. There are going to be many curves,” Marynia Kolak, a health and spatial data science researcher at the University of Chicago, told me.

It’s the local — not national or statewide — curves of new cases and deaths that have epidemiologists most worried now.

These localized outbreaks can be found across the nation, many in states that reopened earlier but also in some states that held back a little longer. According to a map put together by University of Chicago’s Center for Spatial Data Science, clusters can be found in nearly every area of the country except for the northernmost states and parts of the West.

Kolak pointed to Montgomery, Ala. — part of the South’s “Black Belt” — where cases are suddenly surging. There are also hot spots in the state’s Tuscaloosa and Walker counties, along with several counties in central Mississippi. 

She’s paying close attention to a cluster of cases in southwest Kansas spilling over into the Oklahoma panhandle, which have been linked to outbreaks at a meatpacking plant.

Nowhere are cases more concentrated than in the Navajo Nation, an American Indian territory that spans northeastern Arizona, southeastern Utah and northwestern New Mexico. There, leaders have imposed weekend and nightly curfews in an effort to stem the virus, which has infected more than 400 people out of every 10,000 Navajo Nation residents.

These types of actions — expanding social distancing restrictions — is something every local official across the nation will have to consider if they start observing increased spread, experts say. 

County and even more localized data is crucial to discovering the hot spots and containing them.

That's according to Max Henderson, CEO of Covid Act Now, a website providing coronavirus data. He's working on a county-level scoring system that notifies policymakers and citizens when their region is about to become an outbreak area.

“We really have to look at our data in our area and decide whether this is the right action specific to our circumstances,” Henderson said.

It’s part of trying to find a new normal, where communities seek a sustainable way of living life even before a coronavirus vaccine is available.

What's reasonable policy in, say, rural counties in California will look very different from the situation in heavily populated regions such as Los Angeles or San Francisco, Henderson said.

“I don’t think we’re going to go back to a period where state level, one-size-fits-all is going to be a reasonable response,” he said.

The national curve looks more promising.

And the states that opened earliest aren't seeing massive spikes in cases despite dire predictions.

Governors who started reopening first were widely criticized, as some epidemiologists predicted large increases in cases and fatalities. But in most of these states — many in the southeast — the overall number of daily new cases is either relatively flat or even diminishing slightly.

The curve is bending upward in Texas — but only slightly. That’s also true of Mississippi, which is confirming 300 new cases per day compared with about 250 cases daily a month ago.

In Georgia, where Gov. Brian Kemp (R) moved to reopen some businesses in late April, about 625 new cases are being confirmed daily, according to 91-DIVOC, a visualization project created by University of Illinois professor Wade Fagen-Ulmschneider using coronavirus case numbers from Johns Hopkins University. That’s down slightly from one month ago, when closer to 700 new cases were being confirmed every day.

Daily confirmed cases are also trending downward in Colorado, where Gov. Jared Polis (D) was the most aggressive blue-state governor in reopening. The state is finding about 300 new cases per day, compared with about 550 new cases per day one month ago.

It’s a similar story in Florida, where the curve of new cases has remained flat for weeks. Gov. Ron DeSantis (R) recently blasted reporters for waxing “poetically for weeks and weeks about how Florida was going to be just like New York.”

“Wait two weeks, Florida is going to be next, just like Italy,” DeSantis said. “Well, hell, we’re eight weeks away from that and it hasn’t happened.”

Ahh, oof and ouch

AHH: Officials are worried about potential spread of the coronavirus as protests sparked by the death of George Floyd continue.

Protests are growing bigger in size and in intensity. Demonstrators are holding hands and marching to express their rage and grief as the pandemic rages on.

“The rules of the covid-19 pandemic, so recently learned at considerable inconvenience, have been discarded on the streets in recent days,” Lenny Bernstein reports. “Protesters frequently find it impossible to stay six feet apart, to avoid hand-to-hand contact or to dodge the respiratory droplets of their shouting, chanting comrades amid the swirling chaos. And because the virus can be spread by people with no symptoms, it can be impossible to figure out whom to avoid.” 

“There’s no question that when you put hundreds or thousands of people together in close proximity when we’ve got this virus all over the streets, it’s not healthy,” Maryland Gov. Larry Hogan (R) said in an interview on CNN. “…Two weeks from now, across America we're going to find out whether or not this gives us a spike and drives the numbers back up again or not." 

Atlanta Mayor Keisha Lance Bottoms (D) urged demonstrators to get coronavirus tests. 

“If you were out protesting last night, you probably need to go get a covid test this week,” Bottoms said at a news conference over the weekend. “There is still a pandemic in America that’s killing black and brown people at higher numbers.”

The Post's Marissa J. Lang:

In Minnesota, Gov. Tim Walz (D) reminded demonstrators: “We are still in the middle of a pandemic.”

In Los Angeles, coronavirus testing centers shuttered on Saturday afternoon as Los Angeles Mayor Eric Garcetti cited “safety worries across the city.”

The Daily Beast's Sam Stein: 

It remains to be seen whether these demonstrations lead to a spike in cases. In the meantime, there are precautions people can take. 

“Crowded protests, like any large gathering of people in a close space, can help facilitate the spread of covid-19, which is why it’s so important participants wear masks, eye protection and bring hand-gel,” Saskia Popescu, an infectious-disease epidemiologist at George Mason University’s Schar School of Policy and Government, told The Post in an email.

OOF: Robert Redfield, director of the Centers for Disease Control and Prevention, defended the agency’s failure to detect early the spread of the coronavirus in the United States.

“Redfield was among three CDC officials who spoke with reporters Friday about a comprehensive analysis by the agency that found the coronavirus began spreading in the United States as early as the second half of January, eluding detection by public health surveillance systems that help monitor for early signs of novel contagions,” Lena H. Sun and Joel Achenbach report.

Redfield dismissed the idea that widespread diagnostic testing would have helped, had it been available, saying it would still have been like “looking for a needle in a haystack.”

The new CDC analysis looked at public health surveillance data, confirmed cases of covid-19 and the transmission of distinct genetic strains of the virus. 

“The results are consistent with other scientific studies that have described a two-stage viral attack that began in January on the West Coast with the coronavirus introduced by travelers from China and continued in February as travelers from Europe brought the virus to the East Coast," Lena and Joel write. "Most of the virus spreading in the United States can be traced to the introductions from Europe.” 

OUCH: Some states are allowing dentists to resume treating patients. That means establishing a whole new set of safety protocols. 

“Unlike doctors treating covid-19 patients, dentists are not considered front-line workers and until recent days had largely been left out of the nationwide triaging of personal protective equipment, according to interviews with leaders of several state dental associations,” Chelsea Janes reports. “They are retooling their offices to meet new and stricter health and safety guidelines.” 

Another issue dentists have to consider: Their tools can cause wide sprays of respiratory particles. The CDC and World Health Organization have suggested the respiratory droplets expelled by infected people are the primary way the coronavirus spreads.

“Multiple dentists who were interviewed said that while they regularly wore more basic surgical masks when treating patients, they did not normally rely on the more protective N95 masks,” Chelsea writes. “Most dentists, many almost entirely out of work the last two months, did not budget for those upgrades, fueling fears some dentists will lose their practices.”

The Trump administration’s response

Global health experts and government officials panned President Trump’s plans to exit the World Health Organization. 

Such a move by the United States, the single biggest financial contributor to the U.N. agency, will have an impact on the WHO's budget amid the ongoing pandemic, Karla Adam writes.

Jens Spahn, Germany’s health minister:  

“Trump said that the annual $400 million that the U.S. contributes to the organization will be redirected ‘to other worldwide and deserving urgent global public health needs’ without giving specifics,” Karla adds. 

In a joint statement, E.U. Commission president Ursula von der Leyen and foreign affairs chief Josep Borrell called on the United States to reconsider. 

“Now is the time for enhanced cooperation and common solutions,” the statement said. “Actions that weaken international results must be avoided.” 

“Of the $893 million the United States sent in the 2018 and 2019 funding period, $237 million was an ‘assessed contribution’ — a type of membership fee that may prove hard to cut without congressional approval,” David J. Lynch and Emily Rauhala report. “At greater risk is what’s known as the ‘voluntary contribution,’ that is money provided to U.S. agencies for health efforts and then given to WHO programs.”

Industry efforts

Manufacturers are ramping up the production of some of the most critical supplies – such as masks, plastic dividers and hand sanitizer — that will be needed as the nation starts to reopen. 

Costs for these materials have skyrocketed. 

“The alcohol used in sanitizer has tripled in price since January. Wait times for plexiglass-style sheeting are now measured in months rather than weeks,” the Wall Street Journal’s Sharon Terlep and Austen Hufford report. “Scores of companies are hunting for fabrics that block virus-laden particles to supply their employees with masks. All told, the $5 billion U.S. market for personal-protection equipment is expected to grow nearly 15% this year from 2019, according to IBISWorld, a market "

Coronavirus latest

Here are a few more stories to catch up on after the weekend: 

There’s more to learn about the coronavirus: 
  • New York physicians, citing four case studies, say children with the mysterious inflammatory syndrome linked to the coronavirus may be experiencing deadly “cytokine storm,” Ariana Eunjung Cha reports.
  • More than 100 scientists and clinicians have called for verification of a study that found the treatment of covid-19 patients with chloroquine and hydroxychloroquine may have increased the risk of abnormal heart rhythms and death, the New York Times’s Roni Caryn Rabin reports.
More on the Trump administration’s response: 
  • The administration removed warnings about how choirs can spread the coronavirus in its guidance for the reopening of houses of worship, Lena and Josh Dawsey report.
The hardest hit:
  • Families are calling for a nursing home in Vallejo, Calif., to be shut down after more than 100 residents there tested positive for coronavirus and 16 died, the Los Angeles Times’s Hayley Smith reports.
On the front lines: 
  • Intensive care units are filling up in some cities. “The availability of ICU beds is one measure of a hospital’s ability to care for its most vulnerable patients — people with severe illness who require more staff to treat them and may need life-support equipment such as a ventilator to breathe,” Politico’s Nolan D. McCaskill reports. “And it's served as a metric for whether the local health care system is able to handle a coronavirus outbreak, albeit a constantly shifting one.”
In the region:
  • The District of Columbia has the capacity to test about 5,500 people for the coronavirus a day, between its public lab and those linked with hospitals and other providers. But the number of people seeking tests doesn’t reach anywhere near that, Steve Thompson reports. “Demand for testing has been slow in the District and elsewhere, experts say, because of a lingering sense of test scarcity, confusion about who qualifies to get one, a lack of easy access in underserved communities and skepticism about testing operations,” he writes.
In other news:                   
  • Missouri’s last abortion clinic can stay open, an independent arbiter ruled, ending a year-long battle between the state and its sole clinic, Reis Thebault and Emily Wax-Thibodeaux report.
  • The FDA called on five companies to voluntarily recall a diabetes drug, metformin, because it found higher-than-acceptable levels of a cancer-causing contaminant, the Wall Street Journal’s Dave Sebastian reports.

Sugar rush

On May 30, SpaceX’s Crew Dragon capsule separated from the Falcon 9 rocket’s second stage booster and entered a stable low-Earth orbit. (The Washington Post)