with Paulina Firozi

President Trump has spent the past few days arguing that coronavirus cases are only rising because more Americans are being tested. 

That argument might have been true in April, when testing was still ramping up. It’s not true anymore. 

Here's what he said this morning: 

The wide testing net means the U.S. can finally accurately determine where and how fast the virus is spreading. 

The fact that testing has increased means the infection trends are no longer distorted. Back when the country was conducting fewer than 150,000 tests per day, it was impossible to get a good sense of how quickly the virus was spreading. Not enough people were being tested to get the full picture of its transmission. The World Health Organization recommends that countries do enough testing that less than 5 percent of people taking them would be confirmed positive.  

The United States was far from that goal for much of the spring. In March, only about 20,000 people were being tested every day and the positivity rate was about 20 percent, according to data from Johns Hopkins University. Even as testing expanded, to daily testing around 130,000 in April, the positivity rate was still above 10 percent by the month’s end.

But testing rapidly expanded and the overall positivity rate fell rapidly throughout May. And for most of June, the United States has met the WHO’s testing guidelines. About half a million tests are being conducted daily. Fewer than 5 percent of all tests nationally have been coming back positive — indicating most cases are being detected.

"The way to tell whether a rise in cases is indicative of increased spread in the population — rather than a byproduct of conducting more tests — is by seeing how many tests are identifying infections," as Johns Hopkins epidemiologist Jennifer Nuzzo wrote for The Post.

Now that testing has ramped up, it's easier to track emerging hotspots. 

Most of the coronavirus case increases are coming from Florida, Texas and Arizona.

Scott Gottlieb, former commissioner of the Food and Drug Administration:

As Florida grew its testing capacity throughout the spring, the positivity rate dropped from about 11 percent in early April to less than 4 percent in mid-May. But now it’s on the rise again, exceeding 10 percent over the past two days.

“Florida added more than 3,000 new cases for the first time Thursday, surpassed 4,000 on Saturday and added nearly 3,500 on Sunday,” Adam Kilgore reports. “On Monday, it surpassed 100,000 total confirmed cases.

Texas has a similar story. Its testing positivity rate hovered around 5 to 6 percent in May and the beginning of June, but has recently exceeded 10 percent.

Arizona, which is seeing a particularly troubling spike, only ever managed to get its positivity rate down to about 7 percent. But it’s now up to 20 percent after a steady three-week rise.

On the flip side, New York saw its positivity rate plummet — and stay down. 

The state had an enormous number of cases and hardly any testing at the pandemic’s outset in the United States. At the beginning of April, half of all tests were coming back positive. But as testing expanded, New York's test positivity rate plummeted and has remained below 2 percent for the last few weeks. 

Other states are also touting their lowered positivity rates.

Virginia Gov. Ralph Northam (D):

White House press secretary Kayleigh McEnany didn’t communicate the full picture yesterday.

She faced multiple questions from reporters about the president’s comments at a campaign rally Saturday night. There, Trump claimed he had told his administration to “slow the testing down” because it would “find more cases.”

McEnany said Trump’s remarks were a joke intended to mock the media. But she didn’t address the fact that cases are rising even amid sufficient testing.

“He was joking about the media and their failure to understand the fact that when you test more, you also find more cases,” she said.

Ahh, oof and ouch

AHH: More than 20 public health officials have resigned, retired or been fired during the pandemic.

The cases had to do with harassment or pushback the officials were getting for trying to keep their communities safe, Rachel Weiner and Ariana Eunjung Cha report. “Public health workers, already underfunded and understaffed, are confronting waves of protest at their homes and offices in addition to pressure from politicians who favor a faster reopening,” they write.

Lori Tremmel Freeman, chief executive of the National Association of County and City Health Officials, said the officials left their role “due to conditions related to having to enforce and stand up for strong public health tactics during this pandemic.” 

Marcus Plescia, chief medical officer with the Association of State and Territorial Health Officials, said attacks on health officials have been particularly awful in California, Colorado, Georgia, Ohio and Pennsylvania.

Some have been fired after advocating a more cautious response to the pandemic, while others retired or resigned as citizens and politicians blamed them for the disruptions in their lives that come with the ongoing public health crisis. 

“I don’t think I’ve ever seen anybody resign for the kinds of reasons we’ve seen recently,” Plescia said. “We are very concerned that if it continues to get worse it’s going to have major implications for who will be willing to have these jobs.”

Theresa Anselmo, executive director of the Colorado Association of Local Public Health Officials, said 80 percent of members had reported being threatened and more than that were at risk of termination or lost funding.

“It’s exhausting to be contradicted and argued with and devalued and demoralized all the time, and I think that’s what you’re seeing around the country,” Anselmo said.

OOF: At least 13 people who attended recent Black Lives Matter protests in South Carolina tested positive for the virus.

In response, protest organizers in the state are halting demonstrations and urging participants to get tested, Brittany Shammas, Chelsea Janes, Lateshia Beachum and Lenny Bernstein report

“In a video posted Sunday on Facebook, organizer Lawrence Nathaniel said demonstrators who marched in Columbia, S.C., between May 30 and June 17 had tested positive,” they write. “He said four organizers were confirmed infected, along with three photographers and six protesters.”

“We need to do our part,” he said. “Go get tested. Don’t come to a protest until you get tested, okay?”

Twenty-nine states and territories have reported increases in their seven-day averages of new confirmed cases. 

"Daily totals continued to approach record levels not seen since March and April,” our colleagues write. “Public health authorities blamed virus-fatigued states that reopened before they had vanquished the virus while leaders of some of those states cited other factors.”

Many cities where marches took place said they had not traced any infection surges to the events. But that doesn't prove anything yet, epidemiologists warned.

“Some experts estimate case spikes could take as many as four weeks to appear in data, in part because a week or more can pass before someone infected shows symptoms, and additional time often passes before that person seeks a test," they write.

OUCH: Two more Trump campaign staffers who attended the Tulsa rally have tested positive for the virus.

That’s in addition to six staffers from the campaign’s advance team who tested positive ahead of the event and did not attend the rally. 

“The two workers, members of the campaign’s advance team, tested positive when ‘another round of testing’ was conducted after the rally, according to Tim Murtaugh, the campaign’s communications director. He said the staff members in question had attended the event, but had worn masks the entire time,” the New York Times’s Annie Karni reports. “… It was not immediately clear how many people the staff members interacted with inside the arena, or whether either of them had been in contact with President Trump or Vice President Mike Pence, who was also at the rally.”

In a statement, Murtaugh said that following the latest positive tests, “the campaign immediately activated established quarantine and contact-tracing protocols.” 

The White House eased some restrictions on its grounds yesterday. 

For the first time since mid-March, visitors can now enter the White House complex without the previously required temperature check. 

Those who come into close contact with Trump will still undergo testing and temperature checks, John Wagner reports for The Post’s live blog. 

“In conjunction with Washington, D.C. entering Phase Two today, the White House is scaling back complex-wide temperature checks,” White House spokesman Judd Deere said. “In addition to social distancing, hand sanitizer, regular deep cleaning of all work spaces, and voluntary facial coverings, every staff member and guest in close proximity to the president and vice president still being temperature checked, asked symptom histories, and tested for COVID-19.”

The Trump administration's efforts

The president has extended immigration restrictions through the end of the year and limited many categories of foreign workers. 

The White House says it will preserve jobs for U.S. workers amid the pandemic, estimating the restrictions will prevent foreign workers from filling 525,000 jobs, Nick Miroff and Tony Romm report. The measures will apply only to applicants seeking to come to the United States, not workers who already are on U.S. soil.

“The ban expands earlier restrictions, adding work visas that many companies use, especially in the technology sector, landscaping services and the forestry industry,” they report. “It excludes agricultural laborers, health-care professionals supporting the pandemic response and food service employees, along with some other temporary workers.” 

The freeze will apply to “the H1-B visa category for highly skilled workers, the H4 visa for their spouses and the L visas companies use to transfer international employees into the United States. Most H2-B visas — for temporary workers who would stay in the United States for up to three years — also will be suspended, the officials said, with exceptions for hospitality and food service employees.” 

Critics argue the president is using the pandemic to push for the kind of immigration restrictions he has long praised.

In the states

In California, Gov. Gavin Newsom (D) said hospitalizations in the state increased 16 percent in the last two weeks.

“Those that suggest we’re out of the woods, those that suggest this somehow is going to disappear, these numbers tell a very, very different and sobering story,” Newsom said at a news conference.

“The Democratic governor started easing his stay-at-home order roughly six weeks ago and has now allowed 54 of 58 counties in the state to open businesses again,” the Los Angeles Times’s Taryn Luna reports. “Newsom also noted a modest uptick in the rate of positive cases — from 4.5% to 4.8% — in the last week. The number of patients in intensive care has also increased by 11% over two weeks, he said.” 

The governor has previously said California may need to reimpose restrictions if cases surge, but he has not provided any details in doing so. 

The hardest hit

Income and race are major predictors of infections among older Americans, according to a federal analysis. 

“The findings released Monday are based on billing records for people on Medicare who have contracted the virus,” Amy Goldstein reports. “They echo the commonly understood pattern that black Americans are more likely to test positive for and to be hospitalized for covid-19, the disease caused by the coronavirus, than other racial and ethnic groups. But they also point to the role of poverty as the pandemic has sped through U.S. communities in the winter and spring.” 

The analysis found Medicare beneficiaries who also qualified for Medicaid were four times as likely to have been infected or hospitalized with the coronavirus as those covered by Medicare alone. That’s according to billing records from more than 325,000 cases from January through mid-May.

Amy adds: “The new data is consistent with that of the CDC report in finding pronounced racial and ethnic disparities in how likely individuals are to be infected or hospitalized. The new data found that, out of every 100,000 U.S. residents on Medicare, 731 black people were infected, compared with 380 Hispanics, 281 whites and 256 Asians.” 

A report from the Centers for Disease Control and Prevention found ER visits to hospitals dropped markedly during the pandemic. 

In the 10 weeks since the beginning of the pandemic, emergency department visits dropped 23 percent for heart attacks, 20 percent for strokes and 10 percent for hyperglycemic crises — findings that suggest patients either avoided medical facilities because of coronavirus-related concerns or otherwise couldn’t access care, Steven Goff writes for The Post’s live blog. 

“The substantial reduction for these life-threatening conditions might be explained by many pandemic-related factors, including fear of exposure to covid-19, unintended consequences of public health recommendations to minimize nonurgent health care, stay-at-home orders, or other reasons,” the CDC said. “A short-term decline of this magnitude in the incidence of these conditions is biologically implausible for [heart attack] and stroke and unlikely for hyperglycemic crisis.”

Congress on coronavirus

Republicans are worried about how their years-long efforts to get rid of the Affordable Care Act will affect them in an election year. 

It’s a concern that has become particularly acute as the pandemic leaves people worried about affordable coverage, the New York Times's Sheryl Gay Stolberg reports. 

“The issue will come into sharp focus this week, when the White House is expected to file legal briefs asking the Supreme Court to put an end to the program, popularly known as Obamacare,” she writes. “Speaker Nancy Pelosi, seizing on the moment, will unveil a Democratic bill to lower the cost of health care, with a vote scheduled for next week in the House.” 

Republicans have not been able to come up with an alternative to the ACA, but the pandemic — which has underlined not only issues related to health-care costs but also has exposed disparities in care — has made it clear for Republicans that they must develop a proposal for the short and long term.  

Sheryl adds: “The coronavirus has changed the national discussion around health care in ways that go beyond the issue of cost. The pandemic has exposed racial disparities in care, making health care a more important issue for African-Americans and Latinos, core Democratic constituencies.”

Coronavirus latest

And here are a few more stories to catch up on this morning:

In the region: 

The District, Maryland and Virginia reported 19 coronavirus-related deaths and 806 new infections yesterday, continuing a decline in cases the area has experienced since the middle of last month, Julie Zauzmer, Rebecca Tan and Christine Condon report.

More on Trump’s efforts: 

Trump has become increasingly preoccupied with perceptions of his mental and physical health, Ashley Parker and Josh Dawsey report. He has also refused to wear a mask and has suggested that others who wear them are showing weakness or fear. 

Global efforts: 

The World Health Organization wants increased production of dexamethasone, a steroid that a British clinical trial found could help some severely sick patients, Siobhán O'Grady writes for The Post’s live blog. 

The pandemic’s mental health toll: 

Mental health and addiction treatment facilities are struggling to stay afloat, some waiting months for coronavirus relief funds. Nearly a third of such centers haven’t received any funding that’s been sent to hospitals and other health providers, Politico’s Rachel Roubein and Brianna Ehley report.

Sugar rush

After 13 summers, one D.C. summer camp has reinvented itself by introducing a "pod" structure — groupings of children — so that campers can safely gather. (The Washington Post)