The rising tide of coronavirus cases in the U.S. South and West, coming four months into the outbreak, emerged amid a patchwork of often confusing or conflicting rules across government that have proved inconsistent and often difficult to enforce, making the pandemic harder to halt.
With the federal government handing off many decisions over reopening, the states have been the primary drivers behind moves with the most impact on the coronavirus’s spread. States, in turn, have often given responsibility for many of those decisions to counties, cities and businesses.
The result is a dizzying mix of rules and guidelines that can differ widely from one region to the next. It is a reflection of the American system of governance that limits federal power and distributes power across states and localities, but to health officials it is an ineffective way to manage a pandemic.
Calm Before the Surge
The CDC recommends, among other guidelines, that states have a downward trajectory of cases for two weeks before starting to reopen.
Daily Covid-19 cases, per 100,000 people
California
May 18
Governor announces the easing of criteria for counties that want to reopen faster than the rest of the state
60
40
20
0
M
A
M
J
J
Florida
June 5
Bars, tattoo shops, massage parlors, tanning salons and movie theaters allowed to open in select areas at half capacity
60
40
20
0
M
A
M
J
J
South Carolina
60
May 18
Hair salons, public pools and gyms open
40
20
0
M
A
M
J
J
Texas
May 27
Governor announces expansion of services and activities allowed to reopen during second phase
60
40
20
0
M
A
M
J
J
Source: Johns Hopkins University
Some states have called for clearer, more-consistent guidance from the federal government, which has delivered mixed messages on masks and lockdowns—though federal officials say some states have ignored what guidance the government did provide. By the time the Trump administration issued in-depth guidance on reopening in May, all 50 states had begun the process.
North Carolina required mask-wearing statewide on June 26, but a dozen sheriffs said they wouldn’t make people abide by it. Next door, on the same day, the Republican governor of South Carolina said a statewide mask mandate would create “a false sense of security,” and wouldn’t be enforceable. Then local officials in the coastal cities of Myrtle Beach and North Myrtle Beach decided to require mask-wearing there.
In Southern California, when bars in Riverside County opened, neighboring Los Angeles County residents pushed for the same. Officials wound up allowing Los Angeles County bars to open June 19 even though infections were increasing. “I regret that,” said Barbara Ferrer, director of the county health department, who now confronts new-case numbers that often exceed 2,000 a day, more than any other California county. “I wish we had been able to wait a little longer,” she said.
Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in a Wall Street Journal interview on Monday that multiple approaches and plans among local jurisdictions contributed to the different levels of outbreaks states are currently seeing.
While the federalist system mostly works well, Dr. Fauci said: “It would seem that in this circumstance you’d have to question that.” He said the federal government could do a better job making the case to Americans to take personal responsibility for not propagating the pandemic. “I’m not sure we do that very well,” he said. “We need to get people like myself, like my colleagues out there more.”
Dr. Fauci said state leaders often say they wish they had more central guidance on reopening, though he added that most states wanted to make their own decisions until the case count began ticking up. For the federal government, he said: “It’s kind of like you’re damned if you do, you’re damned if you don’t.”
On June 5 at the Knight’s Pub in Orlando, Fla., patrons descended on the college hangout, embracing Florida’s decision to reopen bars and other venues despite the state’s climbing coronavirus case count. Bars were permitted to operate at 50% capacity indoors and full capacity outdoors with social distancing.
The bar’s owner, Michael D’Esposito, said that without more-detailed guidance from state or local officials on how to reopen, he drew on Centers for Disease Control and Prevention recommendations and fellow business operators’ input. Security guards broke up large groups, he said, and masked bartenders stopped serving every 30 minutes to sanitize bar tops.
Dr. Anthony Fauci at a Senate hearing in June.
Photo: al drago/Agence France-Presse/Getty ImagesTwo days later, a customer called reporting possible Covid-19 symptoms, he said. At least 41 coronavirus cases have since been linked to the bar, according to the state. Four days after reopening, Mr. D’Esposito shut the pub down. “It was a no-brainer,” he said. “The community wasn’t ready.”
Then Florida officials suspended the bar’s alcohol license, citing a lack of social distancing—a move Mr. D’Esposito is challenging, saying he hewed to the rules. Florida has since prohibited alcohol consumption at bars statewide.
‘No national goal’
A consistent national approach is the most effective way to combat a pandemic, which doesn’t stop at state or local borders, epidemiologists say.
In the U.S. response so far, “there is no national goal, no national objective,” said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy. “We make each state come up largely with its own guidelines for how to respond.”
While some other countries have curbed the virus with a national focus, including federal states such as Germany, the White House doesn’t believe it would have made sense to more rigorously enforce federal guidelines for reopening because the virus affected every state differently, an administration official said. The country’s size and vast differences in its population mean a policy that might work in Chicago would make little sense in rural New Mexico.
Starting in early spring, the White House sought to shift responsibility for lockdown and reopening decisions to the states. In mid-April, President Trump initially asserted “total” authority over reopening the country, drawing blowback from governors in several states who had begun building their own plans in the absence of federal guidelines. The next day, he said he wouldn’t pressure any governor to reopen.
In late April, the White House rejected a CDC plan with detailed procedures for schools and businesses to reopen and requested revisions to make it less prescriptive. Over the last two weeks in May, the CDC posted 62 pages of in-depth guidance on reopening, after it was cleared by the White House.
The Trump administration also faced some legal limits in its ability to direct states’ responses, though there are no laws preventing the White House from issuing clear guidelines and urging states and individuals to adhere to them.
Myrtle Beach, S.C., Memorial Day weekend.
Photo: Sean Rayford/Getty ImagesPublic-health experts credit the Trump administration with significantly scaling up testing, though they say the push came so late that it has been difficult to catch up. Recently, the availability of tests has again become an issue. The administration also succeeded in increasing the production of ventilators, directing companies such as General Motors Co. to manufacture them.
Alyssa Farah, White House director of strategic communications, said: “The federal government has been working side by side with states since day one to ensure they have the infrastructure, medical supplies, testing capacity, and hospital capacity to treat the virus.”
Still, the U.S. now has the world’s most Covid-19 cases, more than 3 million out of 12 million world-wide, according to Johns Hopkins University data as of July 9. The nation had 40.44 deaths per 100,000 residents, the ninth highest rate among the top 10 countries.
Cases have been trending up over the past week in 35 states, according to Johns Hopkins. Florida, California, Arizona and Texas reported the most new cases nationally as of July 5; adjusted for population, Arizona, Florida, Louisiana, California and South Carolina topped the list. The seven-day average of new deaths generally has climbed in these states over the past two weeks; some hospital intensive-care units in Texas and Florida have reached or neared capacity.
An Atlanta barbershop, April 27.
Photo: Dustin Chambers/Bloomberg NewsDr. Fauci in the interview said the U.S. never locked itself down to the same degree as Europe, where more than 90% of the European Union was locked down for a period, compared with about 50% of the U.S. Those aggressive restrictions allowed Europe to bring down its baseline case count, making it easier to prevent individual cases from becoming surges, he said.
“If you look at the curve of the U.S. as a nation, we went up, we came down, but we never got lower than 20,000 or so a day—which for some countries that’s the highest they’ve ever been,” he said. “For us, that became our baseline.”
Administration officials point to America’s death count, which Johns Hopkins data show is lower per capita than some European countries. One of the officials said the U.S. faced different economic pressures to reopen than Europe, which the official said has a stronger safety net for workers. Officials also argue prolonging lockdowns could have had harmful ramifications for mental health, addiction, child abuse and suicide.
Florida Gov. Ron DeSantis removes his mask to speak during a news conference last month.
Photo: Ivy Ceballo/Tampa Bay Times/Zuma PressThe White House doesn’t view the current surge as being driven by how the country reopened, the administration official said. “There were always going to be new cases,” the official said.
Dr. Fauci said in an interview with “The Journal” podcast published Wednesday that the White House Task Force was discussing “taking those guidelines that we have for opening America and actually fine-tuning them a bit so that the states and the cities have some really more concrete guidelines about what they should do or not do.”
In recent weeks, the federal government has issued conflicting guidance to states on how and when to reopen schools. Mr. Trump for months has publicly called for schools to reopen. On Wednesday, he pushed federal health officials to ease coronavirus guidelines for schools, threatened to withhold federal funding from districts that don’t reopen, and tweeted that he disagreed with the CDC guidelines for opening schools, which advise schools to have students and staff wear face coverings, consider spacing desks 6 feet apart and consider closing dining halls and playgrounds. CDC Director Robert Redfield on Thursday said the agency would “clarify” its guidelines.
Lax neighbors
California appeared to be faring well after Democratic Gov. Gavin Newsom issued the nation’s first statewide shelter-in-place order in mid-March. In May, he outlined a system for counties to reopen in stages, as they hit certain metrics on hospitalizations and case numbers. But counties ended up following their own rules, sometimes reopening even as cases climbed.
The system put pressure on local governments to keep up with nearby jurisdictions, effectively allowing those with the most-lax rules to set the standard for everyone. Dr. Ferrer, director of the Los Angeles County health department, said she initially planned to wait three weeks after opening one sector of the economy before opening another, to gauge any effects on the virus’s spread, but: “It’s been so hard to hold that line.”
Mark Ghaly, secretary of California’s Health and Human Services agency, said he didn’t think counties were given too much control over reopening. “We were rock solid for weeks,” he said. “As cases go up, we’ll have our finger near the dimmer switch.”
Republican governors in the South were among the last to order lockdowns and among the earliest to lift them, citing the importance of economic recovery. South Carolina Gov. Henry McMaster declared a statewide stay-at-home mandate April 7 and lifted it May 4. New cases have soared in the weeks since, from 135 a day on May 4 to 1,537 on July 8. Some of the state’s biggest hot spots are on the coast, where towns moved aggressively to try salvaging the tourist season. The positivity rate of people tested on July 7 was 21%, up from 4.4% on May 3, just before reopening.
Restaurant dining outdoors, Manhattan Beach, Calif., July 3.
Photo: Patrick T. Fallon/Bloomberg NewsIn the past month, cases jumped eightfold in Horry County, home to Myrtle Beach. Public-health officials in West Virginia urged residents who visited the city to get tested after several of the state’s counties had outbreaks tied to trips there.
Mr. McMaster has said it is up to local governments to impose further restrictions. He said on June 26 that a statewide mask mandate wouldn’t be enforceable.
A spokesman referred to Mr. McMaster’s June 26 remarks when asked for comment on his hesitancy to call for mask mandates. As for the timing of reopening, he said, Mr. McMaster was in regular contact with the Trump administration and considered federal guidance and state data when reopening.
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North Myrtle Beach Mayor Marilyn Hatley, a Republican and member of the governor’s economic-revitalization task force, said she has no regrets about reopening quickly. “Could we have seen this coming? We don’t have a crystal ball,” Ms. Hatley said. “We could not keep the economy of our state totally shut down.”
Others who pushed for a rapid reopening are having second thoughts. Tony Elliott, who owns a trucking business in Florence, S.C., was a frequent poster in favor of an aggressive timetable on a Reopen SC Facebook page but became a cautionary voice on the page after a friend died of Covid-19 last week.
Mr. Elliott has gone from opposing measures such as a mask mandate to supporting them, he told the Journal, criticizing federal health officials for sending mixed messages. “It goes against my core beliefs as a conservative,” he said. “But how do we go about living our life with this in the back of our mind?”
Mask messaging
Democrats and some Republicans have faulted Mr. Trump for declining to wear a mask publicly. Mr. Trump has said masks are a “double-edged sword” because people can fidget with them, leading them to touch their faces and possibly expose themselves to the virus.
In North Carolina, Democratic Gov. Roy Cooper imposed a statewide mask order June 26, as new cases exceeded 1,600 a day there. A dozen sheriffs said they wouldn’t enforce it. “We’re not going to harass people,” said Sheriff Sam Page of Rockingham County, a Republican. “When people feel that they’re being told what they can and can’t do here in America, that goes against the grain of what America stands for.”
A spokeswoman for Mr. Cooper said that the governor’s order is meant to slow the spread of the virus and: “It is the responsibility of law enforcement to enforce this and other orders.”
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In Florida, where new cases regularly set fresh records and topped 11,000 on July 3, Republican Gov. Ron DeSantis has consistently deferred to local officials on decisions on closures and reopenings. In such a large, diverse state, he has said, restrictions that make sense in South Florida’s urban centers might be inappropriate in rural areas. Florida’s approach seemed to pay off early on, with new case counts remaining low through April and May.
Yet local leaders lacked their own epidemiologists and health-care professionals. Miami Beach Mayor Dan Gelber, a Democrat, said, “I’ve literally been on the phone with the [Florida] Department of Health and said, ‘What should I do?’ and the response has been, ‘We have to check with supervisors.’ ”
Mr. Gelber searched for public-health experts online and assembled his own informal panel. On June 27, the city manager wrote in an email to them, “We are now faced with trying to decide how to get this pandemic back under control…. The issue that everyone is now grappling with is whether to require that masks be worn outdoors.”
Two days later, J. Glenn Morris, director of the Emerging Pathogens Institute at the University of Florida, replied, “Masking everywhere will help, but the impact is probably not going to be that great, given that a lot of people are refusing to wear masks anywhere.” The following day, the city of Miami Beach mandated the use of masks in public places. Dr. Morris confirmed the exchange, adding that a key obstacle with mask rules is compliance.
Mr. Gelber said he has asked the state health department several times what contact tracers are learning about where people are getting infected and where they work—with no feedback. “The absence of information and organization and coordination is stunning to me,” he said.
Austin, Texas, in May.
Photo: Eric Gay/Associated PressA spokesman for the health department didn’t respond to requests for comment. A spokeswoman for Mr. DeSantis said the governor’s policy decisions were guided by data such as the positivity rate for tests, which were low in the lead-up to the reopening of bars.
In Arizona, which currently leads the nation in new cases per capita, Republican Gov. Doug Ducey at first blocked local governments from implementing mask mandates or other orders that exceeded state restrictions. After medical professionals pleaded for a change, he reversed course on June 17, allowing locals to impose mask rules.
The state sought early on to provide residents with clear, uniform guidance, but rising case numbers changed the calculus, said Daniel Ruiz, Arizona’s chief operating officer. “Throughout this process, we’re taking a data-driven approach,” he said.
In Texas, Republican Gov. Greg Abbott lifted a statewide stay-at-home order May 1, when new infections had plateaued. He limited local governments from implementing their own such mandates, saying he trusted Texans to protect themselves and others.
Texas cases began to rise in May, then soar in June. They jumped 65% the week ending June 26, reaching nearly 6,000 a day. Mr. Abbott said he was loath to backtrack. Democratic leaders in the state’s biggest cities called on him to act quickly and asked to be allowed to impose mask mandates, which he had prohibited.
“We find ourselves careening toward a catastrophic and unsustainable situation,” said Harris County Judge Lina Hidalgo in Houston, the top local elected official, in a June 26 news conference. “History will remember the action we take now.”
Mr. Abbott began backtracking. He ordered bars to shut down again. In subsequent days, he mandated the use of masks in most counties and granted local governments the authority to put limits on gatherings of more than 10 people. Mr. Abbott’s office didn’t respond to requests for comment.
He still hasn’t given locals total decision-making autonomy. Houston’s Ms. Hidalgo said Sunday that the mask mandate was too little, too late, and called for more local control. “We don’t have room for incrementalism,” she said on ABC’s “This Week.”
Closing the Knight’s Pub ‘was a no-brainer,’ says its owner.
Photo: Eve Edelheit for The Wall Street Journal—Ian Lovett and Josh Barbanel contributed to this article.
Write to Arian Campo-Flores at arian.campo-flores@wsj.com, Rebecca Ballhaus at Rebecca.Ballhaus@wsj.com and Valerie Bauerlein at valerie.bauerlein@wsj.com
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