Month: April 2022

September 7 was Brazil’s Independence Day, and Brazilian President Jair Bolsonaro used the occasion to continue his assault on the country’s democratic institutions.

Bolsonaro had called on his hardcore supporters to rally, as he battles Congress and the judiciary over their refusal to go along with his attempts to rewrite electoral rules ahead of the 2022 election and over probes into him and his allies that could imperil them criminally.

He addressed crowds in Brasilia and São Paulo, using the platform to attack and threaten the supreme court. “Either the leader of this branch of power gets this minister under control, or this branch will suffer what none of us want,” Bolsonaro said. He said he would not follow the decisions of certain justices, including one who will be in charge of the electoral tribunal during the 2022 elections.

Though an estimated 100,000 Bolsonaro backers gathered in the capital, Brasilia, as well as in São Paulo, according to Brazilian media outlets, the marches did not erupt in mass violence and chaos. Ahead of September 7, some feared a repeat of something like the January 6 insurrection in the United States.

That didn’t happen, despite worries that pro-Bolsonaro demonstrators might try to storm the Supreme Court. Though police and protesters clashed, attempts to push past police barriers largely failed.

But the threat to Brazil’s institutions has not lapsed, not from Bolsonaro nor from those who unquestionably back him.

That danger comes from Bolsonaro’s political weakness. A large swath of the public is angry over his mishandling of the Covid-19 pandemic, which has killed more than 580,000 people, one of the worst death rates in the world. That, along with Brazil’s still-sluggish economy and the myriad scandals following Bolsonaro, has tanked his popularity; his approval rating has hit an all-time low of around 23 percent. Right now he’s losing — badly — in most recent presidential polls, with some suggesting the incumbent might even fail to advance to a runoff.

Bolsonaro is seeing his political, and maybe personal, downfall in real time. Faced with these crises of his own making, he is creating another one against Brazil’s democracy, in a desperate attempt to hold power and protect himself.

“We cannot accept a voting system that does not offer any security in the elections,” Bolsonaro said in São Paulo on Tuesday, according to Reuters. “I can’t participate in a farce like the one sponsored by the head of the electoral court.”

Bolsonaro’s rhetoric isn’t new — from him or, you know, other people. But just because the playbook isn’t original does not make it less of a menace.

“They are fine with going with these democratic processes, provided that they are the winners,” Paulo Barrozo, an associate law professor at Boston College, said of leaders in the mold of Bolsonaro and former US President Donald Trump. “The moment that there is any indication that they’re not going to win, then they are no longer committed to electoral democracy.”

“The playbook is the same, the motivation is the same,” Barrozo continued. “And it remains to be seen how much traction [Bolsonaro] is going to get in the larger Brazil society.”

The September 7 marches were a culmination of Bolsonaro’s attempts to discredit democracy

Bolsonaro’s campaign to discredit Brazilian democracy began way, way before September 7. He decried possible voter fraud even after his first victory in 2018, and his efforts have intensified once in the presidency and as his electoral prospects have worsened.

For months, Bolsonaro has been trying to sow doubt in the electoral system and frame the institutions defending those norms as corrupt actors out to get him. It may sound familiar.

He has repeatedly attacked Brazil’s electronic voting system — a kind of mirror image of Trump’s attacks on vote-by-mail and the like during the 2020 election. He is insisting that Brazilian voters must use paper ballots in the 2022 election, otherwise the results can’t be trusted. (Brazil’s electronic voting system was created to reduce fraud and corruption and to manage the logistics of a complex voting system, and has been in use since the country’s 2002 election.) “I’ll hand over the presidential sash to whoever wins the election cleanly,” the far-right Bolsonaro said in July. “Not with fraud.”

Bolsonaro pushed Congress to change the rules, and on the day Congress debated the voting proposal, he presided over a military parade in Brasilia. Still, Congress declined to pass a law requiring paper ballots; Bolsonaro attacked some of those lawmakers as having been “blackmailed.”

Bolsonaro has also directed his ire toward the judiciary, both the supreme court and what’s known as the Superior Electoral Court, which oversees and administers the country’s elections.

Some current and former supreme court justices have directly criticized Bolsonaro’s anti-democratic rhetoric and defended the integrity of Brazil’s elections. Ultimately the Supreme Court opened an investigation into Bolsonaro’s efforts to spread voting misinformation and threatening Brazil’s democracy.

The supreme court has also opened a bunch of other investigations into Bolsonaro, along with those in his inner circle, including an ally arrested for allegedly spreading fake news. Bolsonaro is under investigation for posting a sealed document from an electoral investigation on social media, in an attempt to prove voter fraud. He’s under investigation for his mishandling of the Covid-19 pandemic, including a possible vaccine kickback scheme. He and his sons are also implicated in other corruption schemes, with potential criminal consequences.

All of these pressures are looking harder and harder for Bolsonaro to shake, and it’s happening against the shadow of Covid-19 and high unemployment and inflation. “The political scenario is worsening for him, so he’s trying to figure out some way to hold on to power to protect himself,” Sean T. Mitchell, an associate professor of anthropology at Rutgers University, told me last month.

The September 7 marches fit with Bolsonaro’s attempts to hold power. The question now is whether the demonstrations were enough to embolden him to launch even more aggressive attacks on the country’s institutions.

Brazil’s September 7 rallies were not January 6. But they are still ominous for Brazilian democracy.

In Brasilia and in São Paulo, Bolsonaro’s supporters draped themselves in the Brazilian flag, or wore its green and yellow colors.

It wasn’t record turnout, but it also wasn’t a total flop. Bolsonaro’s loyalist base showed up, and they are motivated. (There were also some anti-Bolsonaro counterprotests in cities Tuesday, though opposition leaders largely urged their supporters to gather on September 12 instead to avoid potential clashes.) The marches also showed that they are buying into Bolsonaro’s attacks on Brazil’s democracy. They carried pro-Bolsonaro signs, a number in English. Some blasted the Supreme Court. Some called for a military takeover.

It was a show of President Bolsonaro’s die-hard supporters, which was the goal. Bolsonaro is losing popular support, and the calls for his impeachment have intensified. But so far, the public outrage hasn’t fully translated into political consequences; Bolsonaro still has allies in Congress, whom he’s managed to keep by making deals, not out of any ideological loyalty (Bolsonaro actually doesn’t have a political party right now). But Bolsonaro doesn’t want those ties fracturing.

“He’s trying to give a demonstration that will somehow overwhelm his 20 percent approval numbers, show that he has support where it’s really needed — he can bring people out to the streets,” said Amy Erica Smith, an associate professor of political science at Iowa State University. “He’s trying to rally support to himself by showing that he already has support.”

The September 7 marches were also a test for how far Bolsonaro and his backers might take their threats against democracy, and how law enforcement might respond.

Bolsonaro escalated his rhetoric against the supreme court and other institutions — walking up to the coup line, perhaps, but not quite crossing it. There was his threat that if the judiciary continued to act as it had been, it “will suffer what none of us want.” He also declared that he would no longer follow rulings made by one of the supreme court justices, Alexandre de Moraes, who initiated some of the investigations against him.

“I want to tell those who want to make me unelectable in Brazil: Only God removes me from there,” Bolsonaro said in São Paulo, according to the Associated Press.

“There are three options for me: be jailed, killed or victorious. I’m letting the scoundrels know: I’ll never be imprisoned!”

Bolsonaro’s supporters spoke in all-or-nothing language. “Even if we need to pick up arms and die for Brazil then we’ll do that,” Luis Bonne, a 50-year-old civil servant and rally attendee, told the Guardian.

And though the fears that September 7 might become a preemptive “stop the steal” didn’t materialize, experts said the danger hasn’t passed. Instead, it seems clear from Bolsonaro’s language that there is no scenario where he will let the election play out and not challenge the results, or willingly leave.

Where the military stands on this adds to the precariousness of the situation. Bolsonaro does have support among lower ranks and military police, and elected leaders feared that many would turn out for the September 7 marches.

But whether high-ranking generals would go along with a Bolsonaro power grab or break with him is not at all clear. Experts said it’s unlikely he has enough of their support to launch a full-scale coup, but unlikely is not exactly a comfort when it comes to a military takeover. “Nobody can say this with 100 percent certainty among many observers who are watching this,” Smith told me last month. “And the fact that people can’t say this with 100 percent certainty is a source of power for [Bolsonaro].”

Brazil’s institutions have, so far, reacted to Bolsonaro, in some cases quite strongly. “There are very good signs of that working,” Barrozo said. “But again, it’s too close to a fatal accident that it could derail things.”

September 7 showed that Bolsonaro is testing Brazil’s democratic institutions. The question is how far those institutions can push back on him — and how much of his onslaught they can withstand.

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America’s evacuation of Afghanistan is over. But that doesn’t mean the US has fulfilled its obligation to vulnerable Afghans, some of whom are still trapped in their home country.

Even if the decision to withdraw from the country was ultimately the right one, the ensuing humanitarian crisis in Afghanistan is the product of America’s ill-conceived and failed attempts at nation-building. The US therefore has a responsibility to ensure that Afghans facing danger or persecution as the Taliban reassert their vision of religious law can reach safety in the US or in other countries, whether or not they worked alongside American troops.

The US has taken some halting steps toward meeting that obligation. President Joe Biden plans to resettle tens of thousands of Afghans who were able to escape, and has asked Congress to allocate $6.4 billion in emergency funds to support those efforts. Congress is expected to grant that request.

But the actions the US has taken so far should be just the beginning. When it comes to resettlement, Biden and Democrats in Congress have pursued safe, broadly popular policies. But ensuring the safety of all vulnerable Afghans will require doing more than that.

However, in the face of right-wing fearmongering about security and Afghans’ ability to assimilate, it’s not clear that Biden and Democrats in Congress will risk political capital on helping not just the most sympathetic Afghans and those who aided US troops over the past 20 years, but also other at-risk groups, such as women’s rights activists and LGBTQ individuals. Adding to the uncertainty is that Republicans have begun to use the Afghan refugee crisis as a political cudgel against Democrats ahead of the 2022 midterm elections, stoking the same anti-immigrant sentiments that catapulted Trump into office in 2016.

In order to fulfill the US’s obligation to Afghans, Democrats will have to weather — and risk losing their seats over — such attacks. Should they choose to do so, they will find they have some cover: So far, the public has largely supported efforts to resettle Afghans in the US. But public support can be transient. It is up to Biden and his fellow Democrats to assume the risk inherent with broadening the refugee effort now, while the public still supports it. It is also necessary to ensure that support endures through what could be a yearslong resettlement process, as more Afghans continue to seek the US’s protection.

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The US refugee policy was reshaped during the Syrian civil war

The bipartisan consensus on maintaining a robust refugee resettlement program began to unravel after the Paris terror attacks in late 2015 when suicide bombers — reportedly sanctioned by the Islamic State — killed 130 civilians in explosions and mass shootings throughout the city.

There was speculation that one of the attackers was a refugee, one of 6.6 million Syrians who have been displaced since 2011 by the ongoing civil war. It was later confirmed that all of the perpetrators were citizens of the European Union. But the rumors were enough to spark a panic about Syrian refugees — and start a movement at the state level to cut back US admissions of Syrian refugees and resettlement efforts more broadly.

Governors from at least 31 states, all Republican except for New Hampshire’s Maggie Hassan, said in 2015 that they no longer wanted their state to take in Syrian refugees. In 2016, Mike Pence, then the governor of Indiana, tried to prevent refugee resettlement agencies in his state from getting reimbursed for the cost of providing social services to Syrian refugees.

But states didn’t have the legal authority to simply refuse refugees; that’s the prerogative of the federal government. Pence ultimately had to back down after a federal court ruled against his decision to withhold the reimbursements.

Donald Trump, then campaigning for president, stirred up more fear, suggesting that Syrian refugees were raising an army to launch an attack on the US and promising that all of them would be “going back” if he won the election. He said that he would tell Syrian children to their faces that they could not come to the US, speculating that they could be a “Trojan horse.”

When Trump took office, he delivered on his promise to slash refugee admissions from Syria, suspending refugee admissions altogether from January to October 2017. From October 2017 to October 2018, the US admitted only 62 Syrian refugees.

State leaders lined up behind him: The Tennessee legislature, for instance, filed a lawsuit in March 2017 claiming that the federal government was infringing on states’ rights by forcing them to take in refugees (a court challenge that also failed).

The situation with Afghanistan is different in some key ways. Many Afghans seeking refuge in the US worked directly for the US military or US-based organizations, and that’s a group largely perceived as sympathetic. That wasn’t the case with Syrian refugees in 2015.

And in an era when political divisions over immigration policy have never been more fraught, support for welcoming Afghans who aided the 20-year American war effort has so far proved remarkably bipartisan. Polling has shown that 76 percent of Republicans back resettlement efforts — still fewer than Democrats, but a majority nonetheless.

“Right now agencies are getting inundated with calls … from people wanting to step up. The nice thing is it feels bipartisan, at least at this point,” said Alicia Wrenn, senior director for resettlement and integration at the refugee resettlement agency HIAS.

That said, framing Syrian refugees as dangerous paid political dividends for the Republicans involved; it was an effort that helped pave Trump and Pence’s road to the White House, cement GOP control of Congress during the early years of Trump’s administration, and further position the GOP as the party of security. And for some Republicans, it’s a strategy that bears repeating in the face of the Afghan crisis.

The GOP is ready to use the Afghan refugee crisis against Biden

There seems to be a recognition, even among many of the GOP’s immigration hawks, that the US bears some moral responsibility to shepherd Afghans who have worked alongside American soldiers to safety and help them build a new life in the US. All but 16 House Republicans voted for a bill to increase the number of so-called Special Immigrant Visas (SIVs) available to Afghans who worked for the US in July.

Yet there is also a small but vocal wing of the party that, despite criticizing Biden’s perceived failure to carry out an orderly evacuation of Afghan allies at first, now denounces the resettlement of tens of thousands of Afghans in the US, seeing a potential opportunity to rile up the base ahead of next year’s midterm elections.

These critics have incorrectly argued that arriving Afghans are not being properly vetted for potential terrorism threats when, in fact, they are required to undergo thorough security screening in third countries prior to getting on a flight to the US, in addition to health screenings and vaccinations.

Former President Trump put out a statement on August 24:

You can be sure the Taliban, who are now in complete control, didn’t allow the best and brightest to board these evacuation flights. Instead, we can only imagine how many thousands of terrorists have been airlifted out of Afghanistan and into neighborhoods around the world… What a terrible failure. NO VETTING. How many terrorists will Joe Biden bring to America? We don’t know!

Others have followed Trump’s lead. GOP Minority Leader Kevin McCarthy reportedly warned a bipartisan group of House lawmakers that resettling Afghans in the US would mean “terrorists coming across the border.” Republican Sen. Ted Cruz and Ohio Senate candidate J.D. Vance have also thrown doubt on the Biden administration’s vetting procedures.

“Yes, let’s help the Afghans who helped us, but let’s ensure that we’re properly vetting them so that we don’t get a bunch of people who believe they should blow themselves up at a mall because somebody looked at their wife the wrong way,” Vance said in a video posted on Twitter last month. “How do we do it in a way that doesn’t destroy our own sovereignty?”

Their rhetoric echoes Trump’s 2016 playbook, in which he sought to stoke fears not only about terrorism threats from Syrian refugees but also about criminals coming across the southern border from Mexico.

“It definitely surprised me to see stuff like that from some of our representatives,” said Garrett Pearson, director at the refugee resettlement agency World Relief’s North Texas office. “We really try to combat misinformation about refugees. Afghan families are more thoroughly vetted than tourists that come to our country, and they are just looking for a place to find safety and find security.”

Still, while Republican fearmongering isn’t grounded in fact, they are gearing up to invoke Afghan resettlement as a midterm election issue in a bid to retake the House and Senate, where Democrats currently have narrow majorities. And this may make Democrats who recall what a salient issue Syrian immigration was hesitant to back any expansion of the current resettlement program.

Biden has taken steps to bring in more Afghans — but he’s still far from fulfilling the US’s duty

Biden can’t let the GOP politicize refugee resettlement as it did in 2015. The $6.4 billion emergency funding request has not yet passed Congress, and should it be derailed by partisan pressure, it could leave Afghans stranded abroad or facing prolonged stays in US military bases without the resources they need.

Even if the funding does pass, the US still hasn’t fulfilled its obligation to the many Afghans still trapped in their country and in third countries. Biden’s State Department has acknowledged that the majority of SIV applicants were not evacuated and that the system designed to prioritize them for evacuation failed. There could also be tens of thousands of refugees who got out of Afghanistan on their own and now find themselves in neighboring countries without assistance or the ability to make a living. And it’s not clear how many of the Afghans currently at US military bases abroad will actually make it to the US or how long that will take.

The White House has been expectation-setting around how many Afghans the US can aid and absorb. White House press secretary Jen Psaki acknowledged during a briefing in August that there may be millions of Afghans who may want to leave the country, but drew a distinction between them and the much smaller group of roughly 95,000 people the Biden administration has sought to prioritize for resettlement in the US, including 65,000 expected to arrive by the end of September.

Given the US’s role in creating the situation that has led to millions wanting to leave, the federal government must find a way to help. This is within the US’s power: Biden and Democrats in Congress can do more, both abroad and at home. Doing so will require Democrats — even those in swing districts and states, due to the party’s narrow control of Congress — to ignore Republican attacks, and to find the political courage to authorize all the aid that’s needed.

The advocacy group Refugees International has recommended that the administration continue to press for safe passage for Afghans who want to flee Taliban rule, send a US special envoy to Afghanistan, and help the UN increase its humanitarian presence in the country. Biden could enact all of those proposals unilaterally.

Domestically, Biden should raise the refugee admissions ceiling from 62,500 to 200,000 in October, facilitating the resettlement of more Afghan refugees in the US. (Biden had promised to raise the cap to 125,000 earlier this year but hasn’t yet committed to raising it further amid the Afghan refugee crisis.)

Democrats should also push for legislation that would give all Afghans resettled in the US —regardless of which federal program brings them in — access to the same services as refugees, which includes a cash stipend, housing, and job training and placement, among other services. There is already a bipartisan bill recently introduced by Reps. Seth Moulton (D-MA) and Don Bacon (R-NE) that would accomplish just that. Congress should also offer Afghans a pathway to permanent residence in the US.

But that might require taking positions that make them vulnerable to GOP attacks and enacting policies that go beyond what is popular. With the safety of hundreds of thousands of people on the line, that’s a worthwhile risk. The alternative would be a humanitarian crisis of the US’s own making.

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The US is struggling with a resurgence of the coronavirus in the South and West. But the severity of Arizona’s Covid-19 outbreak is in a league of its own.

Over the week of June 30, Arizona reported 55 new coronavirus cases per 100,000 people per day. That’s 34 percent more than the second-worst state, Florida. It’s more than double Texas, another hard-hit state. It’s more than triple the US average.

Arizona also maintained the highest rate of positive tests of any state at more than 25 percent over the week of June 30 — meaning more than a quarter of people who were tested for the coronavirus ultimately had it. That’s more than five times the recommended maximum of 5 percent. Such a high positive rate indicates Arizona doesn’t have enough testing to match its big Covid-19 outbreak.

To put it another way: As bad as Arizona’s coronavirus outbreak seems right now, the state is very likely still undercounting a lot of cases since it doesn’t have enough testing to pick up all the new infections.

The state also leads the country in coronavirus-related hospitalizations. According to the Centers for Disease Control and Prevention, more than one in five inpatient beds in Arizona are occupied by Covid-19 patients — about 42 percent more than Texas and 65 percent more than Florida, the states with the next-highest shares of Covid-19 patient-occupied beds. With hospitalizations rapidly climbing, Arizona became the first in the country to trigger “crisis care” standards to help doctors and nurses decide who gets treatment as the system deals with a surge of patients. Around 90 percent of the state’s intensive care unit beds are occupied, based on Arizona Department of Health Services data.

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While reported deaths typically lag new coronavirus cases, the state has also seen its Covid-19 death toll increase over the past several weeks.

This is the result, experts say, of Arizona’s missteps at three crucial points in the pandemic. The state reacted too slowly to the coronavirus pandemic in March. As cases began to level off nationwide, officials moved too quickly to reopen in early and mid-May. As cases rose in the state in late May and then June, its leaders once again moved too slowly.

“What you’re seeing is not only a premature opening, but one done so rapidly there was no way to ensure the health care and public health systems didn’t get stressed in this process,” Saskia Popescu, an infectious disease epidemiologist based in Arizona, told me.

At the same time, recommended precautions against the coronavirus weren’t always taken seriously by the general public — with experts saying that, anecdotally, mask use in the state can be spotty. That could be partly a result of Republican Gov. Doug Ducey downplaying the threat of the virus: While he eventually told people to wear masks in mid-June, as of late May he claimed that “it’s safe out there,” adding, “I want to encourage people to get out and about, to take a loved one to dinner, to go retail shopping.”

Ducey’s actions and comments “gave the impression we were past Covid-19 and it was no longer an issue,” Popescu said, “which I believe encouraged people to become lax in their masking [and] social distancing.”

After weeks of increases in coronavirus cases and hospitalizations, Ducey pulled back Arizona’s reopening on June 29, closing downs bars, theaters, and gyms.

Experts say the move is a positive step forward, but also one that came too late: With coronavirus symptoms taking up to two weeks to develop, there are already infections out there that aren’t yet showing up in the data. The state can expect cases, hospitalizations, and, probably, deaths to continue to climb over the next few weeks.

Ducey acknowledged the sad reality: “It will take several weeks for the mitigations that we have put in place and are putting in place to take effect,” he said. “But they will take effect.”

Ducey’s office argued it took the action as was necessary at the time, based on the data it collected and its experts’ recommendations. “Our steps are in line with our facts on the ground that we’ve been tracking closely,” Patrick Ptak, a spokesperson for the governor’s office, told me.

Arizona now offers a warning to the rest of the world. The state’s caseload was for months far below the totals in New York, Michigan, and Louisiana, among the states that suffered the brunt of the virus in the US in the early months. But by letting its guard down, Arizona became a global hot spot for Covid-19 — a testament to the need for continued vigilance against the coronavirus until a vaccine or similarly effective treatment is developed.

Arizona was slow to close and quick to reopen

Arizona was initially slow to close down. While neighboring California instituted a stay-at-home order on March 19, Ducey didn’t issue a similar order for Arizona until March 31 — 12 days later.

That might not seem like too much time, but experts say it really is: When the number of Covid-19 cases statewide can double within just 24 to 72 hours, days and weeks matter.

Arizona was also quick to reopen its economy. After states started to close down, experts and the White House recommended that states see a decline in coronavirus cases for two weeks before they reopen. Arizona never saw such a decline. In fact, it arguably never even saw a real plateau. The number of daily new cases rose slowly and steadily through April and into May, and then the exponential spike took off.

So it’s not quite right to say that Arizona is experiencing a “second wave” of the coronavirus. It arguably never controlled the first wave, and the current rise of cases is a result of continued inaction as the initial wave of the virus spread across the state. (The Navajo Nation, which is partly in Arizona, was an initial coronavirus hot spot. But its case count has declined since May, in part because it took strong measures against the virus.)

Arizona and other states experiencing a surge in Covid-19 now “never got to flat,” Pia MacDonald, an epidemiologist at the research institute RTI International, told me. “That means the states didn’t get to very good compliance with the public health interventions that we all need to take to make sure the outbreak doesn’t continue to grow.”

Despite no sustained decline in Covid-19 cases, Arizona moved forward with reopening anyway. Ptak, the governor’s spokesperson, acknowledged that the state didn’t meet the two-week decline in cases, but he said the state had met another federal gating criteria for reopening by seeing a decline in the test positivity rate “week after week” throughout May.

Once the state started to reopen, it moved quickly. Within weeks, Arizona not only let hospitals do elective surgeries but started to allow dining in at restaurants and bars, and gyms and salons, among other high-risk indoor spaces, to reopen. The short time frame prevented the state from seeing the full impact of each step of its reopening, even as it moved forward with additional steps.

Will Humble, executive director of the Arizona Public Health Association, argued it was this rate of reopening that really caused problems for the state. “It was a free-for-all by May 15,” Humble told me. Referencing federal guidelines for reopening in phases, he added, Arizona effectively “went from phase 0 to phase 3.”

It’s not just that Ducey aggressively reopened the state, but that he also prevented local governments from imposing their own stricter measures. That included requirements for masks, which Ducey didn’t allow municipalities to impose until mid-June — weeks after Covid-19 cases started to rapidly rise. (Ptak claimed the governor acted once he received requests from mayors along the southern border to do so.)

Some of that is likely political. As recommendations and requirements for masks have expanded, some conservatives have suggested wearing a mask is emblematic of an overreaction to the coronavirus pandemic that has eroded civil liberties. President Donald Trump has by and large refused to wear a mask in public, even saying that people wear masks to spite him and suggesting, contrary to the evidence, that masks do more harm than good. While some Republicans are breaking from Trump on this issue, his comments and actions have helped politicize mask-wearing and other measures.

For example, there was an anti-mask rally in Scottsdale, Arizona, on June 24. There, a local council member, Republican Guy Phillips, shouted George Floyd’s dying words — “I can’t breathe!” — before ripping his own mask off, according to the Washington Post. (Phillips later apologized “to anyone who became offended.”)

Evidence supports the use of masks: Several recent studies found masks reduce transmission. Some experts hypothesize — and early research suggests — that masks played a significant role in containing outbreaks in several Asian countries where their use is widespread, like South Korea and Japan.

But for a Republican governor like Ducey, the politicization of the issue means a large chunk of his political base is resistant to the kind of measures needed to get the coronavirus under control. And those same constituents are likelier to reject taking precautions against the coronavirus, even if they’re recommended by government officials or experts.

Ducey himself seemed to play into the politics: One day before Trump visited a plant in the state, and as the president urged states to reopen, Ducey announced an acceleration of the state’s reopening plans.

Other factors, beyond policy, likely played a role as well in the rise in cases. While summer in other parts of the country lets people go outside more often — where the coronavirus is less likely to spread — triple-digit temperatures in Arizona can actually push people inside, where poor ventilation and close contact is more likely to lead to transmission.

Some officials have argued Black Lives Matter protests played a role in the new outbreak. But the research and data so far suggest the demonstrations didn’t lead to a significant increase in Covid-19 cases, thanks to protests mostly taking place outside and participants embracing steps, such as wearing masks, that mitigate the risk of transmission. In Arizona, the surge in coronavirus cases also began before the protests took off in the state.

Arizona is now stuck playing catch-up

Arizona saw its coronavirus cases start to increase by Memorial Day on May 25. The increase came hard — with the test positivity rate rising too, indicating early on that the increase was not merely the result of more testing in Arizona. Hospitalizations and deaths soon followed.

Yet Ducey didn’t begin to scale back the state’s reopening until more than a month later — on June 29. This left weeks for the coronavirus to spread throughout the community.

The sad reality is Arizona will suffer the consequences of the governor’s slow action for weeks. Because people can spread the virus without showing symptoms, can take up to weeks to show symptoms or get seriously ill, and there’s a delay in when new cases and deaths are reported, Arizona is bound to see weeks of new infections and deaths even after Ducey’s renewed restrictions.

“Even if I put in 100 percent face mask use and everybody complied with it in Arizona right now, there would still be weeks of pain,” Cyrus Shahpar, a director at the global health advocacy group Resolve to Save Lives, told me. “There are people out there spreading disease, and it takes time [to pick them up as cases], from exposure to symptom onset to testing to getting the testing results.”

Experts argue the state still needs to go even further. Humble advocated for more hospital staffing, a statewide mask requirement, more rigorous rules and better enforcement of the rules for reopening businesses, and improved testing capacity and contact tracing. He also pointed to the lack of timely testing in prisons as one area that hasn’t gotten enough attention and could lead to a blind spot for future Covid-19 outbreaks.

One potentially mitigating factor is the state’s infected have trended younger than they did in initial bouts of the US’s coronavirus outbreak, with people aged 20 to 44 making up roughly half of cases. That could keep the death toll down a bit — though Covid-19 deaths in Arizona have already risen, and experts warn of the risks of long-term complications from the coronavirus, including severe lung scarring, among young people as well.

Above all, experts say that the rise in cases was preventable and predictable.

The research suggests the lockdowns worked. One study in Health Affairs concluded:

Adoption of government-imposed social distancing measures reduced the daily growth rate by 5.4 percentage points after 1–5 days, 6.8 after 6–10 days, 8.2 after 11–15 days, and 9.1 after 16–20 days. Holding the amount of voluntary social distancing constant, these results imply 10 times greater spread by April 27 without SIPOs (10 million cases) and more than 35 times greater spread without any of the four measures (35 million).

The flipside, then, is likely true: Easing lockdowns likely led to more virus transmission.

This is what researchers saw in previous disease outbreaks.

Several studies of the 1918 flu pandemic found that quicker and more aggressive steps to enforce social distancing saved lives in those areas. But this research also shows the consequences of pulling back restrictions too early: A 2007 study in JAMA found that when St. Louis — widely praised for its response to the 1918 pandemic — eased its school closures, bans on public gatherings, and other restrictions, it saw a rise in deaths.

Here’s how that looks in chart form, with the dotted line representing excess flu deaths and the black and gray bars showing when social distancing measures were in place. The peak came after those measures were lifted, and the death rate fell only after they were reinstated.

This did not happen only in St. Louis. Analyzing data from 43 cities, the JAMA study found this pattern repeatedly across the country. Howard Markel, a co-author of the study and the director of the University of Michigan’s Center for the History of Medicine, described the results as a bunch of “double-humped epi curves” — officials instituted social distancing measures, saw flu cases fall, then pulled back the measures and saw flu cases rise again.

Arizona is now seeing that in real time: Social distancing worked at first. But as the state relaxed social distancing, it saw cases quickly rise.

This is why experts consistently cautioned not just Arizona but other states against reopening too quickly. It’s why they asked for some time — two weeks of falling cases — before states could start to reopen. It’s why they asked for states to take the reopening process slowly, ensuring that each relaxation didn’t lead to a surge in new Covid-19 cases.

Because Arizona and its leaders didn’t heed such warnings, it’s now suffering a predictable, preventable crisis — making it the state with the worst coronavirus epidemic in the country that’s suffered the most widespread coronavirus outbreak in the world.

A few months ago, California looked like a success story in the face of the coronavirus pandemic. As New York state’s coronavirus outbreak reached its peak, California’s Covid-19 death rate was less than a tenth of New York’s.

Now, California’s Covid-19 outbreak has gotten so bad that the state is partly closing back down — with Gov. Gavin Newsom on Monday announcing that the state will halt indoor operations for restaurants, wineries, and movie theaters, among other venues, and close bars entirely. It’s an aggressive expansion of a previous action to shut down these kinds of operations in select counties.

California had taken a turn for the worse in recent weeks. Its daily new coronavirus cases are up more than double compared to the previous month. The test positivity rate — an indicator of how widespread infection is, as well as whether an area is conducting enough testing — is increasing, too. Hospitalizations are also up, as hospitals in Los Angeles and other areas have warned they could reach capacity soon. And deaths have started to climb in the state.

So what happened?

The short of it, experts say, is that much of California let its guard down. While the state, and the Bay Area in particular, was among the first in the US to embrace a shelter-at-home order, parts of California have since relaxed or outright halted those measures, letting the coronavirus creep in bit by bit. Meanwhile, precautions against Covid-19 have been inconsistently adopted by the public and businesses — especially as some of the recommended practices, such as wearing a mask, have become politicized.

At the same time, the state has seen major outbreaks in nursing homes, in prisons, and among migrant workers — many of whom are deemed “essential” and are therefore forced to work — that have driven up coronavirus cases further, simultaneously planting seeds for broader community outbreaks.

It’s this mix — of relaxed social distancing policies, inconsistent adoption of precautions, and rise of new Covid-19 hot spots — that have led to California’s turn for the worse. That combination seems to have hit some demographics particularly hard: Cases are especially rising among younger groups — who are perhaps more likely to take advantage of, say, bars reopening — and in Latin communities, where people are more likely to work for businesses deemed “essential,” such as grocery stores or farms.

“The story of California is the story of why we all have to do more,” Kirsten Bibbins-Domingo, an epidemiologist at the University of California San Francisco, told me. “I don’t think we can easily point to a totally outrageous government policy or a totally outrageous citizen action or a totally outrageous anything. It really is that all of these things together matter.” As the state reopened, she argued, “We actually should have upped our game at that time, not just be complacent that we had done so well while we were sheltered.”

Some of the overall uptick in cases is likely due to more testing. All else held equal, more testing will catch more cases. But testing isn’t the whole story; it can’t explain why, for one, hospitalizations and deaths linked to Covid-19 have risen as well.

The outbreaks aren’t universal. The southern parts of the state, including Los Angeles and Imperial County, have been hit much harder compared with some northern areas, including San Francisco and the broader Bay Area.

“We’re a large and diverse state,” Bibbins-Domingo said. “The variations in how different counties have experienced the epidemic and have adopted important public health measures, like masking, have not been helpful.”

The overall trend in California isn’t as bad as the massive outbreaks currently happening in Arizona, Florida, and Texas. That’s likely a result of the state’s slower reopening. People in a predominantly Democratic state are also more likely to embrace changes that President Donald Trump railed against, like when he suggested that people wear masks to spite him.

Still, the trends are heading in the wrong direction in much of California — complicating the image of a state once praised for its quick, decisive action against Covid-19 outbreaks, and underscoring that even states performing well need to maintain vigilance against the virus.

Reopening, predictably, led to more coronavirus cases

On March 16, the Bay Area issued the country’s first regional shelter-in-place order. California followed three days later with a statewide order. It’s this lead of several days, compared with other states, that experts said helped California stay largely ahead of the outbreak, at least at first: When cases can double in a span of 24 to 72 hours, taking action even a few days early can play a huge role.

The research suggests the lockdowns worked. One study in Health Affairs concluded:

Adoption of government-imposed social distancing measures reduced the daily growth rate by 5.4 percentage points after 1–5 days, 6.8 after 6–10 days, 8.2 after 11–15 days, and 9.1 after 16–20 days. Holding the amount of voluntary social distancing constant, these results imply 10 times greater spread by April 27 without SIPOs (10 million cases) and more than 35 times greater spread without any of the four measures (35 million).

Over time, though, state leaders came under pressure by businesses and workers to open up again and end the economic pain. As Covid-19 cases remained relatively flat (although they never truly decreased on a statewide level), there was also a growing sentiment that the situation in California was under control. Some towns, cities, and counties argued that they never suffered a big coronavirus outbreak, so they shouldn’t have to follow the state’s strict rules.

Under all this pressure, Newsom started to relax social distancing measures in May — with a plan to open the state in phases — and delegated more decision-making for reopening down to the local level. While some places, including the Bay Area, have kept a tighter leash than others, the trend in much of the state was toward relaxed restrictions, with workplaces, restaurants, bars, and other venues opening up again.

“Our original response was right on. The politicians really stuck their necks out on it. And I think it’s paid off, with thousands of lives saved,” George Rutherford, an epidemiologist at UCSF, told me. However, “there’s a playbook for what to do, but not a playbook for how to undo it. So I think we’re kind of all feeling our ways.”

The public seemed to embrace the reopening. While restaurant data from OpenTable indicates that dine-in seating in California was down by 90 to 100 percent for most of May, for much of June it was down by 60 to 70 percent — still a huge hit to restaurants, but not nearly as much of one.

The result is that people are increasingly out and about, interacting and infecting each other with the coronavirus. Friends and families began gathering again, especially as they celebrated Memorial Day and the summer kicked off. And as they came together — in poorly ventilated homes, restaurants, and bars, in close proximity to people they don’t live with, often for hours at a time — people spread the virus much more frequently.

Some experts questioned bars and other high-risk indoor spaces reopening in the first place. “From a pandemic standpoint, there’s probably not anything good happening in a bar,” Bibbins-Domingo said. She argued for better priorities in reopening: “We shouldn’t have overreacted to some of the beaches and going outside, and we probably should have been much clearer on the bars.”

Changes in policy can’t fully explain every single outbreak. Some people would break the rules anyway, and others, such as migrant agricultural workers deemed “essential,” were largely exempted from the start. There are factors outside the control of these policies, such as overcrowded housing and tech workers in the Bay Area being able to work from home to social distance while farmers in southern parts of the state can’t.

The outbreaks in some settings, such as nursing homes and prisons, also aren’t as directly tied to reopenings. Prisons are largely cut off from the community, and visitation in nursing homes has been heavily curtailed by the pandemic. The outbreak at a prison in Northern California, San Quentin, seemed to be the result of the transfer of inmates from another prison where infections were rising.

But social distancing restrictions likely played some role even in these examples, given that the virus had to get into these facilities somehow. Nursing home employees, prison guards, and migrant workers, after all, go home and perhaps to bars or restaurants at the end of the workday. In the end, greater community transmission affects everyone in a community.

Local and state officials have also pinned some of the blame on Black Lives Matter protests. But the research and data so far suggest the demonstrations didn’t lead to a significant increase in Covid-19 cases, thanks to protests mostly taking place outside and participants embracing steps, such as wearing masks, that mitigate the risk of transmission.

The decline of social distancing and the rise in cases also aligns with what researchers have seen in past disease outbreaks. Several studies of the 1918 flu pandemic found that quicker and more aggressive steps to enforce social distancing saved lives in those areas. But this research also shows the consequences of pulling back restrictions too early: A 2007 study in JAMA found that when St. Louis — widely praised for its response to the 1918 pandemic — eased its school closures, bans on public gatherings, and other restrictions, it saw a rise in deaths.

Here’s how that looks in chart form, with the dotted line representing excess flu deaths and the black and gray bars showing when social distancing measures were in place. The peak came after those measures were lifted, and the death rate fell only after they were reinstated.

This did not just happen in St. Louis. Analyzing data from 43 cities, the JAMA study found this pattern repeatedly across the country. Howard Markel, a co-author of the study and the director of the University of Michigan’s Center for the History of Medicine, described the results as a bunch of “double-humped epi curves” — officials instituted social distancing measures, saw flu cases fall, then pulled back the measures and saw flu cases rise again.

California has seen that in real time: Social distancing worked at first. But as it’s relaxed social distancing, it’s seen cases quickly rise.

Some people aren’t wearing masks or taking other precautions

As California reopened, experts said the spread of Covid-19 was compounded by some people who failed or refused to follow recommended precautions against the virus.

There was particular resistance to wearing masks in more conservative areas of California, especially in the southern parts of the state. Orange County’s chief health officer resigned due to public resistance against a mask-wearing order. Sheriffs in Orange, Riverside, Fresno, and Sacramento counties said they wouldn’t enforce Newsom’s June order requiring masks in public and high-risk areas. Anecdotally, experts and others in the state told me that mask-wearing seems to be more common in the Bay Area than in the southern parts of California.

The evidence increasingly supports the use of masks to combat Covid-19. Several recent studies found that masks alone reduce transmission. Some experts hypothesize — and early research suggests — that masks played a significant role in containing outbreaks in several Asian countries where their use is widespread, like South Korea and Japan.

The resistance to masks in California, as well as nationwide, is at least partially political. As recommendations and requirements for masks have increased, some conservatives have suggested wearing a mask is emblematic of an overreaction to the coronavirus pandemic that has eroded civil liberties. President Trump, for one, has by and large refused to wear a mask in public, even saying that people wear masks to spite him and suggesting, contrary to the evidence, that masks do more harm than good. While some Republicans are breaking from Trump on this issue, his comments and actions have helped politicize mask-wearing.

There’s also general fatigue, with people growing more and more tired of social distancing as the pandemic continues. Surveys from Gallup found that just 39 percent of people were “always” social distancing in late June, compared with 65 percent in early April; the number of people who “sometimes,” “rarely,” or “never” practice social distancing increased from 7 to 27 percent in the same time frame.

Some experts argue public outreach has failed with regard to encouraging social distancing and mask-wearing, arguing officials could do a much better job not only at communicating the right steps but also at persuading the public to adopt them. They could also do more to reach marginalized communities — in California, by tailoring messages and support to Latin workers in particular.

Nationwide, education is “where we really failed in this outbreak,” Krutika Kuppalli, an infectious disease specialist and a fellow in the Emerging Leaders in Biosecurity Initiative at the Johns Hopkins Center for Health Security, told me. Kuppalli pointed to masks as one example where there’s clearly more work to be done. “Shaming people is not going to make them wear masks,” she explained. “It’s about trying to get people to understand that it’s for the greater good of the community.”

Beyond that, enforcement of social distancing requirements hasn’t been consistent — a problem Newsom acknowledged when he said the state plans to step up enforcement.

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The result of all of this is seen in not only the actions of individuals but also those of businesses. Los Angeles officials in late June found 33 percent of local restaurants and 49 percent of bars weren’t following social distancing protocols, and employees at 44 percent of restaurants and 54 percent of bars weren’t wearing masks or face shields, according to the Los Angeles Times.

The state has to pull back reopening now, before it gets much worse

California isn’t as bad as several other hot spots are in terms of coronavirus cases. Arizona and Florida have more than double the number of cases per day per person, and Texas has nearly 50 percent more.

But the goal, experts argue, is to start cracking down before things get as bad as Arizona or Florida. Because the lag between infection and the onset of symptoms can be as long as two weeks, officials are typically acting too late if they react only once more cases or hospitalizations get reported. In fact, that’s one reason California was initially praised several months ago: The state and Bay Area took the virus seriously before it became a problem on the scale of what New York was seeing at the time.

“One of the things I’ve learned in any outbreak is that if it seems you overreacted, you’ve done a good job,” Kuppalli said. What looks like overreaction, she added, means that “we prevented things from becoming a catastrophe. We don’t want to wait until things are a catastrophe and then react, because that’s too late.”

In some sense, then, Newsom’s latest moves are too late — as cases, hospitalizations, and deaths have already crept up for weeks.

Now it’s an open question if the state can avoid another stay-at-home order. If things were to get to a certain level — where hospitals reach capacity and the death toll is exponentially rising — a full lockdown could be the only option to get the outbreak under control again. To not get to that point, experts have called for more targeted measures, from aggressive testing, contact tracing, and isolating to closing down high-risk areas, particularly indoor venues that are often packed and poorly ventilated.

“We don’t want to get to the point where we just tell everyone to stay home if there are more targeted measures as a starting point,” Cyrus Shahpar, director at Resolve to Save Lives, told me.

So far, the more targeted approach is what Newsom is embracing — shutting down bars, movie theaters, and other indoor gatherings, and encouraging outdoor options for dining. Only in extreme cases, like with Imperial County, has the state pushed more drastic action.

Some of this responsibility falls on the public, too. When people go out, experts recommend wearing a mask, prioritizing outdoor venues over indoor spaces, keeping 6 feet from each other, not touching your face, and washing your hands. How well a community as a whole does that can dictate how bad things get.

“We have to be totally serious about masks,” Rutherford said. “No more screwing around.”

California may have already lost its reputation as being quick to act in the face of the coronavirus. But officials and experts are hoping it still has time to avoid becoming a huge epicenter for Covid-19 — as long as its leaders and the public react accordingly to the rise in cases and deaths.

Many schools across the US gambled on offering in-person classes in early August, even as their states were still battling uncontrolled spread of Covid-19.

In some of those schools, it hasn’t gone well.

In Georgia’s Cherokee County School District, for example, there have been at least 80 positive cases since August 3, and more than 1,100 students, teachers, and staff have had to quarantine. At the high school in Paulding County School District, which came to national attention after photos of halls crowded with mostly maskless students went viral, several students and staff have tested positive, forcing the school to adopt a hybrid model of in-person and virtual learning. In Atlanta, one second-grader tested positive the day after classes started; the same week, a 7-year-old with no underlying conditions died from the virus.

Scientists have found clear evidence that children, especially those over 12, can and do transmit the virus, though the disease is generally more mild than in adults. This means school outbreaks can be a risk for students, teachers, and the wider community.

While many school districts that reopened are reporting infected students, these initial cases may not have originated in the classroom. “For most of these cases in Georgia, schools weren’t open long enough for the transmission to be coming from within the schools,” says Megan Ranney, an emergency physician and the director for the Center for Digital Health at Brown University, who researches pediatric mental health.

Nevertheless, infected students and staff arriving in the first week of school have already prompted shutdowns and quarantines around the country; in Mississippi, over half of counties have reported Covid-19 cases in teachers, staff, or students.

What’s remarkable is that health experts predicted that cases among young people would surge if schools reopened before community transmission was under control — yet many school districts went ahead anyway. “This is exactly what we’ve been warning about — when you have high levels of Covid in the community, you will have cases showing up in schools, just because people are catching it out in the community,” says Ranney.

And it’s not just kids, teachers, and parents who are then at risk — school outbreaks can fan wider outbreaks in communities. A recent superspreading event in Ohio, for example, found that children between ages 6 and 16 were part of the chain of transmission, passing the virus on to other children and adults.

The World Health Organization recommends that schools open only if fewer than five percent of those tested for the virus over a two-week period are positive. In the US, the cutoff for what is considered “safe” for reopening schools currently varies by state, but they all tend to look at similar factors: Oregon, for example, has said counties must have fewer than 10 cases per 100,000 people for three weeks before in-person classes resume. Arizona calls for less than 100 cases per 100,000, or a two-week decline in cases, as well as meeting other standards like hospital capacity.

For comparison, Georgia has had 189 cases per 100,000 people in the last seven days as of August 16. (You can check your own state’s rates at the Centers for Disease Control and Prevention here.) In Georgia, many schools also reopened despite high positivity rates — the percentage of people being tested for Covid-19 who have a positive result. Georgia’s number of positive tests per 100,000 people were also well above the general threshold that public health experts recommend for in-person activities.

A recent study from the American Academy of Pediatrics and the Children’s Hospital Association found that 97,000 children in the US got Covid-19 in the last two weeks of July— representing a 40 percent increase, or almost one-third of the total number of pediatric cases since the pandemic began. It’s unclear whether this is an increase in actual infections or if more children, who are often asymptomatic, are now being tested as schools reopen.

Since testing overall is still inadequate to control the virus in the US, the CDC says the true incidence of Covid-19 in children is still unknown. But as Tom Frieden, former director of the CDC, recently tweeted, kids between 5 and 17 now have the highest positivity rate of all age groups. “Age groups aren’t an island,” he wrote. “Spread in any group is a risk to all.”

The US Department of Education is not publicly tracking Covid-19 cases in K-12 schools, numbers of students quarantined, deaths, or school closures. That led a Kansas teacher to create a crowdsourced Google spreadsheet using media reports to track positive cases of Covid-19 associated with schools in over 40 states. It shows that more than 2,000 students, faculty, administrators, and staff have tested positive for Covid-19 nationwide since early July, and that teachers have already died in Mississippi, Alabama, and California.

Public health experts at the University of Texas at Austin recently published a report analyzing the likelihood that students and teachers would arrive on the first day of school already infected. They found it largely depends on the size of the school and how prevalent Covid-19 is in that school’s community. Based on data from mid-July, their model suggests that in Texas, a school of 100 individuals in Denton County could expect one to two Covid-19 cases in the first week, while higher rates in Harris County likely make up four cases.

Hidalgo County, which currently has a 17 percent positive test rate, looks worse yet, with two to eight cases predicted. (Racial and economic disparities contribute to these differences; Hidalgo County is 90 percent Latinx and has seen a disproportionate number of Covid-19 cases.) These numbers are constantly changing, but they show that with high-enough levels of community transmission, you can pretty much guarantee that at least one person will go to school infected, potentially exposing others.

In other countries where data on school-linked outbreaks is more readily available, the impacts of reopening schools have been mixed. In Denmark, reopening schools for 2- to 12-year-olds didn’t make the country’s already minimal outbreak worse. But many precautions were taken to limit transmission.

Denmark reopened elementary schools with extensive safety measures in place, like staggered entry time. Students were placed in small groups to reduce interaction, and hotels and libraries were utilized as additional class space. Even so, the rate of infection increased after Danish schools reopened, although not enough to keep total cases from declining.

In Israel, new cases have skyrocketed since schools reopened two months ago, but the country also lifted other distancing measures at the same time, making it harder to tease apart the causes. There are many factors that can make reopening schools safer, like mask-wearing, social distancing, and regular testing, so it’s difficult to directly compare different countries’ school plans.

Still, there’s a definite trend: Countries like Vietnam and New Zealand, which have generally done a good job controlling spread, have successfully reopened schools. Others, with higher community transmission, like Chile, have struggled.

With a new disease, it’s important to look at the totality of the emerging body of research on different age groups, rather than individual study results. For example, a widely cited South Korean study initially reported in July found that adolescents might spread the virus more than adults; an update from the same researchers this week found that some of the teens’ purported transmission was likely due to families actually sharing outside exposure.

Overall, the sum of evidence — including independent studies from the US, Iceland, and Germany — finds older children may be as likely to spread the virus as adults when infected. A recent literature review found that “opening secondary/high schools is likely to contribute to the spread of SARS-CoV-2.” (The same review found that children under age 10 may be less susceptible to infection.)

Another review published in The Lancet highlights that adequate testing and contact tracing are essential to reopening schools. That’s not possible currently in many US states, which are still seeing positivity rates as high as 23 percent, along with extreme delays in test results.

Chethan Sathya, a pediatric surgeon and assistant professor of surgery at the Cohen Children’s Medical Center in New York, says that people seem to be missing the point that having an incomplete picture of how Covid-19 impacts kids is not license to send them back to school to find out. Ranney points out that some states, like New York and her home state of Rhode Island, currently have low test positivity, and so it may be safer to reopen schools in those areas. ”The only possible road to reopening schools is with low rates of community transmission,” she says.

“Emerging data suggests that it’s unsafe to send children and teachers into school buildings, even with safety protocols, if the prevalence of cases in the community is too high,” she says. If schools choose to reopen anyway, she adds, “it’s an ongoing experiment on children and staff.”

Correction: An earlier version of this story stated that Georgia had 2,236 cases per 100,000 people in the last seven days as of August 16. In fact, it has had 2.236 cumulative cases per 100,000 people and 189 cases per 100,000 in the last seven days.

Lois Parshley is a freelance investigative journalist. Follow her Covid-19 reporting on Twitter @loisparshley.

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One month ago, I asked epidemiologist Tara Smith if she was worried about states loosening their stay-at-home orders, despite most not meeting the government’s criteria for doing so.

“I am really fearful that by June 1 or June 15, after we’ve seen a couple weeks to a month of [state reopenings], that our cases are going to be climbing,” said Smith, a professor at the Kent State University College of Public Health.

Well, here we are. It’s June 12, and Covid-19 hospitalizations are rising in Arizona, the Carolinas, Utah, Arkansas, Texas, Tennessee, and perhaps Florida. Those states are also seeing higher numbers of positive Covid-19 tests, as well as increases in the percentage of tests that come back positive. This indicates that the higher case counts aren’t simply due to more widespread testing finding milder cases.

Call it a reopening backfire. But really: No expert thought that reopening this quickly was going to work in the first place.

“This is totally predictable”

Many states opened up in early May, hoping the economy would recover while a winning battle against Covid-19 continued apace.

Unfortunately, it’s now clear that in the areas where the virus has come roaring back, few gains against it were made in the last month.

“We managed to disrupt our economy [and] skyrocket unemployment, and we didn’t control the damn virus,” said Jeff Shaman, an infectious disease modeler at Columbia University.

“This is totally predictable, and there have been many warnings,” Sarah Cobey, an infectious disease modeler at the University of Chicago, said. “We’re seeing undeniable signals that prevalence is truly increasing in many states.”

Simply put, reopenings have led to more infections because more people are coming into contact with each other while there’s still a lot of virus around. Mask use is inconsistent, and even when they’re worn properly, masks are not 100 percent effective at preventing transmission.

In Arizona, nursing and long-term care facilities are still hotbeds of transmission. “In Arizona, one in three nursing homes has had a case of Covid-19,” Vox’s Umair Irfan previously reported.

Most concerning, Cobey said, is the increased hospitalization rates in these states — a reminder that the virus can be very severe and deadly for some, and that deaths could also start climbing soon. “It’s a lagging signal, so what it’s really telling us is how transmission rates were changing closer to two weeks ago,” Cobey added. “This implies that unless behavior — the primary driver of transmission — has changed in the meantime, the situation will continue to worsen for another few weeks.”

It’s too soon to know what impact the mass protests against police brutality will have on the pandemic. (Many protesters know the risks and have thoughtful reasons for participating anyway.) The spikes we’re seeing now result from actions and decisions that likely predate them.

How bad might things get in Arizona and other states? We don’t know yet. It might not be a disaster. These states could avoid the worst-case scenario of hospitals being overwhelmed and keep the epidemic curve from spiking to uncontrolled levels. Still, more cases likely means more deaths — some of which could have potentially been avoided.

Overall, though, the trends are not moving in a good direction, and we have yet to see the full Covid-19 consequences of reopening.

Not every place that’s reopening is seeing spikes. Scientists aren’t sure why.

Ending or loosening lockdowns hasn’t led to Covid-19 spikes everywhere.

Georgia was one of the first states to reopen businesses, like barber shops, on April 30. Since then, its Covid-19 cases have more or less remained flat.

“Why didn’t Georgia go through the roof? And the answer is, ‘We don’t know,’” Shaman said. The pandemic is “a real patchwork” in America, he added.

Similarly, Smith said she is “a bit surprised that Ohio is doing as well as we are since reopening.” Maskless armed protesters showed up at the Ohio Statehouse for three weeks to demand that the governor allow businesses to reopen. “We don’t have all the data right now to determine why some [areas] have increased and others have not,” she said. It could depend more on how individuals behave — for instance, whether they’re wearing masks — than on any broad policy the state may enact.

Scientists are still unraveling what makes the difference between a sprawling outbreak in one city and a more manageable one in another. Some factors are policy, demographics, structural inequality and racism, and individual behavior. And some of it is just luck.

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It’s important to remember: Though scientists can’t precisely predict which areas will be hit hardest by Covid-19, they do understand the conditions under which the virus thrives. And so they can predict, broadly, when social distancing isn’t replaced with another safeguard, cases will increase.

The main ingredient that leads to increased cases is more people being in close contact with one another out in public. “I believe the increases we’re seeing in places like Arizona are likely the results of easing social-distancing restrictions too soon,” Eleanor Murray, a Boston University epidemiologist, said.

These new spikes in cases appear to be occurring in places that have largely avoided the worst coronavirus outbreaks so far. But it’s important to remember that even hard-hit places like New York could still see new waves of infections. There are still so, so many people out there who are not immune to the virus.

Is this a “second wave”?

In the US, overall cases have been dropping slowly. But a lot of that is due to the initial huge crisis in New York subsiding, obscuring the emergence of new hot spots.

What’s happening now in Arizona and elsewhere is the continuation of the first wave, or the first wave in those areas.

But “waves” might be the wrong metaphor to describe what’s going on.

Instead, I imagine a bunch of nuclear reactors spread out across the country. Control rods have been taken out in many of these reactors without being replaced by new controls, and the reaction grows. This disaster is maybe more like Chernobyl and less like a tsunami. It’s our actions — both collective and individual — that determine the results.

Ultimately, there’s no quick, snappy metaphor that really gets at the complexity of how the virus spreads. But at the same time, the story is simple: When you don’t do enough to stop people with no immunity from getting infected, transmissions occur.

Experts never said that eternal lockdowns were the only choice we had to combat the pandemic. They argued that once areas got the initial case spikes under control through widespread social distancing (with new cases decreasing over at least a two-week span), a new phase of control should begin with widespread testing and contact tracing. The initial lockdown period avoided the worst possible scenario, but the US didn’t use that time to prepare for managing the pandemic in the future. And now we’ve wasted the weeks that have passed since reopening.

“As prevalence rises, the demands on contact tracing increase too, because there are more cases to track,” Cobey said. “At some point it becomes more practical for governments to institute blanket interventions to reduce prevalence.”

That is, we may have no choice but to enter lockdowns again. The scary thought: What if states or businesses aren’t willing to do it? How many people will die? How many hospital systems will be overwhelmed?

Too many communities and states “are acting like we’re done with it,” Shaman said of the pandemic. “And we’re nowhere near done with this.”

Around the world, people’s mental health is in trouble. Even before the pandemic hit, rates of depression and anxiety were rising globally. Now that we also have Covid-19 to contend with, the problem is even more glaring.

Studies show that all the virus-induced losses — of life, of jobs, of social connection — have come with serious upticks in mental illness worldwide. In the US, for example, the prevalence of depression is four times as high as it was in the second quarter of 2019.

The pandemic has highlighted the inadequacy of our existing tools for coping with these problems. It’s not just that a health crisis can easily disrupt access to mental health services, though we’ve definitely seen that to be true. It’s also that drugs like traditional antidepressants are, at best, only a partial solution. While their effectiveness has been hotly contested over the past decade, the evidence now shows that they are more effective than a placebo, but not that much more effective. (Once we account for the placebo response, the effect size of the drugs themselves is modest.) And for some folks who have treatment-resistant depression, the drugs don’t work at all.

So if you want to invest in the mental health of people around the world, making us all more resilient to future crises, what can you do?

The promise of psychedelics to treat depression and PTSD, explained

Believe it or not, your best bet might be to fund drug development for psychedelic-assisted mental health treatments. At least that’s the upshot of a new in-depth report by Founders Pledge, an organization that guides entrepreneurs committed to donating a portion of their proceeds to effective charities.

Psilocybin, the active ingredient in magic mushrooms, is being investigated as a potential treatment for depression. Over the past decade, a few studies have investigated the effectiveness of psilocybin for treating depression and end-of-life anxiety in cancer patients, and found that the psychedelic had a surprisingly large effect.

Meanwhile, the drug MDMA (also known as ecstasy) is being studied for use in people with post-traumatic stress disorder. MDMA, which affects serotonin, dopamine, and norepinephrine levels, is best known as a party drug. But research suggests it can also relieve depression and help users access and process memories of emotional trauma. The users in studies participate in psychotherapy sessions where a therapist helps them integrate what they experienced while taking MDMA — which often includes increased feelings of empathy and bonding — into daily life.

There’s some evidence to suggest that ingesting these substances, in a safe setting and under the supervision of trained therapists, can be more helpful with depression and PTSD than traditional drugs; in some studies, the reported effect sizes for psilocybin, say, are greater than the effect sizes of the current best treatments for depression (though these studies have limitations, so we would need more data to establish this with certainty). Psychedelics might also be helpful for anxiety, addiction, and other issues.

If this seems surprising, it’s worth noting that medical research into psychedelics has been going on since the late 1800s. In the 1940s and 1950s, psychiatrists used LSD to treat pain, anxiety, and depression. (There are promising preliminary results from studies of LSD for anxiety, though larger controlled studies are needed.) And in the 1970s and 1980s, psychotherapists and psychiatrists administered MDMA to thousands of patients. As psychedelics became popular for recreational use, though, MDMA was banned in 1985 in the US, and the research slowed in many countries.

As Michael Pollan detailed in How to Change Your Mind, research into the therapeutic potential of psychedelic drugs has been undergoing a renaissance over the past decade. These therapies are now gaining traction in some quarters. In Oregon, Measure 109 is on the ballot in November, and if passed, the state will be the first in the US to allow psilocybin therapy to be administered by licensed facilitators.

We still need a lot more research on these treatments, though — and one of the benefits of funding the drug development process is that that process will involve doing high-quality studies to prove efficacy and safety. We also need organizations willing to do the hard work of getting a drug approved for medical use nationwide.

The Usona Institute is one such organization that the Founders Pledge report highlights. It’s currently working on drug development for psilocybin as a depression treatment in the US, and it’s already got a preliminary Breakthrough Therapy Designation from the FDA. That’s an acknowledgment that the FDA thinks the early evidence shows psilocybin may have an advantage over available therapy, and it means the FDA offers Usona intensive guidance on its drug development so that it may gain expedited approval. Founders Pledge thinks Usona will put your dollars to better use than any other organization in this space. If interested, you can donate here.

A close runner-up is the Multidisciplinary Association for Psychedelic Studies, which is carrying out drug development for MDMA-assisted psychotherapy for PTSD in the US, Canada, Israel, and soon Europe. If interested, you can donate here. This treatment is already in phase 3 trials, which means approval of MDMA as a therapy could be granted in these countries in a few years.

But the large-scale rollout of new drugs takes a long time. Founders Pledge estimates that for MDMA, it’ll take six to nine years, while for psilocybin the timeline will be more like eight to 11 years.

What if you want to improve mental health right now, during the pandemic?

Investing in causes that may have a big positive impact in the long term is a wise thing to do. But during a pandemic, some people will want to relieve the suffering they see happening right now.

“The psychedelics drug development won’t be done for years. So in terms of having an impact now, that’s not the way to go,” Aidan Goth, who co-wrote the Founders Pledge report, told me.

He emphasized, though, that investing in global mental health during the pandemic is a worthy cause. Mental illness can feed into physical illness, and in itself may cause as much suffering as physical illness in some cases. It can also harm people’s ability to hold a job or care for their dependents. Plus, we should not fall prey to the misconception that mental health is a so-called first-world problem.

“We’ve looked at the burden of mental health globally, and it is a really, really big problem in lower- and middle-income countries as well. It’s not true that it’s just affecting people in high-income countries,” Goth said.

If you’re itching to improve people’s mental health while the pandemic is in full swing, you’d do well to invest in a project that gives you an immediate return on your investment. For that purpose, Founders Pledge recommends a couple of organizations: StrongMinds and Action for Happiness.

There’s a serious lack of mental health professionals in many developing countries in Africa. StrongMinds, a Uganda-based organization, understood that in order to treat the millions of African women suffering from depression, it would have to train laypeople.

Since its founding in 2013, it’s scaled up pretty quickly. Lay facilitators have led group talk therapy sessions reaching a total of 70,000 women. Over a 12-week period, the women learn to identify the triggers of their depression and devise strategies to overcome them.

As demonstrated in two randomized controlled trials, this is a powerful and cost-effective intervention, Founders Pledge researchers say. They estimate that StrongMinds prevents the equivalent of one year of severe major depressive disorder for a woman at a cost of around $248 — a pretty good deal, especially when you consider this helps the woman as well as her dependents.

StrongMinds says it is “uniquely positioned” to meet the demand for depression treatment in sub-Saharan Africa during the pandemic. It’s offering teletherapy, a chatbot, and other treatment approaches in line with social distancing requirements.

Like StrongMinds, Action for Happiness brings people together in small groups and it’s run by volunteers in each local community. But this one is a UK-based organization that mostly operates in Europe, though it’s also reached countries like the US and Australia.

Action for Happiness provides eight-week courses, called Exploring What Matters, where participants talk through strategies for crafting a happier life, such as developing a mindfulness practice. The course has been shown to improve subjective well-being, with reductions in depression and anxiety and increases in happiness and life satisfaction. Based on a randomized controlled trial, Founders Pledge found this program to be extremely cost-effective, with high potential for scale-up.

During the pandemic, Action for Happiness has gone from in-person courses to virtual ones, launching a free online coaching program to improve wellbeing.

Given that Founders Pledge evaluated StrongMinds and Action for Happiness before the pandemic, you might wonder whether these organizations are still helping people cost-effectively now that they’ve had to shift from an in-person to an online methodology.

Goth explained that when Founders Pledge researchers evaluate an organization, they examine not only the specific programs it’s running but also the organization as a whole — whether its leadership is strong and whether its management can be trusted to competently carry out its mission. So the researchers still believe in StrongMinds’ and Action for Happiness’s ability to serve people effectively now.

“We trust that they’re well-run and we think they’re doing good work given the circumstances,” Goth said. “They’re the best we’re aware of.”

If this cause speaks to you, you can donate to StrongMinds here or donate to Action for Happiness here.

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The US rollout of Johnson & Johnson’s single-dose Covid-19 vaccine was halted Tuesday as regulators race to investigate rare blood-clotting complications linked to the shot. The move may force thousands of people scheduled to receive the shot this week to scramble for an alternative.

Both the Food and Drug Administration and the Centers for Disease Control and Prevention recommended a pause in distributing the vaccine after six reported cases of cerebral venous sinus thrombosis (CVST). These clots block blood flowing out of the brain and can quickly turn deadly.

The complications were found in women between the ages of 18 and 48, and they arose between six and 13 days after receiving the Johnson & Johnson vaccine. “Of the clots seen in the United States, one case was fatal, and one patient is in critical condition,” said Peter Marks, the head of the FDA’s Center for Biologics Evaluation and Research, during a Tuesday press conference.

However, the fact that so few cases led to a nationwide pause of the vaccine has raised questions about a possible overreaction.