California and Oregon rolled back their reopenings on Monday, two of several states across the country that are struggling to get surging coronavirus case counts under control.

California Gov. Gavin Newsom has ordered the statewide closure of all bars and halted the indoor operations of restaurants, wineries, theaters and a handful of other venues, the The New York Times reported.

“We’re going back into modification mode of our original stay-at-home order,” Newsom said Monday. “This continues to be a deadly disease.”

California’s two largest public school districts, in Los Angeles and San Diego, said on Monday that all teaching would remain online in the fall, the Times reported.

In Oregon, Gov. Kate Brown again banned private indoor gatherings of more than 10 people and required face coverings be worn outside, the Washington Post reported.

Other hard-hit states are also grappling with how to best slow the rampant spread of COVID-19.

In Texas, a top medical adviser to Gov. Greg Abbott said the state may need to roll back its reopening plans and reinstitute a lockdown if cases keep climbing, the Times reported.

Dr. Mark McClellan, a former commissioner of the U.S. Food and Drug Administration, told the Times that a lockdown in Texas was a “real possibility” that Abbott may be forced to impose in the next few weeks.

“I don’t think we have much time before having to go to a more extreme step,” McClellan said. Already, the coronavirus’ rapid spread has forced Abbott to pause the state’s reopening, closing bars again and issuing a mask order for most Texans.

In Florida, deaths are at their highest seven-day average level of the pandemic. After reporting a record-breaking 15,300 new cases of infection on Sunday, the state posted its second-highest total ever — 12,600 new cases — on Monday, the Times reported.

With more than 2,000 patients hospitalized and hundreds in ICUs in Miami, that city “is now the epicenter of the pandemic,” one infectious disease expert said Monday.

“What we were seeing in Wuhan — six months ago, five months ago — now we are there,” Lilian Abbo, with the Jackson Health System said during a news conference Monday, CNN reported. The Chinese city of Wuhan, the original epicenter of the coronavirus crisis, went into a 76-day lockdown in late January after a deadly outbreak infected and killed thousands.

Hospitals filling up, testing delays continue

Adding to the problem, long delays in testing are hampering efforts to contain future spread of the coronavirus, the Post reported. Many testing sites are struggling to provide results in five to seven days. Others are taking even longer, the newspaper reported, as outbreaks across the Sun Belt have strained labs beyond capacity.

And there were signs of new trouble in regions outside current hotspots: Twenty states and Puerto Rico reported a record-high average of new infections over the past week, the Post reported. In the Midwest, cases have been trending upward in every state except Nebraska and South Dakota.

The case spikes are resulting in another grim fact: Hospitals across the South and West are being flooded with COVID-19 patients and are having to cancel elective surgeries and discharge patients early as they try to keep beds open, the Times reported.

In Miami-Dade County, Fla., six hospitals have reached capacity as virus cases spike. In response, Miami Mayor Carlos Gimenez rolled back reopening plans by imposing a curfew and closing restaurants for indoor dining, the Times reported.

“We’ve definitely had a sharp increase in the number of people going to the hospital, the number of people in the ICU, and the number of people on ventilators,” he told the Times. “We still have capacity, but it does cause me a lot of concern.”

To try to address the shortage of beds in Texas, Abbott last week ordered an increase in hospital bed capacity in nearly 100 counties, extending a ban on elective procedures to new corners of the state, the Times reported.

Even though regular wards are being converted into intensive care units and long-term care facilities are being opened for patients too sick to go home, doctors say they are barely managing, the newspaper said.

“When hospitals and health care assistants talk about surge capacity, they’re often talking about a single event,” John Sinnott, chairman of internal medicine at the University of South Florida and chief epidemiologist at Tampa General Hospital, told the Times. “But what we’re having now is the equivalent of a bus accident a day, every day, and it just keeps adding.”

Staffing shortages

While hospital beds are easily converted for ICU use, the more difficult challenge is having enough advanced practice nurses who are qualified to care for such patients and equipment such as ventilators, hospital experts told the Times.

Hospitals can “pivot enough space,” Jay Wolfson, a professor of public health at the University of South Florida, explained. “The trick is going to be staffing. If you get people burned out, they get sick, then you lose critical care personnel.”

Beds aren’t the only thing hospitals are running out of now: Roopa Ganga, an infectious disease specialist at two hospitals near Tampa, told the Times that they lacked sufficient supplies of the proven COVID-19 medication remdesivir, forcing her to choose which patients needed it the most. Patients were also being discharged “aggressively,” sometimes returning in worse shape a few days later.

“About five people came back in one week last week,” she said. “That is making me feel like, you know, you got to slow down.”

A handful of states have actually brought the virus under control after being slammed in the early stages of the pandemic. Determined to keep case counts low, New York, Connecticut and New Jersey have said they will mandate quarantines for travelers coming from states that are experiencing large spikes in new cases, the Times said.

By Tuesday, the U.S. coronavirus case count neared 3.4 million as the death toll passed 135,000, according to a Times tally.

According to the same tally, the top five states in coronavirus cases as of Tuesday were: New York with nearly 407,000; California with over 336,000; Florida with over 282,000; Texas with nearly 274,000 and New Jersey with over 177,400.

Vaccine research makes headway

Meanwhile, the search for an effective vaccine continues.

The federal government will pay Novavax $1.6 billion to speed development of 100 million doses of a coronavirus vaccine by the beginning of next year, the Times reported last week.

The deal is the largest that the Trump administration has made so far with a company as part of Operation Warp Speed, a federal effort to make coronavirus vaccines and treatments available to the American public as quickly as possible, the Times said.

The U.S. Department of Health and Human Services (HHS) had already said that it would provide up to $1.2 billion to the drug company AstraZeneca to develop a potential coronavirus vaccine from Oxford University, in England.

That research agreement funds a clinical trial of the potential vaccine in the United States this summer with about 30,000 volunteers, the Times reported.

The goal? To make at least 300 million doses that could be available as early as October, the HHS said in a statement.

The United States has already agreed to provide up to $483 million to the biotech company Moderna and $500 million to Johnson & Johnson for their vaccine efforts. It is also providing $30 million to a virus vaccine effort led by the French company Sanofi, the Times reported. Moderna said a large clinical trial of its vaccine candidate would begin in July.

Nations grapple with pandemic

Elsewhere in the world, the situation remains challenging.

Even as the pandemic is easing in Europe and some parts of Asia, it is worsening in India. That country now has the third-highest number of COVID-19 cases, with over 906,000 infections, a Johns Hopkins tally showed.

Brazil has also become a hotspot in the coronavirus pandemic, with nearly 1.9 million confirmed infections by Tuesday, according to the Hopkins tally. It has the second-highest number of cases, behind only the United States.

Cases are also spiking wildly in Russia: As of Tuesday, that country reported the world’s fourth-highest number of COVID-19 cases, at nearly 739,000, the Hopkins tally showed.

Worldwide, the number of reported infections passed 13 million on Tuesday, with more than 573,000 deaths, according to the Hopkins tally.

More information

The U.S. Centers for Disease Control and Prevention has more on the new coronavirus.

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