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Coronavirus Surge in South and West Looks Different From North's

The Wall Street Journal. logo The Wall Street Journal. 5 days ago Elizabeth Findell, Brianna Abbott, Eliza Collins
a group of people on a boat in the water © Eric Gay/Associated Press

PHOENIX—The virus that ravaged Northeastern U.S. cities is surging through Southern and Western states. It’s different this time.

Younger people are getting sick with Covid-19. States that had brief coronavirus lockdowns are struggling to encourage social distancing and mask-wearing. Many people appear to have embraced their usual summer rituals. Health officials are sounding alarms about a surge in cases racing not through nursing homes, but bars and house parties. Hospitals are filling with medically-vulnerable elderly—but also 20-somethings and patients in their 30s and 40s.

Some took the end of stay-home orders as permission to live their lives again, unimpeded. Phoenix entrepreneur Jimmy Flores, 30, spent the night of June 6 at a nightclub with friends, sharing drinks. Two days later, he felt sick. The next week, he was on a hospital oxygen tube after testing positive for Covid-19.

“I’m a young, active, healthy person with no previous conditions,” he said. “I didn’t take it seriously for myself. I was not practicing the social-distancing guidelines. I didn’t wear a mask. I thought I was invincible.” Mr. Flores said he went from not knowing anyone with Covid-19 to knowing 15 victims. After eight days’ hospitalization, he is recovering at home.

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The U.S. has confirmed more than 2.4 million Covid-19 cases, and more than 124,000 have died, according to Johns Hopkins University data as of Friday morning. New cases have climbed to more than 30,000 a day—back to their April peak—after dropping to around 20,000 a day in May. Nearly 40,000 new cases were reported on Thursday, a record; Florida, Texas, California and Arizona accounted for nearly half of the new cases.

Early hot spots such as New York, New Jersey and Illinois are seeing steady declines in cases, hospitalizations and deaths. New daily Covid-19 cases in states such as Arizona and Texas are reaching records, and hospitalizations are increasing. Texas rolled back its reopening Friday.

“We’re still in the first wave, and that first wave is taking different shapes,” Centers for Disease Control and Prevention Director Robert Redfield said in a Thursday briefing. The U.S. has improved its testing ability and is seeing more cases in young people, who typically have better outcomes, he said.

But younger people in Texas and Arizona are taking hospital beds and straining the health-care system, he said. “These hot spots that we see, I don’t minimize them. They’re significant,” he said.

Arizona’s Covid-19 hospitalizations since it reopened May 15 have grown from 789 to 2,110, according to state data Thursday. Nine of 10 hospital ICU beds were full this week, state data show.In Texas, nearly 6,000 tested positive for Covid-19 Thursday, versus just over 600 new diagnoses on Memorial Day, state data show; hospitalizations rose to more than 4,700 from just over 1,500 in that period.

Patrick Ptak, a spokesman for Arizona Gov. Doug Ducey, said the state is making efforts to target young people and encourage mitigation techniques, such as mask wearing.

Monday, Texas Gov. Greg Abbott said the virus “is now spreading at an unacceptable rate in Texas.” Friday, he said all bars must close again immediately, recreational tubing operations must halt, and restaurants must reduce capacity from 75% to 50%. Outdoor gatherings of 100 or more must be approved.

Gov. Abbott’s office didn’t respond to requests for comment.

The steady and broad increase, said Dr. James McDeavitt, dean of clinical affairs at Baylor College of Medicine, indicates it can’t be tied to any one thing, whether Memorial Day, protests sparked by the killing of George Floyd or other particular events. In general, public-health experts attribute the rise in cases to people becoming more mobile, congregating in groups and dropping safety measures.

Increased testing is likely responsible for part of the data shift toward younger people, epidemiologists said. Health officials and doctors are testing more mild and asymptomatic patients nationwide than in March and April, as the availability of tests has grown, they said.

Another possible factor: The virus is spreading in some of the hottest states. People might be staying in the air-conditioned indoors “where you can’t physically distance” said Dr. Joe K. Gerald, associate professor of public-health policy and management at University of Arizona. Phoenix temperatures hit 108 Thursday.

Skeptics about that explanation include Dr. McDeavitt, who said he believed Houstonians are outdoors more now than they were in February and March.

The percentage of tests coming back positive is rising around America, which epidemiologists said indicates the disease is spreading. And the percentage of positive tests is now higher in the 18-to-49 age group than among older brackets, CDC data show—a departure from earlier patterns.

Of Arizona’s more than 66,000 confirmed cases since the pandemic began, nearly 60% had been younger than 45 as of Friday. The Louisiana Department of Health last week announced an outbreak of more than 100 cases linked to a cluster of bars near Louisiana State University. The state is seeing a rise in cases among the 18-to-29 age group but not among those 65 and older, even as it is doing more testing in settings such as nursing homes, said Alex Billioux, assistant secretary of the state health department’s office of public health.

In California, more than 60% of the nearly 196,000 cases were under age 49, state data as of June 24 show. California Gov. Gavin Newsom last week required residents to wear masks in public. Florida reported new daily cases rose from 1,222 on May 27 to 8,933 on Thursday with a median age of 34.

Health experts said they had expected cases to increase as lockdowns ended. In addition to increased testing, the numbers are likely due to changing behaviors, said Nadia Abuelezam, an infectious-disease epidemiologist at Boston College. Young people are likely being less cautious about social distancing or returning to work, she said, while more-vulnerable people—and hard-hit places such as nursing homes—might be taking more precautions.

“Things open up and people immediately think it’s time for the barbecues and pachangas,” said Dr. Ivan Melendez, public-health authority of South Texas’s Hidalgo County. The average age, he said, is 35 among people testing positive in the county, where hospitalizations increased fivefold and deaths have doubled in the last two weeks.

Because younger people are more likely to have better Covid-19 outcomes, the new surge in cases might not result in as many deaths as before. Still, “there’s a bit of a false narrative out there that because you’re young, you’re OK if you get infected,” Dr. McDeavitt said. “We see people in their 20s and 30s in our ICUs gasping for air because they have Covid-19.”

The more the virus spreads, he said, the harder it is to keep from vulnerable populations.

The average age of people in Arizona who were infected fell from 48 in March to 39 in June, according to analysis of state data by the University of Arizona’s Dr. Gerald. The average age of Covid-19 deaths rose from 62 to 69.

“I know many young people out there feel invincible,” Gov. Ducey said Thursday, urging citizens to stay home and practice social distancing when out, “but your parents and grandparents are not invincible.”

In Texas, largely spared in the coronavirus’s earliest spikes, people often say they don’t know anyone with Covid-19, said Dr. Marc Boom, chief executive of Houston Methodist hospital system. He tells them: “The way things are going, everyone’s going to know someone.”

“We’re sort of loudly banging on the bell and saying: We are going to start looking like New York City,” he said.

Dr. Boom and Houston-area hospitals have warned they are within a couple of weeks of exceeding their ICU capacity. Thursday, Gov. Abbott issued an order suspending elective surgeries in four of the state’s largest counties.

Texas’ surge comes after a phased state reopening beginning May 1. Many bar owners, angry they weren’t allowed to open immediately, as restaurants were, lobbied hard and staged a “soft opening” May 15. Three days later, Gov. Abbott said bars could open that week.

On the weekend of June 13, bars were bumping on Austin’s Sixth Street nightclub strip. People without masks crowded counters and bounced to DJs. Crowds spread across the street.

In recent weeks, the Texas Alcohol and Beverage Commission began suspending liquor licenses of bars not following rules. One belonged to Bob Woody, once dubbed the Mayor of Sixth Street for his ownership in some 20 bars, who in May hung white sheets with messages such as “Gov Abbott Let Us OPEN.” He said he had followed the rules, turning dance floors into seating areas, having staff wear masks and requiring patrons to use hand sanitizer.

Tussles between local jurisdictions and the states have complicated the virus response. The Texas and Arizona governors initially barred local officials from requiring masks, then let them make their own rules within the last two weeks.

Michal Kaerner, a 21-year-old student in Tempe, Ariz., on Wednesday said nightlife near Arizona State University seemed to have returned to a pre-coronavirus status: “Nobody really seems to care.”

Houston resident Debbie Loux, 62, made masks for her adult children in March but worries her 31-year-old son and his friends became complacent when the lockdown dragged on.

“They all went to the lake,” she said, “and I was just ready to kill him.”

Write to Elizabeth Findell at Elizabeth.Findell@wsj.com, Brianna Abbott at brianna.abbott@wsj.com and Eliza Collins at eliza.collins@wsj.com.

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