Wearing a mask – a public health tool – has been politicized in the USA.  It is unfortunate because many countries have shown that masking and social distancing can work to slow the spread and severity of a pandemic.  In the USA, the three largest states, California (CA), Texas (TX), and Florida (FL) have all experienced a significant resurgence in COVID-19 cases for the last 6 weeks since the end of May (see figure below).  Each of them has seen record new highs in daily case counts and deaths.  However, their reaction to the resurgence has been different and their recent experience and prognosis going forward will be very different.

California as the largest state in the USA had the highest level of cases per capita in May as they expanded testing and picked up more asymptomatic and mild cases.  When infections exploded in June, Governor Newsom reacted the earliest and mandated mask-wearing across the state on June 19th.  Subsequently, he ordered bars in 7 counties to close and in a series of increasingly stringent steps, CA is now closing indoor businesses serving about 80% of the population.  Many counties (Los Angeles, San Diego, and San Francisco for example) have decided not to reopen physical schools in the Fall because they do not believe they could be opened safely.  These rational mitigation steps have all helped CA slow the exponential growth in cases to become now the lowest of the top three states in daily cases. 

Mitigation stepsCA DateTX DateFL Date
Mandate mask19-Jun2-Jul
Close drinking in bars28-Jun26-Jun26-Jun
Closing indoor businesses 60%1-Jul
Closing indoor businesses for 80%13-Jul
Not reopening schoolsLA, SD, SF

By comparison, Texas has been more reluctant to shut down the state, although recently Governor Abbott has threatened that if individuals and businesses do not help to slow the outbreak he may be left with no choice.  In the meantime, he did mandate the usage of masks statewide on July 2nd.

Florida’s Governor DeSantis has been the slowest to face reality.  Against all evidence, he insists that the recent resurgence is due to wider testing of young adults and is nothing to worry about.  At the state level, the only action taken to date is the closing of indoor bar drinking.  At the city and county level, many mayors have taken stronger mitigation steps but without quick and decisive action at the state level, the virus will continue to rage in FL with cases per capita soaring from the lowest in May to the highest among the top three states now. 

The prognosis is for worse to come to Florida.  The following figure shows the hospitalization rate (7-day rolling averages) for the top three states.  For both Texas and California, the daily net hospitalization (new admissions minus discharges) show that they have peaked and are on a downward trend. The daily hospitalization rate for Florida is still rising – reaching a new record of 458 admissions, yesterday.  This does not bode well for Florida. 

Widespread mask-wearing can mitigate the spread of the virus as both CA and TX have shown.  And if everyone also practiced social distancing consistently, it will slow the virus substantially.  If individuals do not do this voluntarily, the government has to step in as they have done in CA and mandate safe behavior.  Having done so, California is showing early signs of bending the curve and controlling the latest virus outbreak.