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As states began the process of reopening over the last six weeks, some areas across the country saw an uptick in positive COVID-19 cases. As a result, some reopening plans have been stalled or, in some cases, walked back.
For those still able to move forward with their reopening procedures, however, the attention is now turning toward how they can remain reopened and avoid another shutdown. To achieve as much, most local health officials agree that keeping gatherings small, wearing masks and maintaining six feet of social distance are the keys to ensuring a safe path forward.
Rising numbers of COVID-19 cases in West Virginia have taken some wind out of the sails of the state's recovery, with Gov. Jim Justice reimposing a handful of restrictions last week.
Justice ordered the cancellation of summer fairs and festivals, which had received a green light to resume earlier this month. He also lowered the limit on group gatherings from 100 people to 25 and ordered bars in Monongalia County, the home of West Virginia University, to be closed for 10 days due to the number of cases there.
"I think he (Justice) would say he is really trying to thread that needle appropriately" and balance the health of the citizens and avoid as much as possible the economic harm that could come with closing things down again, said Dr. Clay Marsh, who heads up the state's coronavirus response.
The number of positive cases in West Virginia doubled over the last two weeks, Marsh said. The rate of positive tests climbed over 3 percent in recent days from less than 1 to 1.2 percent two weeks ago, he said.
To get those numbers moving in the opposite direction, he said, West Virginia residents need to practice social distancing and wear masks, something Justice made mandatory – albeit without penalties – two weeks ago. The state must also continue to increase testing, which will provide data that allows decision-makers to tailor their approach to combating the virus.
"You don't want to take a hammer to fix something that has a very specific need," Marsh said.
Expanded testing can identify "super-spreaders" who don't realize they're infected because they are asymptomatic or presymptomatic, Marsh said.
While "most people do OK with COVID," Marsh said, West Virginia has a number of populations who are at higher risk for problems from the disease due to factors including age, underlying health conditions like obesity and heart disease and even smoking or the use of e-cigarettes.
Although younger people are thought to be less at risk for serious health effects, the long-term effects of the disease are still unknown, Marsh said. Information about the virus continues to evolve, with recent indications suggesting it is more of a vascular disease than a disorder of the lungs.
"People with blood type A (can) have much worse outcomes than people with blood type O," Marsh said. "The blood is clotting throughout a lot of people's bodies with COVID" leading in some cases to mild strokes or heart attacks, he said.
As cases started climbing again just across the border in parts of Pennsylvania, Gov. Tom Wolf announced more restrictions during a Wednesday briefing. He said cases are on the rise due to people ignoring guidelines on social distancing and wearing masks in public, along with out-of-state travel and "a lack of national coordination."
"We don't want to become Florida," Wolf said during the briefing. "We don't want to become Texas. We don't want to become Arizona. We have got to act now."
In an executive order, Wolf mandated that restaurants and bars cannot sell alcohol for on-site consumption unless it's with a meal. They are also to operate at 25 percent occupancy while prohibiting bar seating.
"We have seen these efforts work during the first wave in the spring, and they will work again if we all do our part," Wolf said during the briefing. "I know you are eager for life to get back to normal, and I am, too."
Earlier this month, Wolf's administration mandated that people wear masks when in public. He reiterated the importance of masks last week.
"We want people to spend time together, but to do so while practicing social distancing and wearing masks when required," he said. "When you leave your home and you're not participating in an outdoor exercise, wear a mask."
The state's Department of Health Secretary Rachel Levine challenged Pennsylvanians to "make a choice" and do what they can to prevent the spread of COVID-19 when it comes to masks and social distancing.
As COVID-19 cases continue to rise in Ohio, health officials there are focusing on informing communities and slowing the spread of the virus.
"Improvement within the county regarding COVID-19 can only occur if the residents of each community choose to take responsible steps to slow the spread," Huron County Public Health information officer Melanie Myers said. "It is crucial that everyone comes together to follow the recommendations and orders of Gov. Mike DeWine and the Ohio Department of Health."
Those measures include staying home when sick, wearing masks in public, banning mass gatherings and limiting unnecessary public exposures.
"If, as a community, we come together and take these steps, we can limit the county's exposure to this disease and can make a tremendous impact on reducing the number of those infected and potential unnecessary deaths," she said.
Myers added that she didn't want to speculate on if there will be another statewide shutdown, but as they continue to see an increase in cases, they are encouraging the community to take necessary steps to prevent any further potential mandates.
"During these unprecedented times, it is of utmost importance to take care of one another and make decisions that are in the best interest of our community rather than what is best for our personal interests," she said. "When choosing to leave home for unnecessary needs or duties, residents should remember that the decision made today can impact a child, pregnant woman, grandparent or loved one in the coming weeks."
Kristofer Wilster, director of environmental health for Trumbull County Combined Health District, said the further spread of the virus is of the utmost concern. He said community members should continue to wash their hands, use hand sanitizer, social distancing and wear masks in public.
In the Columbiana County Health District, public information officer Laura Fauss said their major concerns are residents not wearing masks and not getting preventive care like vaccinations, checkups or mammograms.
She said to prevent another shutdown, residents should follow the same measures they have been following – wearing a mask, keeping six feet between yourself and others, washing hands, cleaning high touch surfaces regularly and not touching your face.
Fauss said that if the cases increase to the point where they are close to overwhelming hospitals, there will be another shutdown.
"Our epidemiologist likened the situation that we are in right now to someone that has been taking a class," Fauss said. "They worked hard all year on homework, studying and doing special projects (stay at home orders and gradual reopening) and now we're at the final exam. If we fail the final exam, all the hard work we have done will be lost. We must continue to work hard at stopping the spread of this disease."
At Firelands Regional Medical Center, Dr. Scott Campbell said the hospital's concerns are running efficiently and safely for patients while being mindful of the presence of COVID-19.
"We have spent countless days since the initial news that COVID-19 existed, preparing our hospital, employees and staff for combating whatever this virus sends our way," Campbell said. "Thanks to the initial social distancing, the curve flattened, which gave us time to adequately prepare."
Norwalk safety-service director Ralph Fegley said people have been doing everything to keep from going into another shutdown.
"I don't see anything different we can do – pray maybe," he said. "I don't anticipate (another shutdown). Maybe I'm being optimistic, but I just don't see it."