Two huge COVID-19 surges make Louisiana an outlier in the U.S.

In April, the United States COVID-19 outbreak greatly affected a handful of states including New York, New Jersey, Michigan, Massachusetts and Louisiana. Now in July, the United States COVID-19 outbreak is affecting a different group of states including Arizona, Florida, South Carolina and Texas. But it’s also affecting Louisiana – again.

Most states with COVID-19 surges early on in the U.S. outbreak now have their infection rates under control. And the states experiencing bursts of COVID-19 cases  now mostly had a relatively low number of cases at the start of the pandemic.

But Louisiana is an outlier. It’s been at the top of the list of states with serious COVID-19 outbreaks twice.

Louisiana’s COVID-19 outbreak has been up, down and up again over the past four months. In March, the state’s cases were growing faster than anywhere else in the world. Then, a stringent stay-at-home order “flattened the curve,” and the case count dropped. Now, after nearly two months of a partial reopening, the state is seeing a worrisome increase in cases again.

Louisiana has the fourth highest coronavirus infection rate of any state in the country behind Arizona, Florida and South Carolina. Gov. John Bel Edwards said the state’s virus uptick is so significant that it has caught the attention of officials at the White House.

“We have lost all the gains made in June and are now seeing some numbers that rival our peak back in April,” he said at a press conference Wednesday. “We do have some regions that are actually above the hospitalizations that they ever saw.”

Public health experts said it isn’t clear why Louisiana has gone through two spikes of coronavirus cases, while almost all other states have seen just one. But most other states that experienced severe COVID-19 outbreaks in March and April have been more cautious about their reopenings than Louisiana.

New York, New Jersey, Michigan and Massachusetts — who saw surges in coronavirus early on in the pandemic — have all implemented mask requirements, according to data compiled by Boston University on state coronavirus policies. Edwards has so far declined to put a mask mandate in place in Louisiana, saying that he would have a difficult time enforcing such a measure.

Louisiana also opened restaurants and bars earlier than many of the other states with severe outbreaks in March and April, according to Boston University. In New York state, bars still aren’t open at all and, in New York City, restaurants are not allowed to have indoor dining yet.

Restaurants here have been allowed to open up to 50 percent capacity indoors, and bars have been allowed to go to 25 percent capacity since early June. In recent weeks health officials have tied bars to some of Louisiana’s larger coronavirus clusters.

“They are opening very slowly in New York City. We did not open that slowly here,” said Susan Hassig, a professor in Tulane University’s epidemiology department.

The more severe restrictions do appear to be keeping the virus at bay. New York and New Jersey have averaged a one percent positive test rate for coronavirus over the last seven days. Michigan and Massachusetts have averaged a three percent test rate. Meanwhile, Louisiana has averaged a nine percent test rate, according to an analysis done by The New York Times.

Hassig said, in retrospect, that Louisiana may have moved too quickly from “Phase 1” of its reopening — in which bars were closed and restaurants operated with even more restrictions — to the current “Phase 2.” 

Edwards shifted to the “Phase 2” reopening in early June. At the time,  Republicans in the Louisiana Legislature were threatening to nullify all of the state’s coronavirus restrictions if the governor didn’t make moves to reopen businesses. Unlike most of the other states with severe coronavirus outbreaks early on in the pandemic, Louisiana is politically conservative. Though the governor is a Democrat, the Legislature and all other statewide officers are controlled by Republicans.

Louisiana’s first and second coronavirus outbreaks can also be treated as distinct events. The first spike — in March and April — was concentrated in the New Orleans metropolitan area. This second surge is a result of coronavirus spreading through other parts of the state, such as Lafayette and Lake Charles.

“We have a statewide epidemic. It’s no longer one region or two regions out of the nine that are really causing our case growth,” Edwards said Wednesday.

Public health officials said it’s possible that residents in parts of Louisiana outside New Orleans weren’t taking the coronavirus restrictions as seriously. Their communities weren’t hit as hard by the first round of outbreaks, so they may not be as willing to socially distance and wear a mask. The lax behavior could have contributed to the state’s second surge.

“People’s behaviors do not reflect what happened in March and April,” said Rebecca Christofferson, an assistant professor and infectious disease expert at LSU. “I wonder if people just don’t realize how bad it was.”

Other public health experts said it also would have been difficult for Louisiana to escape a second spike under any circumstances. All of the states surrounding Louisiana are seeing a surge in cases.

“This time it is really a regional phenomenon. I think the whole region probably opened a little bit early. There was a sense that it wasn’t a big deal anymore,” said  Joshua Sharfstein, a professor with the Bloomberg School of Public Health at Johns Hopkins University. “It would be stunning if Louisiana could avoid the fate of its neighbors.”

The jump in cases has caused some people to question why Edwards isn’t implementing more restrictions again. Texas Gov. Greg Abbott, a Republican, closed bars and put a statewide mask mandate in place after a sharp increase in infections there. Some wonder why Edwards isn’t doing the same.

But some public health experts believe additional restrictions can have a downside, particularly if they cause a public backlash.They can also be ineffective if governments don’t have the ability to enforce them.

“You don’t want to set up a paper tiger that is going to cause a lot of blowback – that says you have to wear a mask when you can’t enforce it,” Hassig said.