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An increasing number of people in Arizona, Florida, Oregon and Texas are being admitted to the hospital because of Covid-19, adding to concern that some of the most populous U.S. states are facing a new wave of illness after lifting lockdown orders. At least 10 U.S. states set records on Wednesday for the highest daily rise in new coronavirus cases.

The U.S., which lacks a unified national response to the pandemic, has largely failed to flatten the curve of infections as nations including South Korea and New Zealand have. In many other countries, leaders are focused on stamping out localized outbreaks: Beijing, for example, closed schools to fight a returning threat. But in America, governors have to decide whether to ask citizens to return to widespread lockdowns that could wallop their just-opened economies all over again.

“When people started moving around and didn’t see any Covid-19 among their friends, people started letting down their guard,” said Ali Mokdad, professor of health metrics sciences at the Institute for Health Metrics and Evaluation at the University of Washington.

He said the U.S. may have avoided an earlier spike when economies first opened because the public was initially very cautious, though that is changing. Mokdad said he already expected a seasonal increase in Covid-19 in September, but now that could be worse because it will be starting from a higher base of infections.

“You’re going to see more infections and more mortality,” Mokdad said.

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