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A number of Southern and Western states are seeing a spike in COVID-19 cases. Why aren’t their death rates rising, too?

As beaches in Florida reopen, the state is reporting record daily totals of new coronavirus cases.Marcio Jose Sanchez/Associated Press

As Massachusetts restaurants opened for inside dining Monday and other services were given the green light, a troubling and unmistakable trend is taking hold across more than a dozen other states that eased their coronavirus restrictions weeks ago.

Cases are surging across the South and West, where life has moved toward near normal, with crowds of people dining, dancing, partying, and often ignoring pleas to socially distance and wear face masks.

But, even as infections increase anew, the number of deaths attributed to COVID-19 in some of these states, including Florida, Arizona, and Texas, is not rising. At least, not yet.


Public health experts warn that a corresponding jump in fatalities in these surging states may be around the corner, because deaths in COVID-19 have come to be known as a “lagging indicator,” following several weeks after infection.

Massachusetts is among the states with the largest number of cases nationwide, and it has moved more slowly in reopening. But the specter of a similar spike in cases here looms.

The fear was underscored Monday by health and community advocates who warned that the Baker administration’s reopening policies and time frame have failed to protect low-wage essential workers, many of them Black and Latino, who have borne a disproportionate share of infections and deaths.

Health experts are learning more daily about COVID-19 transmission, treatment, and who is at greatest risk, but there are still many unanswered questions, said Dr. Howard Koh, a former Massachusetts public health commissioner who was an assistant health secretary in the Obama administration.

Restaurants along the River Walk in San Antonio have reopened, but some parts of Texas have seen virus cases balloon.Eric Gay/Associated Press

“We are seeing in California and Washington states, where leaders there have been pretty careful, we are seeing rises [in infections] there and hot spots,” said Koh, now a professor at Harvard’s T.H. Chan School of Public Health.

Koh said there are signs of more younger people being infected now in some states compared to earlier in the pandemic, potentially a sign that older adults with underlying health conditions are heeding advice and being more cautious, while younger adults are becoming more lax.


That, he said, might also partially explain the phenomenon of surging cases but lagging death counts in some states, because younger people, often with mild symptoms, can spread the disease but have not suffered high death rates in the pandemic.

“The medical world is also getting more familiar with treating very ill COVID-19 patients,” Koh said. That, along with the news last month that the drug remdesivir helped shorten recovery for hospitalized patients, may help explain why fewer people seem to be dying right now in states that are experiencing a surge, he said.

Dr. Brooke Nichols, an assistant professor of global health at Boston University’s School of Public Health said it’s too soon to say whether spikes in death will follow the surges elsewhere, but she worries about cases climbing in Massachusetts — just not immediately.

Nichols said that because Massachusetts was hit so hard by the virus, and many residents knew someone who was sickened or died, most will wear masks and be cautious, at least in the coming weeks as more businesses reopen.

“I think we will get amnesia eventually, whether in the next month or two months,“ Nichols said. “Maybe through the summer months and interacting outside, people’s [relaxed] behavior will be mitigated for a while, but I do fear people will take the liberties we have in the summer and interacting with each other now and take that behavior inside in the fall and that worries me more,” she said.


But a coalition of 94 Massachusetts public health, community, and labor organizations is worried now. The Task Force on Coronavirus & Equity released a statement Monday criticizing the Baker administration for not tracking data on low-wage workers, people with disabilities, people who don’t speak English, and others who have been hard hit by the pandemic.

On Friday, the administration released a report that found the rate of positive cases among Black and brown residents is more than three times that of white residents. But it lacked the granular data the coalition says is needed as the state reopens to know whether certain groups or occupations are being infected at higher rates than others.

The task force pushed for a bill the governor eventually signed this month that will require the Baker administration to collect and report more detailed COVID-19 data, including the occupation, primary language, race, and ethnicity for all those who test positive, are hospitalized, or die from the disease.

But coalition members say they are frustrated by the administration’s slow pace on this.

“This is something we have called on the administration to prioritize for a couple of months now,” said Carlene Pavlos, executive director of the Massachusetts Public Health Association, which coordinates the task force. “This has not been a high enough priority for the administration to focus on groups that are much likely to be harder hit, but we have no way of measuring that.”


The concerns were raised as state officials reported Monday that the coronavirus death toll in Massachusetts had risen by 17 to 7,874 and that the number of people testing positive for the virus had climbed by 149 to 107,210, as key metrics lingered at low levels relative to the surge earlier this year.

The data show that one of the four key metrics the administration is monitoring to determine the pace of reopening fell, while two stayed stable and one ticked up slightly.

The seven-day weighted average of positive test rates stayed stable for the third consecutive day at 1.9 percent on Sunday. It has dropped 93 percent since April 15.

The three-day average of the number of patients hospitalized for the coronavirus decreased on Sunday to 937 from 962 a day earlier. It has dropped 74 percent since April 15.

The number of hospitals using surge capacity stayed stable at two for the second consecutive day on Sunday — a statistic that is still down from a high of 21 in early May and that has seen a 90 percent decrease since April 15.

But a fourth metric, the three-day average of COVID-19 deaths, rose slightly, from 22 on Thursday to 26 on Friday. However, that statistic has still dropped 83 percent since April 15.

Jaclyn Reiss of the Globe staff contributed to this report.


Kay Lazar can be reached at kay.lazar@globe.com Follow her @GlobeKayLazar.