Data: Nephron and JHU; Table: Axios Visuals

Most of the states facing large coronavirus outbreaks today didn't build up their public health systems enough ahead of time.

Why it matters: States like Arizona, Florida and Texas had months to learn from the mistakes of New York and other early hotspots, yet find themselves now in similar situations.

The big picture: The U.S. has rapidly scaled up its testing and contact tracing capabilities, but they're still not nearly enough.

  • States should have at least 30 contact tracers per 100,000 people during the pandemic, according to the National Association of County and City Health Officials. Most states' workforce falls far short of that metric, according to a Nephron Research analysis.
  • The World Health Organization has said 5% or less of diagnostic tests should come back positive for at least 14 days before governments allow reopening, but many states are now well above this threshold, per Johns Hopkins University.
  • In some hotspots, people are having a hard time getting tested, leading to long lines and crowding, the NYT reports. Overall, the U.S. still isn't doing the number of tests that many experts say it needs to be.

Between the lines: Part of the reason the U.S. economy shut down was to buy states time to build up their public health infrastructure. Many states failed to do so before reopening, leading to today's predictable results.

The bottom line: There's no reason why any city or state in the U.S. can't eventually become a coronavirus hotspot.

  • Arizona, Texas and Florida are learning this the hard way, but there are plenty of places that still have more time to build up their testing, tracing and isolation capabilities.

Go deeper: Bigger, wealthier cities lead on coronavirus recovery

Go deeper

Oct 7, 2020 - Health

The cost of Washington's coronavirus failures

Illustration: Aïda Amer/Axios

President Trump’s cavalier attitude toward the coronavirus is already making the pandemic worse in his own backyard, and the failure to reach a deal on a new round of stimulus will likely make it worse all across the country, for months.

Why it matters: Heading into the winter months without a new round of stimulus in place will leave vulnerable workers without a financial safety net if they get sick — and because of that, experts say, it will likely make the pandemic itself worse.

Oct 6, 2020 - Health

D.C. reports most new COVID cases since June amid White House outbreak

Photo Illustration: Eniola Odetunde/Axios. Photo: Chris Graythen/Getty Images

Washington, D.C. reported 105 new coronavirus cases on Monday, the highest number of new infections since June.

Why it matters: A cluster of at least 20 cases has been tied to the White House, raising concerns that the virus may be spreading into the surrounding community.

With Trump's return, risks rise in the West Wing

Photo: Win McNamee/Getty Images

White House aides have advised President Trump to avoid the Oval Office while he's still infected. But they’re making arrangements for him to work out of the Diplomatic Reception Room, and use it as a backdrop for future televised remarks, two White House officials tell Axios.

Why it matters: The preparations show that far from bunkering down in the residence until he's well, Trump is considering remaining active while he recovers from COVID. Any Trump movement in the West Wing would create a series of risks for his staff.