The U.S. Is Not In A Second Wave. It's Stuck In The First : Consider This from NPR Nationwide, numbers were never trending downward in any big way. Now in some states that are reopening, they are going up. Oregon and Arizona are two of those places. Each state is taking a different approach.

Testing is more available than ever before. Some cities are urging people who don't feel sick to get a test, just as a precaution. But WPLN's Blake Farmer reports some insurance companies won't pay for the cost of a test unless it's "medically necessary."

Due to the pandemic, a lot of states are making it easier to vote by mail. NPR's Miles Parks says this new process could mean waiting a lot longer for elections results come November.

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This episode was recorded and published as part of this podcast's former 'Coronavirus Daily' format.

There Is No 'Second Wave.' The U.S. Is Still Stuck In The First One

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Before we get to the show, just a quick announcement. For months now, this pandemic has been the biggest story in the world, but that's not going to be true forever. At the same time, we want to keep helping you understand what is happening every day. So pretty soon, we're going to start bringing you news that's not just about the pandemic. And we're going to give the show a new name. We're calling it Consider This. What is not changing is we will keep bringing you the most important news about this virus as soon as we know it. In the meantime, we would love to hear from you. Our email is Thanks a lot.

OK. So it's time to just say it. We are not in a second wave because across this country, cases never really went down in any big way. Back in May, the numbers looked a little better after things started to improve in the Northeast, which was hit really hard. Then came Memorial Day, warmer weather and more states opening up. It might have felt like things were getting better. They weren't. The United States is still in the first wave.


ASHISH JHA: We're going to continue seeing 25- to 30,000 additional deaths a month.

MCEVERS: Ashish Jha with Harvard's Global Health Institute.


JHA: This is really quite bad. And the level of virus and the level of disease burden in our country is very, very large.

MCEVERS: Coming up, the U.S. is testing more and more people, who's paying for all those tests. And another reality we will all have to adjust to is what we won't know on election night. This is CORONAVIRUS DAILY from NPR. I'm Kelly McEvers. It's Monday, June 15.


KATE BROWN: Good morning, everyone. Thank you all for joining us today.

MCEVERS: Last week, the governor of Oregon, Kate Brown, made a tough decision.


BROWN: To all of the business owners who had planned to reopen this weekend, I want to acknowledge how difficult this is for all of you.

MCEVERS: Like a lot of places, Oregon was seeing case numbers go up. They nearly doubled there in the past two weeks. And hospitalizations were going up, too.


BROWN: As Dr. Fauci has said, we don't make the timeline. The virus makes the timeline.

MCEVERS: Restaurants, bars, nail salons, tattoo parlors - a lot of them were ready to open on Friday. Then state health officials decided to hit the brakes.


BROWN: This is essentially a statewide yellow light.

MCEVERS: Businesses will have to wait another week, at least.


DOUG DUCEY: So this has always been about saving lives.

MCEVERS: Not all states are taking that approach.


DUCEY: And it's also about livelihoods in the state of Arizona.

MCEVERS: Over the past week, Arizona has seen an average of more than 1,300 new COVID-19 cases each day. But Governor Doug Ducey is not slowing down reopening plans. He is talking a lot about hospital capacity.


DUCEY: We put the stay-at-home order there so we could prepare for what we are going through right now.

MCEVERS: His message seemed to be, Arizona can deal with the cost of reopening if that cost is more people in the hospital.


DUCEY: We can care for Arizonans that need it. We can provide them the hospital care and comfort and attention. And today, we can do that. We can also do that...

MCEVERS: Saskia Popescu, an epidemiologist based in Phoenix, says it's not just when Arizona decided to open up. Its stay-home order was lifted a month ago. It was also about how fast they did it.


SASKIA POPESCU: A lot of the concerns surrounding the reopening of Arizona, like many states that were not quite there yet, was that it was done so rapidly, there wasn't time to make sure we were doing it appropriately and correctly.

MCEVERS: Stores, restaurants, gyms were allowed to open with some general guidelines to socially distance, all in the span of a few weeks. And the state has no mask requirements for public spaces. Also, it's important to say that the rise in cases isn't just because of more testing. The rate of tests coming back positive is up, too. Other states are now watching Arizona to see how things go. And in a conference call last week, a deputy director at the CDC, Jay Butler, hinted that some places with rising cases that are planning to reopen might need a plan B.


JAY BUTLER: More extensive mitigation efforts, such as what were implemented back in March, may be needed again. And that is a decision that really needs to be made locally based on what is happening within the community regarding disease transmission.


MCEVERS: There is way more testing happening than there used to be, and that's a good thing. In some places, there are enough tests for people to get one just out of precaution, even if they're not feeling sick. But there's a new issue with that. Insurance companies argue they can't just pay for everyone to get tested whenever they feel like it. Here's Blake Farmer of WPLN in Nashville.


BLAKE FARMER: Lynne Cushing of Nashville says she had been pretty strict about social distancing until the recent protests, which she felt compelled to attend.

LYNNE CUSHING: I had hoped to kind of stay on the periphery or at least along the edge a little bit. But I didn't think about the fact that everybody's going to be chanting all these - there's going to be a lot of forced air, you know, coming out at people in the demonstration.


UNIDENTIFIED PROTESTER: (Chanting) Show me what democracy looks like.

UNIDENTIFIED PROTESTERS: (Chanting) This is what democracy looks like.

FARMER: So the next day, after marching in her mask, she went to a curbside clinic for a COVID-19 test. Cushing knew health plans had to cover the test and can't even charge a copay.

CUSHING: Because I have health insurance, I'm lucky in that regard.

FARMER: A law passed by Congress requires health plans to cover medically necessary testing. But as testing capacity grows, a gray area is beginning to appear. Sabrina Corlette at Georgetown University says the law can be interpreted various ways.

SABRINA CORLETTE: That requirement may only apply if you've been referred for a test by a health care professional after presenting with symptoms of the disease.

FARMER: Health plans have been erring on the side of patients in paying the full cost. But the nation's largest insurer, UnitedHealthcare, says in a statement they can only pay for tests deemed medically necessary. Otherwise, they worry about runaway costs.

Kristine Grow is the spokesperson for America's Health Insurance Plans.

KRISTINE GROW: These are some very big numbers that we are looking at.

FARMER: The trade group just funded a study that estimates the cost of all the precautionary testing needed over the next year. More than protesters, they're concerned about everyone returning to offices that may institute testing requirements. They project it could cost health plans $25 billion a year if the government doesn't step in to pay.

GROW: And that's why we think it's very important to approach testing with a very strategic approach, one that's based on science and has very clear direction on who gets tested, how often.

FARMER: Employment attorneys say most businesses aren't making workers get tested at this point, settling for temperature checks and questionnaires. But at least one industry is already staring down the dilemma of who pays.

Christine Thelen is a lawyer with the firm Lane Powell in Portland who represents nursing home companies. She says one-time testing wouldn't be that big of a deal.

CHRISTINE THELEN: It also adds up for the number of times 'cause as you know, you take a COVID-19 test today, but that doesn't mean that three days from now I don't test positive.

FARMER: Many states are mandating coronavirus tests for nursing home staff every week. In New York, it's twice a week. And already, health plans are balking at the cost. But Thelen says no worker should be asked to pay their own way.

THELEN: I think employers need to pay for it.

FARMER: As for protesters, many cities are offering to fund the precautionary tests, including in Nashville. Lynne Cushing was right to be worried. She tested positive after the march, though she says she knew the risk.

CUSHING: Absolutely, it still feels that way. I don't regret it.

FARMER: As gatherings resume, even with precautions, people will need more tests.

MCEVERS: WPLN's Blake Farmer in Nashville.


MCEVERS: We know the pandemic will change a lot of things about voting this November. It'll change who votes. The number of new voter registrations have been down dramatically the last few months. It'll change how. Some states, but not all, have made it easier to vote by mail. And it will probably change when we know who won. Here's NPR's Miles Parks.


MILES PARKS: On the night of Pennsylvania's June 2 primary, things looked bleak for Nina Ahmad. She was running in a crowded primary field for the statewide auditor general position. If she won, she would become the first woman of color to be nominated for a statewide executive position. But things weren't looking good. She trailed by tens of thousands of votes, and supporters started reaching out to her, saying it was a good try.

NINA AHMAD: A lot of people were worried. They emailed like, what's going on? She lost. I'm so sorry. And I said, just hold your horses.

PARKS: Ahmad is the former deputy mayor of Philadelphia and also a scientist. Naturally, she wanted to wait for all the numbers. It was a full week after election day before she took the lead. And it was nine days after election day when she finally declared victory.

AHMAD: What I'm learning from this is that you have to trust the process.

PARKS: As states across the country transition to more mail voting, it's been a similar story, with results coming days and weeks after voting is complete. And election experts like Nate Persily of Stanford University say voters need to be patient in November.

NATE PERSILY: We really need to get into a mindset that we will not know who the winner of the election is on election night.

PARKS: The biggest reason for the delays is that mail ballots take longer to process than in-person votes. Officials need to verify signatures, open envelopes. And in many states, including Pennsylvania, much of that can't even begin until Election Day.

Now, that's not inherently a problem. It doesn't mean anything's going wrong with the election or the tabulation. In fact, those safeguards are actually in place to protect against fraud. But what keeps experts like Persily up at night is that if voters don't understand that, the election becomes fertile ground for conspiracy theories.

PERSILY: In some ways, this is the worst year to have a pandemic that affects election administration because we were already worrying about disinformation and loss of confidence.

PARKS: This scenario has played out multiple times already in just the past two years. After the 2018 midterms, Republicans, including President Trump, questioned the legitimacy of votes that were counted after Election Day in California, Arizona and Florida because they skewed more towards Democrats. Many experts worry the same thing will happen again this year. The problem, according to election officials, is that expectations haven't been set correctly.

KATHY BOOCKVAR: The headlines that say this is a disaster if there's a delay - that's not right.

PARKS: Pennsylvania Secretary of State Kathy Boockvar.

BOOCKVAR: If we all anticipate that accurate vote counts with a higher volume by mail or for any reasons - because there's a pandemic or because of civil unrest - if it takes longer because it takes longer to make sure the count is accurate, then that's the opposite of a disaster.

PARKS: On the contrary, she said it's a sign that election officials are doing their job and counting every single vote.

MCEVERS: NPR's Miles Parks. Additional reporting in this episode by NPR's Nurith Aizenman, Will Stone, who's been reporting on Arizona for NPR, and Amelia Templeton of Oregon Public Broadcasting. For more on the coronavirus, you can stay up to date with all the news on your local public radio station and in our daily coronavirus newsletter, "The New Normal." Sign up at

I'm Kelly McEvers. We'll be back with more tomorrow.

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