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As COVID-19 cases rise again, how will the US respond? Here’s what states have learned so far

<span class="caption">States have tried shutting down bars and limiting restaurants to outdoor seating to slow the coronavirus's spread.</span> <span class="attribution"><a class="link rapid-noclick-resp" href="http://gettyimages.com/detail/news-photo/patrons-dine-at-an-outdoor-restaurant-along-5th-avenue-in-news-photo/1227674724" rel="nofollow noopener" target="_blank" data-ylk="slk:Sandy Huffaker/Getty Images">Sandy Huffaker/Getty Images</a></span>
States have tried shutting down bars and limiting restaurants to outdoor seating to slow the coronavirus’s spread. Sandy Huffaker/Getty Images

When COVID-19 began spreading in the U.S. in early spring, governors in hard-hit states took drastic steps to reduce the threat and avoid overloading their health care systems. By shutting down nonessential businesses and schools and ordering people to stay home, they slowed the virus’s spread, but several million people lost jobs.

Since then, we’ve witnessed a series of ad hoc experiments with more targeted approaches. As states started to reopen, they tested different levels of restrictions, such as face mask mandates and capacity constraints on restaurants. Some closed bars when cases rose again but left other businesses open. Others set restrictions that would be triggered only for hot spots when a county’s positive case numbers passed a certain threshold.

Now, as cooler weather moves more people indoors and daily case numbers rise, states and communities are looking to those successes and failures as they consider what future strategies should look like. Could more targeted closures and restrictions be effective, or will a return to statewide stay-at-home orders be needed again?

As public health researchers, we’ve been following the strategies as they evolve, and we see lessons those experiments hold for the country.

Better testing and treatment, but a long way to go

The nation’s ability to respond to the virus has improved since COVID-19 first reached U.S. cities.

Testing capacity has expanded and results are available faster. That means people who become infected can be isolated faster. Treatment methods have also improved. For the most severe cases, innovative use of low-cost steroids and repositioning patients to support breathing have helped seriously ill patients recover faster.

However, there is still no vaccine, a lot of questions remain about new therapies, and shortages are predicted for personal protective equipment as a new flu season approaches.

People stand in line at a clinic offering quick coronavirus testing near Long Beach, California.
Rapid tests and more testing supplies at clinics have helped pinpoint coronavirus hotspots. Brittany Murray/MediaNews Group/Long Beach Press-Telegram via Getty Images

With colder weather now arriving, the nation faces a greater potential for virus outbreaks to spread. More person-to-person contact will be inevitable with more indoor activities and in-person classes in schools and colleges.

The upcoming holidays will also mean more inside gatherings and travel. Throughout the pandemic, data have revealed a pattern of increased cases within two weeks of holidays and other events that increase contact and related exposures. For example, an uptick in cases in the Midwest was linked to late summer gatherings around Labor Day and the reopening of colleges. State and local leaders need to be prepared.

So what works?

From the nationally reported and global case data, it seems clear that requirements for social distancing and mask-wearing combined with stay-at-home orders and business closures can effectively reduce virus transmission.

New Jersey and New York initially implemented strict, prolonged measures and were able to keep case rates lower through the summer, while several states that quickly lifted restrictions saw their