While the coronavirus curve appeared to be flattening in South Carolina last month, disease activity has recently taken a sharp turn upward, and public health experts said the increase can't be fully explained by more robust testing across the state.
"I think it’s hard (to tell), to be honest, because as you do more tests, you’re going to catch more infections," said Michael Sweat, director of the Medical University of South Carolina's Center for Global Health. "(The increase) is probably partially because of more testing, but more likely, we’re seeing a true increase in the number of cases."
According to data reported by the S.C. Department of Health and Environmental Control, more than 13,000 South Carolinians have tested positive for COVID-19 this year and more than 500 people have died from the disease.
DHEC reports the number of new cases on a daily basis, and on a few occasions this past week, the daily counts were among the highest-ever on record for the state.
One metric the state health department uses to account for the increased number of tests performed is the percent of all tests yielding a positive result. That number has also recently increased. On May 21, the percent positive of all tests was 4.8 percent. On June 3, it had grown to 5.5 percent.
"It can change so rapidly," Sweat said. "It can really, really blow up overnight."
While statewide numbers give an overview of the disease's activity across South Carolina, Sweat said regional data is more useful.
MUSC is specifically tracking COVID-19 in Charleston, Lancaster and Florence, where the health system operates hospitals.
"Every place is a little unique. In Charleston, we’re still in a low growth rate," he said, "but it’s something to watch because it’s going up."
Sweat said "there is no question" that the recent increase in cases is directly tied to changes in restrictions. In May, people started moving around more outside their homes. Cellphone tracking data proves it, he said.
When nonessential businesses closed and Gov. Henry McMaster put in place a stay-at-home order, human mobility in South Carolina dropped to 30 percent of its normal level. Now, Sweat said, we're back up to 85 percent.
"Everyone’s predicting ... that we’re going to see an uptick," he said. "That’s really what’s interesting. We know when you do a lockdown, it has a profound effect. It stops an epidemic. How much is enough to keep it in control? That’s something we’re going to learn our way through."
Dr. Jim Ellis. president of the Prisma Health Medical Group — Midlands, agreed that the curve is hard to predict at this point.
"If you look at all the predictive analytics models out there, they’re just that — predictive," Ellis said. "We’ve really been blessed in South Carolina that it hasn’t been as bad as everywhere else."
That doesn't mean it couldn't take a turn for the worse, he said. Public health experts need to be particularly vigilant about high-risk environments, such as nursing homes, correctional facilities, factories and poultry plants, he said.
"What happens if this does get worse? We are preparing," he said.
Sweat, with MUSC, said it is still too soon to tell how outdoor protests in response to the death of George Floyd will impact the spread of disease in South Carolina and across the country.
He expressed equal concern about indoor "super-spreader" events, such parties or crowded bars.
"I’m very supportive of people protesting … but (protests have) a lot of characteristics that are risky," he said. Chanting, failure to avoid social distancing guidelines and refusal to wear masks increases the risk of transmission.
During a staged demonstration at MUSC on Friday afternoon called "White Coats for Black Lives," more than 100 hospital employees knelt for a moment of silence that lasted 8 minutes and 46 seconds.
Nearly everyone who participated in the outdoor demonstration wore masks, but social distancing guidelines weren't strictly followed. An on-campus security officer at one point instructed participants to spread out.
"Social distancing," he said. "Social distancing, please."