‘People have to be responsible for themselves’: Why five states are refusing 'lockdowns' against coronavirus

Without stay-at-home orders on the state or local level, 'holdouts' in rural America face threats from an outbreak and the closures of vulnerable hospitals

Maryam Jorgensen of Des Moines, Iowa waits for a bus to the grocery store. The state is among a handful without any stay-at-home measures. (AP)

By the time Florida's stay-at-home order kicks in on 2 April, two weeks after the arrival of thousands of spring breakers on the state's beaches, the number of identified coronavirus cases in the state climbed past 5,000.

Arizona's governor issued a stay-at-home order this week after banning cities from setting their own measure, tying the hands of mayors across the state against the advice of health officials.

Without a nationwide order to keep people indoors and close non-essential businesses in an effort to curb the viral spread through stringent "social distancing" measures, a staggered and patchwork response from state governments has made attempts to quarantine Americans essentially moot.

By April, 12 states have not issued statewide orders to stay at home, and 12 states have not closed so-called "nonessential" businesses.

But there remains a handful of states without either of those orders, on neither state or city levels, as health officials across the US continue to urge people to stay indoors and avoid going outside and risk interacting with infected people or unknowingly infecting others.

Republican governors in Arkansas, Iowa, Nebraska, North Dakota and South Dakota — the last states standing — said they're not considering virtual "lockdowns" in their respective states.

Asked why he hasn't considered a national order, Donald Trump said "because states are different" and that "some states don't have much of a problem."

At a White House briefing on 1 April, he said: "They don't have thousands of people that are positive or thousands of people that think they might have it, or hundreds of people in some cases." (This week, South Dakota became the last state to report more than 100 cases.)

Whether the White House or local governments put orders in place in coming days, experts say the damage is done. Harvard professor Juliette Kayyem, a former US Department of Homeland Security official in the Obama administration, said it's time for a national stay-at-home measure — at least three weeks ago.

She said: "The fat lady has sung, govs."

Asked whether every state would have a stay at home order, US Surgeon General Jerome Adams told NBC that the White House suggestions ("30 days to slow the spread") are essentially a "national stay-at-home order."

He said that the administration wants "nationally people to understand the importance of social distancing" and is leaving those guidelines to states to determine their plans.

But virologist Joseph Fair told the network that those mitigation efforts only work "if all 50 states are doing the same thing."

He said: "Everybody gets on the same page as far as what they're going to do and everybody implements the same measures."

But even if that starts now, those "social distancing" rules would need to be in place for at least 10 weeks to be effective.

He said: "If everyone is not doing it, there are still going to be people spreading it. There are things we're going to have to do — we have to go to the grocery store, we have to go to the pharmacy. There are people working in hospitals. But we can all do our own part and everyone has to do it."

Arkansas is the last state in the south without any statewide measure. Neither Governor Asa Hutchinson nor any county or city in the state has told residents to stay at home.

She said: "I do not want to go to a shelter-in-place environment."

On 1 April, Nebraska Governor Pete Ricketts ordered schools to continue operating, without students, but he has refused a statewide stay-at-home order. There are no such orders in the rest of the state.

Many Americans fear the consequences of relative martial law under the Trump administration, forcing people in their homes and out of their jobs without the assurance of any social safety nets and as a cover for the administration's more authoritarian impulses.

But several state officials say they delayed or refused to tell their residents to stay home to keep their fragile economies moving, echoing the president's claims to "re-open" the economy and weigh the loss of lives against the loss of business.

Iowa Governor Kim Reynolds has ordered many, but not all, nonessential businesses to close, but won't issue a statewide stay-at-home order, despite calls from lawmakers and other officials, as 946 cases of the virus were identified in the state this week.

She said: "I can't lock the state down, I can't lock everybody in their home ... We have to make sure the supply chain is up and going. We have an essential workforce that has to be available.

"What else are we doing" by ordering people to stay home "except for potentially disrupting the supply chain, putting additional pressure on the essential workforce, and making sure that we are considering how we bring that back up?" Reynolds said. "And, actually, what's the benefit of taking that additional step?"

She has called for "personal responsibility" instead, saying that limiting "the amount of times that we're going out, what we're going out for, where we're going, and minimising the number of people that we're around, we will start to accomplish, hopefully, what we're trying to do."

Fourteen counties in Missouri have mandate stay-at-home orders and nonessential business closures, but Governor Mike Parson won't issue a statewide order.

He said it's a matter of "personal responsibility."

"When you start talking about shutting the state down for 30 days, 60 days or 90 days, the effects that has on everyday people are dramatic," he said. "That means businesses will close, people will lose their jobs, the economy will be in worse shape than ever."

North Dakota and South Dakota, with largely rural and spread-out populations, also don't have orders anywhere in their state telling people to stay at home or close nonessential businesses.

South Dakota — the last state to hit more than 100 cases — only has a ban on gatherings of more than 10 people.

Rural Americans live an average of 10.5 miles from the nearest hospital, while people in urban and suburban neighbourhoods live, on average, five miles away from a hospital, according to Pew Research Center.

But more than 1 million Americans live in rural areas at least 20 miles from the nearest hospital, and a majority of those residents are 60 and older and more prone to chronic illness, putting them in a more acutely at-risk population if exposed to Covid-19.

They largely live in states that do not have any stay-at-home orders in place.

More than 400 rural hospitals across the US are at risk of closing, as Republican-led governments have refused to expand Medicaid in their states leaving health systems to rely on negative margins, according to the Chartis Center for Rural Health.

Since 2016, 41 rural hospitals across the US have closed, mostly in the southeast and Great Plains.

More than 40 per cent of rural hospitals in Florida, Missouri, Mississippi, Tennessee and Texas are considered "vulnerable" to closure. Of that group, only Florida and Tennessee have ordered statewide stay-at-home measures.

Those hospitals could be bolstered by $100bn from Congress aimed at hospitals and health providers, though it's unclear how that will be allocated.

Texas, a large and rural state with several massive metropolitan areas, has stay-at-home orders in more than two dozen cities and counties, putting roughly 82 per cent of the state under shelter-in-place orders

Echoing the president's support for "reopening the US" by Easter, a timetable he has since withdrawn, Texas Lt Gov Dan Patrick was slammed for his Fox New appearance in which he suggested that senior citizens should be willing "take a chance on your survival in exchange for keeping the America that all America loves" by putting Americans back to work in the middle of the pandemic.

In a letter to Governor Greg Abbot, Democrats in the state have urged the governor to act: "Despite the hardship, the best science we have is clear that this is the best way forward for our state and our country."

He recently announced that religious services in Texas are considered "essential" after police arrested pastors in Louisiana and Florida for holding large Sunday ceremonies.

After Arizona Governor Doug Ducey barred cities in his state from setting their own orders, Tucson Mayor Regina Romero's office told The Independent that the city was exploring "all options" to set an order at the local level.

The state's emergency management director resigned last month citing a "lack of communication and transparency" through the coronavirus response.

The governor ultimately issued a stay-at-home order this week, but has left in place a broad list of businesses considered "essential" that can remain open.

Several other Democratic mayors in Republican states have issued citywide measures in the absence of statewide orders.

Mississippi Governor Tate Reeves has urged people to stay at home but has not made that an order. Oxford mayor Robyn Tannehill did.

Alabama Governor Kay Ivey has advised residents to "consider" staying home "now and for the foreseeable future" but has not issued a statewide order. Birmingham mayor Randall Woodfin did.

This week, Wyoming Governor Mark Gordon said the state still has no plans for an order. Jackson mayor Pete Muldoon's order went into effect "immediately" last week.

White House officials have praised stringent measures in hard-hit states and cities, but insist on respecting "statehood" in the face of the crisis.

Mike Pence told CNN: "At the present moment, we truly do believe that the strong actions taken in places like California and Washington and New York and New Jersey are appropriate ... We fully support those efforts."

The vice president said the administration is "going to continue to bring the president the best recommendations based on real-time data and science for what every state, what every community should be doing" but is aiming to "reopen" the country by early June and "put America back to work."

He said: "We could well have the coronavirus largely behind us."

UPDATE (07.04.20): A previous version of this article reported that 3,000 cases of the virus had been identified in the state of Iowa.This was inaccurate. The article has been updated to reflect the correct​ figure at the time of publication.