By Sarah Fowler, Anne Gearan & Rachel Weiner

Even before President Trump admonished his top coronavirus adviser for saying the country was entering a "new phase" of widespread infection, patients at Mississippi's only Level 1 trauma hospital were already on a wait for ICU beds.

“Our ICUs have been full for weeks,” LouAnn Woodward, a vice chancellor at the University of Mississippi Medical Center in Jackson, said Thursday. “It’s a very acute issue we’re facing here.”

Mississippi, now experiencing the country’s highest rate of positive tests, is emblematic of the pandemic’s new reality. The virus is no longer principally an urban problem: It is present throughout every state, and those infected often don’t know it, leading to what top public health officials call “inherent community spread.”

This has proved true for Ohio Gov. Mike DeWine (R), who learned he had the novel coronavirus when he tested positive Thursday morning in advance of a planned meeting with Trump. Trump went ahead with his visit to a Whirlpool plant; DeWine, the second governor known to have contracted the virus, went into self-isolation. Later Thursday, DeWine tweeted that a subsequent test had come back negative.

The situation in Mississippi is unfolding as well in other largely rural parts of the country, including in Alabama and California’s Central Valley, places where so much viral material is circulating that when people get infected, many are unsure when or how it happened — so the outbreaks cannot be easily traced and contained.

State health officials in Alabama, for instance, say they are starting to see the impact of a mask mandate imposed two weeks ago. But some worry the dramatic spread might be attributable to people giving up on testing, as results can take days or weeks to come back.

“My fear is if we don’t see some decline in hospital caseloads, we’re going to be really, really challenged when we’re faced with increased caseloads due to schools reopening,” said Don Williamson, president of the Alabama Hospital Association. “I hope I’m wrong but I don’t know of any biological reason I’ll be wrong.”

School openings in Alabama are a local decision, but public health officials offer guidance in part based on the risk in that county. As of Thursday, 44 of the state’s 67 counties are considered “high risk” or “very high risk.”

In California, the eight-county Central Valley has resisted many measures to bring down the infection rate and is now the state’s most concerning region. Over the past week, the number of cases in Fresno County has risen 41 percent, although in recent days the hospitalization rate has declined slightly.

Much of the population is made up of Latinos, who now have more than half of California’s nearly 530,000 coronavirus cases while accounting for 40 percent of the population. The region, scorching hot in the summer months, is also the heart of a multibillion-dollar agriculture industry that has taken little time off.

Late last month, Gov. Gavin Newsom (D) announced that he would send medical “strike teams” and $52 million in federal aid to the Central Valley.

In Ohio, Trump wished the governor well but said little new about the pandemic. He wore a mask during his plant tour, but not as he railed against “the plague inflicted upon us by China.”

In an implicit rejection of the assessment given earlier this week by Deborah Birx, the physician overseeing the White House coronavirus response, the president said the current approach of protecting vulnerable populations is working.

“Our strategy shelters those at highest risks while allowing those at lower risk to get safely back to work and school,” Trump said. “Instead of a never-ending blanket lockdown, causing severe, long-term public health consequences, we’ve targeted and looked at data-driven approaches.”

Birx on Sunday urged Americans to take extreme health precautions as infections and deaths rise sharply nationwide, saying, “I want to be very clear: What we’re seeing today is different from March and April,” while noting that cases are increasing in rural and urban areas. “It is extraordinarily widespread.”

Anthony S. Fauci, the nation’s top infectious-disease expert, backed her up on Monday, as Trump tweeted his disdain.

In the early stages of the U.S. coronavirus outbreak, DeWine, who leads the nation’s seventh-most-populous state, stood out among governors for his aggressive response in canceling a sports festival and closing schools and bars before the virus had spread so much.

By contrast, Mississippi Gov. Tate Reeves, a Republican who won office last year with support from Trump, has been slow and inconsistent in his approach to the coronavirus, vacillating on what businesses can open and whether local governments can impose stricter rules than the state has been willing to do.

His “healthy at home” order lasted only a few weeks, and after weeks of arguing that a statewide mask mandate would be ineffective, he imposed one this week and reversed course to delay in-person school for a portion of students.

“I’ve been criticized by an awful lot of people, but I’ve taken a piecemeal approach because I believed firmly that that was the best way to get the most number of people to participate,” Reeves said this week.

He also said that all metrics show the state is “starting to turn a corner.” Daily caseloads are declining, but deaths are rising, as is the percentage of tests coming back positive. Over the past two weeks, according to the Federal Emergency Management Agency, Mississippi’s positivity rate — 21.7 percent — was the country’s highest.

Because caseloads are dependent on the level of testing, the task force Birx leads has been focused on percent positivity as a key indicator. A high percentage of positive tests suggests that the virus is widespread in the community and not enough people are being tested.

“Our test positivity rate is too high,” Reeves acknowledged, but he said it might be skewed by poor reporting from the private sector.

The state reported nearly 1,000 new cases Thursday and 21 deaths. Over the past week, it has tallied nearly 7,000 new cases and 214 fatalities.

Tim Moore, president of the Mississippi Hospital Association, has urged caution, citing the ICU predicament. More than half the state’s ICU beds are filled with covid-19 patients, and only about a quarter of the state’s total ICU beds are available, he said.

Only the sickest patients typically end up in the ICU, but Moore and others are eyeing the potential for a surge in such patients as primary schools reopen under Reeves’s latest plan.

“I’m not quite as optimistic right now as maybe the governor is,” he said in an interview. “It’s a bad move to open up all these schools right now. Have you ever tried to socially isolate a second-grader? It’s like trying to keep frogs in a wheelbarrow.”

Moore said he is grateful for Reeves’s mask mandate and hopes it is extended another two weeks. Already, he said, more people are wearing masks and resisting less when asked to put one on.

Trump has said mask mandates aren’t needed, but that people should wear face coverings on their own. He continues to insist that schools open on time, even as some Republican governors are ordering delays.

As the school year begins, parents in Mississippi have encountered what they say are confusing messages from state leaders and a disappointing realization that the virus remains a persistent risk.

In Rankin County, Emily Frederick’s two children will start school Aug. 17, doing a hybrid schedule of attending in person and learning online for the first two weeks before attending in person full-time. She would prefer that classes for 9-year-old Katie Beth and 8-year-old Garrett be entirely virtual, but she missed a district cutoff window to sign up.

“I’m not afraid that they’ll catch the virus or transmit the virus so much, but I’m worried that the virus will transmit in the school and then we’ll be back to the not knowing and back to going back and forth between virtual and in the classroom,” Frederick said.

Carey Wright, Mississippi’s superintendent for education, said Thursday afternoon she has gotten positive feedback from superintendents whose districts opened this week, but that the future is uncertain.

As of Thursday morning, the Corinth School District confirmed that more than 100 students were quarantined after positive cases were identified on campus. The district went back to school last week.

When asked if she expected a similar situation at other Mississippi schools, Wright said, “Let me just say, I won’t be surprised.”