EVERY THREE days or so, the United States suffers as many deaths from covid-19 as lives were lost in the Sept. 11 terrorist attacks. The pandemic is emphatically not over: Some places are experiencing new spikes in cases, positive test results, hospitalizations and deaths, especially in the south and west. Absent national leadership, the country is now a crazy quilt of local responses, with the virus surging in places and flattening in others, but still on the march overall.

By one measure, the 14-day direction is “trending poorly” in 24 states, “making progress” in 21 states and the District, and “trending better” in just five states. Some localities are particularly hard-hit a month after reopening around Memorial Day, including Arizona, which on May 15 lifted its stay-at-home order. People flooded Phoenix-area bar districts, ignoring social distancing guidelines, the Associated Press reported, noting there were no requirements to wear face masks, no major increases in contact tracing and no scale-up of infection control at nursing homes. Today, the state has seen a 198 percent increase in cases over the past two weeks and 14.2 percent of test results are positive.

Texas also opted for a rapid reopening — and its hospitalizations passed 2,100 on Wednesday for the first time during the pandemic. That’s a 42 percent increase in patients since Memorial Day weekend, when beachgoers swarmed the coast and a water park near Houston opened to big crowds. Texas has had a 54 percent increase in cases over 14 days. Other states of concern include North Carolina, South Carolina, Florida and Georgia.

There is not an absolute correlation between these surges and the reopenings. Some spikes may reflect better testing. But the hospitalizations are an unambiguous sign of trouble. It will be worse if the latest outbreaks are uncontained, as states continue to open up and ease restrictions. If there is another explosive surge, as occurred in New York City in March, whole swaths of the United States may face the agonizing and exceedingly difficult question of whether to reimpose lockdown orders.