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Anyone feeling confident about having COVID-19 under control should take a few minutes to watch Dr. Sakina Naqvi’s testimony before Minnesota lawmakers last week.

The Fairview Health Services pulmonary and critical care specialist’s voice is hoarse and she exudes exhaustion while describing caring for severely ill patients. This new strain of coronavirus has yet to settle into a predictable pattern of symptoms, behaving differently from one patient to the next. “We routinely find ourselves at a loss because what should be true isn’t,’’ said Naqvi, who wore blue scrubs as she spoke during the videoconference hearing on Wednesday. “The realization of what we do not know continues to grow.’’

Months into the COVID-19 pandemic, Naqvi’s mix of caution and humility may be unsettling, but it’s appropriate — not just inside hospitals, but in general. Dramatic case count increases in states that previously had escaped the worst of the pandemic are a reminder of how little control there is over the virus and how much there still is to learn. Important decisions, such as reopening schools and easing other restrictions, will be made with the best but likely imperfect information available at the time. Adjustments will be necessary as knowledge expands or viral behavior continues to defy understanding.

The steep learning curve means schools, if they reopen for in-person classes, may have to close again if Minnesota disease metrics take a turn for the worse. The same holds true for bars, restaurants and other organizations dependent on people gathering indoors, a known risk factor for spreading COVID-19. “We’re going to be coexisting with this virus for some time,” said Andy Slavitt, who ran the federal Centers for Medicare and Medicaid Services in the Obama administration. Slavitt also testified at Wednesday’s hearing.

Minnesota has recently been faring better than many states, with the daily number of new cases holding relatively steady while COVID surged elsewhere, according to the New York Times COVID tracker. But the pandemic’s accelerating course in Arizona, Florida and South Carolina shows how quickly this can change.

The three had previously been relatively unscathed as COVID hit New York hard earlier this year. Now, according to the New York Times, these Sun Belt states have the “world’s worst outbreaks.” The ranking system looked at each U.S. state and compared it internationally for case growth, adjusted for population. Arizona, Florida and South Carolina are ranked 1, 2 and 3, with Bahrain at 4.

For perspective, consider that as recently as June 9, Arizona had fewer cases than Minnesota, according to the Kaiser Family Foundation’s COVID tracker. But as of early Friday, Arizona had reported 112,671 confirmed cases, while Minnesota had 40,201.

Some might question whether more testing is responsible for the three states’ case growth. The reality: The states are testing more, but the percentage of positive tests, along with rising hospitalizations and deaths, indicates increased spread.

Slavitt brought a welcome note of optimism to Wednesday’s hearing, saying that social distancing and other mitigation measures have given scientists valuable time to study the virus and develop treatments. But there’s still a long way to go.

Expectations about returning to normal should be adjusted accordingly. This will likely happen in fits and starts, as occurred during the 1918 influenza pandemic. The only thing certain at this time is that we will have to learn to live with uncertainty and adjust as necessary in the months ahead.

— Minneapolis Star Tribune, July 10