America’s most populous state has become one of the nation’s worst epicenters for the disease, setting new records for cases, hospitalizations and deaths almost every day. Things are so bad in Southern California that some patients are being treated in hospital tents, while doctors have begun discussing whether they need to ration care.

The turnabout has confounded leaders and health experts. They can point to any number of reasons that contributed to California’s surge over the past several weeks. But it is hard to pinpoint one single factor — and equally hard to find a silver bullet…

Some have blamed the strict rules themselves, saying that cooped-up Californians couldn’t take it any longer and decided they need to live their lives. Others have said congregant settings remain a severe concern in a housing-constrained state, especially in low-income communities where residents live in tight quarters and must continue to work in-person to survive.

The state hasn’t employed strict enforcement and has relied on its regulatory agencies to cite the worst-offending establishments in spot cases. But it has no real hammer against people gathering or engaging in everyday social activities, and many local law enforcement agencies have made a point of declaring they will not become the stay-at-home police.