PHOENIX (AP) — When the coronavirus flared in China this week, the country canceled flights, suspended reopenings and described the situation as “extremely grave.” With cases still rising in some U.S. states, local officials have balked at requiring people to wear masks.

In the United States, which has more reported cases and deaths than anywhere else, local authorities are wrestling with balancing demands for constitutional rights and personal freedom with warnings from health officials that being lax will have deadly consequences.

China responded Wednesday to a new outbreak in Beijing by scrapping more than 60% of its flights to the capital, canceling classes and strengthening requirements for social distancing. It was a sharp retreat for the nation that only in March had declared victory over COVID-19.

“This has truly rung an alarm bell for us,” Party Secretary Cai Qi told a meeting of Beijing’s Communist Party Standing Committee.

In other countries where infections have flared, governments responded by again tightening restrictions.

But as U.S. states decide how and when to reopen parts of the economy amid surges in cases in places like Arizona and Florida, requiring even the use of masks has become a political and cultural debate, with some local officials defying pleas from doctors.

“Wearing masks decreases the shed of this virus,” said Dr. Bill Saliski, a lung specialst at Jackson Hospital in Montgomery, Alabama. “If this continues the way we’re going, we’re going to be overrun.”

Montgomery County has added more than 700 coronavirus cases in the past week, more than any other county in Alabama, with a total of 2,922 infections.

Saliski appealed to the Montgomery City Council on Tuesday night to mandate face coverings at public gatherings of 25 or more, but the measure failed, with members concerned about trampling on individuals' rights.

“I think to make somebody do something or require somebody to wear something is an overreach,” said council member Brantley Lyons.

Council member Audrey Graham upbraided members for what she said was a failure to act.

“I think we fail to realize how serious this really is,” Graham said. “We are not taking a stand. We’re doing nothing. Nothing here.”

South Carolina Gov. Henry McMaster has expressed concerns about mandating masks as infringing on civil liberties, stressing that people must take responsibility for their actions.

“There are some limits to what we can do and what we can enforce,” he said, adding: “At this point, the answer is individual responsibility. It’s not mandates by the government.”

The state has added 595 new virus cases, bringing the total to nearly 20,000 since the outbreak began. In all, 607 people have died from the virus in South Carolina.

A heated debate about masks has erupted in Arizona, where cases have been growing daily. Hundreds of medical professionals signed a letter urging Gov. Doug Ducey to require them, and the state’s largest newspaper, the Arizona Republic, on Wednesday said he should take action.

Ducey has encouraged people to use masks but, like President Donald Trump, has not worn one himself during any of his news conferences and has rebuffed calls to issue an order requiring them. He has also resisted imposing new restrictions on businesses, attributing Arizona’s surge in cases to increased testing.

Arizona has been doing more tests, which can yield more cases, but health experts say a better way to see if more people getting sick is to look at the percentage of positive tests. When that percentage rises, it means the outbreak is worsening -- not just that more people are getting tested.

Arizona currently leads the nation with the highest seven-day average positive test rate: 17.7%, or about double the national average and well above the 10% threshold that health officials find worrisome. It also has the most new cases per capita in the nation in the past 14 days. The state's leading hospital system says it is almost running out of beds, and more than 1,100 people visited emergency rooms Tuesday with positive or suspected cases.

Several restaurants and other businesses also have had to close because staff tested positive in the last week, including one sports bar chain in a hard-hit Phoenix neighborhood where staff was not required to wear masks.

In parts of Florida, people under 35 are testing positive at a higher rate since the pandemic began, contributing to a surge in cases, officials said Wednesday.

In St. Petersburg, three popular bars closed after employees tested positive.

“This is happening statewide. Ideally, we would have leadership from the top and this would be a statewide decision,” St. Petersburg Mayor Rick Kriseman said, adding that Gov. Ron DeSantis has encouraged people to use masks but not mandated them.

Pinellas County Commissioner Ken Welch said the county's cases initially were in assisted living residences and nursing homes but now have shifted to younger people. He said 25% of the cases are in the African-American community.

Welch and Kriseman, both Democrats, blamed Republicans DeSantis and Trump.

DeSantis said he has no intention of closing Florida’s economy again despite the new cases, saying many of those getting sick are young and thus unlikely to suffer serious illness or death.

DeSantis said much of the two-week spike in confirmed infections that pushed the daily total past 2,700 on Tuesday can be traced to farm workers or businesses where a few positive cases led to widespread testing that uncovered high percentages of asymptomatic or barely symptomatic cases.

Since the virus emerged in China late last year and spread worldwide, there have been more than 8.1 million confirmed cases and at least 443,000 deaths, according Johns Hopkins University. Experts say the true toll is much higher. The U.S. has the most infections and deaths in the world, with a toll that neared 117,000 on Wednesday.

European nations, which embarked on a wide-scale reopening this week, watched with trepidation as the Americas struggled with the pandemic and new outbreaks were reported in Asia.

After lockdown restrictions were relaxed in Iran, Health Minister Saeed Namaki said he realized the extent of the challenge when he took a domestic flight.

“Many people have become careless, frustrated with wearing masks,” he said. “They did not observe (social) distancing in the flight’s seating and the airliner’s ventilation system was not working.”

Tang reported from Phoenix, Moritsugu from Beijing, and Pane from Boise, Idaho. Associated Press reporters around the world contributed.