"We are seeing that in places that are opening, we're not seeing this spike in cases," Azar told broadcaster CNN. "We still see spikes in some areas that are in fact close to very localised situations."

Many states across the country, which has revorded more than 88,000 virus-related deaths - by far the most in the world - are starting to ease restrictions to varying degrees.

Azar said local leaders must judge "whether a bar being open, a restaurant, a school is the right thing."

"These are very localised determinations; there should not be a one size fits all to reopening," he said.

"But re-open we must because it's not health versus the economy. It's actually health versus health," he said, pointing to possible health consequences of maintaining shutdowns, such as cases of self-harm and a lack of cardiac procedures and other vaccinations.

Australian Associated Press