Joe Biden secured an unsurprising victory in Ohio’s primary on Tuesday, in a significant first major test of statewide elections via mail amidst the coronavirus outbreak.

The majority use of a mail-in ballot system came as a result of Covid-19 regulations, with voters advised not to attend polling stations in person due to the statewide stay-at-home order to stem the spread of the virus.

Overall turnout was surprisingly strong, according to Ohio’s secretary of state, Frank LaRose, and while the system was reported to have caused some confusion among residents it wasn’t said to have created significant disruption.

“It was better than OK. It was great,” Mr LaRose said.

Around 1.5 million votes were cast in the election by midday on Saturday, according to Mr LaRose’s office, fewer than half of the total number cast in 2016’s primary.

However, the secretary insisted that tens of thousands of ballots were received on Tuesday.

Donald Trump has publicly heavily opposed the widespread use of mail-in ballots, having claimed that if elections were to go ahead with measures to make absentee voting more accessible that “you’d never have a Republican elected in this country again”.

“The things they had in there were crazy. They had things, levels of voting that if you’d ever agreed to it, you’d never have a Republican elected in this country again,” said Mr Trump said in response to the $4bn Democrats had attempted to include in a coronavirus relief bill to safeguard November’s presidential election.

Mr Trump and other Republicans have expressed fear that the use of all absentee ballots would lead to widespread voter fraud.

Wisconsin primary Show all 13 1 /13 Wisconsin primary Wisconsin primary Steve Merriweather waits to vote inside Riverside University High School during the Wisconsin primary REUTERS Wisconsin primary Aaron Lipski, the assistant chief of the Milwaukee Fire Department, stands in a tyvec suit as he monitors health an safety at a polling station inside Hamilton High School during the Wisconsin primary REUTERS Wisconsin primary Voters practise social distancing in Milwaukee during the Wisconsin primary REUTERS Wisconsin primary Voters wait to cast their ballots at a polling station in Milwaukee during the Wisconsin primary REUTERS Wisconsin primary Rachel Messenger wears a sign reading 'Thank you for risking your life to vote' outside Riverside University High School in Milwaukee during the Wisconsin primary REUTERS Wisconsin primary Voters in masks wait to cast their ballots in Milwaukee during the Wisconsin primary REUTERS Wisconsin primary A line of voters outside Riverside University High School in Milwaukee during the Wisconsin primary REUTERS Wisconsin primary Voters filling out their ballots in Milwaukee during the Wisconsin primary REUTERS Wisconsin primary People wearing protective masks wait to vote in Milwaukee during the Wisconsin primary REUTERS Wisconsin primary A City of Milwaukee Election Commission worker takes a break during the Wisconsin primary AP Wisconsin primary City of Milwaukee Election Commission workers process absentee ballots during the Wisconsin primary AP Wisconsin primary Voters waiting to cast their ballots in Milwaukee during the Wisconsin primary EPA Wisconsin primary A line of people wait in their cars for their turn to vote at Riverside High School in Milwaukee during the Wisconsin primary EPA

The president even previously accused some who cast ballots in US elections by mail of “cheating”, despite having applied for one himself to participate in the Florida primary.

Democrats have argued that forcing residents to choose between voting and endangering their health by leaving the house amidst the pandemic is an act of “voter suppression”.

“[Mr Trump] is apparently willing to expose voters to the deadly Covid-19 for purely partisan political advantage,” said Zoe Logfren, a Democratic representative who spearheaded the campaign to include provisions in the relief bill.

Wisconsin voters were faced with such a decision when the primary election went ahead as planned at the beginning of this month.

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After a drawn-out conflict over whether the voting would be delayed, the state’s conservative top court ruled in-person voting would go ahead as planned.

Images from polling day showed voters forced to wait together in lines spanning several blocks to attend polling booths in person, despite a statewide stay-at-home order remaining firmly in place to stem the spread of the coronavirus, which had claimed at least 92 lives in the state at the time.

Officials in Milwaukee have now reportedly been able to trace seven positive coronavirus cases back to in-person voting during the Wisconsin primary, while officials said they were aware of 40 cases in people who had either worked at the polls or voted in-person, The Hill reported.

In a similar bid as Wisconsin, the Ohio the primary was originally recommended to be delayed until June, however, after facing legal pressure was forced to implement a largely absentee mail-in process.

The new structure involved most of the electorate casting absentee ballots by submitting three different pieces of documentation by mail.

Only homeless and disabled residents were initially encouraged to attend a polling station to cast a ballot in person, however anyone without a mail ballot was permitted to attend a polling station.

In a poll cast by The Wall Street Journal and NBC, 67 per-cent of Americans agreed that in the current circumstances of the pandemic, they would support changing the law so that mail-in voting was available to all Americans

Some states already cast their vote entirely by mail including Colorado, Hawaii, Oregon and Utah, however, their decisions to do so remain independent from the coronavirus outbreak.

Ken Blackwell, the former Ohio election chief, said he didn’t see Tuesday’s results setting a precedent.

“My opinion going forward is that no serious thought should be given to converting to mail-in balloting for the November election,” Mr Blackwell said.

“You lick an envelope and mail in a ballot, there’s all kinds of evidence that would suggest that there would be ballots lost, and because you’ve taken out the bipartisan oversight at the basic community level, you lose a degree of almost guaranteed legitimacy.”

Last week the House passed the relief bill with $400 mil in provisions the possible eventuality that the 2020 presidential election may take during the coronavirus pandemic.