The COVID-19 pandemic in the United States is part of the worldwide pandemic of coronavirus disease 2019 (COVID-19). More than 27,000,000 confirmed cases have been reported since January 2020, resulting in more than 463,000 deaths, the most of any country and the eighth-highest per capita.[6][9] The U.S. has nearly a quarter of the world's cases and a fifth of all deaths. More Americans have died from COVID-19 than during World War II.[10] COVID-19 became the third leading cause of death in the U.S. in 2020, behind heart disease and cancer.[11]
On December 31, 2019, China announced the discovery of a cluster of pneumonia cases in Wuhan. The first American case was reported on January 20, and then-President Donald Trump declared the U.S. outbreak a public health emergency on January 31. Restrictions were placed on flights arriving from China,[12][13] but the initial U.S. response to the pandemic was otherwise slow, in terms of preparing the healthcare system, stopping other travel, and testing.[14][15][16][a] Meanwhile, Trump remained optimistic on the future of the coronavirus in the United States.
The first known American deaths occurred in February.[18][b] On March 6, Trump signed the Coronavirus Preparedness and Response Supplemental Appropriations Act, which provided $8.3 billion in emergency funding for federal agencies to respond to the outbreak.[19] On March 13, President Trump declared a national emergency.[20] In mid-March, the Trump administration started to purchase large quantities of medical equipment,[21] and in late March, it invoked the Defense Production Act to direct industries to produce medical equipment.[22] By April 17, the federal government approved disaster declarations for all states and territories. By mid-April, cases had been confirmed in all fifty U.S. states, and by November in all inhabited U.S. territories. A second rise in infections began in June 2020, following relaxed restrictions in several states.[23]
In late November 2019, coronavirus infections had first broken out in Wuhan, China.[31][32] China publicly reported the cluster on December 31, 2019.[3] On January 6, U.S. Health and Human Services offered to send China a team of Centers for Disease Control and Prevention (CDC) health experts to help contain the outbreak, but China ignored the offer,[33] which the CDC said contributed to the U.S. and other countries getting a late start in identifying the danger and taking early action.[34][35]
After China confirmed that the cluster of infections was caused by a novel infectious coronavirus[3] on January 7, the CDC issued an official health advisory the following day.[36] The World Health Organization (WHO) warned on January 10 about the strong possibility of human-to-human transmission and urged precautions.[37] On January 20, the WHO and China both confirmed that human-to-human transmission had indeed occurred.[38] The CDC immediately activated its Emergency Operations Center (EOC) to respond to the outbreak in China.[39] Also, the first report of a COVID-19 case in the U.S. was reported.[3] After other cases were reported, on January 30, the WHO declared a Public Health Emergency of International Concern (PHEIC)—its highest level of alarm[40]—warning that "all countries should be prepared for containment."[41][42][e] The same day, the CDC confirmed the first person-to-person case in America.[44] The next day, the U.S. declared a public health emergency.[45] Although by that date there were only seven known cases in the U.S., the HHS and CDC reported that there was a likelihood of further cases appearing in the country.[45]
The Trump administration evacuated American nationals from Wuhan in late January; the evacuees were greeted by officilas who did not wear protective gear because the Trump administration worried about "bad optics."[46] On February 2, the U.S. enacted travel restrictions to and from China.[13] On February 6, the earliest confirmed American death with COVID-19 (that of a 57-year-old woman) occurred in Santa Clara County, California. The CDC did not report its confirmation until April 21,[18] by which point nine other COVID-19 deaths had occurred in Santa Clara County.[47] The virus had been circulating undetected at least since early January and possibly as early as November.[48] On February 25, the CDC warned the American public for the first time to prepare for a local outbreak.[49] However, large gatherings that occurred before then accelerated transmission.[50]
By March11, the virus had spread to 110 countries, and the WHO officially declared a pandemic.[24] The CDC had already warned that large numbers of people needing hospital care could overload the healthcare system, which would lead to otherwise preventable deaths.[52][53] Dr. Anthony Fauci said the mortality from the coronavirus was 10 times higher than the common flu.[54]
By March 12, diagnosed cases of COVID-19 in the U.S. exceeded a thousand.[55] On March 16, the White House advised against any gatherings of more than ten people.[56] Since March 19, the State Department has advised U.S. citizens to avoid all international travel.[57]
By the middle of March, all fifty states were able to perform tests with a doctor's approval, either from the CDC or from commercial labs. However, the number of available test kits remained limited, which meant the true number of people infected had to be estimated.[58] As cases began spreading throughout the nation, federal and state agencies began taking urgent steps to prepare for a surge of hospital patients. Among the actions was establishing additional places for patients in case hospitals became overwhelmed.[59] Manpower from the military and volunteer armies were called up to help construct the emergency facilities.[60][61]
Throughout March and early April, several state, city, and county governments imposed "stay at home"quarantines on their populations to stem the spread of the virus.[62] By March 27, the country had reported over 100,000 cases.[63] On April 2, at President Trump's direction, the Centers for Medicare & Medicaid Services (CMS) and CDC ordered additional preventive guidelines to the long-term care facility industry.[64] On April 11, the U.S. death toll became the highest in the world when the number of deaths reached 20,000, surpassing that of Italy.[65] On April 19, the CMS added new regulations requiring nursing homes to inform residents, their families and representatives, of COVID-19 cases in their facilities.[66] On April 28, the total number of confirmed cases across the country surpassed one million.[67]
May to August 2020
By May 27, less than four months after the pandemic reached the U.S., 100,000 Americans had died with COVID-19.[68] State economic reopenings and lack of widespread mask orders resulted in a sharp rise in cases across most of the continental U.S. outside of the Northeast.[69] A study conducted in May 2020 indicated that the true number of COVID-19 cases in the United States was much higher than the number of confirmed cases with some locations having 6 to 24 times higher infections.[70][71]
On July 6, the United States Department of State announced U.S. withdrawal from the World Health Organization effective July 6, 2021.[72] The U.S. passed five million COVID-19 cases by August8.[73]
On July 10, the CDC adopted the Infection Fatality Ratio (IFR), "the number of individuals who die of the disease among all infected individuals (symptomatic and asymptomatic)," as a new metric for disease severity, replacing the Symptomatic Case Fatality Ratio and the Symptomatic Case Hospitalization Ratio. Per the CDC, the IFR "takes into account both symptomatic and asymptomatic cases, and may therefore be a more directly measurable parameter for disease severity for COVID-19."[74]
In July, U.S. PIRG and 150 health professionals sent a letter asking the federal government to "shut it down now, and start over".[75] In July and early August, requests multiplied, with a number of experts asking for lockdowns of "six to eight weeks"[76] that they believed would restore the country by October 1, in time to reopen schools and have an in-person election.[77]
In August, over 400,000 people attended the 80th Sturgis Motorcycle Rally in Sturgis, South Dakota, and from there, at least 300 people in more than 20 states were infected.[78] The CDC followed up with a report on the associated 51 confirmed primary event-associated cases, 21 secondary cases, and five tertiary cases in the neighboring state of Minnesota, where one attendee died of COVID-19.[79]
On September 22, the U.S. passed 200,000 deaths, according to data from Johns Hopkins University.[80] In early October, an unprecedented series of high-profile U.S. political figures and staffers announced they had tested positive for COVID-19.[81][82] On October 2, Trump announced on Twitter that both he and the First Lady had tested positive for the coronavirus and would immediately quarantine.[83][82] Trump was given an experimental Regeneron product with two monoclonal antibodies[84][f] and taken to Walter Reed National Military Medical Center,[86] where he was given remdesivir and dexamethasone.[87]
USA Today studied the aftermath of presidential election campaigning, recognizing that causation was impossible to determine. Among their findings, cases increased 35% compared to 14% for the state after a Trump rally in Beltrami County, Minnesota. One case was traced to a Biden rally in Duluth.[88]
On November 9, President-electJoe Biden's transition team announced his COVID-19 Advisory Board.[89] On the same day, the total number of cases had surpassed 10 million[90] while the total had risen by over 1 million cases in the ten days prior, averaging 102,300 new cases per day.[91] Pfizer also announced that its COVID-19 vaccine may be up to 90% effective.[92][93] In November, the Trump administration reached an agreement with a number of retail outlets, including pharmacies and supermarkets, to make the COVID-19 vaccine free once available.[94]
In spite of recommendations by the government not to travel, over two million people ended up flying on airlines during the Thanksgiving period.[95] On December 8, the U.S. passed 15 million cases, with about one out of every 22 Americans having tested positive since the pandemic began.[96] By December 12, TSA employees across U.S. airports had a 38% increase in COVID-19 infections.[97] On December 14, the U.S. passed 300,000 deaths, representing an average of more than 961 deaths per day since the first known death on February 6. More than 50,000 deaths were reported in the past month, with an average of 2,403 daily deaths occurring in the past week.[98] On December 20, a 52-year-old female Black woman, Dr Susan Moore died of complications from COVID-19, after she was sent home from the hospital following her treatment. Moore had raised a complaint against the biased medical treatment of Black patients, where a white doctor at a hospital in suburban Indianapolis downplayed her complaints of pain.[99]
On December 24, following concerns over a probably more easily transmissible new SARS-CoV-2 variant from the United Kingdom (B.1.1.7), the CDC announced testing requirements for American passengers traveling from the UK, to be administered within 72 hours, starting on December 28.[100][101] On December 29, the U.S. reported the first case of this variant in Colorado. The patient had no travel history, leading the CDC to state, "Given the small fraction of US infections that have been sequenced, the variant could already be in the United States without having been detected."[102] On December 30 and 31, the country's second and third confirmed cases of the variant were reported in California and Florida.[103][104]
On January 1, 2021, the U.S. passed 20 million cases, representing an increase of more than one million over the past week and 10 million in less than two months.[108][109] On January 6, the CDC announced that it had found at least 52 confirmed cases of the more contagious SARS-CoV-2 variant in California, Florida, Colorado, Georgia, and New York; and it also stressed that there could already be more cases in the country.[110] In the following days, more cases of the variant were reported in other states, leading former CDC director Tom Frieden to express his concerns that the U.S. will soon face "close to a worst-case scenario".[111] It was believed the more contagious variant was present in the U.S. since October.[112]
Also on January 6, supporters of President Trump stormed the United States Capitol building.[113] At least one activist participated in the riot despite a recent positive COVID-19 diagnosis,[114] and few members of the crowd wore face coverings, with many coming from out of town.[113] A group of maskless Republicans sheltering in place were recorded refusing masks offered by Representative Lisa Blunt Rochester (D–DE),[115] and as many as 200 congressional staffers reportedly sheltered in various rooms inside the Capitol, further increasing the risk of transmission.[113][116]Brian P. Monahan, the attending physician of Congress, later reported that members of Congress may have been exposed to others with COVID-19 while sheltering in place.[115][117] Four members of Congress have since tested positive due to the exposure.[118]
On January 19, the U.S. passed 400,000 deaths, just five weeks after the country passed 300,000 deaths.[119] On January 22, the U.S. passed 25 million cases, with one of every 13 Americans testing positive for COVID-19.[120]
Responses
Main article: /Responses
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Conspiracy theories and misinformation reached millions of Americans through social media and television commentary.[124] As a result, many people believe falsehoods, for example, that wearing masks is dangerous, that a global syndicate planned the virus, or that COVID-19 is a hoax.[124][125]Facebook announced that it had labeled or deleted 179 million user posts containing COVID-19 misinformation during the first three quarters of 2020.[126] President Trump has repeatedly broadcast misinformation to downplay the threat of the virus and to deflect criticism of the administration's response.[127] Trump has asserted that he does this to "show calm", stating "I don't want to create a panic" [128]
Impacts
Economic
Marquee at a closed music venue in Washington, D.C.
The pandemic, along with the resultant stock market crash and other impacts, led a recession in the United States following the economic cycle peak in February 2020.[129] The economy contracted 4.8 percent from January through March 2020,[130] and the unemployment rate rose to 14.7 percent in April.[131] The total healthcare costs of treating the epidemic could be anywhere from $34billion to $251billion according to analysis presented by The New York Times.[132] A study by economists Austan Goolsbee and Chad Syverson indicated that most economic impact due to consumer behavior changes was prior to mandated lockdowns.[133] During the second quarter of 2020, the U.S. economy suffered its largest drop on record, with GDP falling at an annualized rate of 32.9%. As of June 2020, the U.S. economy was over 10% smaller than it was in December 2019.[134]
President Trump and Airline CEOs discuss COVID-19's impact on the travel industry on March 4, 2020
In September, Bain & Company reported on the tumultuous changes in consumer behavior before and during the COVID-19 pandemic. Potentially permanently, they found acceleration towards e-commerce, online primary healthcare, livestreamed gym workouts, and moviegoing via subscription television. Concurrent searches for both low-cost and premium products, and a shift to safety over sustainability, occurred alongside rescinded bans and taxes on single-use plastics, and losses of three to seven years of gains in out-of-home foodservice.[135]OpenTable estimated in May that 25% of American restaurants would close their doors permanently.[136]
The economic impact and mass unemployment caused by the COVID-19 pandemic has raised fears of a mass eviction crisis,[137][138][139][140] with an analysis by the Aspen Institute indicating 30–40million are at risk for eviction by the end of 2020.[141][142] According to a report by Yelp, about 60% of U.S. businesses that have closed since the start of the pandemic will stay shut permanently.[143]
Impact of the pandemic on various economic variables
In May, daily infection and death rates were still higher per capita in densely populated cities and suburbs, but were increasing faster in rural counties. Of the 25 counties with the highest per capita case rates in May, 20 had a meatpacking plant or prison where the virus was able to spread unchecked.[151] By July rural communities with populations less than 50,000 had some of the highest rates of new daily cases per capita. Factors contributing to the spread of COVID-19 in these communities are high rates of obesity[152][dubious – discuss], the relatively high numbers of elderly residents, immigrant laborers with shared living conditions and meat-processing plants.[153]
The pandemic has had far-reaching consequences beyond the disease itself and efforts to contain it, including political, cultural, and social implications.
Disproportionate numbers of cases have been observed among Black and Latino populations,[25][26][27] and there were reported incidents of xenophobia and racism against Asian Americans.[28] Of four studies published in September, three found clear disparities due to race and the fourth found slightly better survival rates for Hispanics and Blacks.[154] As of September 15, Blacks had COVID-19 mortality rates more than twice as high as the rate for Whites and Asians, who have the lowest rates.[155]CNN reported in May that the Navajo Nation had the highest rate of infection in the United States.[156] Additionally, a study published by the New England Journal of Medicine in July revealed that the effect of stress and weathering on minority groups decreases their stamina against COVID.[157]
In September, NPR reviewed its previously reported data from the COVID Tracking Project[158] finding again that COVID-19 infected and killed people of color at higher rates than Whites and more than their share of the population. Blacks died 1.5 times and in some states 2.5 times their share of the population. Hispanics and Latinos died more often in 19 states, and were infected more frequently in 45 states. Native American and Alaskan Native deaths and cases were disproportionally high in 21 states and 5 times more in some states, with insufficient data in some states. White non-Hispanics died at a lower rate than their share of the population in 36 states and D.C.[159]
By April, closed schools affected more than 55 million students.[160]
The pandemic prompted calls from voting rights groups and some Democratic Party leaders to expand mail-in voting. Republican leaders generally opposed the change, though Republican governors in Nebraska and New Hampshire adopted it. Some states were unable to agree on changes, and a lawsuit in Texas resulted in a ruling (which is under appeal) that would allow any voter to mail in a ballot.[161] Responding to Democratic proposals for nation-wide mail-in voting as part of a coronavirus relief law, President Trump said "you'd never have a Republican elected in this country again" despite evidence the change would not favor any particular group.[162] Trump called mail-in voting "corrupt" and said voters should be required to show up in person, even though, as reporters pointed out, he had himself voted by mail in the last Florida primary.[163] Though mail-in vote fraud is slightly higher than in-person voter fraud, both instances are rare, and mail-in voting can be made more secure by disallowing third parties to collect ballots and providing free drop-off locations or prepaid postage.[164] April7 elections in Wisconsin were impacted by the pandemic. Many polling locations were consolidated, resulting in hours-long lines. County clerks were overwhelmed by a shift from 20 to 30% mail-in ballots to about 70%, and some voters had problems receiving and returning ballots in time. Despite the problems, turnout was 34%, comparable to similar previous primaries.[165]
According to a study published in Science Advances, areas with higher levels of COVID-19 fatalities were less likely to support Trump and Republican candidates for Congress.[166]
The United States has been subjected to pandemics and epidemics throughout its history, including the 1918 Spanish flu, the 1957 Asian flu, and the 1968 Hong Kong flu pandemics.[167][168][169] In the most recent pandemic prior to COVID-19, the 2009 swine flu pandemic took the lives of more than 12,000 Americans and hospitalized another 270,000 over the course of approximately a year.[167]
According to the Global Health Security Index, an American-British assessment which ranks the health security capabilities in 195 countries, the U.S. in 2020 was the "most prepared" nation.[170][171]
^This chart only includes lab-confirmed cases and deaths. Not all states report recoveries. Data for the current day may be incomplete.
^The editorial board for The Wall Street Journal suggested the world may have been "better prepared" had the PHEIC been declared a week sooner, when the virus had spread to other countries.[43]
^In a news release, Sean Conley, physician to President Trump, incorrectly identified Regeneron's monoclonal antibody product as polyclonal.[85]
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