‡Suspected cases have not been confirmed by laboratory tests as being due to this strain, although some other strains may have been ruled out.
The COVID-19 pandemic in the United States is part of the worldwide pandemic of coronavirus disease 2019 (COVID-19). More than 33.4 million confirmed cases have been reported since January 2020, resulting in more than 599,000 deaths, the most of any country, and the twentieth-highest per capita worldwide. As many infections go undetected, the Centers for Disease Control estimates that as of March 2021, there have been a total 114.6 million infections in the United States. The U.S. has about one-fifth of the world's confirmed cases and deaths. COVID-19 became the third-leading cause of death in the U.S. in 2020, behind heart disease and cancer. U.S. life expectancy dropped from 78.8 years in 2019 to 77.8 years in the first half of 2020.
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 President Donald Trump declared the U.S. outbreak a public health emergency on January 31. Restrictions were placed on flights arriving from China, but the initial U.S. response to the pandemic was otherwise slow, in terms of preparing the healthcare system, stopping other travel, and testing.[a] Meanwhile, Trump remained optimistic and was accused by his critics of underestimating the severity of the virus.
After China confirmed that the cluster of infections was caused by a novel infectious coronavirus on January 7, the CDC issued an official health advisory the following day. The World Health Organization (WHO) warned on January 10 about the strong possibility of human-to-human transmission and urged precautions. On January 20, the WHO and China both confirmed that human-to-human transmission had indeed occurred. The CDC immediately activated its Emergency Operations Center (EOC) to respond to the outbreak in China. Also, the first report of a COVID-19 case in the U.S. was reported. After other cases were reported, on January 30, the WHO declared a Public Health Emergency of International Concern (PHEIC) – its highest level of alarm – warning that "all countries should be prepared for containment."[e] The same day, the CDC confirmed the first person-to-person case in America. The next day, the U.S. declared a public health emergency. 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.
The Trump administration evacuated American nationals from Wuhan in late January; the evacuees were greeted by officials who did not wear protective gear because the Trump administration worried about "bad optics". On February 2, the U.S. enacted travel restrictions to and from China. 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, by which point nine other COVID-19 deaths had occurred in Santa Clara County. The virus had been circulating undetected at least since early January and possibly as early as November. On February 25, the CDC warned the American public for the first time to prepare for a local outbreak. The next day "Patient Zero" (Manhattan attorney Lawrence Garbuz, then thought to be the first community-acquired case) became ill in New York City.
By March 11, the virus had spread to 110 countries, and the WHO officially declared a pandemic. 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. Dr. Anthony Fauci said the mortality from the coronavirus was 10 times higher than the common flu.
By March 12, diagnosed cases of COVID-19 in the U.S. exceeded a thousand. On March 16, the White House advised against any gatherings of more than ten people. Three days later, the United States Department of State advised U.S. citizens to avoid all international travel.[dead link]
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. 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. Manpower from the military and volunteer armies were called up to help construct the emergency facilities.
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. By March 27, the country had reported over 100,000 cases. 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. 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. 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. On April 28, the total number of confirmed cases across the country surpassed one million.
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. 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. 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 6–24 times higher infections, which was further confirmed by a later population-wide serosurvey.
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".
In July, U.S. PIRG and 150 health professionals sent a letter asking the federal government to "shut it down now, and start over". In July and early August, requests multiplied, with a number of experts asking for lockdowns of "six to eight weeks" that they believed would restore the country by October 1, in time to reopen schools and have an in-person election.
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. 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.
USA Today studied the aftermath of presidential election campaigning, recognizing that causation was impossible to determine. Among their findings, cases increased 35 percent compared to 14 percent for the state after a Trump rally in Beltrami County, Minnesota. One case was traced to a Joe Biden rally in Duluth.
On November 9, President-elect Biden's transition team announced his COVID-19 Advisory Board. On the same day, the total number of cases had surpassed ten million while the total had risen by over a million in the ten days prior, averaging 102,300 new cases per day. Pfizer also announced that its COVID-19 vaccine may be up to ninety percent effective. 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.
In spite of recommendations by the government not to travel, more than two million people flew on airlines during the Thanksgiving period. On December 8, the U.S. passed fifteen million cases, with about one out of every 22 Americans having tested positive since the pandemic began. By December 12, TSA employees across U.S. airports had a 38 percent increase in COVID-19 infections. 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.
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. 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."
On January 1, 2021, the U.S. had twenty million cases, representing an increase of more than a million over the past week and ten million in less than two months. On January 6, the CDC announced that it had found at least 52 confirmed cases of the B.1.1.7 variant, and it also stressed that there could already be more cases in the country. 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". It was believed the variant had been present in the U.S. since October.
On January 19, the U.S. passed 400,000 deaths, just five weeks after the country passed 300,000 deaths. On January 22, the U.S. passed 25 million cases, with one of every 13 Americans testing positive for COVID-19. On January 25, the U.S. reported its first case of a new SARS-CoV-2 variant from Brazil (P.1) in Minnesota. Three days later, on January 28, the country reported its first two cases of a new, possibly vaccine-resistant SARS-CoV-2 variant from South Africa (B.1.351) in South Carolina. On February 22, the U.S. passed 500,000 deaths, just five weeks after the country passed 400,000 deaths. By March 5, more than 2,750 cases of COVID-19 variants were detected in 47 states; Washington, D.C.; and Puerto Rico.
In the first prime time address of his presidency on March 11, Biden announced his plan to push states to make vaccines available to all adults by May 1, with the aim of making small gatherings possible by July 4. On March 24, the U.S. passed thirty million cases, just as a number of states began to expand the eligibility age for COVID-19 vaccines. Experts began warning against public relaxation of COVID-19 mitigation measures as vaccines continue to be administered, with one, CDC director Rochelle Walensky, warning of a new rise in cases.
By March 27, more than 8,000 cases of the B.1.1.7 variant were reported across 51 jurisdictions. By April 1, the number increased to more than 11,000, with cases mostly being reported in Florida and Michigan. By April 7, the B.1.1.7 variant had become the dominant COVID-19 strain in the U.S. On April 12, the U.S. reported its first cases of a new "double mutant" SARS-CoV-2 variant from India (B.1.617) in California. By April 25, the country's seven-day average of new infections was reported to be decreasing, but concerns were raised about drops in vaccine demand in certain parts of the U.S., which were attributed to vaccine hesitancy. On April 29, the CDC estimated that roughly 35% of the U.S. population had been infected with the virus as of March 2021, about four times higher than the official reported numbers.
On May 4, Biden announced a new goal of having 70 percent of all adults in the U.S. receive at least one COVID-19 vaccine shot by July 4, along with steps to vaccinate teenagers and more inaccessible populations. On May 6, a study by the Institute for Health Metrics and Evaluation estimated that the true COVID-19 death toll in the U.S. was more than 900,000 people. On May 9, Dr. Fauci confirmed that the U.S. death toll was likely undercounted.
On May 13, the CDC changed their guidance and stated that fully vaccinated individuals do not need to wear masks in most situations. Some states ended their mask mandates shortly after, while others maintained the mandate. The CDC was criticized for confusion resulting from the announcement as it did not remove existing state and local mandates. The guidance did not remove the federal mask mandate on public transportation.
On January 28, the CDC updated its China travel recommendations to level3, its highest alert. On February 8, the WHO's director-general announced that a team of international experts had been assembled to travel to China and he hoped officials from the CDC would also be part of that mission. In late January, Boeing announced a donation of 250,000 medical masks to help address China's supply shortages. On February 7, The State Department said it had facilitated the transportation of nearly eighteen tons of medical supplies to China, including masks, gowns, gauze, respirators, and other vital materials. On the same day, U.S. Secretary of State Pompeo announced a $100million pledge to China and other countries to assist with their fights against the virus.
Contact tracing is a tool to control transmission rates during the reopening process. Some states like Texas and Arizona opted to proceed with reopening without adequate contact tracing programs in place. Health experts have expressed concerns about training and hiring enough personnel to reduce transmission. Privacy concerns have prevented measures such as those imposed in South Korea where authorities used cellphone tracking and credit card details to locate and test thousands of nightclub patrons when new cases began emerging. Funding for contact tracing is thought to be insufficient, and even better-funded states have faced challenges getting in touch with contacts. Congress has allocated $631million for state and local health surveillance programs, but the Johns Hopkins Center for Health Security estimates that $3.6billion will be needed. The cost rises with the number of infections, and contact tracing is easier to implement when the infection count is lower. Health officials are also worried that low-income communities will fall further behind in contact tracing efforts which "may also be hobbled by long-standing distrust among minorities of public health officials". As of July 1, only four states are using contact tracing apps as part of their state-level strategies to control transmission. The apps document digital encounters between smartphones, so the users will automatically be notified if someone they had contact with has tested positive. Public health officials in California claim that most of the functionality could be duplicated by using text, chat, email, and phone communications.
In the United States, remdesivir is indicated for use in adults and adolescents (aged twelve years and older with body weight at least 40 kilograms (88 lb)) for the treatment of COVID‑19 requiring hospitalization. The FDA issued an emergency use authorization (EUA) for the combination of baricitinib with remdesivir, for the treatment of suspected or laboratory confirmed COVID-19 in hospitalized people two years of age or older requiring supplemental oxygen, invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO). In early March, President Trump directed the FDA to test certain medications to discover if they had the potential to treat COVID-19 patients. Among those were chloroquine and hydroxychloroquine, which have been successfully used to treat malaria for over fifty years. A small test in France by researcher Didier Raoult had given positive results, although the study was criticized for design flaws, small sample size, and the fact that it was published before peer review. On March 28, the FDA issued an Emergency Use Authorization (EUA) which allowed certain hospitalized COVID-19 patients to be treated with hydroxychloroquine or chloroquine. On June 15, the FDA revoked the EUA for hydroxychloroquine and chloroquine as potential treatments for COVID-19, saying the available evidence showed "no benefit for decreasing the likelihood of death or speeding recovery". However, Trump continued to promote the use of hydroxychloroquine for COVID-19 by late July.
From early 2020, more than 70 companies worldwide (with five or six operating primarily in the U.S.) began vaccine research. In preparation for large-scale production, Congress set aside more than $3.5billion for this purpose as part of the CARES Act. On November 20, 2020, the Pfizer–BioNTech partnership submitted a request for emergency use authorization for its vaccine to the Food and Drug Administration (FDA), which was granted on December 11. On December 18, 2020, the FDA granted the Moderna vaccine emergency use authorization, which Moderna had requested on November 30, 2020. Starting on December 14, 2020, the first doses of COVID-19 vaccine were administered.
Polling showed a significant partisan divide regarding the outbreak. In February, similar numbers of Democrats and Republicans believed COVID-19 was "a real threat": 70% and 72%, respectively. By mid-March, 76% of Democrats viewed COVID-19 as "a real threat", while only 40% of Republicans agreed. In mid-March, various polls found Democrats were more likely than Republicans to believe "the worst was yet to come" (79–40%), to believe their lives would change in a major way due to the outbreak (56–26%), and to take certain precautions against the virus (83–53%). The CDC was the most trusted source of information about the outbreak (85%), followed by the WHO (77%), state and local government officials (70–71%), the news media (47%), and President Trump (46%). A May 2020 poll concluded that 54% of people in the U.S. felt the federal government was doing a poor job in stopping the spread of COVID-19 in the country. 57% felt the federal government was not doing enough to address the limited availability of COVID-19 testing. 58% felt the federal government was not doing enough to prevent a second wave of COVID-19 cases later in 2020. In September 2020, Pew Research Center found that the global image of the United States had suffered in many foreign nations. In some nations, the United States' favorability rating had reached a record low since Pew began collecting this data nearly twenty years ago. Across thirteen different nations, a median of fifteen percent of respondents rated the U.S. response to the pandemic positively.
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. The economy contracted 4.8 percent from January through March 2020, and the unemployment rate rose to 14.7 percent in April. The total healthcare costs of treating the epidemic could be anywhere from $34billion to $251billion according to analysis presented by The New York Times. A study by economists Austan Goolsbee and Chad Syverson indicated that most economic impact due to consumer behavior changes was prior to mandated lockdowns. 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 percent. As of June 2020, the U.S. economy was over ten percent smaller than it was in December 2019.
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.OpenTable estimated in May that 25 percent of American restaurants would close their doors permanently.
The economic impact and mass unemployment caused by the COVID-19 pandemic has raised fears of a mass eviction crisis, with an analysis by the Aspen Institute indicating 30–40 million are at risk for eviction by the end of 2020. According to a report by Yelp, about sixty percent of U.S. businesses that have closed since the start of the pandemic will stay shut permanently.
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. 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,[dubious – discuss] the relatively high numbers of elderly residents, immigrant laborers with shared living conditions and meat-processing plants.
Disproportionate numbers of cases have been observed among Black and Latino populations. Of four studies published in September 2020, three found clear disparities due to race and the fourth found slightly better survival rates for Hispanics and Blacks. As of September 15, 2020, Blacks had COVID-19 mortality rates more than twice as high as the rate for Whites and Asians, who have the lowest rates.CNN reported in May 2020 that the Navajo Nation had the highest rate of infection in the United States. Additionally, a study published by the New England Journal of Medicine in July 2020 revealed that the effect of stress and weathering on minority groups decreases their stamina against COVID.
From 2019 to the first half of 2020, in the United States the life expectancy of a white person decreased 0.8 years; a Hispanic person, 1.9 years; and a Black person, 2.7 years. The COVID Tracking Project published data revealing that people of color were contracting and dying from COVID-19 at higher rates than Whites. An NPR analysis of April–September 2020 data from the COVID Tracking Project found that Black people's share of COVID-19 deaths across the United States was 1.5 times greater (in some states 2.5 times greater) than their share of the U.S. population. Similarly, Hispanics and Latinos were disproportionately infected in 45 states and had a disproportionate share of the deaths in 19 states. Native American and Alaskan Native cases and deaths were disproportionally high in at least 21 states and, in some, as much as five times more than average. White non-Hispanics died at a lower rate than their share of the population in 36 states and D.C.
By April 2020, closed schools affected more than 55 million students.
The pandemic prompted calls from voting rights groups and some Democratic Party leaders to expand mail-in voting, while Republican leaders generally opposed the change. Some states were unable to agree on changes, resulting in lawsuits. Responding to Democratic proposals for nationwide 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. 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. 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.
High COVID-19 fatalities at the state and county level correlated with a drop in expressed support for the election of Republicans, including the reelection of President Trump, according to a study published in Science Advances that compared opinions in January–February 2020 with opinions in June 2020.
The United States has experienced pandemics and epidemics throughout its history, including the 1918 Spanish flu, the 1957 Asian flu, and the 1968 Hong Kong flu pandemics. 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.
According to the Global Health Security Index, an American-British assessment which ranks the health security capabilities in 195 countries, the U.S. was the "most prepared" nation in 2020.