2020 coronavirus outbreak in the United States

The COVID-19 pandemic in the United States is a part of the worldwide pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In the United States, it has resulted in confirmed cases with all-time deaths, the most of any country, and the twentieth-highest per capita worldwide. The COVID-19 pandemic ranks first on the list of disasters in the United States by death toll; it was the third-leading cause of death in the U.S. in 2020, behind heart disease and cancer. From 2019 to 2020, U.S. life expectancy dropped by 3years for Hispanic and Latino Americans, 2.9years for African Americans, and 1.2years for white Americans. These effects persisted as U.S. deaths due to COVID-19 in 2021 exceeded those in 2020, and life expectancy continued to fall from 2020 to 2021.

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.

The first known American deaths occurred in February. On March 6, 2020, Trump allocated $8.3 billion to fight the outbreak and declared a national emergency on March 13. The government also purchased large quantities of medical equipment, invoking the Defense Production Act of 1950 to assist. By mid-April, disaster declarations were made by all states and territories as they all had increasing cases. A second wave of infections began in June, following relaxed restrictions in several states, leading to daily cases surpassing 60,000. By mid-October, a third surge of cases began; there were over 200,000 new daily cases during parts of December 2020 and January 2021.

COVID-19 vaccines became available in December 2020, under emergency use, beginning the national vaccination program, with the first vaccine officially approved by the Food and Drug Administration (FDA) on August 23, 2021. Studies have shown them to be highly protective against severe illness, hospitalization, and death. In comparison with fully vaccinated people, the CDC found that those who were unvaccinated were from 5 to nearly 30 times more likely to become either infected or hospitalized. There has nonetheless been some vaccine hesitancy for various reasons, although side effects are rare. There have also been numerous reports that unvaccinated COVID-19 patients have strained the capacity of hospitals throughout the country, forcing many to turn away patients with life-threatening diseases.

A fourth rise in infections began in March 2021 amidst the rise of the Alpha variant, a more easily transmissible variant first detected in the United Kingdom. That was followed by a rise of the Delta variant, an even more infectious mutation first detected in India, leading to increased efforts to ensure safety. The January 2022 emergence of the Omicron variant, which was first discovered in South Africa, has led to record highs in hospitalizations and cases, with as many as 1.5 million new infections reported in a single day.

State and local responses to the pandemic have included the requirement to wear a face mask in specified situations (mask mandates), prohibition and cancellation of large-scale gatherings (including festivals and sporting events), stay-at-home orders, and school closures. Disproportionate numbers of cases have been observed among Black and Latino populations, as well as elevated levels of vaccine hesitancy, and there has been a sharp increase in reported incidents of xenophobia and racism against Asian Americans. Clusters of infections and deaths have occurred in many areas. The COVID-19 pandemic has also led to misinformation and conspiracy theories and has highlighted weaknesses in the U.S. public health system.

Timeline

December 2019 to April 2020

In November 2019, COVID-19 infections had first broken out in Wuhan, China. China publicly reported the cluster on December 31, 2019. After China confirmed that the cluster of infections was caused by a novel infectious coronavirus on January 7, 2020, the CDC issued an official health advisory the following day. On January 20, the World Health Organization (WHO) and China both confirmed that human-to-human transmission had 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 publicly reported, though the ''All of Us'' study (released in 2021) showed five states already had cases weeks earlier. After other cases were reported, on January 30, the WHO declared a Public Health Emergency of International Concern (PHEIC)its highest level of alarmwarning that "all countries should be prepared for containment." The same day, the CDC confirmed the first person-to-person case in the U.S. The next day, the country 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 January. 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, New York City saw the sickening of its "patient zero", Manhattan attorney Lawrence Garbuz, then thought to be the first community-acquired case. Another case known as "patient zero" in Los Angeles is a man named Gregg Garfield, who spent 64 days in the Burbank Hospital, on a ventilator for 30 days, with a 1% chance to live. Contracting the virus from a ski trip, Garfield was able to return to the slopes, although with fingers and toes amputated. In February, Vice President Mike Pence took over for Secretary Alex Azar as chair of the White House Coronavirus Task Force.

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 COVID-19 was ten 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.

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. 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.

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 26, '' New York Times'' data showed the United States to have the highest number of known cases of any country. 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 1million.

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 6, the United States Department of State announced the country's withdrawal from WHO effective July 6, 2021. 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. In July, US 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. The U.S. passed five million COVID-19 cases by August 8.

September to December 2020

On September 22, the U.S. passed 200,000 deaths, according to data from Johns Hopkins University. In early October, an unprecedented series of high-profile U.S. political figures and staffers announced they had tested positive for COVID-19. On October 2, Trump announced on Twitter that both he and the First Lady had tested positive for COVID-19 and would immediately quarantine. Trump was given an experimental Regeneron product with two monoclonal antibodies and taken to Walter Reed National Military Medical Center, where he was given remdesivir and dexamethasone.

'' 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, Minnesota.

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 2million people flew on airlines during the Thanksgiving period. On December 8, the U.S. passed 15million cases, with about one out of every 22 Americans having tested positive since the pandemic began. 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, later called Alpha, 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 say, "Given the small fraction of US infections that have been sequenced, the variant could already be in the United States without having been detected."

January to April 2021

On January 1, 2021, the U.S. passed 20million cases, representing an increase of more than a million over the past week and 10million in less than two months. On January 6, the CDC announced that it had found at least 52 confirmed cases of the Alpha 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 25million cases, with one of every 13 Americans testing positive for COVID-19. On January 29, a nationwide requirement for use of face masks on public transit and other forms of public transportation was issued by the CDC and the federal Transportation Security Administration, to go into effect on February 1. (Subsequently, extended, the federal mask mandate for public transportation remains in effect in April 2022.)

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 30million 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 CDC director Rochelle Walensky, warning of a new rise in cases.

By April 7, the Alpha 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, later called Delta, 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.

May to August 2021

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. The country ultimately did not reach that goal, with only 67 percent of the overall adult population having done so by July 4. 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 its guidance and said 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 the confusion resulting from the announcement, as it did not remove existing state and local mandates. The guidance also did not remove the federal mask mandate on public transportation. On June 15, the U.S. passed 600,000 deaths, though the number of daily deaths had decreased due to vaccination efforts.

By June, COVID-19 cases rose again, especially in Arkansas, Nevada, Missouri, and Wyoming. The rising numbers were believed to be attributable to the Delta variant. By July 7, the Delta variant had surpassed the Alpha variant to become the dominant COVID-19 strain in the U.S., according to CDC data. By August the Delta variant accounted for 99 percent of all cases and was found to double the risk of hospitalization for those not yet vaccinated."Among the unvaccinated, Delta variant more than doubles risk of hospitalization"
''Los Angeles Times'', August 28, 2021

On August 1, the U.S. passed 35million cases. By early and mid-August, hospitals in some states with low vaccination rates began to exceed capacity. One-quarter of the U.S. population resides in eight states—Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Nevada, and Texas—but, by mid-August, these states together had a half of COVID-19 hospitalizations in the nation. By the end of the month, the ICUs of five of those—Alabama, Arkansas, Florida, Georgia, and Texas—were over 90% full.

September to November 2021

On September 8, the U.S. passed 40million cases. By September 15, one in every 500 Americans had died from COVID-19. By September 20, COVID-19 had killed over 675,000 Americans, the estimated number of American deaths from the Spanish flu in 1918. As a result, COVID-19 became the deadliest respiratory pandemic in recent American history. The Associated Press called the new numbers a "colossal tragedy" because, despite a century of advances in science, the country failed to take full advantage of vaccines. On October 1, the U.S. passed 700,000 deaths. On October 18, the U.S. passed 45million cases. On November 26, Biden announced that the U.S. will restrict travel from South Africa and seven other African countries due to concerns over a new variant from the area, called Omicron.

December 2021 to March 2022

At the beginning of January 2022, the number of cases per day exceeded 1,000,000. As of February 1, fatality rates were 63% higher in the U.S. than other large wealthy countries, due in part to far lower vaccination rates compared to those countries. On March 9, the Biden administration advised Congress of a lack of funding for testing, therapeutics and vaccines, but Republicans continued to block new spending on the pandemic so Democrats removed an emergency aid package from a proposed spending bill. On March 20, Dr. Anthony S. Fauci warned of an "uptick" in cases like Europe has seen recently, stating the U.S. should "be prepared for the possibility that we might get another variant".

April to June 2022

In April 2022, it was reported by CNN that COVID-19 numbers reached pandemic lows across the US, resulting in many testing sites closing their doors. With testing sites seeing as low as single digits per day, Director of Public Health Services Division of the Haywood County Health and Human Services Agency in North Carolina Sarah Henderson suggested that she expected most counties to see closures soon, if they hadn't already. "We were seeing an excess of 100 patients at our testing site in the first few days f January which doesn't sound like a lot, but our community is very small," Henderson said. "The last couple of weeks, we have seen single digits every day. I certainly won't speak for other counties, but I think we're probably heading in that direction where if they're not closing down, they're decreasing hours and staff."

On April 18, 2022, the federal transportation mask mandate, which had been extended to May 3 by the Biden administration on the advice of the CDC, was ended nationwide by U.S. District Judge Kathryn Kimball Mizelle

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