COVID-19 pandemic in the United States

Health and Human Services (HHS) Secretary Alex Azar signs a public health emergency declaration.

The United States along with more than 100 other countries have been subjected to pandemics and epidemics throughout their history, including the 1918 Spanish flu, the 1957 Asian flu, and the 1968 Hong Kong flu pandemics.[171][172][173] In the most recent pandemic prior to COVID-19, over the course of one year (April 2009–April 2010), the H1N1 swine flu took the lives of more than 12,000 Americans and hospitalized another 270,000.[171]

The United States Intelligence Community, in its annual Worldwide Threat Assessment report of 2017 and 2018, said if a related coronavirus were "to acquire efficient human-to-human transmissibility", it would have "pandemic potential". The 2018 Worldwide Threat Assessment also said new types of microbes that are "easily transmissible between humans" remain "a major threat".[174][175][176] Similarly, the 2019 Worldwide Threat Assessment warned that "the United States and the world will remain vulnerable to the next flu pandemic or large-scale outbreak of a contagious disease that could lead to massive rates of death and disability, severely affect the world economy, strain international resources, and increase calls on the United States for support."[176][177]

In January 2017, the U.S. government had updated its estimate of resource gaps, including ventilators, face masks, and hospital beds.[178] A vaccine for a related coronavirus, SARS, was developed in the U.S. by 2016, but never progressed to the stage of human trials due to a lack of funding.[179] While the U.S., like many countries, did face criticism at the beginning or during the outbreak, the high quality of the laboratories in the U.S. and its skilled epidemiological workforce, were its best strengths.[180] While some countries and cities did take the risk of a pandemic seriously enough to prepare years ahead of time, there was often a failure to follow through due to financial constraints or from making decisions without proper support of health or science professionals. New York City, for instance, took preparatory steps more than a decade ago, but then discontinued them in favor of other priorities.[181]

A number of organizations in the U.S. have been involved for years preparing the country and other nations for epidemics and pandemics. Among those is the Coalition for Epidemic Preparedness Innovations, co-founded by the Bill & Melinda Gates Foundation, Wellcome Trust, the European Commission. Since 2017 it has tried to produce a platform approach for dealing with emerging epidemic diseases which would enable rapid vaccine development and immunity research in response to outbreaks.[182] In the final year of the administration of George W. Bush, the Biomedical Advanced Research and Development Authority (a division of the Department of Health and Human Services) "estimated that an additional 70,000 [ventilators] would be required in a moderate influenza pandemic"; a contract was let and work started, but no ventilators were ever delivered.[183]

In 2017, outgoing Obama administration officials briefed incoming Trump administration officials on how to respond to pandemics by using simulated scenarios.[184] Obama's national security advisor Susan Rice met with her successor, General Michael Flynn, where she outlined the risk of a pandemic with a tabletop exercise and gave him a pandemic guidebook.[185] In a 2017 and 2018 annual report by the U.S. government, Worldwide Threat Assessment, it warned that a coronavirus with human-to-human transmissibility would have "pandemic potential".[186]

The Trump administration simulated a series of pandemic outbreaks from China in 2019 and found that the U.S. government response was "underfunded, underprepared, and uncoordinated" (see Crimson Contagion).[187] Among the conclusions of the test was the lack of certain medical supplies to meet demand due to their needing to be imported. President Trump responded to the simulation with an executive order to increase the availability and quality of flu vaccines, and the administration later increased funding for the pandemic threats program of the Department of Health and Human Services (HHS).[188] White House economists published a study in September 2019 that warned a pandemic could kill half a million Americans and devastate the economy.[189]

Despite these reports, briefings, and exercises, President Trump commented in March 2020, "Nobody knew there would be a pandemic or epidemic of this proportion....It’s an unforeseen problem. What a problem. Came out of nowhere."[190]

In May 2018, National Security Advisor John Bolton reorganized the executive branch's United States National Security Council (NSC), largely merging the group responsible for global health security and biodefense—established by the Obama administration following the 2014 ebola epidemic—into a bigger group responsible for counter-proliferation and biodefense. Along with the reorganization, the leader of the global health security and biodefense group, Rear Admiral Timothy Ziemer, left to join another federal agency, while Tim Morrison became the leader of the combined group.[191][192] Critics of this reorganization referred to it as "disbanding" a pandemic preparedness group.[192][193]

After the coronavirus outbreak, reporters repeatedly asked Trump about this reorganization, and Trump provided conflicting responses. On March 6, 2020 when asked at a press briefing if he would "rethink" the 2018 choice not to have a pandemic preparation office, Trump implied that the reorganization had been a reasonable choice at the time because "you can never really think [a pandemic] is going to happen ... who would have thought we would even be having the subject?"[194] On March 13, when PBS NewsHour White House correspondent Yamiche Alcindor asked if the reorganization had hampered the government response to the coronavirus outbreak, Trump berated her for asking a "nasty question", and he added: "I didn't do it ... Disbanding, no, I don't know anything about it ... It's the administration, perhaps they do that, let people go ... things like that happen."[195] On April 1, Fox News journalist John Roberts began a question by saying "you got rid of the pandemic office in the National Security Council," and Trump replied, "We didn't do that," describing the allegation four times as "false" but not elaborating further.[196][197]

Also in 2018, Homeland Security Advisor Tom Bossert left the administration, reportedly at Bolton's request. Bossert had helped to create the Trump administration's biodefense plans, and it was his responsibility to coordinate the government's response in the event of a biological crisis.[198] Bossert's successor, Doug Fears, and Fears' successor Peter J. Brown, took over the biodefense responsibilities of the DHS. Bloomberg News reported in January 2020 that biodefense was by then a "less prominent" part of the Homeland Security Advisor's responsibilities.[199][200] In another departure, Luciana Borio, the National Security Council director for medical and biodefense preparedness, left her post in March 2019. The Washington Post reported in March 2020 that the White House would not confirm the identity of Borio's replacement.[191]

Reuters reported in March 2020 that the Trump administration had in the years before the coronavirus outbreak drastically reduced the number of staff working in the Beijing office of the U.S. CDC from 47 to 14. According to Reuters, one of the staff eliminated in July 2019 was training Chinese field epidemiologists to respond to disease outbreaks at their hotbeds. Trump claimed that the report of the trainer being cut was "100% wrong", but the U.S. CDC acknowledged that the report was true.[27][201] The Trump administration also confirmed that it had closed the Beijing offices of the National Science Foundation (NSF) and the United States Agency for International Development (USAID); these offices had been each manned by a single U.S. official.[201] In addition, the Trump administration acknowledged it had eliminated one managerial position from the Beijing office of the U.S. Department of Agriculture; Reuters reported that the position oversaw an animal disease monitoring program.[201]

The Trump Administration also ended funding for the PREDICT pandemic early-warning program in China, which trained and supported staff in 60 foreign laboratories, with field work ceasing September 2019.[202] The scientists tasked with identifying potential pandemics were already stretched too far and thin.[203]

Since 2015, the federal government has spent $9.8 million on two projects to prevent a mask shortage in the event of a pandemic, but abandoned both projects before completion.[204] A second BARDA contract was signed with Applied Research Associates of Albuquerque, to design an N95-rated mask that could be reused in emergencies without reduced effectiveness. Though federal reports had called for such a project since 2006, the ARA contract wasn't signed until 2017, and missed its 15-month completion deadline, resulting in the 2020 pandemic reaching the United States before the design was ready.[204]

Previous respiratory epidemics and government planning indicated a need for a stockpile of ventilators that were easier for less-trained medical personnel to use. BARDA Project Aura issued a request for proposals in 2008, with a goal of FDA approval in 2010 or 2011. A contract for the production of up to 40,000 ventilators was awarded to Newport Medical Instruments, a small ventilator manufacturer, with a target price of $3,000, much lower than more complicated machines costing more than $10,000, and it produced prototypes with target FDA approval in 2013. Covidien purchased NMI and after requesting more money to complete the project (bringing the total cost to around $8 million) asked the government to cancel the contract, saying it wasn't profitable.[205] The government awarded a new $13.8 million contract to Philips, in 2014. The design for the Trilogy Evo Universal gained FDA approval in July 2019. The government ordered 10,000 ventilators in September 2019, with a mid-2020 deadline for the first deliveries and a deadline of 2022 to complete all 10,000. Despite the start of the epidemic in December, the capacity of the company to have produced enough to fill the full order, and the ability of the government to force faster production, the government did not reach an agreement with Philips for accelerated delivery until March 10, 2020.[205][206] By mid-March, the need for more ventilators had become immediate, and even in the absence of any government contracts, other manufacturers announced plans to make many tens of thousands.[207] In the meantime, Philips had been selling a commercial version, the Trilogy Evo, at much higher prices,[206] leaving only 12,700 in the Strategic National Stockpile as of March 15.[205]

Compared to the small amount of money spent on recommended supplies for a pandemic, billions of dollars had been spent by the Strategic National Stockpile to create and store a vaccine for anthrax, and enough smallpox inoculations for the entire country.[208]

In 2016, the NSC laid out pandemic strategies and recommendations including, moving swiftly to fully detect potential outbreaks, securing supplemental funding, considering invoking the Defense Production Act, and ensuring sufficient protective equipment available for healthcare workers. The Trump administration was briefed on it in 2017, but declined to make it official policy.[209] Azar and Morrison, then a Special Assistant to the President and Senior Director for Weapons of Mass Destruction and Biodefense on the National Security Council, listed the threat of a pandemic as the issue that worried them most at the BioDefense Summit in April 2019.[210]

By late January, Health and Human Services Secretary Alex Azar had already offered to send a team of U.S. health experts to China multiple times but had not received their approval.[119][211] Nor had the WHO yet been to China to perform its own investigation despite weeks of requests.[212] Meanwhile, on January 28, the CDC updated its China travel recommendations to level 3, its highest alert.[119] Alex Azar submitted names of U.S. experts to the WHO and said the U.S. would provide $105 million in funding, adding that he had requested another $136 million from Congress.[213][214] On February 8, the WHO's director general announced that a team of international experts had been assembled to travel to China and that he hoped officials from the CDC would also be part of that mission.[212][214] The WHO team consisted of 13 international researchers, including two Americans, and toured five cities in China with 12 local scientists to study the epidemic from February 16–23.[215] The final report was released on February 28.[216]

At that time, a number of U.S. organizations began sending personal protective equipment to China in late January. Boeing announced a donation of 250,000 medical masks to help address China's supply shortages,[217] while the United Church of Christ (UCC) and American Baptist Churches USA joined an ecumenical effort of American churches to provide much-needed medical supplies to China.[218]

The U.S. State Department also took steps to help China. Deputy Secretary of State Steve Biegun offered America's "deepest compassion" to the Chinese as the State Department organized a "robust effort to help the Chinese people get their arms around this outbreak".[126] The State Department said on February 7 that it has facilitated the transportation of nearly 17.8 tons of medical supplies to China, including masks, gowns, gauze, respirators, and other vital materials.[219] On the same day, U.S. Secretary of State Pompeo announced a $100 million pledge to China and other countries to assist with their fights against the virus.[220] On March 21, China said it had not received epidemic funding from U.S. government and reiterated that again on April 3.[221] A few weeks later the State Department offered to help Iran fight its own outbreak, as their cases and deaths were dramatically increasing.[222][223]

March 18: Colorado National Guard, CDPHE, and San Miguel County personnel assist at a drive-up testing center in Telluride, Colorado.

May 14: COVID-19 test conducted in Salt Lake City, Utah

April 5: Testing team in Charleston, West Virginia responds to a confirmed case in a nursing home.

Beyond identifying whether a person is currently infected, coronavirus testing helps health professionals ascertain how bad the epidemic is and where it is worst.[224] However, the accuracy of national statistics on the number of cases and deaths from the outbreak depend on knowing how many people are being tested every day, and how the available tests are being allocated. As of late March, most countries do not provide official reports on tests performed, therefore there is no centralized World Health Organization (WHO) data on COVID-19 testing.[225]

While the WHO opted to use an approach developed by Germany to test for coronavirus, the United States developed its own testing approach. The German testing method was made public on January 13, and the American testing method was made public on January 28. The WHO did not offer any test kits to the U.S. because the U.S. normally had the supplies to produce their own tests.[226] In February, the U.S. CDC produced 160,000 coronavirus tests, but soon it was discovered that many were defective and gave inaccurate readings.[21][227] Although academic laboratories and hospitals had developed their own tests, they were not allowed to use them until February 29, when the FDA issued approvals for them and private companies.[21] Approvals were required by federal law due to the outbreak being declared as a public health emergency.[228]

Meanwhile, from the start of the outbreak to early March 2020, the CDC gave restrictive guidelines on who should be eligible for COVID-19 testing. The initial criteria were (a) people who had recently traveled to certain countries affected by the outbreak, or (b) people with respiratory illness serious enough to require hospitalization, or (c) people who have been in contact with a person confirmed to have coronavirus. Only on March 5 did the CDC relax the criteria to allow doctors discretion to decide who would be eligible for tests.[22]

The United States had a slow start in widespread coronavirus testing.[229][230] Fewer than 4,000 tests were conducted in the U.S. by February 27.[21] The first U.S. case of a person having coronavirus of unknown origin (a possible indication of community transmission) saw the patient's test being delayed for four days after being hospitalized on February 19, because he had not qualified for a test under the initial federal testing criteria.[231] In Washington state, a group of researchers from the Seattle Flu Study defied federal and state officials to conduct their own tests from February 25, using samples already collected from flu study subjects who had not given permission for coronavirus testing. They quickly found a teenager infected with coronavirus of unknown origin, newly indicating that an outbreak had already been occurring in Washington for the past six weeks. State regulators stopped these researchers' testing on March 2, although the testing later resumed through the creation of the Seattle Coronavirus Assessment Network.[232][233]

On March 5, Vice President Mike Pence, the leader of the coronavirus response team, acknowledged that "we don't have enough tests" to meet the predicted future demand; this announcement came only three days after FDA commissioner Stephen Hahn committed to producing nearly a million tests by that week.[234] Senator Chris Murphy of Connecticut and Representative Stephen Lynch of Massachusetts both noted that as of March 8 their states had not yet received the new test kits.[235][236] Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases, acknowledged on March 12 it was "a failing" of the U.S. system that the demand for coronavirus tests was not being met;[237] Fauci later clarified that he believed the private sector should have been brought in sooner to address the shortfall.[238] By March 11, the U.S had tested fewer than 10,000 people.[23]

By mid-March, the U.S. had tested 125 people per million of their population, which was lower than several other countries.[239] The first COVID-19 cases in the U.S. and South Korea were identified at around the same time.[240] Critics say the U.S. government has botched the approval and distribution of test kits, losing crucial time during the early weeks of the outbreak, with the result that the true number of cases in the United States was impossible to estimate with any reasonable accuracy.[145][241]

By March 12, all 50 states were able to perform tests, with a doctor's approval, either from the CDC or local commercial lab.[242] This was followed by the government announcing a series of measures intended to speed up testing. These measures included the appointment of Admiral Brett Giroir of the U.S. Public Health Service to oversee testing, funding for two companies developing rapid tests, and a hotline to help labs find needed supplies.[243] The FDA also gave emergency authorization for New York to obtain an automated coronavirus testing machine.[244]

On March 13, drive-through testing in the U.S. began in New Rochelle, Westchester County, as New Rochelle was the U.S. town with the most diagnosed cases at that time.[245] By March 22, drive-through testing had started in more than thirty states, although the Associated Press reported that "the system has been marked by inconsistencies, delays, and shortages", leading to many people waiting hours or days even though they showed symptoms and were recommended by a doctor to get a test. A lack of supplies had already forced the closure of drive-through testing in seven states.[246]

In a March 13 press conference, the Trump administration announced a campaign to conduct tests in retail store parking lots across the country,[247] but this was not widely implemented.[248]

By March 30, more than a million people had been tested,[29] but not all the people showing symptoms were being tested.[249][237][250] Because of the shortage of testing, statistics quoted on the number of confirmed cases, and on the rate of growth of cases, may be inaccurate.[251]

During the weeks of April 6 and 13, the U.S. conducted about 150,000 tests per day, while experts recommended at least 500,000 per day prior to ending social distancing, with some recommending several times that level. Building up both testing and surveillance capacity are important to re-opening the economy; the purpose of social distancing is to buy time for such capacity-building.[252]

The New York Times reported on April 26 that the U.S. still had yet to reach an adequate level of testing capacity needed to monitor and contain outbreaks. The capacity has been hampered by shortages of reagents, shortages of test kits components like nasal swabs, shortages of protective gear for health workers, limited laboratory workers and equipment, and the federal government's limited interventions to solve shortages, instead leaving the issue to the free market, causing states and hospitals to compete with each other for supplies.[253]

By early May, the U.S. was testing around 240,000 to 260,000 people per day, but this was still an inadequate level to contain the outbreak, reported The Washington Post, The Atlantic, NPR, and FactCheck.org.[35][254][255][256]

By June 26, 2020, Dr. Anthony Fauci was publicizing pooled testing as a way to speed up testing by a factor of 10 —from 0.5 million individuals, to five million individuals in a single day.[257] Of the 41 federally funded "community-based testing" sites originally established in March, 13 were set to lose federal funding by the end of June. They will remain under state and local control. The sites that will lose funding are in Texas, Illinois, New Jersey, Colorado and Pennsylvania. Adm. Brett Giroir, the Assistant Secretary for Health, described the original community-based testing program as having become "antiquated."[258]

March 3: President Donald Trump and Dr. Anthony Fauci visit the Vaccine Research Center and the Viral Pathogenesis Laboratory at the National Institutes of Health.

There is currently no drug approved for treating COVID-19 either as a therapy or a vaccine, nor is there any clear evidence COVID-19 infection leads to immunity (although experts assume it does for some period).[259] As of late March 2020, more than a hundred drugs were in testing.[260]

On May 4, however, the Israel Institute for Biological Research (IIBR) announced that it had successfully isolated a key antibody that can be used for treatment. The antibody neutralizes the coronavirus infection from a person's body. The laboratory called it a "significant breakthrough", which would be patented and then mass-produced.[261][262]

In April 2020, the CDC began testing blood samples to determine if a person has been exposed to the virus, even without showing symptoms, which could provide information about immunity.[263] Learning who is protected is a primary factor in deciding when people can fully return to society.[264] Until then, physical distancing is recommended as it has been shown to slow the spread of the disease.[265] Due to the emergency nature of the pandemic, former FDA commissioners Drs. Scott Gottlieb and Mark McClellan have called for the FDA to develop therapeutics and vaccines that would be exempt from some regulatory requirements.[266] The FDA has also sent warning letters to at least seven retailers selling essential oils, nasal sprays, herbal remedies, and other products claiming to test for, treat, or prevent COVID-19.[267]

In early March President Trump directed the FDA to test certain medications to discover if they had the potential to treat COVID-19 patients.[266] Among those were chloroquine and hydroxychloroquine, which have been successfully used to treat malaria for over 50 years. A small test in France had apparently given good results[268] and they were being tested in a European Union-wide clinical trial.[269] Some U.S. physicians, under the compassionate use and Emergency Use Authorization exceptions by the FDA, have prescribed them while trials and analysis are still ongoing.[266][270][271]

In May 2020, a multinational study found that use of hydroxychloroquine or chloroquine provided no benefit, but instead increased the risk of heart arrhythmias and death compared to those who did not receive these drugs in their treatment.[272] However, the following month, the study was retracted by its authors after the data that it was based on was called into question and could not be validated.[273] Nevertheless, there is no evidence proving the drug is effective in preventing or treating coronavirus infections and experts advise against its use outside of a clinical trial.[274]

While there is no vaccine for coronavirus as of April, research is ongoing in a number of countries to create one.[275] More than 70 companies and research teams are working on a vaccine, with five or six operating primarily in the U.S.[276] Contributing funds to the research is Bill Gates, whose foundation will be focusing entirely on the pandemic, and he anticipates having a vaccine ready in 12 months.[277] Scott Gottlieb, former commissioner of the FDA, when a vaccine is ready for testing, about 25,000 people, in different groups, would be given the vaccine, two weeks apart, until 100,000 people have been inoculated over about six weeks. Researchers would then have a large enough sampling to see if the vaccine works. If successful, the next massive challenge would be making enough vaccines.[276] In preparation for large-scale production, Congress set aside more than $3.5 billion for this purpose as part of the CARES Act.[278][276] Among the labs working on a vaccine is the Walter Reed Army Institute of Research, which has previously studied other infectious diseases, such as HIV/AIDS, Ebola, and MERS. By March 18, tests had begun with dozens of volunteers in Seattle, Washington, which was sponsored by the U.S. government. Similar safety trials of other coronavirus vaccines will begin soon in the U.S.[279] This search for a vaccine has taken on aspects of national security and global competition.[280]

April 13: Protest by National Nurses United over lack of personal protective equipment at UCLA Medical Center

The first known case of COVID-19 in the U.S. was confirmed by the CDC on January 21, 2020.[281] The next day, the owner of the medical supply company Prestige Ameritech wrote to HHS officials to say that he could produce millions of N95 masks per month, but the government was not interested. "We are the last major domestic mask company," the business owner informed the government in a follow-up letter on January 23, without success.[282]

An unclassified Army briefing document, prepared February 3, on the coronavirus projected that "between 80,000 and 150,000 could die". The estimates also correctly said asymptomatic people could "easily" transmit the virus, that military forces could be tasked with providing logistics and medical support to civilians, including "provid[ing] PPE (N-95 Face Mask, Eye Protection, and Gloves) to evacuees, staff, and DoD personnel".[283] Trump administration officials declined an offer for congressional coronavirus funding on February 5. The officials, including HHS secretary Alex Azar, "didn't need emergency funding, that they would be able to handle it within existing appropriations," Senator Chris Murphy recalled.[284] On February 7 Mike Pompeo announced the administration donated more than 35,000 pounds of "masks, gowns, gauze, respirators, and other vital materials" to China the same day the WHO warned about "the limited stock of PPE (personal protective equipment)".[281]

In early March, the country had about 12 million N95 masks and 30 million surgical masks in the Strategic National Stockpile (SNS), but it was estimated by the DHS that the stockpile only had 1.2% of the roughly 3.5 billion masks that would be needed if COVID-19 were to become a "full-blown" pandemic.[285] As of March, the SNS had over 19,000 ventilators (16,660 immediately available and 2,425 in maintenance), all of which dated from previous administrations.[286] A previous 2015 CDC study found that seven billion N95 respirators might be necessary to handle a "severe respiratory outbreak".[287] Vessel manifests maintained by U.S. Customs and Border Protection showed a steady flow of the medical equipment needed to treat the coronavirus being shipped abroad as recently as March 17. Meanwhile FEMA said the agency "has not actively encouraged or discouraged U.S. companies from exporting overseas" and asked USAID to send back its reserves of protective gear for use in the U.S.[288][289] President Trump evoked the Defense Production Act to prohibit some medical exports.[290] Some analysts warned that export restrictions could cause retaliation from other countries that have medical supplies the United States needs to import.[291]

Some states had immediate needs for ventilators; hospitals in New York City, for example, ran out.[292][293] By the end of March, states were in a bidding war against each other and the federal government for scarce medical supplies such as N95 masks, surgical masks, and ventilators.[294][295][31] Meanwhile, as States scrambled to purchase supplies at inflated prices from third party distributors (some of which later turned out to be defective), hundreds of tons of medical-grade face masks were shipped by air freight to foreign buyers in China and other countries.[296] In February, the Department of Commerce published a guidance advising US firms on compliance with Beijing's fast-track process for the sale of "critical medical products", which required the masks shipped overseas meet US regulatory standards.[297][298] According to Chinese customs disclosures, over 600 tons of face masks were shipped to China in February. Rick Bright, a federal immunologist and whistleblower testified in May that the federal government did not take proper action to acquire the needed supplies.[296]

Medical organizations, such as the American Medical Association and American Nurses Association implored Trump to obtain medical supplies, because they were "urgently needed".[299] That led President Trump to sign an order setting motion parts of the Defense Production Act, first used during the Korean War, to allow the federal government a wide range of powers, including telling industries on what to produce, allocating supplies, giving incentives to industries, and allowing companies to cooperate.[300][301] Trump then ordered auto manufacturer General Motors to make ventilators.[32]

During this period, hospitals in the U.S. and other countries were reporting shortages of test kits, test swabs, masks, gowns and gloves, referred to as PPE.[302][303][304] The Office of Inspector General, U.S. Department of Health and Human Services released a report regarding their March 23–27 survey of 323 hospitals. The hospitals reported "severe shortages of testing supplies", "frequently waiting 7 days or longer for test results", which extended the length of patient stays, and as a result, "strained bed availability, personal protective equipment (PPE) supplies, and staffing". The hospitals also reported "widespread shortages of PPE" and "changing and sometimes inconsistent guidance from federal, state and local authorities".[305] At a press briefing following the release of the report President Trump called the report "wrong" and questioned the motives of the author. Later he called the report "Another Fake Dossier!"[33]

In early April, there was a widespread shortage of PPE, including masks, gloves, gowns, and sanitizing products.[306] The difficulties in acquiring PPE for local hospitals led to orders for gowns and other safety items being confiscated by FEMA and diverted to other locations, which meant that in some cases states had to compete for the same PPE.[307] The shortages led in one instance of a governor asking the New England Patriots of the NFL to use their private plane to fly approximately 1.2 million masks from China to Boston.[308] At that time, Veterans Affairs employees said nurses were having to use surgical masks and face shields instead of more protective N95 masks.[309]

An unexpectedly high percentage of COVID-19 patients in the ICU required dialysis as a result of kidney failure, about 20%.[310] In mid-April, employees at some hospitals in New York City reported not having enough dialysis machines, were running low on fluids to operate the machines, and reported a shortage of dialysis nurses as many were out sick with COVID-19 due to lack of sufficient PPE.[310][311][312]

Excess mortality from March 1 to April 4 was higher than the number of confirmed deaths.

Deceased in a 53-foot "mobile morgue" outside a hospital in Hackensack, New Jersey on April 27, 2020

By March 26, the United States, with the world's third largest population, surpassed China and Italy as the country with the highest number of confirmed cases in the world.[313] On a per capita basis, the U.S. had the 11th most cases of any country.[314] By April 25, The United States ranked 10th in deaths per million people with 158, compared to Italy (423), Spain (474), and France (326).[315][316] By April 25, the U.S. had over 905,000 confirmed coronavirus cases and nearly 52,000 deaths, giving it a mortality rate around 5.7 percent. Comparatively, Spain's mortality rate was 10.2 percent and Italy at 13.5 percent; Dr. Deborah Birx pointed out the nation's low mortality rate during a White House coronavirus briefing.[317][14] Of those, more than 10,000 deaths occurred in nursing homes. Most nursing homes did not have easy access to testing, making the actual number unknown.[318] Subsequently, a number of states including Maryland[319] and New Jersey[320] reported their own estimates of deaths at nursing homes, ranging from 20 to 50 percent.

In counting actual confirmed cases, some have questioned the reliability of totals reported by different countries. Measuring rates reported by countries such as China or Iran have been questioned as potentially inaccurate.[321] In mid-April 2020, China revised its case totals much higher and its death toll up by 50% for Wuhan, partly as a result of a number of countries having questioned China's official numbers.[322] Iran's rates have also been disputed, as when the WHO's reports about their case counts were contradicted by top Iranian health officials.[323] Within the U.S., there are also discrepancies in rates between different states. After a group of epidemiologists requested revisions in how the CDC counts cases and deaths, the CDC in mid-April updated its guidance for counting COVID-19 cases and deaths to include both confirmed and probable ones, although each state can still determine what to report.[324] Without accurate reporting of cases and deaths, however, epidemiologists have difficulty in guiding government response.[325]

According to an excess mortality analysis of seven of the worst-affected states, there are an additional 9,000 deaths than expected from prior years which are not explained by official reported coronavirus mortality statistics. In these states the death rate was nearly 50% higher than baseline between March 8 and April 11. (Excess mortality is higher than these figures because some death certificates have yet to be processed and reported).[326]

Mike Pence (right) delivers remarks at a Coronavirus Task Force briefing on February 29, accompanied by Alex Azar (left) and Anthony Fauci.

Trump administration officials were briefed to the coronavirus outbreak in China on January 3, 2020.[327] Health officials first substantially briefed the president about the virus on January 18, when HHS secretary Alex Azar called Trump while he was at Mar-a-Lago.[328][329]

On January 27, then-acting chief of staff Mick Mulvaney convened a meeting with White House aides to draw greater attention to the virus among senior officials.[329] Two days later, on January 29, President Trump established the White House Coronavirus Task Force, led by Secretary Azar, to coordinate and oversee efforts to "monitor, prevent, contain, and mitigate the spread" of COVID-19 in the United States.[330][331][332] On February 26, Trump appointed Vice President Mike Pence to take charge of the nation's response to the virus.[333]

FEMA was put in charge of procuring medical supplies on March 17.[334][335] Six CDC staff members spoke to CNN for a story published on May 20. The officials said that the CDC was not trusted by the White House and had "been muzzled", with their post-March recommendations "watered down". In previous administrations, they were treated as "scientists", but for the Trump administration, "if the science that we are offering up contradicts a specific policy goal, then we are the problem."[336]

In early May, President Trump proposed that the coronavirus task force should be phased out, to accommodate another group centered on reopening the economy. Amid a backlash, Trump publicly stated that the coronavirus task force would continue on "indefinitely".[337] However, by the end of May, the coronavirus task force was meeting far less frequently, only once per week, when earlier in the pandemic, it was meeting every day including weekends.[338]

A U.S. Customs and Border Protection officer checks the travel documents of a pilot arriving from an international flight.

Temperature screening of arrivals at Luis Muñoz Marín International Airport in Puerto Rico on March 17, 2020

On January 31, three major U.S. airlines (Delta, American, and United) announced that beginning in early February they would suspended flights between the U.S. and China,[339][340] although United Airlines continued select flights for returning Americans.[341] Later that day, President Trump announced travel restrictions which would come into effect on February 2, preventing foreign nationals from entering the U.S. if they had been in China within the previous two weeks. The immediate family members of U.S. citizens and permanent residents were exempt from this restriction.[342][343] Major Chinese carriers began to suspend flights from China to the United States three days after the announcement of the travel restrictions.[341] In addition to restricting foreign nationals, Trump imposed a quarantine for up to 14 days on American citizens returning from Hubei, the main coronavirus hotspot at the time. This was the first quarantine order the U.S. federal government had issued in over 50 years.[342][343] Although at the time the WHO recommended against countries imposing travel restrictions,[344] HHS secretary Alex Azar said the decision stemmed from the recommendations of HHS health officials.[345] The New York Times analysed that more than 380,000 people arrived in the U.S. from China in January, including around 4,000 from Wuhan. After the restrictions began, almost 40,000 people arrived in the U.S. from China in February and March.[346]

Following the China-related restrictions, the Trump administration imposed other restrictions from weeks later:

• In mid-February, the CDC opposed allowing fourteen people who had tested positive for COVID-19 while passengers on the cruise ship Diamond Princess to be flown back to the U.S. without completing a 14-day quarantine. They were overruled by officials at the U.S. State Department.[347]
• On March 2, travel restrictions were implemented on foreign nationals who had been in Iran within the previous two weeks. An exemption was made for immediate family members of U.S. citizens and permanent residents. This measure was announced on February 29.[39]
• On March 12, the CDC recommended against any non-essential travel to China,[348] most of Europe,[349] Iran,[350] Malaysia,[351] and South Korea.[352][353] The following week, the U.S. Department of State recommended that U.S. citizens not travel abroad, while those who are abroad should "arrange for immediate return to the United States" unless prepared to remain abroad indefinitely.[354][355]
• On March 19, the State Department suspended routine visa services at all American embassies and consulates worldwide.[356]
• By March 20, the U.S. began barring entry to foreign nationals who had been in 28 European countries within the past 14 days. American citizens, permanent residents, and their immediate families returning from abroad could re-enter the United States under the new restrictions, but those returning from one of the specified countries must undergo health screenings and submit to quarantines and monitoring for up to 14 days. In addition to the earlier travel restrictions in place, Trump extended this quarantine and monitoring requirement to those coming from Iran and the entirety of China. Flights from all restricted countries are required to land at one of 13 airports where the United States Department of Homeland Security (DHS) has "enhanced" entry screenings.[357][342] At least 241 foreigners (including several Canadians), who had recently traveled in China and Iran, were denied entry to the United States between February 2 and March 3.[358][359]
• On April 21, President Trump announced a forthcoming executive order barring people from seeking Green cards during a period of 60 days.[360][361]

March 29: Hospital beds prepared at the Los Angeles Convention Center

The WHO on January 30 warned that "all countries should be prepared for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread" of the virus.[362] February 25 was the first day the CDC told the American public to prepare for an outbreak.[27]

By February the CDC was exploring options to control the spread of COVID-19 in the United States. Six cities believed to be high-risk were selected for early "sentinel surveillance" to try to detect the virus in patients who did not meet CDC guidelines for testing; those cities were Chicago, New York, San Francisco, Los Angeles, Seattle and Honolulu. Very few tests were successfully completed within a five-week window. Once testing showed the disease was spreading among those without travel-related risk factors, public officials in California began to issue "stay at home" orders; it would be at least a week before similar orders were issued in other parts of the country.[363]

At a White House press briefing on April 1, Dr. Anthony S. Fauci said that, even though he expected social distancing rules can eventually be relaxed even before the availability of a vaccine, a vaccine will still be necessary to end the pandemic.[364]

Montana National Guard screen out-of-state travelers at the Amtrak station in Shelby, Montana, on April 3, 2020.

As part of the early efforts to contain and mitigate the pandemic within the United States, Surgeon General Jerome Adams announced in early March that local leaders would soon have to consider whether to cancel large gatherings, consider telework policies, and close schools.[365] Over the next few weeks, a number of states imposed stay-at-home orders of diverse scope and severity, which placed limits on where people can travel, work and shop away from their homes.[366]

On March 16, Trump announced "15 Days to Slow the Spread"—a series of guidelines based on CDC recommendations on topics such as physical distancing, self-isolation, and protecting those at high risk. The government also recommended closing schools and avoiding gatherings of more than ten people.[367][368][369] Coronavirus Response Coordinator Deborah Birx cited an analysis by Imperial College London that if nothing was done by government officials, 2.2 million would die in the United States.[370] The researchers recommended enforced social distancing for the entire population and closing all schools and universities.[371] The White House recommended "social distancing". One month later, epidemiologists Britta Jewell and Nicholas Jewell estimated that, had social distancing policies been implemented just two weeks earlier, U.S. deaths due to COVID-19 might have been reduced by 90%.)[372]

By March 21, governors in New York, California and other large states had ordered most businesses to close and for people to stay inside, with limited exceptions. The order in New York, for instance, exempts financial institutions, some retailers, pharmacies, hospitals, manufacturing plants and transportation companies, among others. It placed a ban on non-essential gatherings of any size and for any reason.[366]

In late March, Trump announced that the National Guard would be deployed to California, New York, and Washington, and FEMA would send large medical stations with thousands of beds to the three states.[373] The city of Chicago said it would rent more than a thousand empty hotel rooms to house coronavirus patients who need to be isolated but do not require hospitalization.[374] Containment and care facilities would include two Navy hospital ships.[375] USNS Mercy arrived in Los Angeles on March 27,[376] and USNS Comfort arrived in New York City on March 30.[377]

On March 28, the president said he had decided not to enact a tri-state lockdown of New York, New Jersey, and Connecticut, after having publicly suggested earlier in the day he was considering such a move; instead he ordered the CDC to issue a travel advisory suggesting voluntary travel limitations in these states.[378]

Buildings normally used for sports and entertainment were transformed into field hospitals. The Coachella Valley Music and Arts Festival, for instance, was postponed to October and the fairgrounds where it is normally held was turned into a medical center.[379] To prepare housing for homeless persons, states such as California have procured private hotels and motels as emergency shelters and isolation spaces.[380] Manpower from the military and volunteer armies were called up to help construct the emergency facilities.[381][382]

On March 31, Birx reiterated the projection of 1.5 million to 2.2 million deaths if government officials did nothing to stop the virus, compared with 100,000 to 240,000 deaths if measures such as social distancing were taken.[383] As April began, various state and local officials, including the mayors of New York[384] and Los Angeles,[385] and the governors or health departments of Colorado,[386] Pennsylvania,[387] and Rhode Island[388] encouraged residents to wear non-medical cloth face coverings while in public, as an additional measure to prevent unknowingly infecting others. The CDC issued a similar recommendation on April 3. Health officials have generally advised against the use of medical-grade PPE (such as surgical masks and respirators) by the general public, as they should be saved for healthcare personnel due to shortages.[389][390]

In early May, the Institute for Health Metrics and Evaluation at the University of Washington predicted that the American death toll would reach 137,000 by early August.[391]

Speaker Nancy Pelosi signs the future Coronavirus Preparedness and Response Supplemental Appropriations Act on March 5, 2020.

On March 6, 2020, the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 provided $8.3 billion to fight the pandemic. The deal includes "more than $3 billion for the research and development of vaccines, therapeutics and diagnostics, as well as $2.2 billion for the CDC, and $950 million to support state and local health agencies".[392][393] Another bill, the Families First Coronavirus Response Act, was approved on March 18. It provides paid emergency leave and food assistance be provided to affected employees, along with free testing.[394]

With guidance from the White House, Senate Majority Leader Mitch McConnell proposed a third stimulus package amounting to over $1 trillion.[lower-alpha 3][lower-alpha 4][lower-alpha 5] On March 22 and 23, the $1.4 trillion package, known as the Coronavirus Aid, Relief, and Economic Security Act (or CARES Act), failed to pass in the Senate.[407][lower-alpha 6][lower-alpha 7] The act was revised in the Senate, coming to $2 trillion, including $500 billion for loans to larger businesses such as airlines, $350 billion for small business loans, $250 billion for individuals, $250 billion for unemployment insurance, $150 billion for state and municipal governments, and $130 billion for hospitals.[412] It passed unanimously in the Senate late the night of March 25.[413] On March 27, the House approved the stimulus bill and it was signed into law by President Trump.[414] On April 21 and 23, respectively, the Senate and House passed a $484 billion bill which will help fund the Paycheck Protection Program (created by the CARES Act), provide $75 billion in funding to hospitals, and implement nationwide testing for the virus;[415][416] the president signed it into law on April 24.[417] McConnell has cautioned against any further spending, saying it would not fix the problem,[418] and later revealed that he is "in constant communication with the White House and if we decide to go forward we'll go forward together."[419][lower-alpha 8]

On May 12, the Republican-led Senate committee on Health, Education, Labor and Pensions (HELP) heard testimony, delivered remotely, about the effectiveness of the Trump administration's response. The expert witnesses were Dr. Anthony Fauci of the NIH, Dr. Robert Redfield of the CDC, Admiral Brett Giroir of the USPHS, and Dr. Stephen Hahn of the FDA.[421]

On March 13, 2020, Democratic House Representatives Ro Khanna and Tim Ryan introduced legislation to provide payments to low-income citizens during the crisis via an earned income tax credit.[422] The U.S. House Committee on Financial Services released a stimulus proposal on March 18 in which the Federal Reserve would fund monthly payments of "at least $2,000 for every adult and an additional $1,000 for every child for each month of the crisis".[423][lower-alpha 9] On March 18, Representative Rashida Tlaib proposed similar legislation which would involve sending pre-loaded $2,000 debit cards to every American, with $1,000 monthly payments thereafter until the economy recovers.[424][lower-alpha 10] On April 14, Khanna and Ryan introduced legislation with 18 Democratic co-sponsors which would provide $2,000 in monthly payments to 16-year-old and older Americans making less than $130,000 a year.[425] House Representative Ilhan Omar has presented legislation that would cancel rent and home mortgage payments for a year.[426] More recently, Representatives Tlaib and Pramila Jayapal have proposed giving Americans $2,000 a month until the crisis ends and $1,000 a month for a subsequent year. Representatives Madeleine Dean and Don Beyer suggest a one-time $1,500 payment possibly to be followed by $1,000 quarterly payments. On May 8, Senators Bernie Sanders,[lower-alpha 11] Ed Markey, and Kamala Harris presented a plan for $2,000 payments to Americans making less than $120,000 annually for up to three months after the crisis ends.[428][lower-alpha 12] Speaker of the House Nancy Pelosi has endorsed some form of guaranteed monthly income,[428] and President Trump reportedly supports sending another one-time payment.[430] On May 15, the House passed a $3 trillion bill which would provide one-time $1,200 payments for individuals making less than $75,000 annually,[431][432] but Mitch McConnell and members of his caucus have pegged it as "dead on arrival" in the Senate.[433]

President Trump has floated using the low interest rates to invest in infrastructure, including roads, bridges, and tunnels, but specifically excluding the initiatives of the Democratic Party's Green New Deal.[434] Pelosi has made similar proposals, suggesting broadband and water projects be included.[435]

Both Republican and Democratic governors have called for $500 billion in unrestricted federal aid to state governments, which are losing billions of dollars in tax revenue due to business closings. Existing aid to states was restricted to specific programs, mostly direct costs related to the pandemic, which faced delays being disbursed,[436] and some of which may need to be returned due to restrictions on how it could be spent.[437] Congressional Democrats attempted to negotiate state aid into federal relief packages.[438] In response to a question from a radio talk show host, Republican Senate Majority Leader Mitch McConnell said he would instead support states going bankrupt (which would require Congress to change the bankruptcy code), prompting criticism from both Democratic and Republican elected officials, including Republican governors.[439][440][437]

On May 5, New York representative Carolyn Maloney introduced a bill in the House which would cancel the student loan debt of healthcare workers.[441]

On May 29, Mitch McConnell said that a fourth and final relief bill would be decided on in about a month.[442] On June 19, he said it should focus on "future generations", including liability shields from pandemic-related lawsuits against corporations and universities.[443]

Federal Reserve chair Jerome Powell participates in a videoconference of the Federal Open Market Committee from the Eccles Building in June 2020.

On March 3, 2020, the Federal Reserve lowered target interest rates from 1.75% to 1.25%,[444] the largest emergency rate cut since the 2008 global financial crisis,[445] in an attempt to counteract the outbreak's effect on the American economy.[446]

On March 11, during his Oval Office address, Trump announced that he had requested a number of other policy changes:

• He would ask Congress to provide financial relief and paid sick leave for workers who were quarantined or had to care for others.
• He would instruct the Small Business Administration (SBA) to provide loans to businesses affected by the pandemic, and would ask Congress for an additional $50 billion to help hard-hit businesses.
• He would request that tax payments be deferred beyond April 15 without penalty for those affected, which he said could add $200 billion in temporary liquidity to the economy.
• He would ask Congress to provide payroll tax relief to those affected.[447]

On March 15, the Federal Reserve cut their target interest rate again to a range of 0.0% to 0.25% and announced a $700 billion quantitative easing program similar to the one initiated during the financial crisis of 2007–08.[448] Despite the moves, stock index futures plunged, triggering trading limits to prevent panic selling.[449] The Dow Jones Industrial Average lost nearly 13% the next day, the third-largest one-day decline in the 124-year history of the index.[450] That day, the CBOE Volatility Index closed at the highest level since its inception in 1990.[451] On March 17, the Federal Reserve announced a program to buy as much as $1 trillion in corporate commercial paper to ensure credit continued flowing in the economy. The measure was backed by $10 billion in Treasury funds.[452] At this point, the federal government neared agreement on a stimulus proposal including direct cash payments to Americans.[453] Trump announced that the Small Business Administration would be providing disaster loans which could provide impacted businesses with up to $2 million.[454]

On March 18, Trump announced that the United States Department of Housing and Urban Development (HUD) would be suspending all kinds of foreclosures and evictions until the end of April.[455] The week of March 19, the Federal Housing Finance Agency ordered federally-guaranteed loan providers to grant forbearance of up to a year on mortgage payments from people who lost income due to the pandemic. It encouraged the same for non-federal loans, and included a pass-through provision for landlords to grant forbearance to renters who lost income.[456]

On March 20, Trump announced that the Department of Education would not be enforcing standardized testing for 2020. Trump had also instructed to waive all federally held student loans for the next 60 days, which could be extended if needed.[457] Treasury Secretary Steven Mnuchin announced that the deadline for several federal filings including income tax returns and payments would be extended to July 15, 2020.[458]

On March 22, Trump announced that he had directed FEMA to build four large medical stations with 1,000 beds for New York, eight large medical stations with 2,000 beds for California, and three large medical stations and four small medical stations with 1,000 beds for the State of Washington.[459]

On March 23, the Federal Reserve announced large-scale expansion of quantitative easing, with no specific upper limit, and reactivation of the Term Asset-Backed Securities Loan Facility. This injects newly created money into a variety of financial markets including corporate bonds, exchange-traded funds, small business loans, mortgage-backed securities, student loans, auto loans, and credit card loans. The Fed also lowered its repurchase agreement interest rate from 0.1% to 0.0%.[460] On the same day, Trump postponed the October 1, 2020, deadline for Americans on commercial airlines to carry Real ID-compliant documents.[461] On April 3, Trump announced that the federal government would use funds from the CARES Act to pay hospitals for treatment of uninsured patients infected with the coronavirus.[462] On April 20, Trump said he will sign an executive order to temporarily suspend immigration to the United States because of the pandemic.[463][464]

A White House Coronavirus Task Force briefing on February 29

In January 2020, President Trump disregarded warnings from his administration's officials about the threat the virus posed to the United States in favor of the country's economic considerations.[465] He publicly downplayed the danger until mid-March, making numerous optimistic statements, including that the outbreak was "under control" and being overcome, or that the virus would somehow vanish.[26] On February 26, speaking of the number of known infected in the country at the time, Trump predicted "the 15 within a couple of days is going to be down to close to zero—that's a pretty good job we've done."[466] However, by the end of March, The Washington Post described Trump's pronouncements as having "evolved from casual dismissal to reluctant acknowledgment to bellicose mobilization".[467] When asked about his initial dismissive comments, Trump explained that he wanted to "give people hope" as a "cheerleader for the country", although he "knew everything".[468]

On March 11, 2020, Trump gave an oval office address where he announced an imminent travel ban between Europe and the United States. The announcement caused chaos in European and American airports, as Americans abroad scrambled to get flights back to the United States. The administration later had to clarify that the travel ban applied to foreigners coming from the Schengen Area, and later added Ireland and the UK to the list.[469][470] The flawed rollout of the travel ban led to hours-long waits and crowded lines at major airports for incoming passengers to the U.S., causing a public health hazard.[471] Trump also listed several economic policy proposals designed to provide tax relief for workers, aid small businesses, and fight the spread of the virus. Trump declared that insurance companies "have agreed to waive all co-payments for coronavirus treatments" (After the speech, the America's Health Insurance Plans association clarified the waivers were only for tests, not for treatments).[472] On March 13, Trump declared the coronavirus to be a national emergency, freeing up $50 billion in federal funds to fight the outbreak.[28]

Starting March 16, Trump began to hold daily press briefings on the coronavirus situation, lasting from an hour to more than two hours and usually broadcast live by the television networks.[473] On March 16, Trump said for the first time that the coronavirus was "not under control", and the situation was "bad" with months of impending disruption to daily lives, and a recession possible.[474] Also on March 16, Trump and the Coronavirus Task Force released new recommendations based on CDC guidelines for Americans, titled "15 Days to Slow the Spread". These recommendations included physical distancing and hygienic instructions, as well as directions to the states in dealing with school closures, nursing homes, and common public venues.[475][476]

On March 17, a French doctor made an online report of a small clinical study claiming good results treating coronavirus patients with the anti-malaria drug hydroxychloroquine. On March 18 the German drug manufacturer Bayer offered to donate millions of doses of the drug to the FDA.[477] The next day, March 19, Trump promoted hydroxychloroquine and chloroquine during his daily briefing as potential treatments by prescription for COVID-19.[478][479] For the next several weeks Trump continued to promote the drug as a potential "game changer" in treatment of the virus.[480] Within days of his first mention of the drug, a shortage occurred for chloroquine and hydroxychloroquine in the United States, while panic buying occurred overseas in Africa and South Asia.[481][482]

March 14 press briefing

On March 22, Trump indicated a desire to scale back physical distancing measures, saying: "We cannot let the cure be worse than the problem itself."[483][484] Despite having said in a previous briefing that he preferred to have mitigation measures be controlled by individual states because it was compatible with the Constitution, Trump said at an April 13 briefing he had the "ultimate authority" to order the end of restrictions.[485] However, on April 16 he assured governors "you are going to call your own shots" about relaxing restrictions.[486] On April 17, Trump gave a public call to "LIBERATE MICHIGAN", "LIBERATE VIRGINIA" and "LIBERATE MINNESOTA", after protests occurred against stay-at-home orders issued by the Democratic governors of these states.[487]

By April, as the pandemic worsened, amid criticism of his administration's response, Trump shied away from admitting any mistakes in his handling of the outbreak ("I couldn't have done it any better"), but has blamed many others: the media (for over-hyping the threat, then not appreciating his administration's response), Democratic governors (for mismanaging responses), the Obama administration (for not preparing enough), China (for a lack of transparency), and the World Health Organization (for "missing the call" on COVID-19).[488]

On April 15, Trump said government data showed the U.S. was "past the peak" of the epidemic and was "in a very strong position to finalize guidelines for states on reopening the country". He announced a temporary halt on funding to the WHO over its handling of the coronavirus outbreak, and alleged Chinese favoritism, pending a review.[489] The next day, April 16, the administration unveiled new federal guidelines for a three-phased approach to restoring normal commerce and services, but only for places with strong testing and seeing a decrease in COVID-19 cases.[490]

From mid-March through late April the White House Coronavirus Task Force met daily in the Situation Room and followed with a press briefing to communicate updates, guidelines, and policy changes to the public. Trump only rarely attended the daily meetings and instead was briefed in the Oval Office shortly before he held the press conference. On April 23, during the Oval Office meeting William Byron, an official from the Department of Homeland Security, offered Trump a brief presentation on the effect of disinfectants and sunlight on the virus on surfaces, which had been discussed during the earlier Situation Room meeting. Following Byron's presentation at the press briefing Trump began asking questions and suggested the possibility that light or disinfectants could be used inside the human body to cure coronavirus. Trump's remarks prompted doctors, lawmakers and the makers of the disinfectant brand Lysol to respond with incredulity and warnings against ingesting disinfectant chemicals.[492][493]

Trump praised and encouraged protestors who violated stay-at-home orders in Democratic states, as well as praised Republican governors who violated the White House's own coronavirus guidelines regarding re-opening their economies.[494][495]

Trump has repeatedly said that the U.S. is "leading the world" with its response to the pandemic. In May he told legislators that he had had phone calls with Shinzo Abe, Angela Merkel and other unnamed world leaders and "so many of them, almost all of them, I would say all of them" believe the U.S. is leading the way. The Guardian writes that none of the world leaders he mentioned have said anything to suggest that Trump's claim was true but rather that Trump's "America first" response has alienated America's close allies. The Guardian writes that Trump's decision to no longer support the WHO during the height of the pandemic and to not take part in a global effort to develop a vaccine "added outrage and prompted complaints that the US was surrendering its role of global leadership." A French poll done in May found that only 2% had "confidence Trump was leading the world in the right direction."[496]

On May 1, the CDC presented a 17-page report titled "Guidance for Implementing the Opening Up America Again Framework" to the administration. It had been written to provide advice for faith leaders, places of business and other public places, educators, and state and local officials as they began to reopen. The White House refused to use the report. Trump said he felt the guidelines were too restrictive, commenting "I see the new normal being what it was three months ago. I think we want to go back to where it was."[497][498] By mid May reports of new cases began to level off and most states began to open restaurants and other places of business, placing limits to the numbers of people allowed in the establishment at the same time. The head of the CDC, Anthony Fauci, warned that if caution was not used the rate of infections could rebound and he was particularly concerned about opening the schools in the fall. In an interview Trump replied to Fauci's statements saying, "we have to get the schools open, we have to get our country open, we have to open our country [...] We have to get it open. I totally disagree with him [Fauci] on schools."[499]

In June 2020, Trump stated that he had instructed his administration to slow down coronavirus testing in order to keep the number of confirmed cases down.[500] This claim was contradicted in sworn testimony by the federal health officials in charge of coronavirus response.[501]

U.S. Surgeon General Jerome Adams (third from left) speaks to the press.

During the early stages of the outbreak, government officials gave mixed assessments of the seriousness and scale of the outbreak. CDC Director Robert R. Redfield said in late January that "the immediate risk to the American public is low," then in late February said it would be "prudent to assume this pathogen will be with us for some time to come". Speaker of the House Nancy Pelosi appeared on television encouraging people to visit the Chinatown neighborhood of her San Francisco district.[502] While federal economic policy chief Larry Kudlow declared the coronavirus containment "pretty close to airtight". Dr. Nancy Messonnier (head of the National Center for Immunization and Respiratory Diseases) and Anthony Fauci (head of the National Institute of Allergy and Infectious Diseases) warned of the impending community spread of the virus in the United States, with Messonnier stating: "Disruption to everyday life might be severe." Around this point, Stephen Hahn, the head of the FDA, warned of national medical supplies being disrupted due to the outbreak. In early March, the U.S. Surgeon General, Vice Admiral Jerome Adams, declared that "this is likely going to get worse before it gets better."[503]

In February 2020, the CDC was notifying the press it expected the infections to spread, and urged local governments, businesses, and schools to develop plans for the outbreak. Among the suggested preparations were canceling mass gatherings, switching to teleworking, and planning for continued business operations in the face of increased absenteeism or disrupted supply chains.[504] CDC officials warned that widespread transmission may force large numbers of people to seek hospitalization and other healthcare, which may overload healthcare systems.[36]

A March 14 article on NBC said CDC officials wanted to recommend everyone over 60 remain inside their homes whenever possible but was instructed by the Trump administration to not say that.[505]

Public health officials stressed that local governments would need assistance from the federal government if there were school and business closures.[235] On March 23, Surgeon General Jerome Adams made several media appearances, in which he endorsed physical distancing measures and warned the country: "This week, it's going to get bad ... we really, really need everyone to stay at home [...] Every single second counts. And right now, there are not enough people out there who are taking this seriously."[506] On April 5, Anthony Fauci said as many as 50% of coronavirus carriers may be asymptomatic.[507] In late April, Trump's adviser and son-in-law, Jared Kushner, declared that in response to the pandemic, "the federal government rose to the challenge, and this is a great success story."[508]

By mid-May, media appearances of senior federal health officials had been sharply reduced.[509]

The Trump administration replaced Christi Grimm as Inspector General of the Department of Health and Human Services after she produced a report documenting severe shortages of medical supplies in U.S. hospitals as COVID-19 cases increased, which contradicted President Trump's claims that hospitals had what they needed.[510] Former Biomedical Advanced Research and Development Authority director Rick Bright filed a whistleblower complaint alleging his transfer to NIH was retaliation for raising concerns about the dangers of scientifically unproven therapies, including sharing information about the known side effects of hydroxychloroquine, which had been promoted by President Trump in press briefings.[511] Bright testified before a Senate committee that HHS officials denied and ignored his January warnings about a shortage in the domestic supply of respirator masks. Bright said he was told that if such a shortage happened, the government would simply change CDC guidelines to tell some people that they did not need to wear masks, to which Bright said he replied, "I can't believe you can sit there and say that with a straight face".[512]

USNS Comfort, docked in Manhattan

The Georgia National Guard assisting the Atlanta Community Food Bank

After mid-March, the federal government made a major move to use the U.S. military to add health care capacity to impacted areas. The United States Army Corps of Engineers (USACE), under existing statutory authority that comes from authorizations and powers of the Federal Emergency Management Agency (FEMA), is leasing many buildings nationwide such as hotels, college dormitories, and larger open buildings to immediately convert them into hospital facilities. To assist USACE and FEMA efforts, the United States Army are dispatching medical soldiers to set up field hospitals in cities widely affected by the pandemic. Some of these facilities will have ICU capability for patients of the pandemic, while others will serve non-coronavirus patients to allow established hospitals to concentrate on the pandemic. A public briefing of the plan was given by Army General Todd Semonite on March 20. USACE will handle leasing and engineering, with contracts for rapid facility modification and setup issued to local contractors. The plan envisions that the operation of the facilities and the provision of medical staff would be entirely handled by the various U.S. states rather than the Federal government.[513] One of the early and largest buildings to be converted is the Jacob K. Javits Convention Center in New York City, which was quickly being transformed into a 2,000-bed care facility on March 23, 2020.[514]

According to a mid-April Newsweek report, the Joint Force Headquarters National Capital Region's Joint Task Force National Capital Region was activated on March 16, operating under multiple contingency plans, from specific pandemic response operations to White House-directed continuity plans, in support of COVID-19 response efforts in the Washington, D.C., Maryland, and Virginia region.[515]

In addition to the many popup hospitals nationwide, the Navy on March 18 prepared to deploy two hospital ships, USNS Mercy and USNS Comfort, to affected areas. The ships will take in non-coronavirus patients transferred from land-based hospitals, so those hospitals can concentrate on virus cases.[375] Mercy arrived in Los Angeles on March 27,[376] and Comfort arrived in New York City on March 30.[377] On April 1, it was reported that the United States Department of Defense was working to provide 100,000 military-style nylon body bags to fulfill a request from FEMA. Only half this number was already kept in stock by the military.[516]

On March 29, citing reduction in on-shore medical capabilities and the closure of facilities at the Port of Miami to new patients, the U.S. Coast Guard required ships in the Seventh District (southeast and Atlantic territories) carrying more than fifty people to prepare to care for sick people onboard indefinitely, for vessels requesting medical evacuation to make arrangements with an on-shore hospital, and for foreign vessels to seek medical assistance from their country of registration.[517][518] Despite earlier opposition from the governor of Florida, arrangements were made allowing MS Zaandam and MS Rotterdam to dock at Port Everglades on April 2 after nearly two hundred people became ill with COVID-19 and four passengers died.[519]

On April 6, the Army announced that basic training would be postponed for new recruits. Recruits already in training would continue what the Army is calling "social-distanced-enabled training".[520]

In regards to the status of U.S. military readiness during the pandemic, Chairman of the Joint Chiefs of Staff General Mark Milley said on April 9 that the military was ready for any contingency and was adapting to "operating in a COVID-19 environment", further warning that it would be a "terrible, tragic mistake" for anyone attempting to take advantage of the crisis to harm the U.S. or its interests. By April 9, 1,898 service members had confirmed cases of COVID-19—1,389 Army soldiers, 367 Air Force personnel, 164 Marines, 597 Navy sailors and 381 National Guard members, less than 0.09% of military forces. 64 service members had been hospitalized.[521]

In April, the army made plans to resume collective training.[522] Social distancing of soldiers is in place during training, assemblies,[523] and transport between locations.[524] Temperatures of the soldiers are taken at identified intervals, and measures are taken to immediately remediate affected soldiers.[525][526]

States, territories, and counties that issued a stay-at-home order:

  Came into effect between March 15 and 21

  Came into effect between March 22 and 28

  Came into effect between March 29 and April 4

  Came into effect between April 5 and 11

Full map including municipalities

To encourage residents to remain at their homes in order to suppress spread of the virus, most U.S. states (either state-wide, or phased in on a county-by-county basis) began to impose "stay-at-home orders" from mid-March onward. These orders typically restricted any public "gatherings", and mandated the closure of entertainment and recreation venues (including bars, casinos, fitness facilities, theaters), dine-in restaurants (although take-out and delivery service could still be offered), and other "non-essential" retail businesses. Certain types of businesses were usually allowed to remain open (subject to social distancing guidelines), including food stores (such as grocery stores), pharmacies, financial institutions, critical infrastructure, and mass media. In some states, hotels were also ordered to close.[366][541] Several states also set up police checkpoints at their borders.[542]

These orders encouraged residents to stay home as much as possible, unless they are conducting an essential business (such as grocery shopping or medical care for themselves or family members), recreational exercise, or a job that cannot be performed via telecommuting.[366] The state of New York mandated that non-essential employees of any business must work from home.[366]

By April 2, about 90% of the U.S. population was under some sort of restriction.[543] After implementing social distancing and stay-at-home orders, many states were able to sustain an effective transmission rate ("R_t") of less than one.[544]

On March 24, Trump expressed a target of lifting restrictions "if it's good" by April 12, the Easter holiday, for "packed churches all over our country".[545] However, a survey of prominent economists by the University of Chicago indicated that abandoning an economic lock-down prematurely would do more economic damage than maintaining it.[546] The New York Times said, "There is, however, a widespread consensus among economists and public health experts that lifting the restrictions would impose huge costs in additional lives lost to the virus—and deliver little lasting benefit to the economy."[547] On March 29, Trump extended the federal physical distancing recommendations until the end of April.[548]

Ohio Governor Mike DeWine says employers must redesign workplaces to keep workers six feet apart, or let them work from home.[549] Connecticut requires employers who are open to keep workers six feet apart, deliver products to customers at curbside or by delivery when possible, protect workers with barriers such as plexiglas, prohibit sharing equipment or desks and if possible have employees eat and take breaks alone in their cars or at their workstations.[550] Commutes by mass transit, where it is not possible to stay six feet apart, may need to be replaced by cars or dispersed workplaces, including homes.[551] If colleges reopen in person, many will lack large enough classrooms to keep students six feet apart, but if they stay online and lose in-person interactions, students may transfer to less expensive online specialist colleges.[552]

In late April 2020, pressure increased on states to remove economic and personal restrictions. On April 19 the Trump administration released a three-phase advisory plan for states to follow, called "Opening Up America Again".[553] Protests calling for an end to restrictions were held in more than a dozen states.[554] Governors in several states took steps to re-open some businesses the last week of April,[555] even though they did not meet the benchmarks set out in the federal guidelines.[556] Trump alternately encouraged[557] and discouraged the reopening actions.[558]

Also in late April, after several meat processing plants were temporarily closed due to coronavirus cases among plant workers, President Trump used the Defense Production Act to order that existing plants must remain open, and that closed plants must re-open with healthy workers.[559]

The CDC prepared detailed guidelines for businesses, public transit, restaurants, religious entities, schools and other public places who may wish to reopen. In early May, the guidelines were edited down however the original seven pages were provided to the Associated Press.[560] Six flow charts were ultimately published on May 15,[561] and a 60-page set of guidelines was released without comment on May 20, weeks after many states had already emerged from lockdowns.[562]

On June 8, 2020, The New York Times published results of its survey of 511 epidemiologists asked "when they expect to resume 20 activities of daily life", with slightly over half of the doctors surveyed responding that they expected to stop "routinely wearing a face covering" in one year or more.[563]

Playground at a Seattle elementary school, closed due to the pandemic

As of April 10, 2020, most American public and private schools—at least 124,000—had closed nationwide, affecting at least 55.1 million students.[565] By April 22, school buildings had been ordered or recommended to be closed for the remainder of the academic year in 39 states, three territories, and the District of Columbia.[565] As schools shift education to online learning, there are concerns about student access to necessary technology, absenteeism, and accommodations for special needs students.[566] School systems also looked to adjust grading scales and graduation requirements to mitigate the disruption caused by the unprecedented closures.[567]

To ensure poor students continued to receive lunches while schools were closed, many states and school districts arranged for "grab-and-go" lunch bags or used school bus routes to deliver meals to children.[568] To provide legal authority for such efforts, the U.S. Department of Agriculture waived several school lunch program requirements.[569]

Many higher educational institutions canceled classes and closed dormitories in response to the outbreak, including all members of the Ivy League,[570] and many other public and private universities across the country.[571] Many universities also expanded the use of pass/fail grading for the Spring 2020 semester.[572]

Due to the disruption to the academic year caused by the COVID-19 pandemic, the U.S. Department of Education approved a waiver process, allowing states to opt-out of standardized testing required under the Every Student Succeeds Act.[573] In addition, the College Board eliminated traditional face-to-face Advanced Placement exams in favor of an online exam that can be taken at home.[574] The College Board also cancelled SAT testing in March and May in response to the pandemic.[575] Similarly, April ACT exams were rescheduled for June 2020.[576]

The Department of Education also authorized limited student loan relief, allowing borrowers to suspend payments for at least two months without accruing interest.[573]

May 5: The New York City Subway began planned overnight shutdowns, the first in its 115-year history, to conduct cleaning.

Several of the largest mass transit operators in the U.S. have reduced service in response to lower demand caused by work from home policies and self-quarantines. The loss of fares and sales tax, a common source of operating revenue, is predicted to cause long-term effects on transit expansion and maintenance.[577] The American Public Transportation Association issued a request for $13 billion in emergency funding from the federal government to cover lost revenue and other expenses incurred by the pandemic.[578] USA Today reported in mid-April that demand for transit service was down by an average of 75 percent nationwide, with figures of 85% in San Francisco and 60% in Philadelphia.[579] Many localities reported an increase in bicycling as residents sought socially distant means of getting around.[580]

As COVID-19 was spreading to several prisons in the U.S., some states and local jurisdictions began to release prisoners considered vulnerable to the virus.[581] To reduce transmission, the Federal Bureau of Prisons started a near-lockdown for all prisoners on April 1, for at least 14 days.[582]

More than 38,000 people were detained by U.S. Immigration and Customs Enforcement (ICE) at the time of the outbreak of COVID-19 in the United States.[583] ICE's response to the outbreak in detention facilities has been widely characterized as substandard and dangerous.[584] Detained people have reported that they are being forced into unsafe, unsanitary, and harmful conditions.[585] Serious irregularities in ICE's testing data have been reported,[586] while ICE has blocked coronavirus testing information at its facilities from being released to the public.[587] The American Civil Liberties Union referred to the COVID-19 pandemic in US immigration detention as "an unquestionable public health disaster".[586]

Chinatown in Houston faced a drop in customers after people falsely and maliciously spread rumors online of an outbreak of the coronavirus.[588]

There have been incidents of xenophobia and racism against Chinese Americans and other Asian Americans.[45][589][590] The U.S. Federal Protective Service and the FBI's New York office have reported that members of white supremacist groups are encouraging one another, if they contract the virus, to spread it to Jews, "nonwhite" people, and police officers through personal interactions and bodily fluids like saliva.[591][592]

Donald Trump listens to Michigan State Representative Karen Whitsett talk about her recovery from the COVID-19. Black Americans in Michigan and elsewhere have suffered from significantly higher rates of infection and mortality than White Americans.

ProPublica conducted an analysis of the racial composition of COVID-19 cases in Milwaukee County, Wisconsin, dating through the morning of April 3. They noted that African Americans comprised nearly half of the county's cases and 22 of the county's 27 deaths.[593]

Similar trends have been seen in regions with sizable African American populations, especially in Deep South states such as Alabama, Georgia, and Louisiana (which reported on April 6 that 70% of its reported deaths had involved African Americans); in Michigan (33% of cases and 41% of deaths as of April 6); in the city of Richmond, Virginia (48% of the city population, 62% of cases, and 100% of its eight deaths as of April 15)[594] and the city of Chicago, Illinois (1,824 of its 4,680 confirmed cases and 72% of deaths as of April 5).[595][596] It has been acknowledged that African Americans were more likely to have poor living conditions (including dense urban environments and poverty), employment instability, chronic comorbidities influenced by these conditions, and little to no health insurance coverage—factors which can all exacerbate its impact.[597][598][599]

The CDC has not yet released national data on coronavirus cases based on race; following calls by Democratic lawmakers and the Congressional Black Caucus, the CDC told The Hill it planned to release data on racial composition of cases.[600][601] Additionally, the Navajo Nation has the highest rate of infection in the United States.[602]

Technology conferences such as Apple Inc.'s Worldwide Developers Conference (WWDC),[603] E3 2020,[604] Facebook F8, Google I/O and Cloud Next,[605] and Microsoft's MVP Summit[606][607] have been either cancelled or have replaced in-person events with internet streaming events.

On February 21, Verizon pulled out of an RSA conference, along with AT&T and IBM.[608] On February 29, the American Physical Society cancelled its annual March Meeting, scheduled for March 2–6 in Denver, Colorado, even though many of the more than 11,000 physicist participants had already arrived and participated in the day's pre-conference events.[609] On March 6, the annual South by Southwest (SXSW) conference in Austin, Texas, was cancelled after the city government declared a "local disaster" and ordered conferences to shut down for the first time in 34 years.[610] The cancellation was not covered by insurance.[611] In 2019, 73,716 people attended the conferences and festivals, directly spending $200 million and ultimately boosting the local economy by $356 million, or four percent of the annual revenue of the region's hospitality and tourism economic sectors.[612]

On March 12, a Post Malone concert at Denver's Pepsi Center proceeded as scheduled, drawing a sellout-crowd of 20,000, likely the largest enclosed gathering in the U.S. before widespread lockdowns.[613]

After the cancellations of the Ultra Music Festival in Miami and SXSW in Austin, speculation began to grow about the Coachella festival set to begin on April 10 in the desert in Indio, California.[614] The annual festival, which has attracted some 125,000 people over two consecutive weekends, is insured only in the event of a force majeure cancellation such as one ordered by local or state government officials. Estimates on an insurance payout range from $150 million to $200 million.[615]

The scale of the COVID-19 outbreak has prompted several major publishers to temporarily disable their paywalls on related articles, including Bloomberg News, The Atlantic, The New York Times, The Wall Street Journal, and The Seattle Times.[616][617] Many local newspapers were already severely struggling before the crisis.[617] Several alt weekly newspapers in affected metropolitan areas, including The Stranger in Seattle and Austin Chronicle, have announced layoffs and funding drives due to lost revenue. Advertisements concerning public events and venues accounted for a majority of revenue for alt-weekly newspapers, which was disrupted by the cancellation of large public gatherings.[617][618] Online advertisements also dropped to avoid running ads next to coronavirus coverage.[619]

A theater marquee in Mount Pleasant, Michigan promotes social distancing.

Most U.S. cinema chains, where allowed to continue operating, reduced the seating capacity of each show time by half to minimize the risk of spreading the virus between patrons.[620] Audience limits, as well as mandatory and voluntary closure of cinemas in some areas, led to total North American box office sales that were the lowest since October 1998.[621] On March 16, numerous theater chains temporarily closed their locations nationwide.[622] A number of Hollywood film companies have suspended production and delayed the release of some films.[623][624]

Many television programs began to suspend production in mid-March due to the pandemic.[625][626] News programs and most talk shows have largely remained on-air, but with changes to their production to incorporate coverage of the pandemic, and adhere to CDC guidelines on physical distancing and the encouragement of remote work.[627][628][629] Quarantine and remote work efforts, as well as interest in updates on the pandemic, have resulted in a larger potential audience for television broadcasters—especially for news programs and news channels. Nielsen estimated that by March 11 television usage had increased by 22% week-over-week. It was expected that streaming services would see an increase in usage, while potential economic downturns associated with the pandemic could accelerate the market trend of cord cutting.[630][631][632] The Hollywood Reporter observed gains in average viewership for some programs between March 9 and April 2, with the top increases including The Blacklist (31.2% gain in average audience since March 9), and 20/20 (30.8%).[633] These effects have also been seen on syndicated programs,[634] and the Big Three networks' daytime soap operas.[635] WarnerMedia reported that HBO Now saw a spike in usage, and the most viewed titles included documentary Ebola: The Doctors' Story and the 2011 film Contagion for their resonance with the pandemic.[636]

The NBA was the first major sports league to suspend operations, including clearing out this March 11 game between the New Orleans Pelicans and Sacramento Kings.

The 2020 BNP Paribas Open tennis tournament at Indian Wells was postponed on March 8, 2020, marking the first major U.S. sports cancellation attributed to the outbreak.[637][638]

In compliance with restrictions on large gatherings, the Columbus Blue Jackets (NHL), Golden State Warriors (NBA), and San Jose Sharks (NHL) announced their intent to play home games behind closed doors, with no spectators and only essential staff present.[639][640][641][642] These proposals were soon rendered moot, when suspension of games for various time periods were announced by almost all professional sports leagues in the United States on March 11 onward, including the NBA (which had a player announced as having tested positive),[643] NHL,[644] Major League Baseball,[645] Major League Soccer, Major League Rugby, and National Volleyball Association.[646][647] College athletics competitions were similarly cancelled by schools, conferences and the NCAA—which cancelled all remaining championships for the academic year on March 12. This also resulted in the first-ever cancellation of the NCAA's popular "March Madness" men's basketball tournament (which had been scheduled to begin the following week) in its 81-year history.[643][648][649]

NFL is considering playing with helmets with installed filters.[650]

A chaplain at Offutt Air Force Base, Nebraska conducts a virtual mass via phone.

Amidst the COVID-19 pandemic, many churches, mosques, synagogues and temples have suspended religious services to avoid spreading the disease.[651] Some religious organizations offered radio, television and online services, while others have offered drive-in services.[652] Despite the pandemic, many American religious organizations continue to operate their food pantries. Churches offered bags filled with meat and toilet paper rolls for needy families.[653] Many mosques have closed for prayers but continue to run their food bank.[654][655][656] The National Cathedral of the United States, which belongs to the Episcopal Church, donated more than 5,000 N95 surgical masks to hospitals of Washington D.C., which were in shortage during the COVID-19 pandemic.[657] Other churches, such as the Church of the Highlands, an evangelical Christian megachurch, have offered free COVID-19 tests in their parking lots.[658]

Some state orders against large gatherings, such as in Ohio and New York, specifically exempt religious organizations.[659] Colorado Springs Fellowship Church insists it has a constitutional right to defy a state closure order.[660] Evangelical college Liberty University of Lynchburg, Virginia, moved its classes online but called its 5,000 back to campus despite Governor Ralph Northam's order to close all non-essential businesses.[661] On March 13, 2020, Bishop Elaine JW Stanovsky of the Pacific Northwest Annual Conference of the United Methodist Church issued a statement that would be updated no later than the start of Holy Week, which directed "the local churches of any size and other ministries in the states of Alaska, Idaho, Oregon and Washington to suspend in-person worship and other gatherings of more than 10 people for the next two weeks."[662] In the state of Kansas, the Democratic governor, Laura Kelly responded to a prime source of spread of the disease by banning religious services attended by more than 10 people.[663] In April, Texas churches were meeting while following social distancing guidelines after Texas Governor Greg Abbott joined more than 30 governors who had already deemed religious services "essential".[664] A federal appeals court ruled that Kentucky churches must be permitted to hold drive-in church services.[665]

In April 2020, Politico reported that the federal government's top addiction and mental health experts began to warn that the coronavirus pandemic could derail the progress the country has made addressing the opioid crisis because such efforts have been "sidelined" by the government's response to COVID-19. The director of the National Institute on Drug Abuse, Nora Volkow, said, "I think we're going to see deaths climb again. We can't afford to focus solely on Covid."[666] In January, the Trump administration announced that opioid overdose deaths in 2018 were down four percent from the previous year. This was the first drop in the statistic in nearly 30 years.[666] According to Portland ABC affiliate station KATU, "The coronavirus has been a crushing blow for the addiction recovery community, specifically, when it comes to social distancing, advocates say."[667]

The plots above are charts showing the number of COVID-19 cases, deaths, and recoveries in the U.S. since February 26, 2020. The plot below uses a log scale for all four y axes on one plot to show relationships between the trends. On a log scale, data that shows exponential growth will plot as a more-or-less straight line. Each major division is a factor of 10. This makes the slope of the plot the relative rate of change anywhere in the timeline, which allows comparison of one plot with the others throughout the pandemic.

The Pandemic Severity Assessment Framework (PSAF) was the CDC's official evaluation framework at the time of the COVID-19 pandemic for measuring the severity of a pandemic.[718] It uses quadrants to evaluate both the transmissibility and clinical severity of a pandemic and to combine these into an overall impact estimate.[719][720] Clinical severity is calculated via multiple measures including case-fatality ratios, case-hospitalization ratios, and deaths-hospitalizations ratios, while viral transmissibility is measured via available data among secondary household attack rates, school attack rates, workplace attack rates, community attack rates, rates of emergency department and outpatient visits for influenza-like illness.[719]

Using the PSAF, Brazilian researchers preliminarily assessed the pandemic to fall in the "very high severity" quadrant of the framework in April 2020 based on Chinese data through February 11, 2020. The assessment was due to its transmissibility rating falling in the highest category and its clinical severity rating falling in the top half of the scale. Based on this preliminary assessment, the COVID-19 pandemic is the most severe pandemic measured on this framework since the 1918 Spanish flu pandemic.[721]

On March 31, 2020, the CDC projected that, even under the best case scenario, eventually at least 100,000 Americans would die of coronavirus.[722] This death toll was reached within two months after the CDC made its projection.[723] Then, at the end of May, the CDC projected that the death toll would reach 115,000–135,000 by June 20;[724] indeed, the CDC eventually counted 119,000 deaths by this date.[725]

For comparison, estimated deaths in the US from the 1918 Spanish Flu, the 1957-1958 H2N2 flu, and the 1968 H3N2 flu were 675,000, 116,000 and 100,000 respectively.[726] Adjusted for growth in population, these would be per-capita equivalents of 2,147,000, 218,000, and 164,000, respectively, in 2020.

The New York Times compared the 100,000 figure to all United States deaths in the Vietnam War (58,220) and Korean War (36,574) combined.[727] The coronavirus death toll reached the equivalent of the Vietnam War figure on April 28,[728] added the equivalent of the Korean War figure on May 23,[729] and surpassed the US death toll of World War One on June 17.[730][731][732]

Based on data from the University of Washington Institute for Health Metrics and Evaluation (IHME) in early May 2020, Yahoo Finance estimated that, over the next three months, COVID-19 deaths would increase more than sixfold in Arizona and South Dakota; more than fourfold in Missouri and Alabama; more than threefold in Minnesota, Iowa, Florida, Mississippi, and North Dakota; and more than twofold in Pennsylvania.[733]