User:Dtester10/2020

The ongoing pandemic of coronavirus disease 2019 (COVID-19), a new infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spread to the United States in January 2020. Cases have occurred in all fifty U.S. states, the District of Columbia, and all inhabited U.S. territories except American Samoa. , the U.S. has the most confirmed active cases and deaths in the world, and all fifty states have received disaster declarations from the federal government. The state of New York has seen over 14,000 deaths, more than any other state.

The first known case of COVID-19 in the U.S. was confirmed on January 20, 2020, in a 35-year-old who had returned from Wuhan, China, five days earlier. On January 29, the White House Coronavirus Task Force was established. Two days later, the Trump administration declared a public health emergency and announced restrictions on travelers arriving from China. According to genomic analysis of New York infections, it is likely the virus was present in New York during mid-February, weeks prior to the first confirmed cases in the state, and that the origin of the virus was Europe instead of Asia. On February 26, a person with "no known exposure to the virus through travel or close contact with a known infected individual" was confirmed by the Centers for Disease Control and Prevention (CDC) in northern California.

The federal government's early response to the pandemic was slow, especially in regards to testing. A manufacturing defect rendered a supply of CDC-developed test kits unusable, and regulatory rules prevented academic laboratories and hospitals from using their own tests. Initially, President Donald Trump dismissed the threat posed by COVID-19, repeatedly making optimistic statements and claiming the outbreak was under control. By the start of March, the government began to heighten its response; the Food and Drug Administration (FDA) began allowing public health agencies, hospitals, and private companies to develop and administer tests, and loosened its requirements to allow anyone with a doctor's order to be tested. As of March 25, at least 418,000 tests had been conducted, and by April2 the number had reached 1,280,000. Although it has surpassed South Korea in the total number of tests performed, it has still performed fewer tests per capita than South Korea.

The CDC warned that widespread transmission of the disease may force large numbers of people to seek healthcare, which may overload healthcare systems and lead to otherwise preventable deaths. Since March 19, 2020, the U.S. Department of State has advised U.S. citizens to avoid all international travel. On March 16, the White House advised against any gatherings of more than 10 people. In mid-March 2020, the Federal Emergency Management Agency (FEMA) told the United States Army Corps of Engineers (USACE) to plan to construct new facilities, including leased hotels and other buildings, and to convert them for use as hospitals and intensive care units. State and local responses to the outbreak have included prohibitions and cancellation of large-scale gatherings (including cultural events, exhibitions, and sporting events), restrictions on commerce and movement, and the closure of schools and other educational institutions. Disproportionate numbers of cases have been observed among African American populations, and there have been reported incidents of xenophobia and racism against Chinese Americans and other Asian Americans.

Current number of non-repatriated cases by state and territory
The CDC publishes official numbers every Monday, Wednesday, and Friday, reporting several categories of cases: individual travelers, people who contracted the disease from other people within the U.S., and repatriated citizens who returned to the U.S. from crisis locations, such as Wuhan, where the disease originated, and the cruise ship Diamond Princess.

However, multiple sources, note that statistics on confirmed coronavirus cases are misleading, since the shortage of tests means that the actual number of cases is much higher than the number of cases confirmed. Likewise, the number of deaths confirmed to be due to coronavirus is likely to be undercounted for the same reason.

Reports predicting global pandemics


The United States along with more than a hundred 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. In the most recent pandemic prior to COVID-19, the 2009 H1N1 swine flu took the lives of more than 12,000 Americans and hospitalized another 200,000. Because of this pandemic and the 2014 Ebola epidemic, which saw only a small number of Americans infected, the Obama Administration increased planning and analysis that focused on deficiencies in the government's response to outbreaks. In 2017, outgoing Obama administration officials briefed incoming Trump administration officials on how to respond to pandemics by using simulated scenarios, although by the time of the COVID-19 outbreak in the U.S., around two-thirds of Trump administration officials at the briefing had left the administration.

An unpublished draft plan by the Pentagon of January 6, 2017, a few weeks before Trump took office, included predictions of a pandemic similar to COVID-19. It predicted shortages of "hospital beds, specialized equipment such as mechanical ventilators, and pharmaceuticals readily available to adequately treat their populations during a clinically severe pandemic". Some commentators felt Trump was, or should have been, aware of warnings given in the plan.

The United States Intelligence Community, in its annual US World Wide Threat Assessment report of 2017 and 2018, stated new types of microbes that are "easily transmissible between humans" remained "a major threat". Similarly, for the 2019 Worldwide Threat Assessment, the U.S. intelligence agencies 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."

Other countries also use the Worldwide Threat Assessment reports in formulating their own plans for a possible pandemic, recognizing that even a genetically modified disease could create a pandemic which would kill thousands or potentially millions. In 2019, the first annual report by the Global Preparedness Monitoring Board, organized by the World Bank and the WHO, also describes the threat of a global pandemic potentially killing tens of millions. Three years earlier, Margaret Chan, then head of the WHO, addressed health officials from 200 countries, emphasizing that emerging diseases, climate change, new global transportation networks and the failure of an increasing number of antibiotics make the planet ripe for the next pandemic.

On April 8, 2020, ABC News reported that in late November 2019, the National Center for Medical Intelligence (NCMI) warned about a contagion spreading in Wuhan and "concluded it could be a cataclysmic event" and repeated this at briefings through December for policy and decision-makers across the federal government, as well as the NSC at the White House. The warning reportedly appeared in the President's Daily Brief in early January 2020, which would have had to go through weeks of vetting and analysis. The ABC story also stated that other intelligence bulletins released after the NCMI report claimed that China was not sharing crucial information about the epidemic with other countries.

In a rare public comment immediately after this story broke, the Pentagon responded by denying that any such NCMI report existed. The head of the NCMI, Dr. R. Shane Day, said in a statement that the story of a November report was "not correct". Vice Chairman of the Joint Chiefs of Staff John Hyten subsequently stated that he saw no U.S. intelligence reports on the COVID-19 outbreak until January. Discussing the ABC News claim, Hyten said: "We went back and looked at everything in November and December. The first indications we have were the reports out of China in late December that were in the public forum."

Preparations
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 disease such as COVID-19, which would enable rapid vaccine development and immunity research in response to outbreaks. According to Sue Desmond-Hellmann, former chancellor of the University of California, San Francisco, there is no substitute for federal preparedness, especially for having a stockpile of protective equipment that healthcare workers need to safely treat patients, and to prepare for "surge capacity" with equipment like ventilators. 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 machines would be required in a moderate influenza pandemic;" a contract was let and work started, but no ventilators were ever delivered.

The U.S. government updated its pandemic plan and public guidelines in April 2017. In January 2017 it had updated its estimate of resource gaps and a list of issues for the U.S. government to consider (called a playbook). These guidelines note that a vaccine for the 2009 H1N1pdm09 swine flu virus took eight months before it was available for distribution at the end of 2009. A vaccine for the 2003 SARS virus took 13 years to develop, and was ready for human trials in 2016, which have not yet happened. A vaccine for the 2009 MERS virus took 10 years to develop, and began human trials in 2019. Nevertheless the guidelines said only six months would be needed to develop and distribute a vaccine for the next pandemic, telling schools and day cares they might need to close that long. The guidelines did not expect any business closures, and told businesses to expect up to two weeks of school closures, saying employees might need to stay home two weeks with their children. The government did not plan for extended periods with a spreading disease, saying, "During a pandemic, infection in a localized area can last about six to eight weeks."

The 2017 guidelines listed steps which could take place, up to voluntary home isolation of sick people, and voluntary home quarantine of their contacts for up to three days. There was no discussion or planning for closing businesses or ordering people to stay home, which may explain officials' delays in deciding on stay-at-home orders in the 2020 COVID-19 pandemic and lack of preparation to distinguish non-essential from essential workers, and to protect essential workers. In the 1918 flu pandemic many cities closed at least bars, for up to six weeks, and most cities had mandatory isolation and quarantine of sick people and their contacts. Cities with the most severe closures had the best economic recovery. The guidelines told businesses to be ready to keep workers three feet apart, though the guidelines said coughs and sneezes can send viruses six feet. Research says sneezes can send droplets twenty-seven feet, and they can lodge in ventilation systems. The guidelines did not consider distances between customers or between them and workers.

A June 2018 review said that pandemic plans in the U.S. and elsewhere were inadequate, since natural viruses can emerge with over 50% case fatality rates, but health professionals and policy makers planned as if pandemics would never exceed the 2.5% case fatality rate of the 1918 pandemic. The military's estimate of resource gaps in January 2017 noted "Deficiencies and vulnerabilities... lack of infrastructure, and PPE... and limited laboratory confirmatory testing... Medical systems may be overwhelmed by a dramatic increase in patient numbers. Staff availability may also be limited as medical personnel become infected."

The list of issues, or playbook, covered normal conditions as well as pandemic conditions. During normal conditions, there was no discussion of estimating and building up stockpiles for use in emergencies. The plan and guidelines were public. The estimate of resources and list of issues were not public, though they were not classified and reporters have obtained them and made them public.

While the U.S. established the Strategic National Stockpile in 2003 as an emergency repository for antibiotics, vaccines and other critical medical supplies, it has not adequately served its role in the current pandemic. According to the Trust for America's Health, in 2017, public health represented just 2.5% of all U.S. health spending ($274 per person), which Desmond-Hellman feels is too small a portion and an under-investment to cover prevention, preparedness, and community recovery during a pandemic. She explained: "For future epidemics to be managed more effectively, we must have better information, and that means having well-funded, well-trained and well-prepared public health experts—trained in statistics, epidemiology, and laboratory and clinical medicine—at the CDC and in the states."

In February 2020, when there were only a dozen cases in the U.S., and before anyone had died, the CDC advised Americans to prepare for an epidemic to contain the virus before it spreads throughout the U.S. Nancy Messonnier, a director at the CDC, explained that with no vaccine or treatment available, Americans must be prepared to take other precautions.

According to the Global Health Security Index, an American-British assessment which ranks the health security capabilities in 195 countries, the U.S. in 2020 is the "most prepared" nation. 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 highest attributes. China, which ranked fifty-first, scored lowest in compliance with international norms for failing to complete several internationally recognized health security plans. It made a number of serious errors at the outset of the outbreak, notably in Wuhan, where it failed to communicate. Local authorities withheld information about the virus from the public and the central government and silenced doctors who spoke out. A study by England's University of Southampton suggests the number of coronavirus cases could have been reduced by 95% had China moved to contain the virus three weeks sooner.

The WHO has been criticized for not acting promptly and by failing to provide available information. The Editorial Board of the Wall Street Journal, is among those who feel the world would have been "better prepared" had the WHO declared a "Public Health Emergency" weeks before it did, since the virus had by then spread to other countries and had already taken on the attributes of a pandemic. Brazil's Health Minister likewise felt that the WHO was too slow in declaring the global coronavirus outbreak a pandemic, which it did six weeks later, thereby complicating Brazil's ability to fully prepare for and curb the spread of the virus after it arrived. By the time it was declared a pandemic on March 11, 2020, the virus had already spread across all continents except Antarctica, to 110 countries, leaving less time for some countries to fully prepare their emergency health organizations.

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.

With the current pandemic, once cases began spreading throughout the nation, federal and state agencies began taking urgent steps to prepare for a surge of hospital patients. Among the actions was establishing additional places for patients in case hospitals became overwhelmed. That included transforming buildings normally used for sports and entertainment events by turning them into field hospitals. The Coachella Valley Music and Arts Festival, for instance, was cancelled and the fairgrounds where it is normally held was turned into a medical center. To prepare housing for homeless persons, states such as California have procured private hotels and motels as emergency shelters and isolation spaces.

Manpower from the military and volunteer armies were called up to help construct the emergency facilities. In addition, unoccupied former clinics and hospitals were being converted with retired and active physicians and nurses were brought in. The CEO of Beth Israel Deaconess Medical Center in Boston, saw the problem: "Anybody with eyes in their head, anybody who is watching what is happening in New York and Washington and elsewhere would be foolish not to get ready now. We are not wasting any time to get as prepared as possible for the surge that is almost certainly coming."

Pandemic simulation tests
Scenario testing can help create models of potential epidemics and pandemics, which can be achieved through large-scale computer simulations. The models can incorporate mitigation measures, seasonality, randomness, and other factors that can vary during a real epidemic. Similar tests are used by the insurance industry to understand risks posed by infrequent natural disasters such as hurricanes and earthquakes.

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". Among the conclusions of the test was the lack of certain medical supplies to meet demand due to their needing to be imported. It led President Trump to issue an executive order to make flu vaccines more readily available and of higher quality, and he provided additional funds for the pandemic threats program in the Department of Health and Human Services (HHS). White House economists published a study in September 2019 that warned a pandemic could kill half a million Americans and devastate the economy.

In 2018, the WHO also ran a simulation exercise of a global pandemic response involving more than 40 countries, although the results appear to be unavailable.

Centralized biodefense strategy
Citing lessons learned from the swine flu pandemic, Ebola outbreak, and the 2001 anthrax attacks, President Trump released a National Biodefense Strategy on September 18, 2018 in response to a Congressional directive. According to Trump, the new strategy was designed to strengthen the nation's defenses against disease outbreaks and bioterrorism and to make responses to them more efficient and better coordinated. Concurrently, he released a National Security Presidential Memorandum that appointed Secretary of HHS Alex Azar to oversee implementation of the government's new biodefense strategy and directed National Security Advisor John Bolton to assist in reviewing and improving the nation's biodefenses. At a time when multiple agencies and departments shared responsibility for biodefense, Bolton and Azar claimed this centralization of primary authority for biodefense in the HHS would provide greater accountability.

Reorganization and departures
In May 2018, Bolton reorganized the executive branch's United States National Security Council (NSC), largely merging the group responsible for global health security and biodefense 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. There were critics of this reorganization, who referred to it as "disbanding" a pandemic preparedness group; and later, Trump berated a reporter for asking if the reorganization had slowed the government response. 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. 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. The NSC created a pandemic playbook (called "Playbook for Early Response to High-Consequence Emerging Infectious Disease Threats and Biological Incidents") in 2016 which laid out strategies and recommendations that an administration should take, including moving swiftly to fully detect potential outbreaks, securing supplemental funding and considering invoking the Defense Production Act, and making sure there are sufficient personal protective equipment available for healthcare workers. The Trump administration was briefed on it in 2017, but administration officials ignored it, and it never became official policy. 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.

In other departures, 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. Meanwhile, in July 2019, Linda Quick, a U.S. CDC expert working within the Chinese Center for Disease Control and Prevention, left her post without a replacement, as her position would have been eliminated in September 2019 due to the China–United States trade war. Reuters reported Quick's departure in March 2020; her role was training Chinese field epidemiologists to respond to disease outbreaks at their hotbeds; the post had existed since 2007 or earlier. The Administration 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. The scientists tasked with identifying potential pandemics were already stretched too far and thin.

Abandoned and delayed efforts to improve mask and ventilator supply
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. The first was a contract from the Biomedical Advanced Research and Development Authority (BARDA, which in 2020 had a budget of $1.5 billion) with Halyard Health (now a subsidiary of Owens & Minor) to design a machine capable of rapid manufacture of N95-rated masks. The design, intended to solve the problem of stockpile waste and decay, was completed in 2018. Halyard requested funding to build a prototype, but this was not granted.

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.

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 for 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. 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. 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. In the meantime, Philips had been selling a commercial version, the Trilogy Evo, at much higher prices, leaving only 12,700 in the Strategic National Stockpile as of March 15.

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. Shortages in the United States and many European countries were contrasted with Finland, which has maintained medical stockpiles since the 1950s, and was able to meet demand for masks from the government supply.

Beginning of outbreak and supply shortages
The first known case of COVID-19 in the U.S. was confirmed by the CDC on January 21, 2020. 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 stated that 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". Trump administration officials declined an offer for congressional coronavirus funding on February 5. The officials, including HHS secretary Alex Azar, said they "didn't need emergency funding, that they would be able to handle it within existing appropriations," Senator Chris Murphy recalled. On February7 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)".

National Geographic reported that as of March 3, 2020, the "U.S. has only a fraction of the medical supplies it needs to combat coronavirus." An additional 300 million N95 respirators and surgical masks could be required to protect health workers. However, in Senate testimony, HHS secretary Alex Azar said "the Strategic National Stockpile has just 30 million surgical masks and 12 million respirators in reserve." HHS said it intends to purchase as many as half a billion respirators and surgical face masks over the next year and a half. A previous 2015 CDC study found that seven billion N95 respirators might be necessary to handle a "severe respiratory outbreak". March 12 the HHS placed its first order of masks and ventilators for healthcare workers of $4.8 million worth of N95 masks. 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. FEMA, meanwhile, said the agency "has not actively encouraged or discouraged U.S. companies from exporting overseas", and has asked USAID to send back its reserves of protective gear stored in warehouses for use in the U.S. The New York Times reported on March 18 that about 170,000 ventilators were in the U.S., versus an American Hospital Association estimate that 960,000 people may need them during the pandemic. The shortage of ventilators is one reason why slowing the spread of the virus is so important. Ramping up production is challenging due to global supply chains and the complexity of the devices, with major U.S. hospitals having trouble finding more. Bloomberg News reported on March 23 that: "NY Governor Andrew Cuomo said the state, which has about 5,000 to 6,000 ventilators, might need 30,000 of them." China is significantly increasing ventilator production to assist other countries, with plans to supply about 14,000 non-invasive ventilators in April. The U.S. government has also called on U.S. manufacturers to assist.

History


Chinese health authorities confirmed that they identified a cluster of a novel infectious coronavirus on December 31, 2019 in the city of Wuhan, officially reporting their findings on January 7, 2020. An American citizen, after traveling from Wuhan, China, to his home in Washington state, became the first U.S. case of the new virus on January 20. The WHO declared the outbreak a Public Health Emergency of International Concern by January 30 and a pandemic by March 11.

Certain European countries, including Italy, Spain, and the United Kingdom, reported on their first coronavirus cases in late January. More than 3.4 million people from China, Italy, Spain, and the United Kingdom, including returning Americans, entered the U.S. in the first three months since the COVID-19 outbreak in Wuhan. From December 2019 to February 2020, 759,493 passengers arrived on American soil from China, 343,402 came from Italy, 418,848 from Spain, and about 1.9 million more arrived from Britain. Research on coronavirus genomes indicates the majority of COVID-19 cases in New York came from European travelers, rather than directly from China or any other Asian country. In March 2020, the European Commission's president Ursula von der Leyen and other EU leaders condemned the U.S. decision to restrict travel from the coronavirus-affected European Union to the United States.

In a series of travel restrictions announced between late January and mid-March, the United States government denied entry to foreign nationals who had traveled within the past 14 days through China, Iran, the United Kingdom, Ireland, or the 26 European countries that comprise the Schengen Area. Americans returning home after traveling in these regions were required to undergo a health screening and submit to a 14-day quarantine. Such quarantines are governed by section 361 of the Public Health Service Act (42 U.S. Code § 264). In early March, the CDC advised Americans against non-essential travel to China, Iran, Malaysia, and the aforementioned European countries.

Throughout March and early April, several state, city, and county governments imposed "stay at home" quarantines on their populations to stem the spread of the virus. By the middle of March, all fifty states were able to perform tests, with a doctor's approval, either from the CDC or from commercial labs in a state, but the number of available test kits remained limited, which meant the true number of people infected with the virus was a challenge to estimate with any reasonable accuracy at the time. The CDC suggested that doctors use their own judgment along with certain guidelines before authorizing a test. By March 12, diagnosed cases of COVID-19 in the U.S. exceeded a thousand, which doubled every two days to reach more than 17,000 by March 20.

Administration officials warned on March 19 that the number of cases would begin to rise sharply as the country's testing capacity substantially increased. Around this time, the United States began running 50,000 to 70,000 coronavirus tests per day. On March 26, the total number of confirmed cases surpassed that of China with more than 85,000, making the U.S. the country with the highest number of coronavirus patients in the world. The country reached another critical mark, as the number of positive cases surged over 100,000 the next day on March 27.

The COVID-19 outbreak has had varying effects on different areas of the U.S. Of the 154 known deaths in the country before March 20, 94 occurred in the state of Washington, with 35 of those at one nursing home. By late March, the toll was greatest in New York, which saw 56% of all confirmed U.S. cases on March 25. Continuing into April, the New York City metropolitan area remained the country's epicenter for the pandemic.

Task force formation


Trump administration officials were briefed to the coronavirus outbreak in China on January 3, 2020. 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. On January 27, then-acting chief of staff Mick Mulvaney convened a meeting in his office with White House aides in order to draw greater attention to the virus among senior officials.

Two days later, on January 29, President Trump established the White House Coronavirus Task Force to coordinate and oversee efforts to "monitor, prevent, contain, and mitigate the spread" of COVID-19 in the United States. Secretary Azar was appointed as the leader of the task force. On February 26, Trump appointed Vice President Mike Pence to take charge of the nation's response to the virus. FEMA was put in charge of procuring medical supplies on March 17.

Containment and mitigation
The early phases of public health efforts for epidemics and pandemics are to contain or limit further outbreaks. Those actions often involve tracing contacts, implementing quarantines, and isolating infectious cases. They demand significant human resources and government staffing at all levels. As an outbreak grows, new facilities may need to be constructed to manage additional infectious cases.

National medical organizations such as the CDC focus on both containment, to first keep the virus from spreading after its detection, and mitigation, to prevent it from spreading quickly beyond containment limits. The process of mitigating the COVID-19 pandemic attempts to extend its time frame by spreading out cases and isolating individuals, which slows the spread of the disease. By that means, it lowers the peak number of new cases, which reduces the likelihood of suddenly over-crowding doctors' offices and hospitals beyond their capacity.

The risk of a truly global pandemic is limited for some diseases, such as Ebola, because of the slow pace of transmission or high probability of detection and containment. COVID-19, at the other extreme, is a pathogen that has high potential to cause a severe pandemic because it easily transmits between people and remains asymptomatic for a long period, thereby lengthening the time it is infectious and not detected.

In general, once a pandemic has begun within a country's borders, the government must begin taking steps to curtail interactions between infected and uninfected populations. The methods used could include isolation of infected patients, quarantine, physical distancing practices, school closures, use of personal protective equipment, and travel restrictions.

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. February 25 was the first day the CDC told the American public to prepare for an outbreak.

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.

Travel and entry restrictions


On January 31, President Trump imposed travel restrictions 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. By this time, three major U.S. airlines had already suspended flights between the U.S. and China, although one of these, United Airlines, continued select flights for returning Americans. Major Chinese carriers did not begin suspending flights from China to the United States until three days after the announcement of the travel restrictions. 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. Although the WHO had recommended against travel restrictions at the time, HHS secretary Alex Azar said the decision stemmed from the recommendations of HHS health officials. Trump expanded those travel restrictions to Iran on February 29.

Over the following few weeks, the Trump administration imposed a number of other travel restrictions:


 * 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.
 * On March 12, the CDC recommended against any non-essential travel to China, most of Europe, Iran, Malaysia, and South Korea. 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.
 * On March 19, the State Department suspended routine visa services at all American embassies and consulates worldwide.
 * 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. At least 241 foreigners (including several Canadians), who had recently traveled in China and Iran, were denied entry to the United States between February2 and March 3.

Containment efforts within the U.S.


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. Over the next few weeks, a number of states imposed lockdown measures of diverse scope and severity, which placed limits on where people can travel, work and shop away from their homes.

On March 16, the White House recommended "social distancing", including closing schools and avoiding gatherings of more than ten people. (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 percent.)

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.

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. 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. Containment and care facilities would include two Navy hospital ships. USNS Mercy (T-AH-19) arrived in Los Angeles on March 27, and USNS Comfort (T-AH-20) arrived in New York City on March 30.

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 that he was considering such a move; instead he ordered the CDC to issue a travel advisory suggesting voluntary travel limitations in these states.

As April began, various state and local officials, including the mayors of New York and Los Angeles, and the governors or health departments of Colorado, Pennsylvania, and Rhode Island 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 personal protective equipment (such as surgical masks and respirators) by the general public, as they should be saved for healthcare personnel due to shortages.

COVID-19 testing


Beyond identifying whether a person is currently infected, coronavirus testing helps health professionals ascertain how bad the epidemic is and where it is worst. 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. But as of late March, most countries do not provide official reports on tests performed, therefore there is no centralized WHO data on COVID-19 testing.

While the World Health Organization (WHO) opted to use an approach developed by Germany to test for COVID-19, 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. In February, the U.S. CDC produced 160,000 coronavirus tests, but soon it was discovered that many were defective and gave inaccurate readings. 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. Approvals were required by federal law due to the outbreak being declared as a public health emergency.

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 COVID-19. Only on March5 did the CDC relax the criteria to allow doctors discretion to decide who would be eligible for tests.

As a result, the United States had a slow start in conducting widespread testing for COVID-19. Fewer than 4,000 tests were conducted in the U.S. by February 27, with U.S. state laboratories conducting only around 200. The first U.S. case of a person having COVID-19 of unknown origin (a possible indication of community transmission in the state of California) 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. Whereas in Washington state, a group of researchers defied a lack of clearance from federal and state officials to conduct their own tests from February 25, using samples already collected from their flu study that their subjects had not given permission for COVID-19 testing. They quickly found a teenager infected with COVID-19 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.

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. Senator Chris Murphy of Connecticut and representative Stephen Lynch of Massachusetts both noted that as of March8 their states had not yet received the new test kits. Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases, acknowledged on March 12 that it was "a failing" of the U.S. system that the demand for coronavirus tests was not being met; Fauci later clarified that he believed the private sector should have been brought in sooner to address the shortfall. By March 13, fewer than 14,000 tests had been done in the United States, reported The Atlantic.

The timing and availability of testing varies across countries. For example, by March 13 South Korea offered drive-through testing centers, which could get results the next day. South Korea also had a government-funded daily testing capacity of 15,000. According to March 16 and 17 statistics from Our World in Data, the U.S. had tested 125 people per million of their population—around the same as Japan. The U.K. tested nearly 750 per million, Italy more than 2,500 per million, and South Korea more than 5,500 per million. The first COVID-19 cases in the U.S. and South Korea were identified at around the same time. 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.

As of March 12, all fifty states were able to perform tests, with a doctor's approval, either from the CDC or from commercial labs in a state. 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. The FDA also gave emergency authorization for New York to obtain an automated coronavirus test unit that will reduce testing time to 3.5 hours.

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. By March 22, drive-through testing had appeared in more than thirty states, however 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 Alabama, Colorado, Florida, Louisiana, New Mexico, Utah, and Virginia.

In a March 13 press conference, the Trump administration announced an effort for tests to be conducted in retail store parking lots across the country, with participating franchises including Walmart, Target, CVS, and Walgreens. The plan was that test data would be sent to labs to complete testing in partnership with local health departments and diagnostic labs. Two weeks later, five stations had been opened by the companies: Walmart two, Target none, CVS one, Walgreens one, and one more from newcomer Rite Aid. These were labelled as "prototype sites" by the Trump administration.

Research into vaccine and drug therapies


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

While most common viruses provide diverse degrees of immunity, with this new virus it is not yet known for certain whether there is absolute immunity, how long that immunity would last or whether certain people can still be reinfected even after recovering. There is also concern that if this virus mutates as does the yearly influenza, there could be a new strain each year. In any case, learning who is protected against the disease's spread is a primary factor in deciding when people can fully return to society. Until then, physical distancing is required as it has shown to slow the spread of the disease to manageable levels.

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. Speed in developing a vaccine is a key element in the midst of the pandemic, as physical distancing, self-isolating, and closures will have to be maintained until a vaccine is developed, which could take 12 to 18 months at best, or else transmission will quickly rebound. By March 18, tests had begun with a few dozen 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. Trials are also underway in China and Europe. This search for a vaccine has taken on aspects of national security and global competition.

The FDA has 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. This is in violation of federal law, since none have been determined to be safe and effective by the FDA.

By March 19, President Trump directed the FDA to accelerate the testing and possible use of certain medications to discover if they would help treat patients who already have COVID-19. Among potential drugs are chloroquine and hydroxychloroquine, which have long been used successfully to treat malaria. In March, both hydroxychloroquine and chloroquine were already being used to treat coronavirus patients by a number of physicians under the limited compassionate use approval of the FDA or as an off-label prescription, while trials and analysis are still ongoing. On March 29, the FDA issued an Emergency Use Authorization, allowing the drugs as treatments for hospitalized coronavirus patients when clinical trials are not available for them to join. Fauci and other public health officials stress hydroxychloroquine is unproven for efficacy against COVID-19, as of early April 2020. In China, trials of chloroquine are underway at dozens of clinics, with early laboratory results showing that it seems to reduce the virus's rate of replication. Chloroquine has been used to treat patients with malaria for nearly a century. An Arizona man died after taking chloroquine phosphate in a high-concentration formulation which is used to control growth of algae and infectious organisms in aquariums.

A closely-related drug, hydroxychloroquine, first approved in the U.S. for lupus in 1955, is typically used to treat certain autoimmune diseases. A study in the peer-reviewed medical journal Clinical Infectious Diseases published on March9 provided dosing recommendations for hydroxycholorquine as a COVID-19 treatment, and showed it to be more effective in inhibiting the virus in vitro than chloroquine. Doctors are currently testing hydroxychloroquine in coronavirus patients. On March 20, the WHO announced a large global trial of both drugs.

Hoarding of hydroxychloroquine, including by doctors prescribing the drug preemptively to family members, and publicity about the drug generated by President Trump caused spot shortages that endangered the health of patients using it to treat lupus and rheumatoid arthritis. Some state pharmacy boards placed limitations on prescriptions for hydroxychloroquine and related medicines. Similarly, Nevada's governor, Steve Sisolak released an executive order banning doctors from prescribing hydroxychloroquine or chloroquine as a coronavirus treatment in his state on March 24, although he later tweeted that doctors in hospitals were exempt from the prohibition.

On March 20, the day after Trump initially mentioned the drug, the Israeli company Teva Pharmaceuticals announced it would manufacture and donate as many doses as possible to U.S. hospitals at no charge, including six million doses by the end of the month. On the same day, Sandoz, a subsidiary of Novartis, said it would donate up to 130 million doses of the drug if approved. Mylan also began increasing its production of the drug in response to low supplies. The HHS reported on March 29 that the government would make available 30 million doses of hydroxychloroquine and a million doses of chloroquine recently donated to the Strategic National Stockpile for doctors to prescribe within limitations for COVID-19 patients under the FDA's Emergency Use Authorization. In a survey of 6,200 physicians in 30 countries by Sermo, 23% of U.S. doctors said they treated COVID-19 patients with hydroxychloroquine. American doctors were significantly more likely to prescribe the drug only for high risk patients, while international doctors used it equally for mild and severe cases. It ranked as the third most-used treatment overall, behind Azithromycin (41%), and analgesics (56%).

Also being tested in research clinics is the antiviral drug remdesivir. It was developed to fight Ebola, although it failed to prove effective for that disease. At a Coronavirus Task Force briefing on March 19, FDA Commissioner Stephen Hahn noted that the FDA had made remdesivir available under compassionate use guidelines for coronavirus patients, while the FDA standard approval process was still ongoing. In addition, the antibody rheumatoid arthritis treatment sarilumab is being tested in clinical trials in the hopes that suppressing some aspects of the immune response can help improve lung function patients who require supplemental oxygen. 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.

Medical supplies
On March 15, senior federal health official Anthony Fauci said the United States had 12,700 ventilators in its national stockpile. On March 19, Vice President Mike Pence declared that the federal government had "literally identified tens of thousands of ventilators", but did not provide further details.

On March 16, Trump told state governors that for medical equipment including respirators and ventilators, "We will be backing you, but try getting it yourselves." On March 24, Trump said state governors who wanted help from the federal government "have to treat us well, also", because "it's a two-way street"; he warned against governors arguing "we should get this, we should get that." On March 24, the Governor of New York, Andrew Cuomo, declared that the state of New York would need 30,000 ventilators to handle the peak of the outbreak in the state, which was predicted to arrive in two weeks. Cuomo also said the federal government had sent only 400 ventilators to New York. Two days later, Trump, citing "a feeling", stated: "I don't believe you need 40,000 or 30,000 ventilators." He also said the Governor of Washington, Jay Inslee, "shouldn't be relying on the federal government"; Inslee says the President needs to enact a "national mobilization of the industrial base in this country" to produce medical supplies.

Trump signed an executive order citing provisions of the Defense Production Act on March 18, which allows the federal government a wide range of powers, including giving directions to industries on what to produce, having companies prioritize certain contracts, allocating supplies, giving incentives to industries, and allowing companies to cooperate. Initially under the act, he conferred more power over contracts and resources to the Health and Human Services Secretary and enacted provisions to prevent hoarding of medical resources.

On March 18, Trump remarked that the federal government ordered 500 million N95 masks to be manufactured to make more private masks available and that American manufacturers were repurposing factories to manufacture masks.

By March 21, the director of the Johns Hopkins Center for Health Security described American hospitals as already facing shortages of test kit reagents, test kit swabs, masks, gowns and gloves. In a March 20 to 24 survey of 214 American mayors (who manage a total 42 million people), 85% said they did not have enough ventilators, 92% said they did not have enough face masks, 88% said there was a shortage of other personal protective equipment, and 92% said they did not have enough test kits. On the prevalence of medical supplies, Trump said on March 29 that "many of the states are stocked up," with certain hospitals "holding ventilators, they don't want to let 'em up." Trump said he could not understand how demand for face masks had supposedly surged from 10,000 to 300,000 per week, saying it was "maybe worse than hoarding": "Are they going out the back door?"

Ventilator manufacturers are facing a shortage of sub-components needed to produce the ventilators, reported Bloomberg News on March 25. When Trump was asked by a reporter on whether the United States would have enough ventilators as needed, he told the reporter: "Don't be a cutie pie."

On March 27, Trump stated governors should be "appreciative", with his administration having "done a job, the likes of which nobody has seen". Trump's outlook on the governors was: "If they don't treat you right, I don't call." Thus, Trump told of advising Vice President Mike Pence, "don't call" Washington governor Inslee and Michigan governor Gretchen Whitmer—although Pence would call anyway, said Trump. Whitmer, who had previously argued that "the federal government did not take this seriously early enough," responded that Michigan still needed personal protective equipment, ventilators, masks and test kits.

An anonymous, informal survey of medical personnel, conducted online in late March by a New Jersey nurse, pointed out the lack of proper equipment as the main issue in current efforts, with 90 percent of respondents claiming they had been forced to work without proper personal protective equipment (PPE).

Masks, gloves, gowns, and sanitising products were soon in short supply. On April 2, 2020, The Washington Post, among other news outlets, reported on the critical shortfall of N95 masks: "severe shortages of the N95 masks in emergency rooms and hospitals. Even surgical masks, which provide some protection, are in short supply at many health-care facilities. Desperate health-care workers have resorted to unvalidated measures to find alternative methods of protecting themselves... [with] more than 500,000 physicians older than 50, representing just over half the nation's entire physician workforce. The average age of nurses in the United States is 51. A 48-year-old emergency department nurse in New York City died of covid-19 on March 24, and emergency department physicians have been reported to have developed severe covid-19 requiring intensive care in Washington state and New Jersey."

On April 3 during the daily Coronavirus Task Force briefing, Trump said hospital administrators were "communicating directly with us that their level of supplies are meeting essential needs. And at the current time, they're really thrilled to be where they are." Responding on NPR, the American Hospital Association said their communications with hospital officials showed that hospitals "are worried about shortages of critical medical supplies, including medication for patients and personal protective equipment, or PPE, for health care workers."

Congressional response


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". 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.

The U.S. House Committee on Financial Services, chaired by Representative Maxine Waters, 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 $1000 for every child for each month of the crisis". Other elements include suspending all consumer and small business credit payments. On March 18, Representative Rashida Tlaib proposed the similar "Automatic BOOST to Communities Act", which would involve sending pre-loaded $2,000 debit cards to every American, with $1,000 monthly payments thereafter until the economy recovers. This would be funded by the U.S. Treasury minting two trillion-dollar coins. According to Tlaib, the Treasury has this authority, and it would not increase the national debt.

With guidance from the White House, Senate Majority Leader Mitch McConnell proposed a third stimulus package amounting to over $1 trillion. 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. 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. It passed unanimously in the Senate late the night of March 25. On March 27, the House approved the stimulus bill, and it was signed into law by President Trump.

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 Democrats' Green New Deal. Nancy Pelosi has made similar proposals, suggesting that broadband and water projects be included. Although the Senate will not reconvene until at least April 20, McConnell has indicated that a fourth bill related to the virus would prioritize health care. Senator Bernie Sanders has called for a monthly basic income to help "every person in the United States, including the undocumented, the homeless, the unbanked, and young adults excluded from the CARES Act".

Other federal policy responses
On March 3, 2020, the Federal Reserve lowered target interest rates from 1.75% to 1.25%, the largest emergency rate cut since the 2008 global financial crisis, in an attempt to counteract the outbreak's effect on the American economy. "The coronavirus poses evolving risks to economic activity," the Federal Reserve said in a statement. "In light of these risks and in support of achieving its maximum employment and price stability goals, the Federal Open Market Committee decided today to lower the target range for the federal funds rate."

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.

On March 15, the Fed cut their target interest rate again to a range of 0% to 0.25%. The Fed also announced a $700 billion quantitative easing program similar to the one initiated during the financial crisis of 2007–08. Despite the moves, stock index futures plunged, triggering trading limits to prevent panic selling. The Dow lost nearly 13% the next day, the third-largest one-day decline in the 124-year history of the index. That day, the VIX—informally known as the market "fear index"—closed at the highest level since its inception in 1990.

On March 17, the Federal Reserve announced a program to buy as much as a trillion dollars in corporate commercial paper to ensure credit continued flowing in the economy. The measure was backed by $10 billion in Treasury funds. At this point, the federal government neared agreement on a stimulus proposal including direct cash payments to Americans. Trump said his administration was working with the Congress to provide rapid relief to affected industries. He remarked that the relief would ensure the American economy would "emerge from the strongest economy on earth". In addition, Trump announced that the Small Business Administration would be providing disaster loans which could provide impacted businesses with up to $2 million.

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.

The week of March 19, the Federal Housing Finance Agency ordered federally-guaranteed loan providers to grant forbearance of up to 12 months 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.

On March 20, Trump announced that the Department of Education will not be enforcing standardized testing for 2020. Trump had also instructed to waive all federally held student loans for the next sixty days, which could be extended if needed. Treasury Secretary Steven Mnuchin also announced that the deadline for filing federal income tax returns and making federal income tax payments due April 15, 2020, are automatically postponed to July 15, 2020. The due date for filing federal gift tax and generation-skipping transfer tax returns and making the related tax payments were also automatically postponed to July 15, 2020.

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

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%. On the same day, Trump also postponed the October 1, 2020, deadline for Americans on commercial airlines to carry Real ID-compliant documents.

On April 3, President Trump announced that the federal government will use funds from the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) to pay hospitals for treatment of uninsured patients infected with the coronavirus.

President Trump
From January 2020 to mid-March 2020, President Trump downplayed the threat posed by COVID-19 to the United States, giving many optimistic public statements. On January 31, Trump issued a travel ban on China, yet continued to publicly play down the threat, stating on multiple occasions that the situation was "under control". On February 26, he said of the virus: "It's going to disappear. One day it's like a miracle, it will disappear. And from our shores, you know, it could get worse before it gets better. Could maybe go away. We'll see what happens. Nobody really knows." On February 27, speaking of the number of infected people in the country at the time, he predicted "the 15 within a couple of days is going to be down to close to zero." On February 28 during a campaign rally in South Carolina, Trump stated that "we are doing everything in our power to keep the infection and those carrying the infection from entering the country. We have no choice." He also accused Democrats of attempting to politicize COVID-19, drawing parallels with his recent impeachment by the House of Representatives by calling the response "their new hoax".

In other remarks, he expressed a focus on the number of U.S. cases; commenting about cruise ship Grand Princess, he stated his preference that infected passengers not disembark as he did not want "to have the [U.S. case] numbers double because of one ship". He cited the relatively low number of confirmed cases in the initial stages of the outbreak, as proof of success of his travel restriction on China. In late February he judged the country as "very, very ready for this, for anything", while in mid-March he rated his administration's response a score of 10/10.

On March 11, 2020, Trump delivered an Oval Office address on national television, just hours after the WHO declared COVID-19 a global pandemic, which caused a quick fall in financial markets. It was the second such address to the country of his presidency, the first being in January 2019, addressing illegal immigration. In his speech, Trump declared that the United States was "suspending all travel from Europe to the United States for the next 30 days", except travel from the United Kingdom, and including "the tremendous amount of trade and cargo" (post-speech, Trump said trade was still approved, while administration officials clarified that "American citizens or legal permanent residents or their families" were not affected). Trump also listed several economic policy proposals, and declared that insurance companies "have agreed to waive all co-payments for coronavirus treatments" (post-speech, America's Health Insurance Plans clarified the waivers were only for tests, not for treatments). Trump praised his administration's response to the "foreign" virus while stating that "a large number of new clusters in the United States were seeded by travelers from Europe." After the WHO announced a 3.4% mortality rate for the cases on March 13, Trump remarked on Fox News's Hannity that this was a "false number" and the true figure was under 1%.

On March 16, Trump changed his tone on the outbreak to a somber one. For the first time, he acknowledged that COVID-19 was "not under control", the situation was "bad" with months of impending disruption to daily lives, and a recession might occur. Also on March 16, President 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. On March 17, "I felt it was a pandemic long before it was called a pandemic." He also said America will achieve total victory against the "invisible enemy", and called Americans to sacrifice together.

On March 16, Trump began referring to COVID-19 as the "Chinese virus", and as a result he was criticized by Chinese and WHO officials for creating a potential stigma against Chinese and Asians. Trump disagreed with the criticism, and said that "China tried to say at one point—maybe they stopped—that it was caused by American soldiers. That can't happen." Trump stopped using the term on March 23, citing the possibility of "nasty language" towards Asian-Americans. On March 26, President Trump spoke on the phone with China's President Xi Jinping, when they pledged to cooperate in fighting against the pandemic. It signaled a fresh détente between the two countries after weeks of rising tensions. On the same day, after a video call summit with the other G20 leaders, Trump stated the United States was working with international allies to stop the spread of the coronavirus and to increase rapid information and data sharing.

After learning about a French clinical study which showed a 70% cure rate in 20 patients, Trump promoted the drugs chloroquine (also known as chloroquine phosphate) and hydroxychloroquine as potential treatments "by prescription" for COVID-19 on March 19. He noted the drugs showed "tremendous promise" and said he was working together with Governor Cuomo to begin quickly studying and treating coronavirus patients with the drugs in New York. He also remarked on their long-term usage as medicines in the United States saying, "the nice part is, it's been around for a long time, so we know that if it—if things don't go as planned, it's not going to kill anybody." Fatal overdoses of these drugs have occurred, and potential side effects are also known. Also during the briefing, Trump falsely claimed that chloroquine had already been "approved very, very quickly" by the FDA as a treatment for COVID-19 (leading the FDA to clarify that it had not yet approved any COVID-19 treatments but was now allowing chloroquine for life-threatening coronavirus cases under compassionate use guidelines).

Within days of this briefing, a shortage occurred for chloroquine and hydroxychloroquine in the United States, while panic-buying occurred overseas in Africa and South Asia. In the state of Arizona, a man died, with his wife in critical condition, after they ingested fish bowl cleaner, which contained chloroquine phosphate. The couple believed the chemical cleaner could prevent them from contracting COVID-19, although the chloroquine phosphate in fish bowl cleaners is not the same formulation found in the medicines chloroquine or hydroxychloroquine. The woman said she'd watched Trump's briefing in which she believed he promoted chloroquine as "basically pretty much a cure". During the same briefing, Trump also discussed remdesivir as another promising COVID-19 therapy.

On March 22, Trump indicated that he was considering scaling back physical distancing measures implemented around a week ago: "We cannot let the cure be worse than the problem itself." A day later, he argued that economic problems arising from physical distancing measures will cause "suicides by the thousands" (without citing evidence) and "probably more death" than COVID-19 itself. He declared that the United States would "soon, be open for business", in a matter of weeks. 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". However, a survey of prominent economists by the University of Chicago indicated abandoning an economic lock-down prematurely would do more economic damage than maintaining it. Law and economics scholars have argued that the lockdown is justified based on a cost-benefit analysis. On March 29, Trump extended the federal government's guidance through April 30.

On March 28, Trump raised the possibility of placing a two-week enforceable quarantine on New York, New Jersey, and "certain parts of Connecticut" to prevent travel from those places to Florida. The federal quarantine power is limited to preventing people reasonably believed to be infected with a communicable disease from entering the country or crossing state lines. Later that day, following criticism from the three governors, Trump withdrew the quarantine proposal. Instead, the CDC issued a travel advisory advising residents of the three states to "refrain from non-essential domestic travel for 14 days effective immediately". On March 30, Trump said the total number of Americans who would die during the epidemic could be 100,000 or more, following a statement from Fauci that 100,000 to 200,000 Americans could die of the virus.

Administration officials


During the early stages of the outbreak, Trump administration officials gave mixed assessments of the seriousness and scale of the COVID-19 outbreak. CDC Director Robert Redfield said in late January that "the immediate risk to the American public is low," then in late February stated it would be "prudent to assume this pathogen will be with us for some time to come". While federal economic policy chief Larry Kudlow was declaring the COVID-19 spread being contained "pretty close to airtight" in late February, 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. Later 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." In March, while giving public briefings from the White House addressing the pandemic, many administration officials and health experts took time to thank Trump for his leadership, as he watched nearby.

In February 2020, the CDC was notifying the press that it was expecting 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. CDC officials warned that widespread transmission may force large numbers of people to seek hospitalization and other healthcare, which may overload healthcare systems.

In late February reporting by ProPublica and NPR said that Senator Richard Burr warned well-connected constituents of the socio-economic ramifications of the coronavirus and had sold up to $1.7 million of stocks while making public statements of reassurances of the government's level of coronavirus preparedness. Burr and his spokesperson would in turn criticize the reports, with Burr calling the NPR report "a tabloid style hit piece".

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

Public health officials stressed that local governments would need assistance from the federal government if there were school and business closures. 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." On March 31, the CDC released several projections of the end of the epidemic. Under the best case scenario, more Americans will die of coronavirus than in the Vietnam War and Korean War combined. On April 5, Anthony Fauci said as many as 50% of coronavirus carriers may be asymptomatic.

U.S. military response


After mid-March 2020, 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 a large number of 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 2020 coronavirus 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, 2020. 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. 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.

In addition to the many popup hospitals nationwide, the Navy on March 18 prepared to deploy two hospital ships, USNS Mercy (T-AH-19) and USNS Comfort (T-AH-20), to affected areas. The ships will take in non-coronavirus patients transferred from land-based hospitals, so those hospitals can concentrate on virus cases. On March 22, Trump announced that Comfort would go to the East Coast and Mercy to the West Coast. He added the government may be using cruise ships. Mercy arrived in Los Angeles on March 27, and Comfort arrived in New York City on March 30. 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.

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. Despite earlier opposition from the governor of Florida, arrangements were made allowing MS Zaandam and MS Rotterdam to dock at Port Everglades on April2 after nearly two hundred people became ill with COVID-19 and four passengers died.

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".

In regards to the status of U.S. military readiness during the outbreak, Chairman of the Joint Chiefs of Staff General Mark Milley said on April9 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 .09% of military forces. 64 service members had been hospitalized.

Economic impact
The pandemic, along with the resultant stock market crash and other impacts, has led to increased discussion of a recession in the United States. Experts differ on whether a recession will actually take place, with some saying it is not inevitable and others saying the country may already be in a recession. Of the economists surveyed in March by the University of Chicago, 51% agreed or strongly agreed there would be a "major" recession caused by COVID-19, while 31% were uncertain or disagreed.

Economic analysts revised their forecasts downward going into March, with Goldman Sachs estimating on March 20 that the economy could contract by as much as 24% on an annualized basis during the second quarter of 2020, following their 5% decline estimate just four days earlier. James Bullard, the president of the Federal Reserve Bank of St. Louis, estimated that GDP would halve in the second quarter.

According to an analysis discussed in the New York Times, insurance premiums may rise by 40% next year because coronavirus costs were not taken into account when setting 2020 premiums. The total healthcare costs of treating the epidemic could be anywhere from $34 billion to $251 billion according to the analysis.

Travel
In mid-March, most major American and foreign airlines began cutting back on domestic and international flights as a result of the sudden drop in travel demand from the pandemic and subsequent travel bans. They have phased out routes and were making frequent schedule updates. Cruise lines suspended all departures from the United States on March 14.

The outbreak produced occasional disruptions to air traffic control with area control centers in New York and Indianapolis, and airport towers at Midway International Airport in Chicago and McCarran International Airport in Las Vegas evacuated for sterilization after at least one person who had been in each tested positive for COVID-19.

On March 14, Amtrak reduced its service between Washington and Boston as the COVID-19 outbreak drastically decreased travel demand. It faced steep revenue losses during the crisis. It also asked noncritical employees "to take time off on an unpaid basis". By the following week, New York's subways, usually the nation's busiest, were running mostly empty, which had the Metropolitan Transportation Authority using $1 billion from its line of credit to stay afloat.

The lobbying group for the airline industry, Airlines for America (A4A), on March 16 called for a $50 billion subsidy, including $4 billion for cargo services. CNBC reports that airlines are preparing for a ban on domestic flights after President Trump said on March 14 he is considering travel curbs and acting DHS Secretary Chad Wolf said all options remained on the table when asked about a possible ban, the first since September 11, 2001. United Airlines said they expected a drop of $1.5 billion in March revenue, American Airlines said they expected to decrease domestic capacity by 20% in April and 30% in May, and Delta Air Lines told employees it would cut capacity by 40%.

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. 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. Many localities reported an increase in bicycling as residents sought socially distant means of getting around.

Financial market impacts


On February 27, 2020, the Dow Jones Industrial Average (DJIA) dropped 1,191 points, the largest single-day point drop in the index's history at the time; some attributed the drop to anxiety about the epidemic. The same day, the S&P 500 logged a 4.4% decline. Since then, the record has been beaten five more times during the outbreak on March9 (2,013), March 11 (1,465), March 12 (2,353), and finally setting the current record for most points lost in a single day by losing 2,997 points on March 16. It once again fell another 1,338 points on March 18. On March 13, the stock market rebounded for the single largest one-day point gain in the market's history by gaining 1,985 points after Trump declared a state of national emergency to free up resources to combat the virus. The six business days it took for the S&P 500 Index to drop 10% (from February 20 to 27) "marked the quickest 10% decline from an all-time high in the index's history". From January 21 to March 1, the DJIA dropped more than 3,500 points, equating to roughly a 13% decrease.

Stock index futures declined sharply during Trump's March 11 address, and the Dow Jones declined 10% the following day—the largest daily decline since Black Monday in 1987—despite the Federal Reserve also announcing it would inject $1.5 trillion into money markets. By March 18, investors were shunning even assets considered safe havens during economic crises, such as government bonds and gold, moving into cash positions. By March 20, the Dow Jones was below the level when President Trump was inaugurated on January 20, 2017, having fallen 35% from its February peak. The markets rallied between March 23 and 26, with the Dow having its best three-day gain since 1931. On March 27, the Dow fell 3.5% and the S&P 500 fell 3.2%. The Nasdaq Index also fell. Boeing fell 10%, while Exxon and Disney each fell 6%.

Employment effects
The number of persons filing for unemployment insurance increased from 211,000 the week ending March 7, to 281,000 for the week ending March 14, an increase of 70,000 or 33%, the largest percent increase since 1992. Just part way through the following week, 15 states had reported nearly 630,000 claims. Goldman Sachs forecast that more than two million people would file the week of March 21, an unprecedented number. Goldman also forecast that the unemployment rate could rise towards nine percent over the second and third quarters, with much depending on the specifics of government stimulus plans. On March 22, Federal Reserve Bank of St. Louis President James Bullard said the unemployment rate could hit 30 percent between April and June, worse than what it was during the Great Depression. On March 26, the Labor Department reported a record number of unemployment claims: 3.28 million (previously 695 thousand in October 1982). For the week ending March 28, 6.6 million people filed unemployment claims. More than ten million Americans lost their jobs and applied for government aid since mid-March 2020. During March, women, younger and less educated workers were hardest hit by job losses, 65% of which were in the leisure and hospitality sector. As another 6.6 million people filed unemployment claims for the week ending April 4, former Fed Chair Janet Yellen said the unemployment rate had already reached at least 12 or 13 percent, the worst since the Great Depression. 5.2 million people filed unemployment insurance claims in the week ending April 11.

Restaurant industry


The U.S. restaurant industry was projected to have $899 billion in sales for 2020 by the National Restaurant Association, the main trade association for the industry in the United States. The industry as a whole as of February 2020 employed more than fifteen million people, representing ten percent of the workforce directly. It indirectly employed close to another 10% when dependent businesses such as food producers, trucking, and delivery services were factored in, according to Ohio restaurateur Britney Ruby Miller.

On March 15, Ohio Governor Mike DeWine and Ohio Health Department director Amy Acton ordered the closure of all bars and restaurants to help slow the spread of the virus, saying the government "encouraged restaurants to offer carryout or delivery service, but they would not be allowed to have people congregating in the businesses." The next day, Illinois, New York, New Jersey, and Maryland followed suit.

Groups of restaurateurs in New York City and Cincinnati called on governments to provide help to the nation's small and independent restaurants. On March 19 the New York group called for state governments to issue orders for rent abatements, suspension of sales and payroll taxes, and a full shutdown so business interruption insurance coverage would be triggered. On March 20 the Cincinnati group called on the federal government to provide a $225 billion bailout to the restaurant industry.

Several restaurant chains altered their operating procedures to prevent the spread of the virus, including removing seating, restricting the use of condiments, and switching to mobile payment systems. Many restaurants opted to close their dining rooms and instead switch to solely take-out food service to comply with physical distancing recommendations.

Retail


A number of retailers, particularly grocery stores, reduced their opening hours to allow additional time to restock and deep-clean their stores. Major stores such as Walmart, Apple, Nike, Albertson's, and Trader Joe's also shortened their hours. Some grocery store chains, including Stop & Shop and Dollar General, devoted a portion of their operating hours to serve only senior citizens. Many grocery stores and pharmacies began installing plexiglass sneeze guards at register areas to protect cashiers and pharmacists, and adding markers six feet apart at checkout lines to encourage customers to maintain physical distance. To prevent hoarding, many supermarkets and retailers placed limits on certain products such as toilet paper, hand sanitizer, over-the-counter medication, and cleaning supplies. However, the Food Marketing Institute announced that its supply chain was not strained and all products would be available in the future. Major retail chains started hiring tens of thousands of employees to keep up with demand, including Walmart (150,000), CVS Pharmacy (50,000), Dollar General (50,000), and 7-Eleven (20,000). Sheetz convenience stores began offering free meals to children in need at select stores in Maryland, North Carolina, Ohio, Pennsylvania and West Virginia. A daily senior shopping hour, checkout line distancing markers, hand washing and sanitizer for employees, disinfecting wipes for customers to use on carts, and a ban on reusable bags became mandatory in Massachusetts on March 25. Many stores began limiting the number of people inside at a time, to increase the typical distance between customers, resulting in outdoor lines with people spaced six feet apart.

Shipping facilities
Since consumers were increasingly relying on online retailers, Amazon planned to hire another 100,000 warehouse and delivery workers and raise wages $2 per hour through April. They also reported shortages of certain household staples.

A March 21 article in the Chicago Tribune reported that employees at UPS, FedEx, and XPO often have been pressured not to take time off, even with symptoms such as fever and cough consistent with coronavirus. Public health authorities say the risk is relatively low to customers receiving packages, in part because coronavirus does not live for very long on cardboard, but it most certainly is a danger for employees on crowded conveyor belts.

At its warehouses, Amazon has stopped exit screenings, as well as group meetings at the beginning of shifts, and has staggered shift times and break times. The company also announced it would provide up to two weeks of pay to all employees diagnosed with coronavirus or placed into quarantine, but presumably not for employees who merely have symptoms of fever and cough. Amazon workers complained paid medical leave was difficult to obtain because of limited access to COVID-19 testing, and some petitioned the company to extend paid leave to elderly and medically vulnerable workers without a positive test. As small numbers of workers have tested positive for COVID-19, various Amazon warehouses have closed for sanitization, including one in Kentucky for several days. Amazon workers at the Staten Island warehouse and some Instacart workers nationwide separately announced strikes for March 30, demanding access to personal protective equipment, better sick pay, hazard pay for Instacart orders, and a longer closure of the Staten Island warehouse for cleaning.

Production of emergency supplies
In response to shortages, some alcoholic beverage facilities started manufacturing and distributing alcohol-based hand sanitizer. General Motors opened its manufacturing, logistics, and purchasing infrastructure for use by Ventec, a manufacturer of medical ventilators. As medical mask manufacturers hired hundreds of new workers and increased output, in response to urgent requests from hospital workers, volunteers with home sewing machines started producing thousands of non-medical masks that can be sterilized and re-used. Fabric was bought privately or donated by Joann Fabrics. The CDC recommended the use of homemade masks (preferably in combination with a full-face splash shield) only as a "last resort" when no other respiratory protective technologies were available, including reused professional masks. Bauer Hockey began manufacturing face shields for medical applications on March 26.

Some U.S. officials and commentators criticized the outsourcing of critical materials—like the production of essential medical supplies—to China.

Surge in medical personnel
Several states and non-profit groups started recruiting retired medical personnel to increase staffing in hospitals and at temporary facilities. Some jurisdictions granted emergency medical licenses to inactive doctors and incoming resident and interns, and expanded the tasks nurses were allowed to do.

Other financial effects


In February 2020, the American companies Apple Inc. and Microsoft began lowering expectations for revenue because of supply chain disruptions in China caused by the virus. In a February 27 note to clients, Goldman Sachs said it expects no earnings growth for U.S. companies in 2020 as a result of the virus, at a time when the consensus forecast of Wall Street expected "earnings to climb 7%". On March 20, 2020 as part of an SEC filing, AT&T cancelled all stock buyback plans included a plan to repurchase stock worth $4 billion during the second quarter. The reasons AT&T gave for the cancellation was to invest the money into its networks and in taking care of its employees during the pandemic.

In response to the economic damage caused by the pandemic, some economists have advocated for financial support from the government for individual Americans and for banks and businesses. Others have objected to government intervention on the grounds that it would alter the role of the Federal Reserve and enshrine moral hazard as a defining market principle.

Senate Intelligence Committee chairman Richard Burr and Georgia senator Kelly Loeffler have faced allegations of insider trading, citing sales of their stock portfolios that coincided with private briefings on COVID-19. On March 20, while denying the allegations, Burr requested an investigation of his trading history by the Senate Ethics Committee. The Department of Justice has also launched an investigation.

Telemedicine
The COVID-19 pandemic has led to a sharp increase in the use of telemedical services in the United States, specifically for COVID-19 screening and triage. On March 26, 2020, GoodRx launched a telemedicine price comparison platform that lists the prices of COVID-19 assessments by telemedicine provider and state. , three companies are offering free telemedical screenings for COVID-19 in the United States: K Health (routed through an AI chatbot), Ro (routed through an AI chatbot), and GoodRx (offered through its HeyDoctor platform).

Timing of removing economic lockdowns
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". However, a survey of prominent economists by the University of Chicago indicated abandoning an economic lock-down prematurely would do more economic damage than maintaining it. The New York Times reported on March 24 that: "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." Bill Gates said: "It's very tough to say to people, 'Hey keep going to restaurants, go buy new houses, ignore that pile of bodies over in the corner, we want you to keep spending because there's some politician that thinks GDP growth is what counts'... It's hard to tell people during an epidemic... that they should go about things knowing their activity is spreading this disease." On March 29, Trump extended the federal physical distancing recommendations until the end of April.

Criticism of proposed remedies
In late March 2020, Nobel Prize-winning economist Joseph Stiglitz stated Congress was not ready to send out checks now (to individuals) and then if the crisis goes on another four weeks, or six weeks, to send out a second batch of checks. He states the U.S. economy was not in great shape to begin with, for example, with overall growth for March 2020 expected to be less than 2%. The main problem will be that people can't go to work because of fear of the virus. And regarding a welfare safety net, he writes, "America has the weakest social protection of almost any of the advanced countries and so we're having to patch in a kind of social protection system on the fly and it's going to be really hard and that means the recovery is going to be very difficult."

Social impacts
To minimize the spread of infection, public health officials and political figures have initiated steps to isolate infected patients, impose quarantines, and recommend or require physical distancing during group activities, including the closing of schools, retail stores, workplaces, sports events, and leisure activities such as dining and movies.

Lockdowns


In extreme instances, a number of cities and states have imposed lockdown measures which limit where people can travel, work and shop away from their homes:
 * California. The Governor has ordered everyone to stay at home except to get food, care for a relative or friend, obtain health care, or go to an "essential job". People working in critical infrastructure sectors may continue to go to their jobs, but should try to keep at least six feet apart from anyone else. Indoor restaurants, bars and nightclubs, entertainment venues, gyms and fitness studios are closed, although some restaurants can still provide take-out meals. Gas stations, pharmacies, grocery stores, convenience stores, banks and laundry services remain open.
 * New York. Non-essential businesses must shut down their in-office personnel functions, with the exception of financial institutions, retailers, pharmacies, hospitals, news media, manufacturing plants and transportation companies, among others. Casinos, gyms, theaters, shopping malls, amusement parks and bowling alleys are to be closed. "Non-essential gatherings" of any size and for any reason are temporarily banned, and in public, people must keep at least six feet away from each other. Residents 70 and older and people with compromised immune systems or underlying illnesses must remain indoors (unless exercising outside), wear a mask in the company of others and prescreen visitors by taking their temperature.

Similar restrictions to varying degree have been imposed in Illinois, Texas, Nevada, New Jersey and Florida, including the shutting down of hotels. , about 297 million people, or about 90% of the population, are under some form of lockdown in the United States. Several states also set up police checkpoints at their borders.

Educational impacts


, at least 124,000 public and private schools had closed nationwide, affecting at least 55.1 million students, with most schools in all 50 states, the District of Columbia, and all five inhabited territories closed statewide. Of these, 21 states and three territories closed school buildings for the remainder of the school year. As schools shift education to online learning, there are concerns about student access to necessary technology, absenteeism, and accommodations for special needs students. School systems also looked to adjust grading scales and graduation requirements to mitigate the disruption caused by the unprecedented closures.

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. To provide legal authority for such efforts, the U.S. Department of Agriculture waived several school lunch program requirements.

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

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. 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. The College Board also cancelled SAT testing in March and May in response to the pandemic. Similarly, April ACT exams were rescheduled for June 2020.

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

Prison impacts
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. To reduce transmission, the Federal Bureau of Prisons started a near-lockdown for all prisoners on April 1, for at least 14 days.

Xenophobia and racism


There have been incidents of xenophobia and racism against Chinese Americans and other Asian Americans. It was reported that Asian Americans were purchasing firearms in response to the xenophobia arising from the pandemic. The FBI issued an alert that neo-Nazi and white supremacist groups were encouraging members to, if they contract it, spread the virus via "bodily fluids and personal interactions" with Jews and police officers.

Racial disparities
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.

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 April6 that 70% of its reported deaths had involved African Americans), and areas such as Michigan (33% of cases and 41% of deaths as of April 6), and the city of Chicago (1,824 of its 4,680 confirmed cases and 72% of deaths as of April 5). 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.

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 that it planned to release data on racial composition of cases.

Event cancellations


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

On February 21, Verizon pulled out of an RSA conference, joining the ranks of AT&T Cybersecurity and IBM. 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. On March 6, the annual South by Southwest (SXSW) conference and festival scheduled to run from March 13 to 22 in Austin, Texas, were cancelled following after the city government declared a "local disaster" and ordered conferences to shut down for the first time in 34 years. The cancellation is not covered by insurance. 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.

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. 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.

Publishing
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.

The pandemic is predicted to have a dire effect on local newspapers, many of which were already severely struggling beforehand. 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. Online advertisements also dropped to avoid running ads next to coronavirus coverage, and physical mass distribution of non-subscription newspapers became less profitable as many establishments closed and pedestrian traffic on sidewalks and transit stations greatly diminished.

Film
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. Audience limits, as well as mandatory and voluntary closure of cinemas in some areas, led to a total North American box office sales the lowest since October 1998. On March 16, numerous theater chains temporarily closed their locations nationwide. A number of Hollywood film companies have suspended production and delayed the release of some films.

Television
A large number of television programs began to suspend production in mid-March due to the pandemic.

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. Most late-night talk shows and news comedy programs began returning to air in late-March, adopting formats that see their hosts presenting the program from their homes rather than in a studio, and featuring celebrity interviews and/or music performances conducted via videoconferencing.

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.

The Hollywood Reporter observed gains in average viewership for some programs between March9 and April 2, with the top increases including The Blacklist (31.2% gain in average audience since March 9), 20/20 (30.8%), America's Funniest Home Videos (27.2%), 60 Minutes (26.7% above average without NFL lead-outs, and the largest gain in the key demographic), and Shark Tank (24%). These effects have also been seen on syndicated programs, and the Big Three networks' daytime soap operas. 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.

Sports
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.

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. 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), NHL, Major League Baseball, and Major League Soccer. 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.

Religious services


Amidst the 2019–20 coronavirus pandemic, many churches, mosques, synagogues and temples have suspended religious services to void the spread of disease. Many religious organizations continued to do charitable work (e.g. deliver food) during the pandemic.

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. Many mosques have closed for prayers but continued to run their food bank. The National Cathedral of the United States, which belongs to the Episcopal Church, donated more than five thousand N95 surgical masks to hospitals of Washington D.C., which were in shortage during the 2019–20 coronavirus pandemic. Other churches, such as the Church of the Highlands, an evangelical Christian megachurch, have offered free COVID-19 tests in their parking lots.

Many churches have suspended in-person worship services, moving worship to radio, television and online services, while others have offered drive-in services. Some state orders against large gatherings, such as in Ohio and New York, specifically exempt religious organizations. Colorado Springs Fellowship Church insists it has a constitutional right to defy a state closure order. Evangelical college Liberty University of Lynchburg, Virginia, moved its classes online but called its 5,000 back to campus despite Governor Ralph Northam's (D) order to close all non-essential businesses. Rev. Rodney Howard-Browne of the River at Tampa Bay Church in Florida was arrested and fined on March 30 for violating coronavirus-related bans on large gatherings. He had encouraged crowds as large as five hundred over the weekend and argued that churches should get exemptions as essential services.

By March 20, every Roman Catholic diocese in the United States had suspended the public celebration of Mass and dispensed with the obligation to attend Mass on the Lord's Day, as had the Personal Ordinariate of the Chair of Saint Peter. The Ukrainian Greek Catholic Church in the United States also suspended public Divine Liturgies.

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." Many parts of the Methodist Churches, which uphold Sunday Sabbatarian teaching, have transitioned their church services online; ninety percent of the parishes within the Pacific Northwest Annual Conference of the United Methodist Church, for example, are now offering worship via internet livestream. 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. The Republican-dominated Legislative Coordinating Council, gave itself the power to overturn her orders and did so on a party-line, 5–2 vote, supported by the Republican Attorney General. On April 11, convening on an expedited basis, the Kansas Supreme Court reinstated her orders.

On March 24, President Trump said, in regard to Easter (April 12), "Wouldn't it be great to have all the churches full? You'll have packed churches all over our country. I think it'll be a beautiful time." As of March 25, many churches were not prepared to risk reopening, and most churches were predicted to remain closed on Easter.

Starting from March 13, mosques in America began to suspend Friday congregational prayers. The Islamic Society of North America and Islamic Medical Association of North America had both recommended the suspension of services. The Islamic Cultural Center of New York shut all activities at its building, and instead offered its classes via the internet.

Although most churches aired Palm Sunday worship via broadcast media or gathered together for drive-in services, some congregations gathered for Holy Week services under the religious exemptions allowed in many areas, while a minority defied the ban on mass gatherings in other areas.

The Sikh Center of New York prepared more than 30,000 home-cooked meals for Americans in self-isolation amid the novel coronavirus outbreak. The Sikh community was approached by New York's Mayor office for food packages that were handed out to several distributing federal agencies in the area.

Opioid crisis impact
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."

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 thirty years. 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."

Public response
Opinion polling showed a significant partisan divide regarding the outbreak. NPR, PBS NewsHour and Marist found in their mid-March survey that 76% of Democrats viewed COVID-19 as "a real threat", while only 40% of Republicans agreed; the previous month's figures for Democrats and Republicans were 70% and 72% respectively. A mid-March poll conducted by NBC News and The Wall Street Journal found that 60% of Democrats were concerned someone in their family might contract the virus, while 40% of Republicans expressed concern. Nearly 80% of Democrats believed the worst was yet to come, whereas 40% of Republicans thought so. About 56% of Democrats believed their lives would change in a major way due to the outbreak, compared to 26% for Republicans. A mid-March poll by the Kaiser Family Foundation found that 83% of Democrats had taken certain precautions against the virus, compared to 53% of Republicans. The poll found that President Trump was the least-trusted source of information about the outbreak, at 46% overall, after the CDC, WHO, state and local government officials, and the news media, although 88% of Republicans expressed trust in the president, second only to their trust in the CDC.

The outbreak prompted an opinion piece in the Boston Globe that called for the United States to adopt social policies common in other wealthy countries, including universal health care, universal child care, paid family leave, and higher levels of funding for public health.

Reporting by the NYT said that many Republicans thought the pandemic would negatively affect Donald Trump's chances of re-election in the 2020 presidential election; during the month of March 2020 when "social distancing" practices began, the governors of many states experienced sharp gains in approval ratings, and Trump—who gave a nationally televised address on 11 March and began giving daily press conferences on 16 March—saw his approval rating increase from 44% to 49%.

On April 12, 2020, former vice-president Joe Biden proposed a plan, published in The New York Times, to safely reopen America.

International aid to the United States
Chinese billionaire Jack Ma has donated coronavirus test kits and face masks to the United States. Russia sent a cargo plane with ventilators and face masks which the U.S. paid for. Kremlin spokesman Dmitry Peskov said that "when offering assistance to U.S. colleagues, [Putin] assumes that when U.S. manufacturers of medical equipment and materials gain momentum, they will also be able to reciprocate if necessary." According to Russia's RBC business daily, the company that manufactures the ventilators that were delivered by Russia is under U.S. sanctions. India has agreed to export Hydroxychloroquine to the United States after being requested to do so by the U.S. president.

Statistics
The following numbers are based on CDC data. However, CDC data is incomplete. In most U.S. locations, testing for some time was performed only on symptomatic people with a history of travel to Wuhan or with close contact to such people. A quarantined nurse in California, showing symptoms of COVID-19 but without a travel history, said she was denied testing by the CDC in early March. CDC testing protocols did not include non-travelling patients with no known contact with China until February 28.

The original CDC-developed tests sent out on February5 turned out to be faulty. On February 29, the FDA announced that labs would be allowed to do their own in-house testing immediately, independently of CDC testing, as long as they complete an emergency use authorization (EUA) within 15 days. In Washington, state regulators at one point told health care workers to stop testing previously collected samples from an existing non-COVID19 flu study.

As of March 18, the CDC reported that 37,824 specimens had been tested for COVID-19, 4,484 of which were tested by CDC labs, and 33,340 tested by U.S. public health labs. The number of deaths is also probably an undercount, as it leaves out some Americans who tested positive but did not have the virus listed on their death certificates, and others who died without being tested. The CDC says it will issue an official estimate of coronavirus deaths in 2021—current estimates may not be reliable.

On March 30, the Institute for Health Metrics and Evaluation estimated a peak in deaths per day by April 15, with a total of about 80,000 deaths in the United States due to coronavirus by August.

Number of non-repatriated cases by date
The plots above are charts showing the exponential growth of COVID-19 tests 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 ten. 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 deaths per day from existing endemic seasonal influenza and pneumonia is about 551 deaths per day, averaged over seasonal variations. The death rate from COVID-19 exceeded that on March 30, 2020.

The Institute for Health Measurements and Evaluation (IHME) publishes estimates for the U.S. and for each state. This model shows estimates graphically for required hospital beds, ICU beds, and ventilators; the page presents separate graphics for estimates of hospital resources, death rate and total deaths, all as a function of date. The date of peak resource requirements are a function of number of current infections, growth rate, and the population of the state. For straight lines that fit early and late portions of the data that show spread rates, see the log plot in Statistics above. The IHME models, as of April 3, 2020, predict peak hospital bed requirements for Washington on about April 2, for Michigan on about April 7, for New York on about April 8, for New Jersey on about April 11, for California on about April 13, and for Florida on about April 21.