The First 100 Days of the U.S. Government’s COVID-19 Response
The Project On Government Oversight (POGO) has compiled a day-by-day timeline of the first 100 days of the U.S. federal government’s response to the novel coronavirus outbreak, which began in China in late 2019 and became a global pandemic. The timeline begins with the glimmers of initial international awareness of this virus that causes COVID-19. But, for the purpose of assessing the U.S. federal government’s response to COVID-19, Day 1 is the first day in which there is public information that a cabinet official was made aware of the outbreak: January 3, 2020.
The period of time chosen—100 days—covers a substantial period covering critical phases from initial awareness of the outbreak, to the virus’s spread globally, to the infection of people across the U.S. and the onset of great pressure being placed on the U.S. healthcare system and economy, to when some models projected a peak in daily deaths. As of publication, there are over 69,000 known deaths in the U.S. attributed to COVID-19.
It also is bookended by a date chosen by the president: Easter, April 12. On March 24, President Donald Trump said he wanted the nation “opened up” by Easter. He later backtracked and said social distancing measures would extend beyond this date, but mid-April is when he and some experts have predicted COVID-19 deaths in the U.S. could peak (a government model run on May 1 shows U.S. daily deaths continuing to rise through May.) April 12 is also the 100th day since one of his cabinet officials was made aware of what was at first just a mysterious outbreak in a Chinese province. On Easter, the director of the National Institute of Allergy and Infectious Diseases, Anthony Fauci, also told CNN that “if you had a process that was ongoing, and you started mitigation earlier, you could have saved lives. Obviously, no one is going to deny that.” He added, “But there was a lot of pushback about shutting things down back then.”
The goal of the timeline is to create a body of facts to enhance public understanding of what the federal government did, didn’t do, or did ineffectively in response to COVID-19. POGO intends for the timeline to be a resource to others examining the government response, such as a potential 9/11 Commission-like body that some legislators say they want to create. While it is impossible to eliminate the benefit of significant hindsight, the timeline attempts to assess how the government’s response could have been more effective based on what was known at the time, such as medical and scientific findings, reporting on the situations in other countries, and statements by top American officials and agencies.
The timeline also tracks some key developments that were not publicly known on the day they occurred, namely the earliest known (as of the publication of this timeline) instances of infected travelers returning to the U.S. and Americans dying from COVID-19. In the case of the former, the date of arrival is significant because those individuals tested positive days after returning to the U.S. The lag in discovery should have further fueled concern by the U.S. government about the efficacy of its disease surveillance because the disease spread before the travelers were isolated. In the case of the latter, the belated discovery in April that two people in California had died from COVID-19 in February underscores how far behind the public health and medical communities were in their efforts to identify the virus and contain its spread.
POGO has endeavored to not only track official government statements on federal efforts, but to compile information published and obtained by journalists and watchdogs. To only give credence to the former would be to rely solely on the government’s often rosier account of its own performance.
Part 1
Early Awareness of the New Outbreak
A new virus was spreading in the city of Wuhan in China’s Hubei province in December 2019 and, by the end of the month, Chinese hospitals were linking the new mysterious illness to a local seafood market. Much was unknown about the virus, including whether it could be transmitted from person to person, but at least one Chinese doctor suspected that it could. On the eve of the new year, early information on the new outbreak started to circulate internationally even as local Chinese authorities sought to discredit warnings that there may be human transmission and that medical professionals should protect themselves.
December 29-January 2
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Chinese Hospitals Link New Illness to Seafood Market
A seafood market in Wuhan, China, in November 2019. (Photo: Arend Kuester/Flickr)
Key Coronavirus Developments
Hospitals in Wuhan, China identify the first four cases, all linked to a Wuhan seafood market, “using a surveillance mechanism for ‘pneumonia of unknown etiology’ that was established in the wake of the 2003 severe acute respiratory syndrome (SARS) outbreak with the aim of allowing timely identification of novel pathogens.”
Key Stats
U.S. Tests Administered (Per Day): 0
U.S. Cases Confirmed: 0
Total U.S. Deaths: 0
Global Confirmed Cases: 4
Global Deaths: 0 -
A Wuhan Doctor Warns Other Doctors to Protect Themselves from the New Illness
Key Coronavirus Developments
Dr. Li Wenliang sends “a message to a group of fellow doctors warning them about a possible outbreak of an illness that resembled severe acute respiratory syndrome (SARS) in Wuhan, Hubei province, China, where he worked. Meant to be a private message, he encouraged them to protect themselves from infection.”
Key Stats
U.S. Tests Administered (Per Day): 0
U.S. Cases Confirmed: 0
Total U.S. Deaths: 0
Global Confirmed Cases: 4
Global Deaths: 0 -
China Informs World Health Organization of an Outbreak of “Pneumonia of Unknown Cause”
Key Coronavirus Developments
The Chinese government tells the World Health Organization’s (WHO) office in China about a new unknown illness. The Wuhan Municipal Health Commission declares, according to a translation, that its investigation has not found any obvious human-to-human transmission and no medical staff infection.
The University of Minnesota’s Center for Infectious Disease Research and Policy notes on its website, citing various sources, that “Health officials in China are investigating the cause of a pneumonia outbreak in the city of Wuhan in Hubei province that has sickened 27 people and seems to be linked to a seafood market.”
Key Stats
U.S. Tests Administered (Per Day): 0
U.S. Cases Confirmed: 0
Total U.S. Deaths: 0
Global Confirmed Cases: 27
Global Deaths: 0 -
The Wuhan Seafood Market is Closed
Key Coronavirus Developments
The WHO requests further information from China “to assess the risk.”
The English-language South China Morning Post reports on the illness.
Chinese government authorities close the Wuhan South China Seafood Market to sanitize it. The market is where the first people diagnosed with the mysterious new illness worked.
The Wuhan Public Security Bureau accuses Dr. Li Wenliang of “spreading rumors.”
Key Stats
U.S. Tests Administered (Per Day): 0
U.S. Cases Confirmed: 0
Total U.S. Deaths: 0
Global Confirmed Cases: 27
Global Deaths: 0 -
Identified Cases Show That Illness Spread Beyond Seafood Market Workers
Key Coronavirus Developments
As of this date, in Wuhan, “41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection” and “27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found,” according to findings published in a medical journal later in January.
An American news outlet, CBS News, runs a wire story from Agence France-Presse on the new outbreak.
Key Stats
U.S. Tests Administered (Per Day): 0
U.S. Cases Confirmed: 0
Total U.S. Deaths: 0
Global Confirmed Cases: 41
Global Deaths: 0
Part 2
Top Levels of the U.S. Government Become Aware
The head of the U.S. Centers for Disease Control and Prevention (CDC), Robert Redfield, became aware of how serious the new illness was around New Year’s Day. On January 3, Redfield informed his boss, Secretary of Health and Human Services Alex Azar, a cabinet official in the Trump administration. The CDC took initial actions in the ensuing weeks, but China delayed in responding to an offer from the agency to send a team to help assess the situation. Over the next week and a half, researchers learn more about the new virus as it claimed its first life. Despite growing speculation that it could spread among people, China continues to downplay the possibility of human-to-human transmission, which was repeated by the World Health Organization, relying on China’s information. Even so, the WHO begins to help prepare governments.
January 3-January 12
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DAY 1: The Head of the U.S. CDC Informs the HHS Secretary About the Outbreak
Key Coronavirus Developments
The BBC reports that government authorities in Wuhan punish 8 people for "publishing or forwarding false information on the internet without verification."
According to the Straits Times, “China’s National Health Commission, the nation’s top health authority, ordered institutions not to publish any information related to the unknown disease, and ordered labs to transfer any samples they had to designated testing institutions, or to destroy them.”
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership
The head of the Centers for Disease Control and Prevention, Robert Redfield, calls Secretary of Health and Human Services Alex Azar to inform him of the new outbreak in China. Azar tells Redfield to inform the White House’s National Security Council.
Key Stats
U.S. Tests Administered (Per Day): 0
U.S. Cases Confirmed: 0
Total U.S. Deaths: 0
Global Confirmed Cases: 41
Global Deaths: 0 -
DAY 2: The World Health Organization Publicly Announces a Cluster of Mysterious Pneumonia Cases in Wuhan, China
Key Coronavirus Developments
On Twitter, the WHO publicly announces that China has informed it that there are mysterious pneumonia cases, although no deaths so far, in Wuhan, China. The WHO says “Investigations are underway to identify the cause of this illness” and that it “is working across the 3 levels (country office, regional office, HQ) to track the situation.”
#China has reported to WHO a cluster of #pneumonia cases —with no deaths— in Wuhan, Hubei Province 🇨🇳 . Investigations are underway to identify the cause of this illness.
— World Health Organization (WHO) (@WHO) January 4, 2020The head of the University of Hong Kong’s Center for Infection says that “the city should implement the strictest possible monitoring system for a mystery new viral pneumonia that has infected dozens of people on the mainland, as it is highly possible that the illness is spreading from human to human.”
Key Stats
U.S. Tests Administered (Per Day): 0
U.S. Cases Confirmed: 0
Total U.S. Deaths: 0
Global Confirmed Cases: 41
Global Deaths: 0 -
DAY 3: WHO, Citing Info From China, Says “No Evidence of Significant Human-to-Human Transmission”
Key Coronavirus Developments
The World Health Organization announces in a press release the emergence of “pneumonia of unknown cause” in China. It states that “the clinical signs and symptoms are mainly fever, with a few patients having difficulty in breathing, and chest radiographs showing invasive lesions of both lungs.” Citing “preliminary information from the Chinese investigation team,” the WHO says “no evidence of significant human-to-human transmission and no health care worker infections have been reported.”
Chinese authorities rule out Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and avian flu and confirm 59 cases. (Within a week, because of advances in understanding of the new coronavirus, Chinese authorities rule out 18 of these 59 cases. See POGO’s extended methodology for more information.)
Key Stats
U.S. Tests Administered (Per Day): 0
U.S. Cases Confirmed: 0
Total U.S. Deaths: 0
Global Confirmed Cases: 41
Global Deaths: 0 -
DAY 4: China Ignores U.S. CDC Offer to Send Team
Key Coronavirus Developments
The head of the University of Minnesota’s Center for Infectious Disease Research and Policy, Michael Osterholm, says if the pathogen implicated in the Wuhan cluster is a coronavirus, he worries about a "superspreader" event.
U.S. Government Actions
Travel Restrictions and Warnings
The CDC issues a level 1 travel watch—its lowest level—because of the outbreak in China. It advises travelers to avoid animals, alive or dead, and sick people.
Surveillance
The CDC also offers to send a team to China, but the Chinese government isn’t responsive.
The head of the National Institute of Allergy and Infectious Diseases, Anthony Fauci, tells Axios, “My guess would be that it's a different kind of coronavirus.” He says that Americans should not be concerned yet but the source of the outbreak needs to be tracked down.
Key Stats
U.S. Tests Administered (Per Day): 0
U.S. Cases Confirmed: 0
Total U.S. Deaths: 0
Global Confirmed Cases: 41
Global Deaths: 0 -
DAY 5: CDC Sets Up a Structure to Address the Outbreak
Key Coronavirus Developments
In Hong Kong, “public fears of the unknown respiratory illness outbreak in a city hit by the SARS outbreak in 2003 have increased demand for N95 respirators, and supplies are running low,” according to the South China Morning Post. N95 respirators are face masks that, if worn properly, filter out the vast majority of tiny particles in the air and in liquids.
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership
The CDC establishes “a Center-led Incident Management Structure” to address the new outbreak and “to optimize domestic and international coordination if additional public health actions are required.”
Key Stats
U.S. Tests Administered (Per Day): 0
U.S. Cases Confirmed: 0
Total U.S. Deaths: 0
Global Confirmed Cases: 41
Global Deaths: 0 -
DAY 6: CDC Alerts U.S. Medical Professionals to Be “On the Look-Out”
Key Coronavirus Developments
Citing Chinese state-run media, the Wall Street Journal reports that Chinese researchers have learned the mysterious illness is caused by a new coronavirus.
U.S. Government Actions
Surveillance
The CDC alerts medical professionals and state and local health departments “to be on the look-out for patients with respiratory symptoms and a history of travel to Wuhan, China.”
Key Stats
U.S. Tests Administered (Per Day): 0
U.S. Cases Confirmed: 0
Total U.S. Deaths: 0
Global Confirmed Cases: 41
Global Deaths: 0 -
DAY 7: WHO Issues Tool to Help Countries Identify Capability Gaps to Address the New Virus
Key Coronavirus Developments
The World Health Organization issues a tool to help countries around the world “better understand existing capacities in the area of detection and response” to the novel coronavirus.
Global researchers urge more information sharing from China. Peter Daszak, president of the EcoHealth Alliance, says, “Every day that we don’t get all that information is a risk of further spread in my opinion.”
Key Stats
U.S. Tests Administered (Per Day): 0
U.S. Cases Confirmed: 0
Total U.S. Deaths: 0
Global Confirmed Cases: 41
Global Deaths: 0 -
DAY 8: The New Coronavirus’s Genome is Made Public
Key Coronavirus Developments
Researchers post the virus’s draft genome online.
Key Stats
U.S. Tests Administered (Per Day): 0
U.S. Cases Confirmed: 0
Total U.S. Deaths: 0
Global Confirmed Cases: 41
Global Deaths: 0 -
DAY 9: First Death Attributed to COVID-19
Key Coronavirus Developments
A Wuhan resident with COVID-19 dies, the first confirmed death attributed to the virus.
Key Stats
U.S. Tests Administered (Per Day): 0
U.S. Cases Confirmed: 0
Total U.S. Deaths: 0
Global Confirmed Cases: 41
Global Deaths: 1 -
DAY 10: The WHO Says China Has Provided “No Clear Evidence That the Virus Passes Easily From Person to Person”
Key Coronavirus Developments
“China shared the genetic sequence of the novel coronavirus,” according to the World Health Organization. The Chinese “government reports that there is no clear evidence that the virus passes easily from person to person.”
Key Stats
U.S. Tests Administered (Per Day): 0
U.S. Cases Confirmed: 0
Total U.S. Deaths: 0
Global Confirmed Cases: 41
Global Deaths: 1
Part 3
The Virus Comes to America
Although it would not be discovered until nearly the end of the month, the first known traveler with coronavirus came to the U.S. on January 13. More would follow as the virus spread to the U.S. and globally and as confirmed cases in Wuhan, China increased, along with deaths. Public health screenings at a handful of the biggest international airports in the U.S. would not begin until after the arrival of at least two of those initial cases, one of which researchers later estimated led to the infection of hundreds of people. Alex Azar, the HHS secretary, called President Trump to discuss the virus the day after the CDC began implementing the limited airport health screenings.
January 13-18
-
DAY 11: A Traveler Returns to the U.S. With the Virus
Key Coronavirus Developments
Thailand confirms the first case outside China.
A traveler returns to the U.S. from Wuhan with the virus. This Chicago resident is not diagnosed with the virus until 10 days later—what will become the second confirmed U.S. case.
Key Stats
U.S. Tests Administered (Per Day): 0
U.S. Cases Confirmed: 0
Total U.S. Deaths: 0
Global Confirmed Cases: 42
Global Deaths: 1 -
DAY 12: Top U.S. Preparedness Official Grows Concerned
Key Coronavirus Developments
The South China Morning Post reports that the Thai woman with COVID-19—the first confirmed international case—did not visit the Wuhan seafood market.
Wuhan’s health authorities state, according to a translation, that clear human-to-human evidence has not been found, but the possibility of limited human-to-human transmission cannot be ruled out although they believe the risk of continued human-to-human transmission is low.
U.S. Government Actions
Healthcare System and Supply Chain Preparedness
Robert Kadlec, HHS’s assistant secretary for preparedness and response, writes in his notebook, “Coronavirus!!!” According to the Washington Post, around this time, Kadlec “had instructed subordinates to draw up contingency plans for enforcing the Defense Production Act. … Aides were bitterly divided over whether to implement the act, and nothing happened for many weeks.”
Key Stats
U.S. Tests Administered (Per Day): 0
U.S. Cases Confirmed: 0
Total U.S. Deaths: 0
Global Confirmed Cases: 42
Global Deaths: 1 -
DAY 13: Another Traveler Returns to the U.S. With the Virus
Key Coronavirus Developments
An American departs Wuhan and flies back to the U.S. with COVID-19. Six days pass before this case is confirmed and made public. This will be the first confirmed case in the United States.
A second person in China dies from COVID-19.
Key Stats
U.S. Tests Administered (Per Day): 0
U.S. Cases Confirmed: 0
Total U.S. Deaths: 0
Global Confirmed Cases: 42
Global Deaths: 2 -
DAY 14: Japan Confirms Its First Case
Key Coronavirus Developments
Japan confirms its first case after a man returns from visiting Wuhan, but who had not visited the seafood market. Japan’s health ministry states “it is possible that the patient had close contact with an unknown patient with lung inflammation while in China.”
Key Stats
U.S. Tests Administered (Per Day): 0
U.S. Cases Confirmed: 0
Total U.S. Deaths: 0
Global Confirmed Cases: 43
Global Deaths: 2 -
DAY 15: German Researchers Develop 1st COVID-19 Test
Key Coronavirus Developments
Researchers in Berlin announce they have developed “a new laboratory assay to detect the novel Chinese coronavirus,” according to a press release. “The assay protocol has now been published by WHO as a guideline for diagnostic detection. The new assay enables suspected cases to be tested quickly.”
Thailand announces its second confirmed case.
U.S. Government Actions
Travel Restrictions and Warnings | Surveillance
The CDC begins “implementing public health entry screening at San Francisco (SFO), New York (JFK), and Los Angeles (LAX) airports.”
Key Stats
U.S. Tests Administered (Per Day): 0
U.S. Cases Confirmed: 0
Total U.S. Deaths: 0
Global Confirmed Cases: 44
Global Deaths: 2 -
DAY 16: The HHS Secretary Calls President Trump About the New Virus
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership
HHS Secretary Alex Azar calls President Trump at Mar-a-Lago to discuss the new virus.
Key Stats
U.S. Tests Administered (Per Day): 4
U.S. Cases Confirmed: 0
Total U.S. Deaths: 0
Global Confirmed Cases: 56
Global Deaths: 2
Part 4
No More Doubt Regarding Human Transmission
On January 19 and 20, China and the World Health Organization confirmed that the coronavirus can be transmitted from person to person and CDC announced on January 21 that it had arrived in the U.S.—although that case was diagnosed days after a traveler had arrived back in the country. While Trump reassured the public on January 22 that it was just one traveler, there was at least one other who had arrived even earlier who was not known yet. And the one confirmed U.S. case likely led to the infection of many more during the days prior to being diagnosed, according to researchers. Given the confirmation of human-to-human transmission at the time, it could not have been ruled out that the one known U.S. case had led to the infection of others. The CDC expands its health screenings to two more airports, bringing the number of screening locations to five.
January 19-22
-
DAY 17: WHO Warns of “Limited Human-to-Human Transmission”
Key Coronavirus Developments
First report of a Chinese case outside of Wuhan.
The WHO writes on Twitter that “some limited human-to-human transmission” is “occurring between close contacts.”
WHO has issued advice for individuals on how to protect themselves and others from the novel #coronavirus (2019-nCoV) https://t.co/f7LSwJe43V
— World Health Organization (WHO) (@WHO) January 19, 2020Key Stats
U.S. Tests Administered (Per Day): 0
U.S. Cases Confirmed: 0
Total U.S. Deaths: 0
Global Confirmed Cases: 192
Global Deaths: 3 -
DAY 18: China Confirms Human-to-Human Transmission
Key Coronavirus Developments
A leading Chinese scientist heading the country’s review of the new coronavirus confirms that it can be transmitted between humans. South Korea reports its first confirmed case.
Key Stats
U.S. Tests Administered (Per Day): 7
U.S. Cases Confirmed: 0
Total U.S. Deaths: 0
Global Confirmed Cases: 212
Global Deaths: 3 -
DAY 19: CDC Announces First Confirmed U.S. Case and Its Own Test
U.S. Government Actions
Surveillance
The CDC announces the first confirmed U.S. case of COVID-19, a traveler who resided in the state of Washington who returned from Wuhan, China, six days earlier. “There are growing indications that limited person-to-person spread is happening. It’s unclear how easily this virus is spreading between people,” Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Disease, says. Messonnier announces that the CDC had finished development of its own test for detecting coronavirus just days before and “used this test to quickly confirm our first U.S. case.”
Surveillance | Travel Restrictions and Warnings
The CDC announces it is adding “entry health screening at two more airports—Atlanta (ATL) and Chicago (ORD)” and raising its travel health warning to level 2 for travelers to Wuhan.
Interagency Coordination, Resources, and White House Leadership
CDC gives its Emergency Operations Center responsibility for handling the response to the outbreak, allowing the agency “to provide increased operational support to meet the outbreak’s evolving challenges.”
Key Stats
U.S. Tests Administered (Per Day): 3
U.S. Cases Confirmed: 1
Total U.S. Deaths: 0
Global Confirmed Cases: 365
Global Deaths: 6 -
DAY 20: Trump Says “We have it totally under control.”
Key Coronavirus Developments
A person infected with the virus returns to France after traveling to Wuhan and falls sick this day, according to a CDC dispatch that was published March. The case would not be diagnosed until January 24.
U.S. Government Actions
Congress | Travel Restrictions and Warnings
Senator Tom Cotton (R-AR) writes to HHS Secretary Alex Azar that “I’m deeply concerned that waging an efficient and successful campaign against this virus depends on the trustworthiness and transparency of the Chinese Communist Party (CCP), an organization with a horrendous history in these matters.”…“[G]iven China’s dismal record on these matters, your Department and all relevant agencies of the U.S. Government must be proactive in planning for scenarios where this infection continues to spread,” Cotton writes. “…[I]f necessary, banning entry to those traveling from China must be contemplated and prepared in order to keep Americans safe.”
Presidential Statements
“We have it totally under control. It’s one person coming in from China. It’s going to be just fine.”
Key Stats
U.S. Tests Administered (Per Day): 10
U.S. Cases Confirmed: 1
Total U.S. Deaths: 0
Global Confirmed Cases: 555
Global Deaths: 17
Part 5
The U.S. Government Begins to Escalate Its Response
During this time, the Chinese government began to take drastic measures to quarantine the city of Wuhan to slow down and stop the spread of coronavirus as China rapidly discovers more cases with expanded testing. The CDC issued its highest travel warning for the city, asking Americans to avoid traveling there unless necessary. The National Institute of Allergy and Infectious Diseases launched a partnership with a company to develop a vaccine—the beginning of a long process. A second U.S. case is confirmed in a woman who arrived even earlier than the first confirmed U.S. case. And the third, fourth, and fifth U.S. cases would soon be confirmed. Meanwhile, German researchers presented evidence that people can spread the virus without showing symptoms. Although the German research was later found to have flaws, a top U.S. official reached out to the Chinese government and became confident that there is asymptomatic transmission (over time, more evidence has emerged).
All of this should have amounted to a clarion call that the outbreak was serious and that the virus was likely spreading silently in America. The Trump administration by the end of the month was further escalating its response, such as limiting entry into the U.S. of travelers coming from Hubei province, effective February 2. However, it only took some actions, such as declaring a public health emergency, after prodding by Congress and, despite the evidence from China that the virus could spread rapidly, the administration held back on asking for more funding even as it was depleting its budget for responding. It also held back on using its legal authority to compel more production of vital medical equipment and supplies.
January 23-February 2
-
DAY 21: Wuhan Puts 11 Million People Under Quarantine
A weibo video posted by a person claiming to be a nurse in #Wuhan Red Cross Hospital. She said medical workers and patients were stuck with three deceased in a packed hospital corridor. No one is here to take care of the bodies. #WuhanPneumonia pic.twitter.com/MKumfLDPki
— Thomas Yau (@Tominmedill) January 24, 2020Key Coronavirus Developments
Wuhan suspends all public transport and air travel (in and out of the city), placing all 11 million city residents under quarantine.
U.S. Government Actions
Medical Countermeasures
The National Institute of Allergy and Infectious Disease Vaccine Research Center "is collaborating with the drug company Moderna and the Coalition for Epidemic Preparedness Innovations (CEPI) to advance a vaccine candidate. Moderna expects this vaccine to enter phase 1 clinical testing in the spring of 2020,” according to the Congressional Research Service, citing a Moderna press release.
Key Stats
U.S. Tests Administered (Per Day): 36
U.S. Cases Confirmed: 1
Total U.S. Deaths: 0
Global Confirmed Cases: 654
Global Deaths: 18 -
DAY 22: France Announces Europe’s First Confirmed Cases
Key Coronavirus Developments
The U.S. announces it has confirmed its second travel-related case, a woman who had returned from Wuhan on January 13.
In a prominent medical journal, researchers write that in China, “The number of deaths is rising quickly. … We are concerned that 2019-nCoV could have acquired the ability for efficient human transmission.” The researchers wrote that “Airborne precautions, such as a fit-tested N95 respirator, and other personal protective equipment are strongly recommended.”
France announces Europe’s first confirmed cases. Citing France’s health minister, a news report states, “One reason why France is the first European country to have confirmed cases is that it has developed a test allowing medics to rapidly diagnose infected people.”
U.S. Government Actions
The CDC puts into effect a level 3 travel notice for Wuhan recommending that travelers avoid all non-essential travel and a level 1 warning for the rest of China, urging travelers to take precautions.
Interagency Coordination, Resources, and White House Leadership
HHS Secretary Alex Azar activates “the Secretary’s Operations Center (SOC)” as “the center of gravity for interagency coordination,” according to the government’s COVID-19 plan.
Congress
“At the urging of Sen. Lamar Alexander (R-Tenn.),” administration officials brief the Senate on the outbreak. The briefing is “sparsely attended,” two congressional staffers tell Politico. Around 14 senators attend.
Surveillance
The Chinese government thwarts a lab-to-lab transfer of samples from the Wuhan Institute of Virology to the University of Texas-Medical Branch. According to the Washington Post, Robert Kadlec, HHS’s assistant secretary for responsiveness and preparedness, had pinned some hope on that transfer to gain more insight into the virus to help develop a disease surveillance system in the U.S.
Presidential Statements
China has been working very hard to contain the Coronavirus. The United States greatly appreciates their efforts and transparency. It will all work out well. In particular, on behalf of the American People, I want to thank President Xi!
— Donald J. Trump (@realDonaldTrump) January 24, 2020Key Stats
U.S. Tests Administered (Per Day): 53
U.S. Cases Confirmed: 2
Total U.S. Deaths: 0
Global Confirmed Cases: 941
Global Deaths: 26 -
DAY 23: Chinese President Xi Says “Accelerating Spread” of COVID-19 A “Grave Situation”
Key Coronavirus Developments
During a high-level government meeting, Chinese President Xi Jinping says COVID-19 is spreading rapidly.
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership
HHS Secretary Alex Azar authorizes for the use of $105 million from the Infectious Diseases Rapid Response Reserve Fund to respond to coronavirus, according to the Congressional Research Service.
Travel Restrictions and Warnings
The U.S. government says it will fly U.S. citizens out of Wuhan by charter jet, but then later says it has limited capacity to do so.
Key Stats
U.S. Tests Administered (Per Day): 101
U.S. Cases Confirmed: 2
Total U.S. Deaths: 0
Global Confirmed Cases: 1,424
Global Deaths: 42 -
DAY 24: U.S. Confirms Third, Fourth, and Fifth Cases
U.S. Government Actions
Congress | Interagency Coordination, Resources, and White House Leadership
Senate Minority Leader Chuck Schumer (D-NY) calls on HHS to declare coronavirus a public health emergency to access $85 million in federal funding. “Should the outbreak get worse they will need immediate access to critical federal funds that at present they remain unable to access,” Schumer says in a press release.
Key Stats
U.S. Tests Administered (Per Day): 79
U.S. Cases Confirmed: 5
Total U.S. Deaths: 0
Global Confirmed Cases: 2,118
Global Deaths: 56 -
DAY 25: FDA Solicits Test Development Proposals
Key Coronavirus Developments
Germany confirms its first coronavirus case.
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership | Surveillance | Healthcare System and Supply Chain Preparedness | Community Mitigation
The White House’s National Security Council holds a meeting on the new coronavirus. According to the New York Times, “There was no checklist about the preparations for a possible pandemic, which would require intensive testing, rapid acquisition of protective gear, and perhaps serious limitations on Americans’ movements.”
Travel Restrictions and Warnings
The CDC puts into effect a level 3 travel notice for all of China recommending that travelers avoid all non-essential travel.
Surveillance | Medical Countermeasures
The FDA solicits proposals from companies interested in developing tests and treatments for the coronavirus. “Being able to quickly and accurately diagnose patients infected with the novel coronavirus is an essential step in helping patients identify the need for care and mitigate the spread of the virus to additional individuals,” the FDA says in a news release.
Interagency Coordination, Resources, and White House Leadership
The CDC Foundation activates “its Emergency Response Fund (ERF) to support COVID-19. … [T]he foundation has greater spending flexibility and can sometimes procure response supplies and services more quickly than CDC through federal procurement processes,” according to the Congressional Research Service.
Key Stats
U.S. Tests Administered (Per Day): 77
U.S. Cases Confirmed: 5
Total U.S. Deaths: 0
Global Confirmed Cases: 2,927
Global Deaths: 82 -
DAY 26: Top CDC Official Says If Asymptomatic Transmission Is a “Significant Issue” Then “We Would Have to Change Our Operations”
U.S. Government Actions
Travel Restrictions and Warnings | Surveillance
HHS Secretary Alex Azar says the CDC will expand screening of travelers from China to 20 airports from five.
Interagency Coordination, Resources, and White House Leadership
Azar says at a press briefing, “We've been monitoring this virus and preparing a response since back in December. … The President and I have been speaking regularly about this outbreak, and I have been speaking with the senior officials at HHS and the White House multiple times each day since the outbreak began to represent an international threat.
The President is highly engaged in this response, and closely monitoring the work we're doing to keep Americans safe.”
Surveillance
The CDC’s Nancy Messonnier says at a press briefing that “there have been isolated reports of asymptomatic infection from several countries … we’re looking at that data closely … we would have to change our operations if indeed that was a significant issue.”
Surveillance | Travel Restrictions and Warnings | Medical Countermeasures | Congress | Healthcare System and Supply Chain Preparedness
Washington state’s two Democratic senators, Patty Murray and Maria Cantwell, demand that Azar provide them “with the latest information regarding the severity of the disease, the country’s capacity to diagnose cases, what steps were being taken to prepare U.S. health care workers, what screening systems were in place at U.S. airports, the status of a novel coronavirus vaccine.”
Economic Response
The Federal Reserve’s notes during a 2-day Open Market Committee meeting state that “the threat of the coronavirus, in addition to its human toll, had emerged as a new risk to the global growth outlook.”
Healthcare System and Supply Chain Preparedness
“Any way you cut it, this is going to be bad,” emails Carter Mecher, a top Department of Veterans Affairs medical adviser. “The projected size of the outbreak already seems hard to believe.”
Key Stats
U.S. Tests Administered (Per Day): 65
U.S. Cases Confirmed: 5
Total U.S. Deaths: 0
Global Confirmed Cases: 5,578
Global Deaths: 131 -
DAY 27: Trump Announces COVID-19 Task Force as Top Advisor Privately Warns of Risk to More Than 1 Million U.S. Lives
Key Coronavirus Developments
An article published in the New England Journal of Medicine says the coronavirus appears to have an average incubation period of 5.2 days (an incubation period is the time between infection and when symptoms begin); in its early stages the epidemic doubled every 7.4 days; and the average infected person spreads the disease to 2.2 others, allowing the virus to spread quickly.
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership
In a memo to President Trump, White House trade advisor Peter Navarro writes that “there is an increasing probability of a full-blown COVID-19 pandemic that could infect as many as 100 million Americans, with a loss of life of as many as 1-2 million souls” and he argues for the “need to take aggressive action to contain the outbreak.”
Interagency Coordination, Resources, and White House Leadership
President Trump announces the President’s Coronavirus Task Force, chaired by HHS Secretary Alex Azar. While the White House’s announcement says, “the Task Force will lead the Administration’s efforts to monitor, contain, and mitigate the spread of the virus," according to a top administration official who spoke to the Washington Post months later, “The genesis of this group was around border control and repatriation” and “It wasn’t a comprehensive, whole-of-government group to run everything.”
Travel Restrictions and Warnings | Interagency Coordination, Resources, and White House Leadership
The president’s chief of staff, Mick Mulvaney, chairs a White House meeting debating whether the State Department should issue a “Level 4”/“do not travel” advisory in response to the outbreak in China, according to the Washington Post.
Key Stats
U.S. Tests Administered (Per Day): 102
U.S. Cases Confirmed: 5
Total U.S. Deaths: 0
Global Confirmed Cases: 6,166
Global Deaths: 133 -
DAY 28: World Health Organization Declares Outbreak a "Public Health Emergency of International Concern," and Azar Warns Trump of Possible Pandemic
Key Coronavirus Developments
The World Health Organization's director general declares the new coronavirus outbreak to be a "public health emergency of international concern." This is the sixth such declaration by the WHO since 2005.
Italian Prime Minister Giuseppe Conte confirmed two cases of coronavirus in the country, but said, "There is no reason to create social alarm or panic." The state of Washington declares a Level 1 Emergency and activates its emergency response center.
The CDC reports the first known instance of person-to-person spread in U.S.—the spouse of the second confirmed U.S. case.
German researchers publish a report on the first supposed confirmed case of asymptomatic transmission in the New England Journal of Medicine. It is cited by a CDC official the next day. In less than a week, the study is found to have fundamental flaws (though subsequent studies find that the virus can be transmitted when an infected person is asymptomatic).
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership
HHS Secretary Alex Azar warns President Trump of the risk of a pandemic on a phone call, according to the New York Times.
Travel Restrictions and Warnings
The State Department issues its highest travel warning: "Level 4: Do Not Travel to China." Its website states that "Those currently in China should consider departing" and warning that "Travelers should be prepared for travel restrictions to be put into effect with little or no advance notice."
Presidential Statements
“We have it very well under control. We have very little problem in this country at this moment—five—and those people are all recuperating successfully.”
Working closely with China and others on Coronavirus outbreak. Only 5 people in U.S., all in good recovery.
— Donald J. Trump (@realDonaldTrump) January 30, 2020Key Stats
U.S. Tests Administered (Per Day): 256
U.S. Cases Confirmed: 5
Total U.S. Deaths: 0
Global Confirmed Cases: 8,234
Global Deaths: 171 -
DAY 29: Trump Administration Announces Restrictions on Travel from China
Key Coronavirus Developments
Researchers write in the Lancet that “independent self-sustaining outbreaks [of 2019-nCoV] in major cities globally could become inevitable because of substantial exportation of pre-symptomatic cases.”
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership
HHS Secretary Alex Azar declares a that “a public health emergency exists and has existed since January 27, 2020.”
Travel Restrictions and Warnings | Interagency Coordination, Resources, and White House Leadership
The administration announces it will bar entry to foreign nationals that pose a threat of transmitting the virus and will quarantine U.S. citizens and foreign nationals traveling to the U.S. from China for up to 14 days starting on February 2. The White House announcement says, “the public health system could be overwhelmed if sustained human-to-human transmission of the virus occurred in the United States. Sustained human-to-human transmission has the potential to have cascading public health, economic, national security, and societal consequences.”
Travel Restrictions and Warnings
The CDC quarantines 195 passengers returning to the U.S. from Wuhan, the first federal quarantine in 50 years.
Surveillance
“There has been an increasing number of reports of person-to-person spread. And now most recently, a report from the New England Journal of Medicine of asymptomatic spread,” Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, says during a briefing. “While we still don’t have the full picture and we can’t predict how this situation will play out in the U.S., the current situation, the current scenario is a cause for concern.”
Interagency Coordination, Resources, and White House Leadership
"We would rather be remembered for overreacting than underreacting," Messonnier says. "We are preparing as if this were the next pandemic."
Interagency Coordination, Resources, and White House Leadership | Congress
In response to a warning from the Government Accountability Office (GA0) in early January that HHS was not ready for a pandemic because a strategic plan GAO reviewed did not fully account for the role the private sector would play, an HHS official sends a letter back to the congressional watchdog agency saying that HHS “had addressed their concerns,” according to the Wall Street Journal.
Key Stats
U.S. Tests Administered (Per Day): 63
U.S. Cases Confirmed: 7
Total U.S. Deaths: 0
Global Confirmed Cases: 9,927
Global Deaths: 213 -
DAY 30: Number of Confirmed Cases Globally Exceeds 10,000
Key Coronavirus Developments
“WHO is aware of possible transmission of 2019-nCoV from infected people before they developed symptoms,” but “Detailed exposure histories are being taken to better understand the pre-clinical phase of infection and how transmission may have occurred in these few instances,” according to a WHO situation report.
U.S. Government Actions
Surveillance
CDC testing criteria expands to include “Travelers from the Hubei province, instead of just Wuhan” and “Cases where respiratory illness was severe enough to require hospitalization, if they traveled from China.”
Key Stats
U.S. Tests Administered (Per Day): 313
U.S. Cases Confirmed: 8
Total U.S. Deaths: 0
Global Confirmed Cases: 12,038
Global Deaths: 259 -
DAY 31: HHS Running Out of Money for COVID-19 Response, Tells Congress It Will Transfer Funds From Other Programs
Key Coronavirus Developments
The Philippines report the first coronavirus death outside of China.
U.S. Government Actions
Congress | Interagency Coordination, Resources, and White House Leadership
HHS notifies Congress that Secretary Alex Azar intends to transfer up to $136 million for COVID-19 response efforts, of which $75 million would be made available to the CDC, $52 million to the office of the assistant secretary for preparedness and readiness, and $8 million to the Office of Global Affairs.
Presidential Statements
“We pretty much shut it down coming in from China.”
Key Stats
U.S. Tests Administered (Per Day): 34
U.S. Cases Confirmed: 8
Total U.S. Deaths: 0
Global Confirmed Cases: 16,787
Global Deaths: 362
Part 6
Virus Spreads in U.S. Mostly Undetected and Uncontained
On February 3, the CDC began to ship testing kits to select public health laboratories. But the test had a flaw that rendered it unreliable. And even after the test was fixed at the end of the month, too few labs could conduct tests, and those that could had too few tests. Meanwhile the virus spread in the U.S., mostly undetected, and thus became ever harder to isolate and contain. The administration took weeks to ask Congress for more funding to address the outbreak domestically even after officials told legislators that funds were inadequate. (The administration’s initial request was one-third of what Congress ultimately approved.)
While the low number of confirmed cases may have contributed to the lack of urgency in the administration’s response, officials should have had enough information to realize those numbers provided a false sense of security. On February 12, the CDC publicly disclosed that its tests were unreliable. And given the evidence from China that the virus can spread rapidly between people, there were ample warning signs that the U.S. should be getting better prepared. In early February, some members of Congress and two former top Trump administration officials were publicly pushing the White House to act more aggressively. Inside the administration during this month, some top officials also recommended urgent action.
February 3-February 24
-
DAY 32: 48 Members of Congress from Both Parties Urge the CDC to Speed Up Testing Efforts
Key Coronavirus Developments
The news arm of the journal Science writes that a New England Journal of Medicine report detailing the first purported case of transmission by an asymptomatic carrier of coronavirus is fundamentally flawed because the source of the infection actually did experience symptoms. That report, published on January 30, was cited by the CDC on January 31 as part of its reason for quarantining people for 14 days after returning from Wuhan. (However, the next day, NIAID Director Anthony Fauci says a discussion with a top Chinese health official gives him confidence that asymptomatic transmission is occurring.)
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership
The White House Office of Science and Technology Policy asks the National Academies of Sciences, Engineering, and Medicine to “rapidly” examine the origins of the virus in order to address both the current spread and prepare for future coronavirus outbreaks.
Healthcare System and Supply Chain Preparedness
The CDC posts “guidance for assessing the potential risk of various exposures to COVID-19 and managing those people appropriately.”
Surveillance | Interagency Coordination, Resources, and White House Leadership
At a news briefing, the CDC says it plans to distribute testing kits to speed up the diagnosis of the coronavirus, but the Food and Drug Administration first has to approve the test for wider distribution to public health labs.
Surveillance | Congress
48 members of Congress from both parties write to Dr. Robert Redfield, the head of CDC, urging the agency to take actions to expand testing quickly.
Key Stats
U.S. Tests Administered (Per Day): 132
U.S. Cases Confirmed: 11
Total U.S. Deaths: 0
Global Confirmed Cases: 19,881
Global Deaths: 426 -
DAY 33: Former Top Trump Officials Call for Expanding Testing
Key Coronavirus Developments
Researchers write a letter to the editor of Nature suggesting that the drugs remdesivir and chloroquine could effectively inhibit coronavirus, recommending “that they should be assessed in human patients suffering from the novel coronavirus disease.”
Two former Trump administration officials—former FDA Commissioner Scott Gottlieb and Luciana Borio, former director for medical and biodefense preparedness policy at the National Security Council—publish a Wall Street Journal op-ed stating that in the U.S. “it’s highly probable that dozens of other cases have gone undetected” and recommending expanding testing, including of people who have not gone to China.
Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, and Mark Olshaker, a documentary filmmaker, pen an op-ed for TIME where they urge, “stop messaging that this [sic] a low risk situation for the U.S. … We must do the best we can with what we have, and authorities should level with the public about what we do and do not know.”
The South Korean government approves its first commercial test a week after meeting with companies about the need for widespread testing and two weeks after detecting its first case. This approval comes about two weeks before cases surged in that country.
U.S. Government Actions
Congress | Interagency Coordination, Resources, and White House Leadership
In a letter to HHS Secretary Alex Azar, Democratic House appropriators Representatives Nita Lowey and Rose DeLauro “strongly urge the Administration to transmit a request to Congress for emergency supplemental appropriations to respond to this public health emergency … no later than Monday, February 10, along with its submittal of the fiscal year 2021 President’s Budget.”
Surveillance | Healthcare System and Supply Chain Preparedness | Interagency Coordination, Resources, and White House Leadership
The Washington Post writes, citing a CDC spokesperson, that the “’enhanced response posture’ of the federal government is based on ‘a dramatic increase in the number of cases reported, supporting efficient person-to-person spread, the geographic expansion of the outbreak, and continued reports of severe illness including those resulting in death.’”
Interagency Coordination, Resources, and White House Leadership
After encountering resistance for more funding from Joe Grogan, the head of the White House’s Domestic Policy Council, Azar speaks with acting Office of Management and Budget Director Russell Vought, according to the Washington Post. (Another Post article states that “By early February, Grogan and others worried that there weren’t enough tests to determine the rate of infection.”)
Surveillance | Healthcare System and Supply Chain Preparedness | Community Mitigation
NIAID Director Anthony Fauci says that he reached out to a top Chinese public health official after learning of the error in the New England Journal of Medicine article on asymptomatic transmission. Despite the error, he says that he is confident the virus can spread asymptomatically. Subsequent studies find asymptomatic transmission.
Congress | Economic Response | Healthcare System and Supply Chain Preparedness
U.S. intelligence officials brief members of the Senate intelligence committee on the outbreak. The “warnings were not highly classified or all that specific, drawn largely from diplomatic wires and publicly reported information,” according to the New York Times, citing three sources. This and a follow-up briefing “were focused on the readiness of the United States for a potential epidemic, but also touched on the possible economic fallout.”
Surveillance
The FDA determines that, given the public health emergency declaration by Azar, there is ample justification to authorize the emergency use of the new CDC test for coronavirus.
Medical Countermeasures
HHS’s Biomedical Advanced Research and Development Authority announces it will leverage an existing partnership agreement with Regeneron Pharmaceuticals “to develop multiple monoclonal antibodies that, individually or in combination, could be used to treat this emerging coronavirus, also known as 2019-nCoV.”
Key Stats
U.S. Tests Administered (Per Day): 93
U.S. Cases Confirmed: 11
Total U.S. Deaths: 0
Global Confirmed Cases: 23,892
Global Deaths: 492 -
DAY 34: CDC Starts Shipping COVID-19 Tests
Key Coronavirus Developments
The World Health Organization asks for $675 million to help fight the new coronavirus worldwide.
“I think at this point, containment is already a lost cause,” Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, tells the Daily Beast.
U.S. Government Actions
Surveillance
The CDC starts shipping its laboratory test kit to detect the new coronavirus.
The Biomedical Advanced Research and Development Authority announces “an Easy Broad Agency Announcement (EZ-BAA)” to solicit applications “for development funding of COVID-19 molecular diagnostics.”
Interagency Coordination, Resources, and White House Leadership | Congress
HHS Secretary Alex Azar argues with an OMB official over a request for more funding with the official accusing Azar of improperly lobbying Congress for funding. Azar wants to request $2 billion from Congress for masks and other supplies, according to one Washington Post article, but is rejected. (Another Post article says Azar sought more than $4 billion total.)
Senate Democrats begin “pushing for emergency supplemental funds to combat the virus during a closed-door coronavirus briefing led by Azar on Feb. 5, the last day of impeachment,” according to Politico. Administration officials say existing appropriations are adequate, according to Senator Chris Murphy (D-CT).
Congress
Senate Republicans “aren’t taking this seriously enough,” Murphy tweets after leaving the Feb. 5 briefing. “Notably, no request for ANY emergency funding, which is a big mistake. Local health systems need supplies, training, screening staff etc. And they need it now.”
Congress | Interagency Coordination, Resources, and White House Leadership
Hawaii’s two senators criticize Azar for poor coordination with state and local governments because Hawaiian authorities were not alerted that a Hawaiian airport would house quarantined travelers. “If you’re going to do a public health response, you have to work with state and local government, and they just didn’t,” Senator Brian Schatz (D-HI) says.
Congress
The House Foreign Affairs Committee holds a hearing, “The Wuhan Coronavirus: Assessing the Outbreak, the Response, and Regional Implications.”
Congress | Surveillance | Travel Restrictions/Warnings
Senator Rick Scott (R-FL) asks the administration to provide “street level mapping” of confirmed cases. Senator Dianne Feinstein (D-CA) asks Azar about quarantine plans, precautions, and resources for quarantining people.
Presidential Statements
[Note: President Trump’s impeachment trial ended in the Senate this day with an acquittal.]
Key Stats
U.S. Tests Administered (Per Day): 107
U.S. Cases Confirmed: 11
Total U.S. Deaths: 0
Global Confirmed Cases: 27,635
Global Deaths: 564 -
DAY 35: The First U.S. Citizen Dies from COVID-19 in Wuhan and the Number of CDC Tests Shipped Pales In Comparison to WHO’s
Key Coronavirus Developments
In Santa Clara County, California, a person dies of COVID-19 (this won’t be confirmed publicly until April 21. As of publication, this is the earliest known virus death inside the U.S. According to the county, this person and two other individuals, who were also belatedly identified as COVID-19 victims, “died at home during a time when very limited testing was available only through the CDC.”)
A 60-year-old American dies in Wuhan, at the time the first known case of a U.S. citizen dying from the disease.
WHO announces it was shipping 250,000 tests to labs around the world.
U.S. Government Actions
Surveillance
The CDC begins distributing 90 tests to some state-run labs in the U.S., according to the Washington Post.
Interagency Coordination, Resources, and White House Leadership | Travel Restrictions and Warnings
The Defense Department says it will accept a request from HHS to provide facilities near 11 major airports to each hold up to 20 U.S. citizens in coronavirus quarantines.
Congress
U.S. intelligence officials brief the House about the outbreak.
Congress | Healthcare System and Supply Chain Preparedness
Senator Jon Tester and other Senate Democrats ask the Department of Veterans Affairs what it is doing to prepare.
Key Stats
U.S. Tests Administered (Per Day): 78
U.S. Cases Confirmed: 11
Total U.S. Deaths: 0
Global Confirmed Cases: 30,794
Global Deaths: 634 -
DAY 36: The Federal Reserve Warns that the Virus Poses An Economic Risk
Key Coronavirus Developments
Li Wenliang, a Chinese doctor who tried to warn about the coronavirus, dies from COVID-19 at the age of 33.
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership | Travel Restrictions and Warnings | Healthcare System and Supply Chain Preparedness | Medical Countermeasures
The president’s coronavirus task force holds a press briefing where HHS Secretary Alex Azar discusses the travel restrictions and says the administration is taking a “targeted approach aimed at slowing the virus’s spread to and within the U.S., giving our government and the global community more time to take preparedness measures, understand the virus, and develop medical countermeasures.” He says “these policies are consistent with those of many other governments; they are based on the current public health situation.”
Economic Response
The Federal Reserve warns that the virus is one potential threat to the growth of the U.S. economy.
Interagency Coordination, Resources, and White House Leadership | Healthcare System and Supply Chain Preparedness
The State Department announces “it is prepared to spend up to $100 million in existing funds to assist China and other impacted countries, both directly and through multilateral organizations, to contain and combat the novel coronavirus.” The State Department announces it has shipped nearly 18 tons of privately-donated personal protective equipment and other supplies to China.
Interagency Coordination, Resources, and White House Leadership | Congress
In a letter to Office of Management and Budget Director Mick Mulvaney, four Democratic Senators express “concern that the Trump Administration’s annual proposed funding cut for pandemic preparedness and response efforts could threaten the government’s ability to effectively combat the spread of the deadly virus.”
Presidential Statements
....he will be successful, especially as the weather starts to warm & the virus hopefully becomes weaker, and then gone. Great discipline is taking place in China, as President Xi strongly leads what will be a very successful operation. We are working closely with China to help!
— Donald J. Trump (@realDonaldTrump) February 7, 2020Key Stats
U.S. Tests Administered (Per Day): 93
U.S. Cases Confirmed: 11
Total U.S. Deaths: 0
Global Confirmed Cases: 34,391
Global Deaths: 719 -
DAY 37: A NYC Lab Finds Flaws in the CDC Test and the COVID-19 Death Toll Exceeds That of SARS
Key Coronavirus Developments
The number of confirmed deaths attributed to COVID-19 exceeds that from the SARS (severe acute respiratory syndrome, which is caused by another coronavirus) outbreak in 2002 and 2003.
U.S. Government Actions
Surveillance
One of the first CDC tests arrives in New York City at a public health lab. According to the Washington Post, “For hours, lab technicians struggled to verify that the test worked. Each time, it fell short, producing untrustworthy results.”
Key Stats
U.S. Tests Administered (Per Day): 79
U.S. Cases Confirmed: 11
Total U.S. Deaths: 0
Global Confirmed Cases: 37,120
Global Deaths: 806 -
DAY 38: The White House Coronavirus Task Force Meets With Governors
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership | Healthcare System and Supply Chain Preparedness | Community Mitigation
The president’s coronavirus task force, including Anthony Fauci, the director of NIAID, and Robert Redfield, the head of the CDC, meets with the National Governors Association. “The doctors and the scientists, they were telling us then exactly what they are saying now,” Maryland Gov. Larry Hogan (R), who attended the meeting, told the Washington Post in April. Hogan later told CNN that he left the briefing “very, very concerned.” “When I left that briefing that the administration gave to governors, we knew this was going to be a serious crisis.”
Key Stats
U.S. Tests Administered (Per Day): 38
U.S. Cases Confirmed: 11
Total U.S. Deaths: 0
Global Confirmed Cases: 40,150
Global Deaths: 906 -
DAY 39: Global Deaths Exceed 1,000
Key Coronavirus Developments
The UK’s Imperial College extrapolates a case fatality ratio “in all infections (asymptomatic or symptomatic) of approximately 1%.”
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership
At the request of HHS, the Federal Emergency Management Agency embeds a team with HHS’s Office of the Assistant Secretary for Preparedness and Response “to support crisis action planning, situational awareness, and operational coordination,” according to the government’s COVID-19 response plan.
Presidential Statements
“I think the virus is going to be—it's going to be fine.”“By April, you know, in theory, when it gets a little warmer, it miraculously goes away.”
Key Stats
U.S. Tests Administered (Per Day): 38
U.S. Cases Confirmed: 11
Total U.S. Deaths: 0
Global Confirmed Cases: 42,762
Global Deaths: 1,013 -
DAY 40: Disease Formally Named COVID-19
Key Coronavirus Developments
The WHO gives the disease the new name COVID-19, or coronavirus disease 2019. The virus causing the disease is named SARS-CoV-2.
WHO announces it has activated a United Nations crisis management team. The head of WHO says “we have to use the window of opportunity. If we don't, we could have far more cases—and far higher costs—on our hands.” The WHO estimates a vaccine may be available in 18 months.
Citing numerous hospital officials, the South China Morning Post reports that the Chinese government had been lying about the number of healthcare workers who had caught the virus.
Illinois becomes the first U.S. state that can test for coronavirus. “The ability to do this testing will mean we will be able to detect any new cases of novel coronavirus earlier and prevent any possible spread,” says an official with the Illinois Department of Public Health.
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership
Government creates “Phases of U.S. Government Response to the 2019 Novel Coronavirus” planning document, according to the government’s COVID-19 plan.
Medical Countermeasures
HHS announces that drug company Janssen and the Biomedical Advanced Research and Development Authority “will share research and development costs and expertise to help accelerate Janssen's investigational novel coronavirus vaccine into clinical evaluation.”
Key Stats
U.S. Tests Administered (Per Day): 97
U.S. Cases Confirmed: 12
Total U.S. Deaths: 0
Global Confirmed Cases: 44,802
Global Deaths: 1,113 -
DAY 41: CDC Announces The Test It Shipped to State Labs is Unreliable
Key Coronavirus Developments
WHO says it is too early to predict the outbreak’s end: “This outbreak could still go in any direction.”
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership
Administration officials say the country “must be prepared for a very large and lengthy public health response to this virus given how easily it appears to be transmitted” and that “HHS would exhaust existing funding for the response soon," according to a letter by Senate Democrats.
Surveillance
The CDC announces that its testing diagnostic kits sent to state public health laboratories have led to “some inconclusive laboratory results.”
Key Stats
U.S. Tests Administered (Per Day): 58
U.S. Cases Confirmed: 12
Total U.S. Deaths: 0
Global Confirmed Cases: 45,221
Global Deaths: 1,118 -
DAY 42: Global Confirmed Cases Exceed 60,000
U.S. Government Actions
Surveillance
HHS Secretary Alex Azar says the CDC has begun working with five public health labs to test those with flu-like symptoms for the novel coronavirus, although this requires diagnostic tests that the CDC said the day before are unreliable.
Congress
Weeks after a Senate briefing on the coronavirus on January 24, Senator Richard Burr (R-NC) and his wife sell shares of 33 stocks worth between $628,000 and $1.7 million, according to financial disclosures first reported by ProPublica and the Center for Responsive Politics. Burr is the author of the 2006 Pandemic and All-Hazards Preparedness Act, which Congress has reauthorized since its initial passage.
Surveillance
Regarding the CDC’s flawed tests, “we’re screwed from a testing standpoint if this thing takes off in the US,” Susan Butler-Wu, Los Angeles County’s director of medical microbiology, writes in an email to fellow scientists, according to the Washington Post.
Medical Countermeasures
In the Proceedings of the National Academies of Sciences, a NIAID team publishes findings that a preclinical trial of Gilead’s remdesivir showed promising results in rhesus monkeys against a related coronavirus.
Key Stats
U.S. Tests Administered (Per Day): 48
U.S. Cases Confirmed: 13
Total U.S. Deaths: 0
Global Confirmed Cases: 60,368
Global Deaths: 1,371 -
DAY 43: Democratic Senators Urge the Administration to Ask for More Funding to Respond
Key Coronavirus Developments
A top Chinese health official says over 1,700 healthcare workers have been infected.
U.S. Government Actions
Surveillance
Nancy Messonnier, the director of the CDC’s National Center for Immunization and Respiratory Diseases, tells reporters that the CDC is revamping its tests and “moving quickly to get those back out” to state and local public health labs.
The CDC elaborates on an announcement from HHS Secretary Alex Azar the day before on a plan to screen people in New York, Chicago, Los Angeles, San Francisco and Seattle. Messonnier says it could provide “an early warning signal to trigger a change in our response strategy.”
Healthcare System and Supply Chain Preparedness
The head of the FDA, Stephen Hahn, announces the FDA is “proactively reaching out to manufacturers as part of our vigilant and forward-leaning approach to identifying potential disruptions or shortages. The FDA has dedicated additional resources to review and coordinate data to better identify any potential vulnerabilities to the U.S. medical product sector, specifically from this outbreak.”
Healthcare System and Supply Chain Preparedness | Surveillance | Travel Restrictions and Warnings
A CDC study recommends “Health care providers should remain vigilant regarding possible 2019-nCoV exposure not only among returning travelers, but also among persons in close contact with 2019-nCoV patients in the United States.”
Interagency Coordination, Resources, and White House Leadership | Community Mitigation
According to the New York Times, a memo called the “U.S. Government Response to the 2019 Novel Coronavirus,” developed in coordination with the White House’s National Security Council, details what mitigation measures could look like, such as: “significantly limiting public gatherings and cancellation of almost all sporting events, performances, and public and private meetings that cannot be convened by phone. Consider school closures. Widespread ‘stay at home’ directives from public and private organizations with nearly 100% telework for some.” It recommends targeted “quarantine and isolation measures” in parts of the U.S. where there is “sustained human-to-human transmission.”
Interagency Coordination, Resources, and White House Leadership
“We strongly urge the administration to transmit an emergency supplemental request that ensures it can and will fully reimburse states for the costs they are incurring as part of this response,” Democratic senators say in a letter to HHS Secretary Alex Azar and Office of Management and Budget Director Mick Mulvaney.
Congress
In the wake of a January 24 briefing by top government officials on coronavirus, Senator Kelly Loeffler (R-GA) buys stocks in Citrix, a company that sells teleworking software.
Presidential Statements
“... we're in very good shape.”
Key Stats
U.S. Tests Administered (Per Day): 41
U.S. Cases Confirmed: 13
Total U.S. Deaths: 0
Global Confirmed Cases: 66,885
Global Deaths: 1,523 -
DAY 44: A Woman In California With No Known Links to People Traveling to COVID-19 Hotspots Is Sick With COVID-19
Key Coronavirus Developments
France announces that a Chinese tourist has died—at the time, the first known death outside of Asia.
A woman with flu-like symptoms takes herself to a small California hospital. Twelve days later the CDC will confirm this patient as the first known case of community transmission in the U.S.
Key Stats
U.S. Tests Administered (Per Day): 55
U.S. Cases Confirmed: 13
Total U.S. Deaths: 0
Global Confirmed Cases: 69,030
Global Deaths: 1,666 -
DAY 45: 44 Americans on Diamond Princess Test Positive
(Photo: Alpsdake/Wikimedia Commons
Key Coronavirus Developments
44 Americans on the Diamond Princess cruise ship test positive.
An international team of researchers publish a study that finds “it is improbable that SARS-CoV-2 emerged through laboratory manipulation of an existing SARS-related coronavirus.”
U.S. Government Actions
Surveillance
CDC and FDA officials meet to discuss solutions to the testing problem, according to the Washington Post.
Travel Restrictions and Warnings | Healthcare System and Supply Chain Preparedness | Interagency Coordination, Resources, and White House Leadership
According to the Washington Post, U.S. government officials debate whether to allow 14 infected Americans to fly home on a chartered jet with a group of over 300 American evacuees. The State Department and a Trump Administration official overrule the CDC, which recommend not flying the groups back together. The CDC requests that it not be mentioned in the government’s news release.
Key Stats
U.S. Tests Administered (Per Day): 25
U.S. Cases Confirmed: 13
Total U.S. Deaths: 0
Global Confirmed Cases: 71,224
Global Deaths: 1,770 -
DAY 46: Diamond Princess Passengers Leave Japan to Return to U.S.
Key Coronavirus Developments
China’s CDC publishes a report that says 14% of those infected with COVID-19 were severe cases, summarized by the University of Minnesota’s Center for Infectious Disease Research and Policy as those including “pneumonia and shortness of breath … about 5% have critical disease, marked by respiratory failure, septic shock, and multi-organ failure.”
Researchers based at Harvard publish a study that says hotter and humid weather “will not necessarily lead to declines in COVID-19 case counts without the implementation of extensive public health interventions.”
In Santa Clara County, California, a person dies of COVID-19. (This won’t be confirmed publicly until April 21. As of publication, this is the second-earliest known U.S. death. According to the county, this person and two other individuals, who were also belatedly identified as COVID-19 victims, “died at home during a time when very limited testing was available only through the CDC.”)
U.S. Government Actions
Travel Restrictions and Warnings
American passengers evacuate the Diamond Princess and will return to the U.S. They will be held in quarantine for 14 days.
Key Stats
U.S. Tests Administered (Per Day): 36
U.S. Cases Confirmed: 13
Total U.S. Deaths: 0
Global Confirmed Cases: 73,258
Global Deaths: 1,868 -
DAY 47: South Korea Identifies Patient Who Sparks a Massive Outbreak
Key Coronavirus Developments
In South Korea, a woman who becomes known in that country as “Patient 31” tests positive. She is believed to have spread the virus to dozens of others and the country’s cases expand six-fold within days.
Researchers publish a paper in the Journal of Infectious Diseasesindicating the likelihood of asymptomatic transmission by examining a family cluster in Wuhan, including an “88-year-old man with limited mobility who was exposed only to asymptomatic family members whose symptoms developed later.”
In the New England Journal of Medicine, researchers document the ineffectiveness of symptom-based screening of predominately German nationals brought back from Wuhan. “We discovered that shedding of potentially infectious virus may occur in persons who have no fever and no signs or only minor signs of infection,” they write.
U.S. Government Actions
Medical Countermeasures
HHS’s Biomedical Advanced Research and Development Authority announces a vaccine development partnership with Sanofi.
Surveillance
The CDC warns laboratories around the U.S. against using tests without an “emergency use authorization” from the FDA.
Key Stats
U.S. Tests Administered (Per Day): 43
U.S. Cases Confirmed: 13
Total U.S. Deaths: 0
Global Confirmed Cases: 75,136
Global Deaths: 2,007 -
DAY 48: First Diamond Princess Deaths
Key Coronavirus Developments
Japan announces that two passengers from the cruise ship Diamond Princess have died, the first deaths among over 600 infected, including many Americans.
U.S. Government Actions
Travel Restrictions and Warnings
A California woman with flu-like symptoms is admitted by the University of California-Davis Medical Center after previously going to a smaller hospital on Feb. 15. UC Davis Medical Center says it sought immediate COVID-19 testing by the CDC. “We requested COVID-19 testing by the CDC, since neither Sacramento County nor the California Department of Public Health is doing testing for coronavirus at this time. Since the patient did not fit the existing CDC criteria for COVID-19, a test was not immediately administered. UC Davis Health does not control the testing process,” the hospital says in a press release a week later. (It was not until February 23 that CDC ordered testing. On February 27, the CDC announces this is the first confirmed case of community transmission in the U.S.)
CDC posts a low-level travel notice for Hong Kong and Japan in response to the COVID-19 outbreak.
Economic Response
The Federal Reserve makes public minutes from its January 28-29 meeting where it mentions that “the threat of the coronavirus, in addition to its human toll, had emerged as a new risk to the global growth outlook.”
Key Stats
U.S. Tests Administered (Per Day): 69
U.S. Cases Confirmed: 13
Total U.S. Deaths: 0
Global Confirmed Cases: 75,639
Global Deaths: 2,122 -
DAY 49: Only 3 of 100+ State Public Health Labs Testing for COVID-19
Key Coronavirus Developments
China extends a suspension of work in the Hubei province to March 11.
U.S. Government Actions
Surveillance | Healthcare System and Supply Chain Preparedness | Community Mitigation
CDC tells state public health officials, "While leaning forward aggressively with the hope that we will be able to prevent community spread, we also are preparing for the worst,” in an email obtained by the Wall Street Journal.
Surveillance
Of the more than 100 public health labs in the U.S., only three—in California, Nebraska, and Illinois—are capable of testing for coronavirus, according to the Association of Public Health Laboratories.
An FDA official places bureaucratic hurdles in front of a University of Washington team seeking to gain approval for a test they developed. According to the Washington Post, the FDA received the necessary files in an email the day before, but the agency’s rules say that submitter should physically mail a disc of files instead. Citing an FDA statement, the Post writes that the submission was “promptly reviewed, despite not having been submitted properly, and was found to be insufficient to demonstrate that the test would work. An FDA official said that afterwards, “we immediately addressed how we receive applications.”
Key Stats
U.S. Tests Administered (Per Day): 60
U.S. Cases Confirmed: 13
Total U.S. Deaths: 0
Global Confirmed Cases: 76,197
Global Deaths: 2,247 -
DAY 50: White House Task Force Members Mull Recommending Social Distancing and UK Researchers Say There Are a Huge Potential Number of Undetected Cases
Key Coronavirus Developments
In South Korea, the number of confirmed cases expands from 31 to 204 over three days.
Italy reports its first confirmed local transmission in its Lombardy region.
Britain’s Imperial College releases a report estimating “that about two thirds of COVID-19 cases exported from mainland China have remained undetected worldwide, potentially resulting in multiple chains of as yet undetected human-to-human transmission outside mainland China.”
The South China Morning Post reports on a spike in cases in a Chinese jail.
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership | Community Mitigation
The White House coronavirus task force convenes and considers when to move from the containment phase of mainly focusing on keeping the virus out of the U.S. into the mitigation phase as it becomes increasingly clear that coronavirus is spreading inside the U.S. On the meeting agenda, according to the New York Times, was when HHS Secretary Alex Azar “should recommend that Mr. Trump take textbook mitigation measures ‘such as school dismissals and cancellations of mass gatherings,’ which had been identified as the next appropriate step in a Bush-era pandemic plan.” Azar, NIAID Director Anthony Fauci, and CDC Director Robert Redfield, all members of the task force, conclude that the U.S. would, according to the Times, “soon need to move toward aggressive social distancing, even at the risk of severe disruption to the nation’s economy and the daily lives of millions of Americans.”
Surveillance
Fauci says that CDC will add Honolulu as a sixth surveillance site to come online at a later point. Two Japanese travelers had visited Hawaii shortly before being diagnosed with the virus.
Key Stats
U.S. Tests Administered (Per Day): 253
U.S. Cases Confirmed: 15
Total U.S. Deaths: 0
Global Confirmed Cases: 76,819
Global Deaths: 2,251 -
DAY 51: Despite Known Overseas Cases of Asymptomatic and Community Transmission, CDC Tells State Officials To Limit Tests
Key Coronavirus Developments
A New Rochelle resident falls ill and attends services at his synagogue, leading to a massive outbreak in New York.
U.S. Government Actions
Surveillance | Healthcare System and Supply Chain Preparedness | Travel Restrictions and Warnings
According to the Wall Street Journal, CDC officials tell state health authorities only to send patients for testing if they have recently traveled to mainland China, despite a tweet by the head of the CDC that said U.S. doctors treating patients who have recently traveled from Japan and Hong Kong—other places with coronavirus cases—should consider the possibility that the patients may have contracted coronavirus. A CDC official told a Minnesota epidemiologist that “This tweet is being taken down”.
Surveillance
FDA official Timothy Stenzel flies to Atlanta to go to the CDC and resolve problems with the agency’s coronavirus test.
Interagency Coordination, Resources, and White House Leadership | Medical Countermeasures | Surveillance | Healthcare System and Supply Chain Preparedness
Politico reports that the administration has told Congress it will soon send a funding request to Congress for as little as $1 billion, “which could be rapidly exhausted by development of potential vaccines, widespread lab tests and numerous other investments.”
Travel Restrictions and Warnings
The CDC issues a medium level travel notice for South Korea and upgrades its notice for Japan to the medium level.
Key Stats
U.S. Tests Administered (Per Day): 258
U.S. Cases Confirmed: 15
Total U.S. Deaths: 0
Global Confirmed Cases: 78,572
Global Deaths: 2,458 -
DAY 52: Top White House Advisor Urges Trump to Obtain At Least $3 Billion Quickly to Prepare
Key Coronavirus Developments
Italy confirms more than 150 cases up from five just days earlier, leading to lockdowns in at least 10 towns, school closures, and event cancellations.
U.S. Government Actions
Surveillance | Travel Restrictions and Warnings
The assistant secretary of preparedness and response, Robert Kadlec, emails an academic researcher about a case of a family who was infected in Wuhan, suggesting a substantial degree of human-to-human transmission by asymptomatic persons. “Is this true?” Kadlec emails, “If so we have a huge whole [sic] on our screening and quarantine effort.”
Interagency Coordination, Resources, and White House Leadership | Congress | Surveillance | Healthcare System and Supply Chain Preparedness | Medical Countermeasures
Inside the White House, trade advisor Peter Navarro writes President Trump a memo that states, “to minimize economic and social disruption and loss of life, there is an urgent need for an immediate supplemental appropriation of at least $3.0 billion” for “prevention, treatment, inoculation, and diagnostics. This is NOT a time for penny-pinching or horse trading on the Hill.” He offers a “conservative estimate” that $618 million is needed to procure personal protective equipment, $528 million for treatment therapeutics, $1.6 billion for vaccine development, and $280 million for diagnostic testing. “Time is of the essence for all four points of the PPE, treatment, vaccine, and diagnostics!” he writes.
Travel Restrictions and Warnings
The CDC issues low level travel notice for Italy and Iran.
Key Stats
U.S. Tests Administered (Per Day): 71
U.S. Cases Confirmed: 15
Total U.S. Deaths: 0
Global Confirmed Cases: 78,958
Global Deaths: 2,469 -
DAY 53: Administration Asks for $1.25 Billion From Congress, Democrats Say Amount is Far Too Low; Stock Market Drops
Key Coronavirus Developments
The U.S. stock market plummets over coronavirus fears in its worst day in two years.
The World Health Organization announces findings from an initial assessment of the situation in China saying that its strict measures were key to keeping the virus from spreading to many more people. The WHO continues to resist designating COVID-19 as a pandemic, but its head of health emergencies says, “It is time to prepare. It is time to do everything you would do in preparing for a pandemic.”
The U.S. military announces that a relative of a U.S. servicemember in South Korea tests positive for coronavirus.
The European Center for Disease Control and Prevention says that in Italy local transmission is occurring, including to healthcare workers in hospitals.
Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, and Mark Olshaker, a documentary filmmaker, write in a New York Times op-ed that the flu season in the U.S. and other countries has already depleted stores of medical protective gear.
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership | Congress
The White House asks Congress to allocate $1.25 billion in new emergency funds to bolster its preparedness and re-purpose another $1.25 billion in existing funds from across the government, including HHS funds for current Ebola response activities. Democrats label the request as insufficient and warn the administration against siphoning funds from other critical health priorities.
Interagency Coordination, Resources, and White House Leadership | Community Mitigation
Robert Kadlec, assistant secretary for preparedness and response, presents President Trump with a plan called “Four Steps to Mitigation,” according to the New York Times.
Congress | Surveillance
CDC Director Robert Redfield writes to 49 members of Congress regarding testing: “CDC’s aggressive response enables us to identify potential cases early and make sure that they are properly handled.”
Travel Restrictions and Warnings
The CDC raises its travel notice for South Korea to its highest level, and upgrades its travel notices for Italy and Iran to a medium level.
Surveillance
The Association of Public Health Laboratories writes to the head of the FDA asking to speed up the approval of tests developed by academic, private, and other labs outside the CDC.
Interagency Coordination, Resources, and White House Leadership | Community Mitigation
According to the government’s COVID-19 response plan, the National Security Council’s Domestic Resilience Group Policy Coordination Committee directs the following strategic objectives: “Implement broader community and healthcare-based mitigation measures. Accelerate outreach to state and local authorities. Preserve and minimize disruptions to critical public and private sector services.”
Medical Countermeasures
Moderna ships experimental vaccines to the National Institute of Allergy and Infectious Diseases.
Presidential Statements
The Coronavirus is very much under control in the USA. We are in contact with everyone and all relevant countries. CDC & World Health have been working hard and very smart. Stock Market starting to look very good to me!
— Donald J. Trump (@realDonaldTrump) February 24, 2020Key Stats
U.S. Tests Administered (Per Day): 71
U.S. Cases Confirmed: 51
Total U.S. Deaths: 0
Global Confirmed Cases: 79,561
Global Deaths: 2,629
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Part 7
It Becomes Clear That The Window for Containment Has Closed
A top CDC official began to issue dire warnings that the virus is likely spreading and that its impacts could be huge. Testing expanded to more state labs and with that more cases were detected, including the first confirmed cases of community transmission. The government loosened its rules on developing and approving tests developed by labs other than the CDC and expanded its criteria for who should get tested. President Trump selected Vice President Mike Pence to take a leading role on the coronavirus task force, which added members. During this time, enough evidence came to light to make it clear that the administration’s highest-profile efforts to combat coronavirus—travel restrictions and screenings at airports—have not kept the virus from entering the country and spreading. By March 2, the vice president acknowledged publicly that mitigation, not containment, was the new goal.
February 25-March 2
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DAY 54: CDC Warns That It Believes COVID-19 Is Spreading, Official Says “Disruption to everyday life might be severe”
Key Coronavirus Developments
A WHO official gives a detailed briefing on what China did to manage the outbreak. China “repurposed the machinery of government” and used public health tactics "on a scale that we have never seen in history” to combat the spread of coronavirus, such as using artificial intelligence and big data to identify cases and trace the contacts of people infected. China updated its clinical guidance six times as it learned more. The world is “simply not ready. It could get ready very fast, but the big shift has got to be in the mindset about how we’re going to manage the disease," the official says, recommending governments prepare the public and get ventilators in place as soon as possible.
A survey of around 3,000 nurses by the California Nurses Association and National Nurses United shows about 13 percent said their healthcare facility had patient isolation plans in place and 31 percent had personal protective equipment available.
The U.S. military announces that a U.S. servicemember in South Korea tests positive for coronavirus.
Daily counts of newly confirmed cases outside of China now exceed those inside China.
U.S. Government Actions
Community Mitigation | Healthcare System and Supply Chain Preparedness
In the United States, CDC officials warn that community transmission of COVID-19 is expected, urging local governments, schools and businesses to develop plans to deal with potential outbreaks. In addition, disruptions to drug supplies could also be expected. “Disruption to everyday life might be severe,” the CDC’s Nancy Messonnier says in a briefing. “Ultimately we will see community spread in the US; not a question of if, but when, and of how many people in this country will have severe illnesses,” says Messonnier. Anne Schuchat, principal deputy director of the CDC, says, “Current global circumstances suggest it's likely this virus will cause a pandemic.”
Surveillance
Messonnier says the CDC is testing as many as 400 samples a day. “There is no current backlog or delay.”
Surveillance | Interagency Coordination, Resources, and White House Leadership
The Defense Department’s National Center for Medical Intelligence raised its warning level regarding coronavirus to WATCHCON 1, meaning there was an imminent risk it could become a pandemic, according to Newsweek. The Joint Chiefs of Staff were briefed on the warning and, according to the Associated Press, the medical intelligence center’s work is typically provided to the HHS secretary.
Medical Countermeasures
The National Institutes of Health announces that it has begun a clinical trial to test whether remdesivir is safe and effective to treat adults hospitalized with COVID-19, the first clinical trial of a potential COVID-19 treatment in the U.S.
Healthcare System and Supply Chain Preparedness
Carter Mecher, a senior medical adviser for the Department of Veterans Affairs who is the VA’s liaison with CDC, circulates a projection that there could be 1.7 million deaths in the U.S. without action. He also writes, referring to personal protective equipment, such as N95 masks, “We should plan assuming we won’t have enough PPE—so need to change the battlefield and how we envision or even define the front lines.”
Surveillance
At this point, only 12 labs outside of the CDC, which are in California, Illinois, Nebraska, Nevada, and Tennessee, are able to test for coronavirus. According to the University of Minnesota’s CIDRAP News, Peter Kyriacopoulos, the chief policy officer for Association of Public Health Laboratories, says one way to rapidly expand testing would be if the federal government authorized 100 APHL-member labs to conduct their own tests until the CDC sorted out the problems with its version.
Congress | Interagency Coordination, Resources, and White House Leadership
HHS Secretary Azar testifies before a Senate appropriations subcommittee. Senators ask him a number of questions related to coronavirus.
Surveillance | Healthcare System and Supply Chain Preparedness
A CDC risk assessment says “The potential public health threat posed by COVID-19 is high, both globally and to the United States.”
Presidential Statements
"You may ask about the coronavirus, which is very well under control in our country. We have very few people with it."
Cryin’ Chuck Schumer is complaining, for publicity purposes only, that I should be asking for more money than $2.5 Billion to prepare for Coronavirus. If I asked for more he would say it is too much. He didn’t like my early travel closings. I was right. He is incompetent!
— Donald J. Trump (@realDonaldTrump) February 25, 2020CDC and my Administration are doing a GREAT job of handling Coronavirus, including the very early closing of our borders to certain areas of the world. It was opposed by the Dems, “too soon”, but turned out to be the correct decision. No matter how well we do, however, the.....
— Donald J. Trump (@realDonaldTrump) February 26, 2020Key Stats
U.S. Tests Administered (Per Day): 65
U.S. Cases Confirmed: 51
Total U.S. Deaths: 0
Global Confirmed Cases: 80,406
Global Deaths: 2,708 -
DAY 55: First Confirmed Community Transmission in U.S.; Trump Taps VP Pence to Lead Coronavirus Task Force and CDC Fixes Flawed Test
Vice President Mike Pence meets with the President’s Coronavirus Taskforce Wednesday, February 26, 2020. (Official White House Photo by D. Myles Cullen)
Key Coronavirus Developments
Two recent residents of a LifeCare Center nursing home in the suburbs of Seattle die, with the facility initially believing it was facing influenza. (Their deaths in connection with COVID-19 are announced on March 3.)
South Korea begins “drive-through” testing centers, “gas station-like facilities where people can get their noses or mouths swabbed for free while still sitting in their car.” Results are available within less than three days.
A Chinese traveler catches COVID-19 in Iran and travels back home to China.
Japan’s prime minister calls for the creation of a national face mask reserve that would be stocked with potential overproduction of face masks.
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership
President Trump taps Vice President Pence to lead the coronavirus response effort.
Interagency Coordination, Resources, and White House Leadership | Community Mitigation
A previously scheduled task force meeting aimed at recommending that President Trump embrace social distancing as a mitigation measure is canceled and replaced with an announcement that Pence will now be leading the task force, according to the New York Times.
Trump calls HHS Secretary Alex Azar to express displeasure with dire warnings by Nancy Messonnier, the CDC’s chief of respiratory diseases, the day before, according to the New York Times. A Wall Street Journal report says Trump “threatened to oust Dr. Messonnier.”
Surveillance | Community Mitigation
The CDC announces the first identified case of possible community transmission in the U.S.—a case with an unknown source of exposure.
Surveillance
The CDC tells state and local officials its “testing capacity is more than adequate to meet current testing demands,” according to a Feb. 26 agency email viewed by the Wall Street Journal.
Surveillance | Interagency Coordination, Resources, and White House Leadership
NIAID Director Anthony Fauci is concerned about the lag in testing and calls Brian Harrison, Azar’s chief of staff to ask “him to gather the group of officials overseeing screening efforts.”
The FDA emails the CDC that labs could skip the unreliable third part of the CDC’s 3-part test, according to the Washington Post. The CDC and FDA tell state officials that the problem of flawed tests that generate inconclusive results has been resolved.
Interagency Coordination, Resources, and White House Leadership | Congress
Azar testifies before a House appropriations subcommittee. The subcommittee chair, Representative Rose DeLauro (D-NY), says, “I have serious concerns about the administration's responsiveness with respect to funding. I understand senators of both parties expressed a similar concern to you at their hearing yesterday. I have repeatedly asked for information about expenditures thus far and about the balances remaining in the Infectious Disease Rapid Response Reserve Fund and yet we have not received an adequate answer.” Similarly, the chair of the full committee, Representative Nita Lowey (D-NY), says that “despite urgent warnings from Congress in the public health community it has taken weeks for the Trump administration to request these emergency funds while tens of thousands have become ill around the world.”
Healthcare System and Supply Chain Preparedness | Interagency Coordination, Resources, and White House Leadership
On an interagency phone call involving HHS and Department of Homeland Security officials, officials discuss using the Defense Production Act to speed up production of N95 masks and other personal protective equipment.
Medical Countermeasures
Gilead Sciences initiates two final-phase studies of its antiviral drug remdesivir as a COVID-19 treatment following the FDA’s acceptance of its new drug filing.
Healthcare System and Supply Chain Preparedness | Travel Restrictions and Warnings
A whistleblower files a complaint with the Office of Special Counsel alleging that government personnel receiving American evacuees from Wuhan were “not properly trained or equipped to operate in a public health emergency situation,” according to the Washington Post.
Presidential Statements
“When you have 15 people, and the 15 within a couple of days is going to be down to close to zero, that’s a pretty good job we’ve done.”
“I think every aspect of our society should be prepared. I don’t think it’s going to come to that, especially with the fact that we’re going down, not up. We’re going very substantially down, not up.”“But, yeah, I think schools should be preparing and, you know, get ready just in case. The words are ‘just in case.’ We don’t think we’re going to be there. We don’t think we’re going to be anywhere close.”
“Whatever happens, we’re totally prepared.”
Responding to a question from a reporter about boosting production of masks, “In fact, we’ve ordered a lot of it just in case we need it. We may not need it; you understand that. But in case — we’re looking at worst-case scenario. We’re going to be set very quickly.” [Note: The Associated Press reviewed contracting records and wrote that “federal agencies largely waited until mid-March to begin placing bulk orders of N95 respirator masks.”]
Key Stats
U.S. Tests Administered (Per Day): 111
U.S. Cases Confirmed: 57
Total U.S. Deaths: 0
Global Confirmed Cases: 81,388
Global Deaths: 2,770 -
DAY 56: HHS Officials Seek to Broaden Testing
Key Coronavirus Developments
Australia implements its pandemic response plan in preparation of a bigger spread, including preparing its hospital system and reviewing its supply chain for personal protective equipment. "In the event of a pandemic, the goal is to slow its spread if it gets to Australia. But with the number of countries that are now affected, we have to be realistic about the likelihood of containment strategies into the weeks ahead," Australia’s health minister says.
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership | Surveillance
The heads of the FDA and CDC hold a conference call with HHS officials. Citing one senior administration official, the New York Times reports that the HHS secretary’s chief of staff “began with an ultimatum: No one leaves until we resolve the lag in testing. We don’t have answers and we need them.” According to the Times, “by the end of the day, the group agreed that the F.D.A. should loosen regulations so that hospitals and independent labs could move forward quickly with their own tests.” According to the Washington Post, Jeffrey Shuren, the FDA’s director for devices and radiological health, says on the call that if the CDC was subject to the same scrutiny as privately run labs, “I would shut you down.” The meeting results in a strategy memo called, “A Plan to Increase Covid-19 testing in the U.S.,” that said the largely unchecked spread of the virus was “leading to significant impact on healthcare systems and causing social disruption” and that “a much broader interagency approach is needed to fill the greater need for diagnostics by commercial manufacturers and laboratories capable of developing their own tests.”
Surveillance | Interagency Coordination, Resources, and White House Leadership | Congress
At a congressional hearing, HHS Secretary Alex Azar says “at least 40 public health laboratories should now be able to test using modified existing CDC test kits,” that a “a newly manufactured CDC test can be sent to 93 public health labs” within days, and a “private-manufactured test based on the new CDC test that can be sent to those same labs as soon as tomorrow pending FDA clearance.” He also says, “It will look and feel to the American people more like a severe flu season in terms of the interventions and approaches you will see.”
Surveillance | Healthcare System and Supply Chain Preparedness
Carter Mecher, a senior medical adviser at the Department of Veterans Affairs, emails “the outbreak has had a good head start.”
Interagency Coordination, Resources, and White House Leadership
Vice President Mike Pence adds Treasury Secretary Stephen Mnuchin and Larry Kudlow, a top economic adviser to the president, to the coronavirus task force. He names Ambassador Deborah Birx, the U.S. global AIDS coordinator, as the White House’s coronavirus response coordinator.
The president’s chief of staff, Mick Mulvaney, sends a government-wide email saying all coronavirus-related communications must go through the vice president’s press secretary, Katie Miller.
Surveillance | Healthcare System and Supply Chain Preparedness
The CDC “updates its criteria to guide evaluation of persons under investigation for COVID-19.”
Congress
In a private meeting, Senator Richard Burr (R-NC), chairman of the Senate intelligence committee and a member of the Senate health committee, tells people that the virus “is much more aggressive in its transmission than anything that we have seen in recent history.” According to a recording of his remarks obtained by NPR, he says, “It is probably more akin to the 1918 pandemic.”
Presidential Statements
“I think it’s an incredible achievement what our country’s done” in terms of the government’s efforts to combat coronavirus.
Congratulations and thank you to our great Vice President & all of the many professionals doing such a fine job at CDC & all other agencies on the Coronavirus situation. Only a very small number in U.S., & China numbers look to be going down. All countries working well together!
— Donald J. Trump (@realDonaldTrump) February 28, 2020Key Stats
U.S. Tests Administered (Per Day): 204
U.S. Cases Confirmed: 58
Total U.S. Deaths: 0
Global Confirmed Cases: 82,746
Global Deaths: 2,814 -
DAY 57: CDC Sets Goal of Testing Capacity in Every State by Early March
The World Health Organization provides an update on the coronavirus, February 28, 2020.
Key Coronavirus Developments
The World Health Organization raises the coronavirus alert to the highest level. The executive director of its health emergencies program says: “This is a reality check for every government on the planet: Wake up, get ready, this virus may be on its way and you need to be ready. You have a duty to your citizens, you have a duty to the world to be ready.”
Washington state, Oregon, and California all report cases from community transmission, which is “a development that closely follows a change in federal policy that frees state public health labs to test for the virus,” according to the University of Minnesota’s Center for Infectious Disease Research and Policy.
A resident of a nursing home in the suburbs of Seattle tests positive for coronavirus (ultimately 37 people linked to the nursing home die and two-thirds of its residents and dozens of staff test positive for coronavirus; roughly one-fifth of COVID-19 deaths are linked to nursing homes as of mid-April).
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership | Congress
Representative John Garamendi (D-CA) tells the press that the vice president’s office directed Anthony Fauci, NIAID’s director, to “stand down” and not appear on five Sunday morning talk shows to discuss coronavirus.
Surveillance
Nancy Messonier, the CDC’s chief of respiratory diseases, says CDC aims to equip every state with the ability to test for the virus by the end of “next weekend.” She says the government has “established that the third component” of the CDC’s three-part test, which experts say was unneeded, “was the cause of the inconclusive results” and “can be excluded from testing without affecting accuracy.”
CDC testing criteria expands to include “Travelers from China, Italy, Iran, Japan and South Korea” and “Cases where respiratory illness was severe enough to require hospitalization, regardless of personal or travel history.”
Messonnier says the CDC disagrees with the University of California-Davis on whether there was a delay in testing the first confirmed patient who contracted coronavirus through community transmission. “According to CDC records, the first call we got about this patient was Sunday the 23rd,” she says, not the 19th.
Surveillance | Interagency Coordination, Resources, and White House Leadership
According to the U.S. Army, problems with the CDC’s test have delayed its use at civilian and Department of Defense labs.
Interagency Coordination, Resources, and White House Leadership
HHS requests the activation of government’s “Emergency Support Functions” for transportation, mass care, emergency assistance, temporary housing, human services, public safety and security, business and infrastructure, and external affairs. These functions span multiple agencies.
Surveillance
Carter Mecher, a senior medical advisor at the Department of Veterans Affairs and the VA’s liaison to the CDC, emails that there may be a two week period where the outbreak can be minimized in the U.S., but the lack of testing is hampering the response: “We have a relatively narrow window and we are flying blind.”
Interagency Coordination, Resources, and White House Leadership
Acting White House Chief of Staff Mick Mulvaney says the media is exaggerating the threat of coronavirus. “They think this will bring down the president, that’s what this is all about,” he says, praising the administration’s actions over the previous month. At the time, Mulvaney is the White House’s liaison to the coronavirus task force.
Presidential Statements
We're ordering a lot of supplies. We're ordering a lot of -- a lot of elements that, frankly, we wouldn't be ordering unless it was something like this. But we're ordering a lot of different elements of medical.”
“This is their new hoax” referring to Democrats who he says are “politicizing the coronavirus.”
Key Stats
U.S. Tests Administered (Per Day): 274
U.S. Cases Confirmed: 60
Total U.S. Deaths: 0
Global Confirmed Cases: 84,112
Global Deaths: 2,872 -
DAY 58: First Confirmed COVID-19 Patient Dies in the U.S.; Washington State Declares State of Emergency
Key Coronavirus Developments
The government of Washington state declares a state of emergency.
U.S. Government Actions
Surveillance | Healthcare System and Supply Chain Preparedness | Community Mitigation | Interagency Coordination/Resources/White House Leadership
The White House and the CDC, along with Washington state, announce the first confirmed COVID-19 death in the United States. The CDC announcement also notes the first confirmed healthcare worker infection in the U.S. and the first known outbreak in a U.S. long-term care facility. (In April, it was discovered that there were even earlier deaths in February due to COVID-19.)
Travel Restrictions and Warnings
The Trump administration announces it is increasing its travel warnings to the highest level with regards to certain areas in Italy and South Korea and expands Iran-related travel restrictions.
Healthcare System and Supply Chain Preparedness | Interagency Coordination, Resources, and White House Leadership
Vice President Mike Pence says the HHS’s assistant secretary for preparedness and response will be announcing “courses of action to increase the availability of masks,” including “prioritizing availability to high-risk healthcare workers.”
Surveillance
The FDA announces a new policy to take advantage of tests developed by commercial, reference, and clinical laboratories nationwide to expand testing capacity.
Key Stats
U.S. Tests Administered (Per Day): 371
U.S. Cases Confirmed: 68
Total U.S. Deaths: 1
Global Confirmed Cases: 86,011
Global Deaths: 2,941 -
Day 59: Researchers Say Virus Has Been Spreading Mostly Undetected in the U.S. for Six Weeks
Key Coronavirus Developments
Researchers examining the virus genomes from the first confirmed U.S. case—a person who returned to Washington state on January 15—and another person infected weeks later conclude that the virus has been spreading mostly undetected for a month and a half. The New York Times writes that means, based on the spread from the first confirmed case, “anywhere from 150 to 1,500 people may have it, with about 300 to 500 people the most likely range,” citing Dr. Mike Famulare, a principal research scientist at the Institute for Disease Modeling.
"By March 1, more than 9,000 people in the U.S. may have already been infected by COVID-19 (coronavirus), far more than the number that had been publicly reported,” according to a study released by Cedars-Sinai about a week later. “This suggests that the opportunity window to contain the epidemic of COVID-19 in its early stage is closing”
In Japan, Sharp Corporation announces one of its electronics factories will turn some of its production capacity to surgical masks with the aim of producing 150,000 masks a day by the end of March and eventually producing 500,000 masks a day. A story by the Japan Times a few days earlier stated that companies producing masks in Japan “have run their plants around the clock since late January and have boosted production to around 400 million masks a month, a figure that still falls short of the government target.”
Key Stats
U.S. Tests Administered (Per Day): 301
U.S. Cases Confirmed: 74
Total U.S. Deaths: 1
Global Confirmed Cases: 88,369
Global Deaths: 2,996 -
Day 60: Pence Says Mitigation, Not Containment, Is Now the Focus
Vice President Mike Pence participates in a video teleconference call with Governors and the White House Coronavirus Task Force Monday, March 2, 2020. (Official White House Photo by Andrea Hanks)
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership | Community Mitigation
Vice President Mike Pence says, “Now we’re focused on mitigation of the spread, as well as the treatment of the people affected.” HHS Secretary Alex Azar says “The degree of risk has the potential to change quickly.”
Interagency Coordination, Resources, and White House Leadership | Healthcare System and Supply Chain Preparedness
Azar designates Robert Kadlec, the assistant secretary for preparedness and response, to lead the department’s response to COVID-19. HHS contains the CDC, NIAID, Biomedical Advanced Research and Development Authority, Centers for Medicare and Medicaid Services, and other health and science-related agencies.
The FDA and CDC allow for emergency use of industrial respirators in healthcare settings by healthcare personnel during the COVID-19 outbreak. “Currently, the majority of respirators on the market are indicated for use in industrial settings,” the announcement states, with the action “maximizing the number of respirators available to meet the needs of the U.S. health care system.”
Presidential Statements
“You take a solid flu vaccine, you don't think that could have an impact, or much of an impact, on corona?”
Key Stats
U.S. Tests Administered (Per Day): 674
U.S. Cases Confirmed: 98
Total U.S. Deaths: 6
Global Confirmed Cases: 90,306
Global Deaths: 3,085
Part 8
The Federal Response Races to Catch Up to the Scope of the Crisis
During this time, starting from a relatively low level of tests compared to other nations, U.S. daily testing expanded over 60-fold, but the number of confirmed cases rose even faster, nearly 600-fold, showing that the virus had spread far and wide during the previous month. But even by the end of this period, on a per capita basis, the U.S.’s testing still lagged significantly behind South Korea, seen as a global model on how to aggressively test, and Italy, which was hit particularly hard by the virus. Even though the virus was known to have been in the U.S. since mid-January, Congress passed the first emergency appropriations to address the virus early during this period, appropriating three times more than what the administration asked for in late February.
Countries such as Italy began to take aggressive social distancing measures. By mid-month, the president issued voluntary guidance recommending social distancing more than two weeks after key members of the White House coronavirus task force believed the administration should begin advocating such measures. Going beyond the federal guidance, some state governors such as California’s Gavin Newsom, a Democrat, and Ohio’s Mike DeWine, a Republican, issued stay-at-home orders.
Looming shortages of N95 masks for healthcare workers and ventilators to help patients breathe prompted pressure from governors, Congress, and experts for the administration to use the Defense Production Act to prioritize U.S. industry’s production of this and other critical equipment. The administration resisted, even though officials had been discussing using the law since mid-January, and it is routinely used in other contexts. The president declined to use the law to procure healthcare supplies to address the crisis reportedly after lobbying from the U.S. Chamber of Commerce and corporations. Other questions also swirled broadly around federal leadership and coordination in procuring supplies for the nation, such as how supplies were being triaged.
During this period, the president’s public communication shifted. It became more serious in tone and moved from downplaying the severity of the situation to emphasizing the potential consequences if major actions were not taken.
March 3-23
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Day 61: WHO Warns of Risks to Healthcare Workers Due to Global Disruption of PPE Supply Chains
Key Coronavirus Developments
The head of the WHO warns of “severe and increasing disruption” to the global supply of personal protective equipment (PPE), putting the lives of healthcare workers at risk.
U.S. Government Actions
Congress | Interagency Coordination, Resources, and White House Leadership | Medical Countermeasures | Healthcare System and Supply Chain Preparedness | Surveillance | Travel Restrictions and Warnings
The Senate Health, Education, Labor, and Pensions Committee holds a hearing on “An Emerging Disease Threat: How the U.S. Is Responding to COVID-19, the Novel Coronavirus.”
Surveillance
The CDC’s Nancy Messonnier at a press briefing says that, as of the night before, there are 27 confirmed cases of Americans contracting the virus through community transmission. “What we are seeing abroad is now what is happening in the United States,” she says.
Key Stats
U.S. Tests Administered (Per Day): 903
U.S. Cases Confirmed: 118
Total U.S. Deaths: 7
Global Confirmed Cases: 92,840
Global Deaths: 3,160 -
Day 62: U.S. Lifts Many Restrictions on Testing But Still Requires a Doctor’s Referral
Key Coronavirus Developments
The state of California declares a state of emergency as six more cases are confirmed in the Los Angeles area.
With six confirmed cases, Russia bans exports of face masks and other medical equipment until June 1.
With 85 confirmed cases, UK Prime Minister Boris Johnson announces that workers self-isolating and “helping to protect all of us by slowing the spread of the virus” will get statutory sick pay from the first day since being off work.
Researchers publish a study in the International Journal of Infectious Diseases of 28 infector-infectee pairs with findings that suggest “a substantial proportion of pre-symptomatic transmission.”
U.S. Government Actions
Surveillance
The CDC announces that the only criteria to get a test now is a doctor’s approval.
Healthcare System and Supply Chain Preparedness
HHS announces it intends to buy 500 million N95 respirators over the next 18 months for the Strategic National Stockpile. The announcement says interested vendors must submit proposals by March 18.
Presidential Statements
“So if, you know, we have thousands or hundreds of thousands of people that get better just by, you know, sitting around and even going to work—some of them go to work, but they get better.”
Key Stats
U.S. Tests Administered (Per Day): 1,319
U.S. Cases Confirmed: 149
Total U.S. Deaths: 11
Global Confirmed Cases: 95,120
Global Deaths: 3,254 -
Day 63: WHO Warns Some Countries Are Not Taking Actions That “Match the Level of the Threat We All Face”
Key Coronavirus Developments
The head of the WHO says that “we are concerned that in some countries the level of political commitment and the actions that demonstrate that commitment do not match the level of the threat we all face.” He says that “leadership from the top” is needed for governments as a whole to act, not just their health agencies. “If countries act aggressively to find, isolate and treat cases, and to trace every contact, they can change the trajectory of this epidemic,” he says.
California and Washington state, following similar actions in New York and Missouri, order health insurance companies not to charge people usual fees associated with COVID-19 related healthcare visits or laboratory tests.
The South China Morning Post reports that the case mortality rate in South Korea is 0.65%, much lower than other estimates of the mortality rate for the virus, likely reflecting the country’s more widespread testing.
U.S. Government Actions
Congress | Surveillance
Senator Patty Murray (D-WA) writes to Vice President Mike Pence demanding answers about delays and issues with coronavirus diagnostic testing.
Surveillance
67 public health labs in 45 states are now testing, “up from 8 a week ago,” tweets Scott Becker, the CEO of the Association of Public Health Laboratories.
Update on US #PublicHealth laboratory system testing: Today 67 PHLs are verified & offering testing, up from 8 a week ago. This includes one or more PHL in 45 states; there are 13 addl labs in progress, 4 of which anticipate being up by the weekend. #COVID19 @APHL 1/
— Scott Becker (@scottjbecker) March 5, 2020Healthcare System and Supply Chain Preparedness | Interagency Coordination, Resources, and White House Leadership
Pence visits 3M, a major manufacturer of N95 masks.
Presidential Statements
With approximately 100,000 CoronaVirus cases worldwide, and 3,280 deaths, the United States, because of quick action on closing our borders, has, as of now, only 129 cases (40 Americans brought in) and 11 deaths. We are working very hard to keep these numbers as low as possible!
— Donald J. Trump (@realDonaldTrump) March 5, 2020Gallup just gave us the highest rating ever for the way we are handling the CoronaVirus situation. The April 2009-10 Swine Flu, where nearly 13,000 people died in the U.S., was poorly handled. Ask MSDNC & lightweight Washington failure @RonaldKlain, who the President was then?
— Donald J. Trump (@realDonaldTrump) March 5, 2020Key Stats
U.S. Tests Administered (Per Day): 1,849
U.S. Cases Confirmed: 217
Total U.S. Deaths: 12
Global Confirmed Cases: 97,886
Global Deaths: 3,348 -
Day 64: Trump Signs $8.3 Billion Emergency Response Bill
President Donald J. Trump, joined by the Secretary of Health and Human Services Alex Azar, left, and Dr. Robert R. Redfield, director of Centers for Disease Control and Prevention, listens to a reporter’s during a visit to the Centers for Disease Control and Prevention Friday, March 6, 2020, in Atlanta. (Official White House Photo by Shealah Craighead)
Key Coronavirus Developments
The WHO announces it has published a research and development roadmap for coronavirus to help coordinate global science and medical efforts.
Austin, Texas’s South by Southwest festival is canceled.
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership
The president signs a bill providing $8.3 billion in emergency funding for federal agencies to respond to the coronavirus outbreak (H.R. 6074: Coronavirus Preparedness and Response Supplemental Appropriations Act 2020).
Interagency Coordination, Resources, and White House Leadership | Surveillance
Surveillance
The FDA finalizes a policy allowing already-certified labs to perform COVID-19 tests on an emergency basis.
Interagency Coordination, Resources, and White House Leadership
Trump names Rep. Mark Meadows (R-NC) as his new chief of staff, replacing Mick Mulvaney. Mulvaney was reportedly the White House’s liaison to the administration’s coronavirus task force.
Presidential Statements
“I think we’re doing a really good job in this country at keeping it down. We’ve been really vigilant, and we’ve done a tremendous job at keeping it down.”
“[A]nybody right now, and yesterday, anybody that needs a test gets a test. They’re there. And the tests are beautiful[…] and the tests are all perfect like the letter was perfect. The transcription was perfect. Right? This was not as perfect as that but pretty good.”
Key Stats
U.S. Tests Administered (Per Day): 2,033
U.S. Cases Confirmed: 262
Total U.S. Deaths: 14
Global Confirmed Cases: 101,801
Global Deaths: 3,460 -
Day 65: South Korea’s CDC Says Many Cases Are Linked to Large Gatherings
Key Coronavirus Developments
Italy’s confirmed cases jump by more than 1,200 to nearly 6,000.
South Korea’s CDC says nearly 73% of confirmed cases in that country are associated with congregating in large groups such as attending sports events or religious services, or working or living in a nursing home.
Washington state has more than 100 confirmed cases, including 16 deaths.
U.S. Government Actions
Surveillance | Interagency Coordination, Resources, and White House Leadership
Stephen Hahn, the head of the FDA, speaks about testing at a White House press briefing. He says that “CDC has shipped tests sufficient to test about 75,000 individuals for COVID-19 to Public Health Laboratories” and “as of last night, more than 1.1 million tests have been shipped to nonpublic health labs.” The numbers do not include testing by commercial or academic labs. Hahn further notes that because the number of tests shipped is greater than the number of patients that can be tested, “With current estimates (and this could change), 2.1 million tests would roughly translate to 850,000 Americans being able to undergo testing.”
Healthcare System and Supply Chain Preparedness | Surveillance
The CDC updates its guidance regarding healthcare workers who may be exposed to the virus.
Key Stats
U.S. Tests Administered (Per Day): 1,788
U.S. Cases Confirmed: 402
Total U.S. Deaths: 17
Global Confirmed Cases: 105,847
Global Deaths: 3,558 -
Day 66: Italy Locks Down Vast Swaths of the Country
Key Coronavirus Developments
Italy locks down a quarter of its population.
U.S. Government Actions
Community Mitigation
On “Meet the Press,” NIAID Director Anthony Fauci says older people and those with underlying medical conditions should avoid travel and large crowds.
Presidential Statements
We have a perfectly coordinated and fine tuned plan at the White House for our attack on CoronaVirus. We moved VERY early to close borders to certain areas, which was a Godsend. V.P. is doing a great job. The Fake News Media is doing everything possible to make us look bad. Sad!
— Donald J. Trump (@realDonaldTrump) March 8, 2020Key Stats
U.S. Tests Administered (Per Day): 1,835
U.S. Cases Confirmed: 518
Total U.S. Deaths: 21
Global Confirmed Cases: 109,821
Global Deaths: 3,802 -
Day 67: Trump Says Country Doesn’t Shut Down for the Flu
Key Coronavirus Developments
Ohio announces its first three cases and its governor declares a state of emergency.
Tom Bossert, the former White House homeland security advisor, writes a Washington Post op-ed that advocates “[s]chool closures, isolation of the sick, home quarantines of those who have come into contact with the sick, social distancing, telework and large-gathering cancellations.”
Presidential Statements
So last year 37,000 Americans died from the common Flu. It averages between 27,000 and 70,000 per year. Nothing is shut down, life & the economy go on. At this moment there are 546 confirmed cases of CoronaVirus, with 22 deaths. Think about that!
— Donald J. Trump (@realDonaldTrump) March 9, 2020Key Stats
U.S. Tests Administered (Per Day): 3,572
U.S. Cases Confirmed: 583
Total U.S. Deaths: 22
Global Confirmed Cases: 113,590
Global Deaths: 3,988 -
Day 68: New York Declares Containment Zone Around New Rochelle
Key Coronavirus Developments
New York state declares a one-mile containment zone around New Rochelle, and announces large gatherings should be canceled for 14 days.
U.S. Government Actions
Healthcare System and Supply Chain Preparedness
The CDC issues updated infection control guidance for healthcare settings, including guidance on the use of personal protective equipment during a shortage.
Surveillance
The CDC reports that 79 state and local public health labs in 50 states and the District of Columbia are testing.
Presidential Statements
“... it will go away. Just stay calm. It will go away.”
“And when people need a test, they can get a test. When the professionals need a test, when they need tests for people, they can get the test. It's gone really well.”
Key Stats
U.S. Tests Administered (Per Day): 3,926
U.S. Cases Confirmed: 959
Total U.S. Deaths: 28
Global Confirmed Cases: 118,620
Global Deaths: 4,262 -
Day 69: World Health Organization declares a pandemic
National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci and other public health officials testify before the House Oversight and Reform Committee on the coronavirus outbreak, March 11, 2020.
Key Coronavirus Developments
The National Basketball Association puts its season on hiatus due to the coronavirus.
The WHO formally declares coronavirus a pandemic. “This is the first pandemic caused by a coronavirus,” said the WHO’s director general. “And we have never before seen a pandemic that can be controlled.”
Washington state’s governor bans gatherings of more than 250 people in three highly-impacted counties. “This is an unprecedented public health situation and we can't wait until we're in the middle of it to slow it down,” Governor Jay Inslee says during a press conference. “We've got to get ahead of the curve. One main defense is to reduce the interaction of people in our lives.”
U.S. Government Actions
Congress | Community Mitigation | Healthcare System and Supply Chain Preparedness
During a House oversight hearing on coronavirus preparedness and response, NIAID Director Anthony Fauci says the estimated COVID-19 mortality rate is 10 times worse than the seasonal flu and “Bottom line: It's going to get worse.”
Community Mitigation
The government's “current risk assessment as of March 11: For the majority of people, the immediate risk of being exposed to the virus that causes COVID - 19 is thought to be low. There is not widespread circulation in most communities in the United States.”
Interagency Coordination, Resources, and White House Leadership | Travel Restrictions and Warnings | Community Mitigation | Surveillance | Healthcare System and Supply Chain Preparedness
President Trump addresses the nation, announcing a 30-day ban on travel from most of Europe.
Healthcare System and Supply Chain Preparedness | Interagency Coordination, Resources, and White House Leadership
President Trump issues an order for the secretaries of the Departments of Health and Human Services and Labor to use their authority “to increase the availability of respirators” because of the anticipated “shortages in the supply of personal respiratory devices (respirators) available for use by healthcare workers in mitigating further transmission of COVID-19.”
Surveillance
The CDC updates testing criteria “to note that people who are immunocompromised or have chronic medical conditions should be factored into priorities for testing,” as described by the Wall Street Journal.
Interagency Coordination, Resources, and White House Leadership | Community Mitigation
The White House coronavirus task force announces 30-day mitigation strategies for New Rochelle—a hard-hit community outside of New York City—Seattle, and Santa Clara in California.
Surveillance | Travel Restrictions and Warnings | Interagency Coordination, Resources, and White House Leadership | Congress
Senators Cory Booker and Robert Menendez, both Democrats from New Jersey, ask the administration questions about screening procedures at major airports, citing reports that people are not being screened despite coming from high-risk countries. (Days later, a former RAND Corporation healthcare expert publishes a highly critical op-ed of screening procedures that she experienced at Dulles International Airport outside of Washington, DC.)
Presidential Statements
....Together we are putting into policy a plan to prevent, detect, treat and create a vaccine against CoronaVirus to save lives in America and the world. America will get it done!
— Donald J. Trump (@realDonaldTrump) March 11, 2020I am fully prepared to use the full power of the Federal Government to deal with our current challenge of the CoronaVirus!
— Donald J. Trump (@realDonaldTrump) March 11, 2020Key Stats
U.S. Tests Administered (Per Day): 4,746
U.S. Cases Confirmed: 1,281
Total U.S. Deaths: 36
Global Confirmed Cases: 125,875
Global Deaths: 4,615 -
Day 70: Stock Markets Plummet
Key Coronavirus Developments
Stock markets plummet with the Dow Jones industrial average dropping more steeply in one day than in any other since 1987.
Researchers publish findings on Chinese patients who tested positive after going to a mall that “indicate that low intensity transmission occurred without prolonged close contact in this mall; that is, the virus spread by indirect transmission.”
U.S. Government Actions
Surveillance | Interagency Coordination, Resources, and White House Leadership
HHS Secretary Alex Azar puts Admiral Brett Giroir in charge of coronavirus testing. (Giroir would tell the Washington Post in early April that this role was important because “There was a clear need for a more aggressive posture” and “Clearly, there needed to be a higher level of leadership and organization.”)
Healthcare System and Supply Chain Preparedness
Contracting records show HHS orders $4.8 million of N95 respirator masks from 3M.
Surveillance
The FDA grants an emergency authorization for the first commercial test, made by Roche.
Key Stats
U.S. Tests Administered (Per Day): 6,702
U.S. Cases Confirmed: 1,663
Total U.S. Deaths: 41
Global Confirmed Cases: 128,352
Global Deaths: 4,721 -
Day 71: Trump Declares a National Emergency
President Trump declares a national emergency, March 13, 2020.
Key Coronavirus Developments
In the Lancet, Italian researchers write, “Intensive care specialists are already considering denying life-saving care to the sickest and giving priority to those patients most likely to survive when deciding who to provide ventilation to. … In the near future, they will have no choice. They will have to follow the same rules that health-care workers are left with in conflict and disaster zones.”
The WHO declares Europe as the new coronavirus epicenter.
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership
President Donald Trump declares a national emergency, which allows the government to access billions in more funding to address coronavirus.
Congress | Surveillance | Economic Response
The House passes H.R. 6201: Families First Coronavirus Response Act, which creates paid sick leave for COVID-19, makes testing free, and expands unemployment benefits.
Interagency Coordination, Resources, and White House Leadership | Surveillance | Medical Countermeasures | Community Mitigation | Travel Restrictions and Warnings
The Department of Health and Human Services issues a COVID-19 Response Plan that is obtained and published by the New York Times. For planning purposes, it assumes the “pandemic will last 18 months or longer and could include multiple waves of illness.”
Surveillance
FDA authorizes emergency use of Thermo Fisher Scientific’s test for COVID-19, the second commercial test so authorized.
Presidential Statements
“To unleash the full power of the federal government in this effort, today I am officially declaring a national emergency. Two very big words. The action I am taking will open up access to up to $50 billion of very importantly—very important and a large amount of money for states and territories and localities in our shared fight against this disease.”
Key Stats
U.S. Tests Administered (Per Day): 7,083
U.S. Cases Confirmed: 2,179
Total U.S. Deaths: 49
Global Confirmed Cases: 145,219
Global Deaths: 5,406 -
Day 72: Trump Expands Europe Travel Ban to British Isles
Key Coronavirus Developments
Spain announces a countrywide lockdown.
U.S. Government Actions
Travel Restrictions and Warnings | Interagency Coordination, Resources, and White House Leadership
White House expands Europe travel ban to include the United Kingdom and Ireland.
Key Stats
U.S. Tests Administered (Per Day): 6,233
U.S. Cases Confirmed: 2,727
Total U.S. Deaths: 58
Global Confirmed Cases: 156,116
Global Deaths: 5,823 -
Day 73: The Fed Cuts Rates to Near Zero
Key Coronavirus Developments
A Harvard epidemiologist tweets CDC surveillance data showing flulike illness in U.S. going up. “[b]est evidence I know for widespread COVID-19 in absence of viral testing,” he says.
U.S. Government Actions
Surveillance
The CDC reports that 89 state and local public health labs in 50 states and the District of Columbia are testing and that “Commercial manufacturers are now producing their own tests.”
Community Mitigation
The CDC issues guidance that says events with 50 or more people should be canceled for the next 8 weeks.
Economic Response
The Federal Reserve cuts interest rates to near zero.
Key Stats
U.S. Tests Administered (Per Day): 5,937
U.S. Cases Confirmed: 3,499
Total U.S. Deaths: 73
Global Confirmed Cases: 167,466
Global Deaths: 6,450 -
Day 74: The White House Announces Voluntary Guidance to Slow the Spread of Coronavirus
Key Coronavirus Developments
The San Francisco area announces first U.S. lockdown.
London’s Imperial College unveils a new study that predicts at least 2.2 million people could die from the coronavirus in the U.S. without mitigation efforts. This study influences the White House to issue guidance on social distancing, according to the White House coronavirus response coordinator, Deborah Birx.
Every U.S. state by this point has declared an emergency.
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership | Community Mitigation
The White House announces a program called “15 Days To Slow The Spread,” a nationwide effort to slow the spread of COVID-19 through the implementation of social distancing. The White House recommends gathering in groups no larger than 10 people.
Medical Countermeasures
At a press conference, Trump says the first phase of a clinical trial has begun. NIAID Director Anthony Fauci says that a vaccine candidate was prepared in 65 days, which he says he believes is a record-breaking amount of time.
Presidential Statements
“We have a problem that a month ago nobody ever thought about. Nobody in the—you know, I’ve read about it. I read about—many years ago, 1917, 1918. I’ve seen all of the different—the different problems similar to this that we’ve had.”
“This is a bad one. This is a very bad one. This is bad in the sense that it’s so contagious. It’s just so contagious. Sort of, record-setting-type contagion.”
“My focus is really on getting rid of this problem — this virus problem. Once we do that, everything else is going to fall into place.”
Key Stats
U.S. Tests Administered (Per Day): 17,661
U.S. Cases Confirmed: 4,632
Total U.S. Deaths: 99
Global Confirmed Cases: 181,603
Global Deaths: 7,140 -
Day 75: Confirmed U.S. Cases Zoom Past 5,000
U.S. Government Actions
Economic Response | Interagency Coordination, Resources, and White House Leadership
The Trump administration announces it will ask Congress for hundreds of billions of dollars to prop up the economy.
Healthcare System and Supply Chain Preparedness
Medicare loosens rules to expand coverage of telemedicine to lower risks to seniors and the burden on healthcare facilities.
Medical Countermeasures
HHS Secretary Alex Azar issues a declaration providing “liability immunity for activities related to medical countermeasures against COVID–19,” effective retroactively to February 4.
Interagency Coordination, Resources, and White House Leadership | Healthcare System and Supply Chain Preparedness
Defense Secretary Mark Esper says the Pentagon will make 5 million N95 masks and 2,000 ventilators available to the Department of Health and Human Services.
Presidential Statements
“I felt it was a pandemic long before it was called a pandemic.”
Key Stats
U.S. Tests Administered (Per Day): 15,609
U.S. Cases Confirmed: 6,421
Total U.S. Deaths: 133
Global Confirmed Cases: 197,113
Global Deaths: 7,930 -
Day 76: Major Emergency Coronavirus Bill Becomes Law Providing Paid Sick Leave for COVID-19-Related Reasons
President Donald J. Trump is joined by Vice President Mike Pence and Secretary of the Treasury Steven Mnuchin as he signs H.R. 6201, the Families First Coronavirus Response Act, Wednesday, March 18, 2020. (Official White House Photo by Shealah Craighead)
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership | Economic Response | Surveillance
President Trump signs the “Families First Coronavirus Response Act,” which provides paid sick leave for COVID-19 related reasons, free coronavirus testing, and expands unemployment benefits.
Surveillance | Community Mitigation | Healthcare System and Supply Chain Preparedness
A CDC study says 80% of U.S. deaths so far have been in people 65 and older.
Interagency Coordination, Resources, and White House Leadership | Healthcare System and Supply Chain Preparedness
In an executive order, President Trump lays the groundwork for using the Defense Production Act, which gives the federal government the power to direct private industry’s production of supplies needed in the national interest.
Travel Restrictions and Warnings
The U.S. and Canadian governments announce they will close their border to nonessential travel.
Key Stats
U.S. Tests Administered (Per Day): 24,639
U.S. Cases Confirmed: 7,783
Total U.S. Deaths: 164
Global Confirmed Cases: 214,846
Global Deaths: 8,779 -
Day 77: California’s Governor Orders Citizens to Stay at Home
Key Coronavirus Developments
California’s governor issues a stay-at-home order, the first such statewide order in the U.S.
Presidential Statements
Trump touts an antimalarial drug as a treatment for coronavirus. “I think it could be a game changer and maybe not. And maybe not. But I think it could be, based on what I see, it could be a game changer.”
“Governors are supposed to be doing a lot of this work, and they are doing a lot of this work. The federal government is not supposed to be out there buying vast amounts of items and then shipping. You know, we’re not a shipping clerk. The governors are supposed to be — as with testing, the governors are supposed — are supposed to be doing it.”
Key Stats
U.S. Tests Administered (Per Day): 27,400
U.S. Cases Confirmed: 13,747
Total U.S. Deaths: 258
Global Confirmed Cases: 242,616
Global Deaths: 9,925 -
Day 78: The Government Warns of COVID-19 Scams
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership | Surveillance | Healthcare System and Supply Chain Preparedness
The FDA warns it is seeing fraudulent tests being marketed that could “pose serious health risks.” The FBI similarly says it is seeing a spike in COVID-19 related scams, and the attorney general urges Americans to report such fraud.
Community Mitigation
The CDC issues interim guidance to retirement communities and independent living facilities on preventing the spread of the virus.
Presidential Statements
“As we did with Canada, we're also working with Mexico to implement new rules at our ports of entry to suspend non-essential travel,” Trump says. “These new rules and procedures will not impede lawful trade and commerce.”
Regarding the prospect of a nationwide lockdown, “I don't think we'll ever find that necessary.”
Key Stats
U.S. Tests Administered (Per Day): 36,161
U.S. Cases Confirmed: 19,273
Total U.S. Deaths: 349
Global Confirmed Cases: 272,247
Global Deaths: 11,405 -
Day 79: HHS Orders Large Numbers of N95 Masks
Key Coronavirus Developments
For the week ending on this day, 3.3 million Americans file unemployment claims.
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership | Surveillance
The White House promises 27 million testing kits will be delivered by the end of the month.
Medical Countermeasures
HHS announces it will fund a new phase of a clinical trial testing an arthritis drug in people with severe cases of COVID-19.
Healthcare System and Supply Chain Preparedness
Contracting records show HHS orders $173 million of N95 masks from 3M to be delivered by the end of April.
Key Stats
U.S. Tests Administered (Per Day): 44,753
U.S. Cases Confirmed: 25,600
Total U.S. Deaths: 442
Global Confirmed Cases: 304,555
Global Deaths: 13,108 -
Day 80: Governors From Both Political Parties Order Lockdowns
Key Coronavirus Developments
The Republican governor of Ohio orders residents to shelter in place, joining some Democratic governors from other states issuing similar orders.
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership
President Trump announces the federal government will fund National Guard activity during the COVID-19 crisis.
Key Stats
U.S. Tests Administered (Per Day): 44,597
U.S. Cases Confirmed: 33,276
Total U.S. Deaths: 586
Global Confirmed Cases: 337,018
Global Deaths: 14,821 -
Day 81: CDC Provides Guidance to Prisons and Detention Centers
Key Coronavirus Developments
Nine states—California, Illinois, New Jersey, New York, Connecticut, Louisiana, Ohio, Oregon, and Washington—now have lockdown orders in effect.
U.S. Government Actions
Community Mitigation
The CDC posts interim guidance for correctional facilities and detention centers on managing COVID-19.
Interagency Coordination, Resources, and White House Leadership | Healthcare System and Supply Chain Preparedness
President Trump signs an executive order authorizing the prevention and punishment of price gouging and hoarding of critical supplies needed to combat COVID-19.
Interagency Coordination, Resources, and White House Leadership | Medical Countermeasures
The White House announces an effort to use national supercomputing power to speed COVID-19 research.
Community Mitigation
The U.S. surgeon general says, “We need you to understand you could be spreading it to someone else.”
Presidential Statements
“Every American has a role to play in defending our Nation from this invisible, horrible enemy.”
Responding to a press question regarding the lack of oversight over how the Treasury Department will allocate massive amounts of money, “I’ll be the oversight.”
Key Stats
U.S. Tests Administered (Per Day): 57,135
U.S. Cases Confirmed: 43,843
Total U.S. Deaths: 786
Global Confirmed Cases: 378,282
Global Deaths: 16,735
Part 9
Emergency Responses to the Economic Fallout and Supply Shortfalls
During this period, the president initially backtracks in his messaging, which in mid-March seemed to be more guided by input from public health experts, and says that he would like restrictions eased by Easter, April 12. Within days, however, the president says social distancing should continue for weeks longer until the end of April and that it is “a matter of life and death.” Congress passes and the president signs legislation with $2.2 trillion of economic relief—considered the largest injection of funding in the U.S. economy ever. Meanwhile, over these nine days, U.S. deaths attributed to COVID-19 go from just over 1,000 to over 6,000.
March 24-April 1
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Day 82: Trump wants country “opened up” by Easter; U.S. COVID-19 Deaths Exceed 1,000
Key Coronavirus Developments
India announces nationwide lockdown after recording around 500 confirmed cases.
U.S. Government Actions
Healthcare System and Supply Chain Preparedness
The Federal Emergency Management Agency announces it will use the Defense Production Act to speed delivery of tests and N95 masks, but then later the same day says it did not need to use the law.
HHS announces it will provide $100 million to hospitals to help them prepare for an influx of COVID-19 patients.
Presidential Statements
“We have to go back to work, much sooner than people thought.”
“I would love to have the country opened up and just raring to go by Easter.”
“Wouldn’t it be great to have all of the churches full?”
Key Stats
U.S. Tests Administered (Per Day): 68,613
U.S. Cases Confirmed: 53,736
Total U.S. Deaths: 1,008
Global Confirmed Cases: 418,079
Global Deaths: 18,928 -
Day 83: The Senate Passes the CARES Act
U.S. Government Actions
Economic Response | Congress
The Senate passes the Coronavirus Aid, Relief, and Economic Security (CARES) Act, the largest economic aid package in U.S. history.
Surveillance | Interagency Coordination, Resources, and White House Leadership
In absolute numbers, the U.S. catches up with South Korea on the number of tests administered, but lags far behind on a per capita basis. The night before, Deborah Birx, the White House coronavirus task force coordinator, said on Fox News that the federal government had “transformed the testing process.” Both countries detected their first case around the same time in January.
Key Stats
U.S. Tests Administered (Per Day): 83,487
U.S. Cases Confirmed: 65,778
Total U.S. Deaths: 1,316
Global Confirmed Cases: 467,723
Global Deaths: 21,556 -
Day 84: U.S. Reports More Confirmed Cases Than Any Other Country
Key Coronavirus Developments
Yale researchers write in a new study that the restrictions on travel from China did not significantly reduce the risk to the U.S. because the disease was relatively contained in China, while restrictions of travel from Iran had little effect because few people travel between Iran and the U.S. The European travel restrictions did reduce the risk of importing the virus, the study found, but the move came too late, after domestic transmission within the U.S. was well established.
The number of confirmed cases in the U.S. exceeds that of any other country.
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership | Community Mitigation | Surveillance
President Trump sends a letter to state governors announcing that the administration will label regions of the country “high risk, medium risk or low risk.” This will be a part of new federal guidelines to inform states on whether to heighten or reduce their social distancing and quarantine measures. This attempt at more nuanced measures relies in large part on the success in expanding testing in the preceding two weeks.
Key Stats
U.S. Tests Administered (Per Day): 100,464
U.S. Cases Confirmed: 83,836
Total U.S. Deaths: 1,726
Global Confirmed Cases: 529,701
Global Deaths: 24,489 -
Day 85: The CARES Act Becomes Law
Key Coronavirus Developments
British Prime Minister Boris Johnson tests positive for COVID-19.
U.S. Government Actions
Economic Response | Congress | Interagency Coordination, Resources, and White House Leadership
The House passes and the president signs the CARES Act into law.
Interagency Coordination, Resources, and White House Leadership | Healthcare System and Supply Chain Preparedness
Trump uses the Defense Production Act to order General Motors to prioritize the production of ventilators.
Key Stats
U.S. Tests Administered (Per Day): 103,070
U.S. Cases Confirmed: 101,657
Total U.S. Deaths: 2,265
Global Confirmed Cases: 593,423
Global Deaths: 27,886 -
Day 86: Over 6 and a Half Million File Jobless Claims, a New Record
Key Coronavirus Developments
For the week ending on this day, 6.6 million Americans file unemployment claims—the highest number on record.
U.S. Government Actions
Medical Countermeasures
The FDA announces it will allow emergency use of convalescent plasma—blood from recovered patients—to treat serious COVID-19 cases.
Key Stats
U.S. Tests Administered (Per Day): 104,366
U.S. Cases Confirmed: 121,465
Total U.S. Deaths: 2,731
Global Confirmed Cases: 660,824
Global Deaths: 31,361 -
Day 87: Trump Extends Social Distancing Guidelines Until End of April
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership | Community Mitigation
The president says his previously announced guidance recommending social distancing should extend for weeks longer, until the end of April.
Presidential Statements
“I want the American people to know that your selfless, inspiring, and valiant efforts are saving countless lives. You’re making the difference. The modeling estimates that the peak in death rate is likely to hit in two weeks. So, I’ll say it again: The peak, the highest point of death rates—remember this—is likely to hit in two weeks. Nothing would be worse than declaring victory before the victory is won. That would be the greatest loss of all.”
“It’s very important that everybody strongly follow the guidelines.”
Key Stats
U.S. Tests Administered (Per Day): 88,780
U.S. Cases Confirmed: 140,909
Total U.S. Deaths: 3,420
Global Confirmed Cases: 720,285
Global Deaths: 34,882 -
Day 88: The Captain of a U.S. Aircraft Carrier Asks for Help to “Prevent Tragic Outcomes”
Key Coronavirus Developments
A new study by Imperial College estimates a 1.4% case fatality rate for those under 60, lower than previous estimates. The director of the University of Minnesota’s Center for Infectious Disease Research and Policy says the rate could change depending on a population’s underlying health issues, such as obesity. In the U.S., about 45% of the population is moderately to severely obese, but such conditions are much rarer in China. The study’s authors themselves note, “Mortality can also be expected to vary with the underlying health of specific populations, given that the risks associated with COVID-19 will be heavily influenced by the presence of underlying comorbidities.”
Government authorities in Russia announce “an open-ended quarantine in Moscow requiring non-essential businesses to close and people to remain indoors,” according to an International Monetary Fund tracker of global policy responses to coronavirus.
U.S. Government Actions
Economic Response | Interagency Coordination, Resources, and White House Leadership
The chair of the Council of Inspectors General for Integrity and Efficiency picks the acting Pentagon inspector general, Glenn Fine, to serve as the head of the new Pandemic Response Accountability Committee.
Community Mitigation
The captain of a U.S. aircraft carrier warns that coronavirus is spreading among its crew, according to a letter obtained by the San Francisco Chronicle.
Key Stats
U.S. Tests Administered (Per Day): 117,450
U.S. Cases Confirmed: 161,831
Total U.S. Deaths: 4,192
Global Confirmed Cases: 782,490
Global Deaths: 38,804 -
Day 89: Trump Says Following Social Distancing Guidelines for the Next Month “A Matter of Life and Death”; U.S. Deaths Exceeds 5,000
Presidential Statements
“It’s absolutely critical for the American people to follow the guidelines for the next 30 days,” Trump says during a news conference. “It’s a matter of life and death.”
Key Stats
U.S. Tests Administered (Per Day): 111,094
U.S. Cases Confirmed: 188,172
Total U.S. Deaths: 5,367
Global Confirmed Cases: 857,608
Global Deaths: 43,602 -
Day 90: Surgeon General Says Mask Recommendations Being Reviewed
U.S. Government Actions
Community Mitigation
On the morning talk show “Good Morning America,” U.S. Surgeon General Jerome Adams says, “We've learned there’s a fair amount of asymptomatic spread and so we've asked the CDC [Centers for Disease Control and Prevention] to take another look at whether or not having more people wear masks will prevent transmission of the disease to other people."
Key Stats
U.S. Tests Administered (Per Day): 107,582
U.S. Cases Confirmed: 213,242
Total U.S. Deaths: 6,501
Global Confirmed Cases: 932,638
Global Deaths: 48,932
Part 10
As U.S. Deaths and Job Losses Mount, the President Lashes Out
The massive increase in the confirmation of cases was followed by a mounting death toll in April. Every day during this period saw over a thousand people in the U.S. lose their lives to COVID-19 and, by the end of the period, the U.S. had more confirmed deaths than any other country. Job losses continued to surge, too. Millions more filed unemployment claims, leading experts to say the economic toll of COVID-19 will exceed that of the Great Recession and could rival that of the Great Depression.
While the passage of the $2 trillion CARES Act by Congress in late March promised to offer some financial relief to the public and businesses, President Trump undermined a key oversight mechanism reviewing how the administration spends hundreds of billions from the relief fund by taking an action that ousts the recently named chair of a pandemic response oversight panel. And when a reporter asked the president about a new Department of Health and Human Services inspector general report that found that hospitals answering a survey said they were short on testing supplies, he said the report “is wrong” and asked out loud whether politics played a role, even though the report was not critical of the administration.
This proved to be a sign of what would come to define the tenor of Trump’s public comments over this period. The president blamed the WHO for not sounding the alarm earlier during the outbreak, although the WHO had urged the U.S. and other nations to take action in response to coronavirus, and U.S. government personnel based at the WHO sent information to the administration as the organization received it. He threatened U.S. funding for the WHO (and on April 14 the president ordered a funding cutoff).
Tension increased within the government’s response effort as well. The president blocked Anthony Fauci, the long-time director of NIAID, from answering a reporter’s question about the effectiveness of a drug the president had touted as a way to treat COVID-19. On Easter, the president retweeted a message with the hashtag #FireFauci after Fauci said on CNN that earlier actions could have “obviously” saved lives, but that the decision was “complicated.”
April 2-April 11
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Day 91: The Navy Removes the Captain Who Warned of Fatal Coronavirus Risks on His Aircraft Carrier
U.S. Government Actions
Healthcare System and Supply Chain Preparedness | Interagency Coordination, Resources, and White House Leadership
The Trump administration uses the Defense Production Act to compel 3M to produce N95 masks. (The administration also requests that the company cease exporting the masks, according to a 3M press release released the following day.) Trump orders HHS Secretary Azar “to invoke the Act with regard to” several other companies on this day as well.
Community Mitigation
The Navy removes an aircraft carrier captain who raised concerns about crew members with coronavirus and the spread of the virus on his ship.
Healthcare System and Supply Chain Preparedness | Interagency Coordination, Resources, and White House Leadership
Presidential advisor Jared Kushner gives a White House briefing where he says “the notion of the federal stockpile was it’s supposed to be our stockpile; it’s not supposed to be state stockpiles that they then use.”
Community Mitigation | Medical Countermeasures
NIAID Director Anthony Fauci says on “Today” that “this is going to get worse before it gets better” and that staying at home and social distancing is “the only thing we have” until there is a vaccine.
Community Mitigation | Interagency Coordination, Resources, and White House Leadership
Deborah Birx, the White House coronavirus task force coordinator, says Americans are not social distancing enough, based on the continuing large number of new confirmed cases coming in. “I know you’ve seen the slope in the United States vs. the slope in Italy. And we have to change that slope ... we see country after country having done that. What it means in the United States is not everyone is doing it,” she says. “I can tell by the curve, and as it is today, that not every American is following” federal social distancing guidelines.
Presidential Statements
Massive amounts of medical supplies, even hospitals and medical centers, are being delivered directly to states and hospitals by the Federal Government. Some have insatiable appetites & are never satisfied (politics?). Remember, we are a backup for them. The complainers should...
— Donald J. Trump (@realDonaldTrump) April 2, 2020“We have states that have been really incredible, by the fact they have kept so low,” the president says of their number of cases.
Key Stats
U.S. Tests Administered (Per Day): 118,023
U.S. Cases Confirmed: 243,622
Total U.S. Deaths: 7,921
Global Confirmed Cases: 1,013,458
Global Deaths: 54,991 -
Day 92: CDC Now Recommends Face Coverings for the Public
The CDC releases an instructional video with the U.S. Surgeon General Dr. Jerome Adams on making face coverings, April 3, 2020.
Key Coronavirus Developments
The WHO says 75 percent of patients in China initially deemed asymptomatic eventually develop symptoms.
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership | Economic Response
The president announces he intends to nominate Brian Miller to serve as the special inspector general for pandemic recovery. Miller is the former inspector general for the General Services Administration and at this time is serving in the White House counsel’s office.
Interagency Coordination, Resources, and White House Leadership | Healthcare System and Supply Chain Preparedness
The day after the president’s son-in-law and advisor, Jared Kushner, says during a White House coronavirus task force briefing that the Strategic National Stockpile isn’t for the use of the states, its website is changed to remove language about the stockpile’s role as a backup for states.
Community Mitigation
In a reversal from its prior recommendation, the CDC recommends that the public, especially in areas with a substantial community transmission, use face coverings when in public, such as when grocery shopping.
Healthcare System and Supply Chain Preparedness
The HHS inspector general issues a new report based on a survey of hospitals from late March that says “severe shortages of testing supplies and extended waits for test results limited hospitals’ ability to monitor the health of patients and staff,” that “widespread shortages of personal protective equipment (PPE) put staff and patients at risk,” and that hospitals “were not always able to maintain adequate staffing levels or to offer staff adequate support,” among other findings.
Medical Countermeasures
The FDA announces a national effort to develop blood-related therapies using “blood donated by people who have recovered from the virus” with antibodies that can combat the virus.
Healthcare System and Supply Chain Preparedness
3M responds to the government’s call to stop exporting masks, saying “ceasing all export of respirators produced in the United States would likely cause other countries to retaliate and do the same, as some have already done. If that were to occur, the net number of respirators being made available to the United States would actually decrease.”
Presidential Statements
Regarding a press question regarding reporting that Trump wants his signature on CARES Act coronavirus relief checks going to Americans: “Me sign? No. There’s millions of checks. I’m going to sign them? No. It’s a Trump administration initiative. But do I want to sign them? No.” (On April 13, the Treasury Department orders the president’s signature to be printed on these checks.)
Key Stats
U.S. Tests Administered (Per Day): 132,232
U.S. Cases Confirmed: 275,367
Total U.S. Deaths: 9,246
Global Confirmed Cases: 1,095,876
Global Deaths: 60,956 -
Day 93: U.S. Deaths Exceed 10,000 and Confirmed U.S. Cases Exceed 300,000
Key Coronavirus Developments
For the week ending on this day, 6.6 million Americans file unemployment claims.
Presidential Statements
Key Stats
U.S. Tests Administered (Per Day): 228,797
U.S. Cases Confirmed: 308,650
Total U.S. Deaths: 10,855
Global Confirmed Cases: 1,176,059
Global Deaths: 67,073 -
Day 94: Trump Stops Fauci From Answering Media Question Regarding a Drug Trump Has Touted
Key Coronavirus Developments
UK Prime Minister Boris Johnson is admitted to a hospital for care.
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership | Medical Countermeasures
During a White House coronavirus task force briefing where President Trump touts hydroxychloroquine, an anti-malarial drug, as a possible treatment for coronavirus, Trump stops NIAID Director Anthony Fauci from answering a reporter’s question about its effectiveness.
Presidential Statements
In response to a reporter asking why bulk purchases of N95 masks did not occur until mid-March: “The people that you’re looking at—FEMA, the military—what they’ve done is a miracle. What they’ve done is a miracle in getting all of this stuff. What they’ve done for states is incredible. And you should be thanking them for what they’ve done, not always asking wise-guy questions.”
Key Stats
U.S. Tests Administered (Per Day): 119,659
U.S. Cases Confirmed: 336,802
Total U.S. Deaths: 12,375
Global Confirmed Cases: 1,249,737
Global Deaths: 72,145 -
Day 95: Trump Removes New Head of Pandemic Oversight Board and Says Watchdog Report on Hospital Readiness is “Wrong”
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership | Economic Response
The president gives the inspector general at the Environmental Protection Agency the responsibility to simultaneously serve as acting Pentagon inspector general, removing Glenn Fine from his role as acting Pentagon IG. This means Fine can no longer serve as the chair of the new Pandemic Response Accountability Committee.
Surveillance
HHS announces it will give $186 million to state and local governments to improve testing and surveillance.
Presidential Statements
The president criticizes a new HHS inspector general report based on a survey of hospitals that says they face a dire shortage of COVID-19 testing supplies and personal protective equipment. The president says, in response to a question from a journalist, that the report is “just wrong. Did I hear the word ‘inspector general,’ really? It's wrong.” He suggests that it is politically motivated even though it is not critical of the administration.
Key Stats
U.S. Tests Administered (Per Day): 150,730
U.S. Cases Confirmed: 366,317
Total U.S. Deaths: 13,894
Global Confirmed Cases: 1,321,427
Global Deaths: 77,707 -
Day 96: Trump Threatens to End Funding of World Health Organization
Key Coronavirus Developments
A resurgence of cases in Singapore prompts a ban on social gatherings of groups larger than 10 for 4 weeks.
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership
President Trump criticizes the World Health Organization and threatens to end U.S. funding, saying it should have raised the alarm earlier, and that it was not independent enough of China.
Presidential Statements
“But we want to look into it—World Health Organization—because they really are—they called it wrong. They called it wrong. They really — they missed the call. They could have called it months earlier. They would have known, and they should have known. And they probably did know, so we’ll be looking into that very carefully.”
“And we’re going to put a hold on money spent to the WHO. We’re going to put a very powerful hold on it, and we’re going to see.”
Regarding a press question that the CARES Act’s Paycheck Protection Program has been confusing for some small businesses and what oversight measures have been put in place to ensure fairness, “It’s taken the measures. And we may even do a different system. Not with this. We’re going to have to probably add more money to this, to save — and to keep our small businesses going and to keep the employees of those small businesses working. But it’s such a positive event and you ask it in such a negative way. It’s just — I wish — I wish we had a fair media in this country, and we really don’t.”
“We are doing an incredible job of testing. We are doing a better job than anybody in the world right now on testing. There’s nobody close. And other nations admit this. Other nations have admitted it very strongly. Other nations are calling us, wanting to know about our testing.”
“We’re increasingly hopeful that the aggressive mitigation strategy we put into place will ultimately allow our hospital system to successfully manage the major influx of cases that — that we have right now. Again, I say that we’re finding, because of the incredible job done by the American people in conjunction with everybody — governors, the military, federal government, state government, local government.”
Key Stats
U.S. Tests Administered (Per Day): 152,745
U.S. Cases Confirmed: 397,121
Total U.S. Deaths: 16,191
Global Confirmed Cases: 1,396,438
Global Deaths: 85,350 -
Day 97: WHO Warns Against Politicizing COVID-19
Key Coronavirus Developments
China ends the 76-day lockdown in Wuhan.
The head of the World Health Organization says “Please don't politicize this virus” a day after President Trump criticizes the WHO and says the U.S. could withhold funding for the organization that coordinates global responses to public health threats such as disease outbreaks.
U.S. Government Actions
Interagency Coordination, Resources, and White House Leadership
HHS announces a contract with Philips to produce ventilators under the Defense Production Act.
Presidential Statements
“If every American continues to strictly adhere to social distancing guidelines, we can defeat the invisible enemy and save countless lives and we can do it much more quickly.”
Regarding a press question on when he learned about the coronavirus outbreak, “I learned when I started—when I learned about the gravity of it was sometime just prior to closing the country to China. And when we closed up the flights coming in from China and various other elements—and then, as you know, we closed up to Europe.”
“The question was asked a little while ago about the World Health Organization. And, as you know, they made a statement on June—on January 14th, I guess it was, that there was no human-to-human transmission. Well, there was. They probably made that statement in the second or third week of December, in addition, but they made it very powerfully on January 14th.” [Note: While on January 19, the WHO stated that “some limited human-to-human transmission [is] occurring between close contacts” which was confirmed by a top Chinese scientist on January 20, the virus was eventually found to be far more infectious than these initial statements indicated.]
Key Stats
U.S. Tests Administered (Per Day): 144,433
U.S. Cases Confirmed: 428,654
Total U.S. Deaths: 18,270
Global Confirmed Cases: 1,480,200
Global Deaths: 91,946 -
Day 98: U.S. COVID-19 Deaths Exceed 20,000; HHS and DHS Project Spike of U.S. Cases Without 30 Days of Stay-at-Home Orders
Key Coronavirus Developments
“SARS-CoV-2 came to the New York City area predominately via Europe through untracked transmissions," says Viviana Simon, a microbiology and infectious diseases professor at the Icahn School of Medicine at Mount Sinai in a press release on a new study she co-authored. The researchers say they conducted the first definitive molecular epidemiology study of SARS-CoV-2. “Only one of the cases studied was infected with a virus that was a clear candidate for introduction from Asia, and that virus is most closely related to viral isolates from Seattle, Washington. The study also suggests that the virus was likely circulating as early as late-January 2020 in the New York City area.”
U.S. Government Actions
Community Mitigation | Interagency Coordination, Resources, and White House Leadership
Projections by HHS estimate that 100,000 more Americans would die if there are no mitigation efforts versus continuing with 30 days of shelter-in-place orders and other social distancing efforts, according to a government document obtained by the New York Times. (The document was dated April 9 and the model it is based on is dated March 31.)
Presidential Statements
“I think we’re in very good shape.”
Key Stats
U.S. Tests Administered (Per Day): 165,833
U.S. Cases Confirmed: 462,780
Total U.S. Deaths: 20,255
Global Confirmed Cases: 1,565,538
Global Deaths: 99,252 -
Day 99: For the First Time, Over 2,000 New U.S. Deaths in One Day
Presidential Statements
“We have masks. We have everything. And we were trying to get ready for the surge.”
Regarding when to relax social distancing guidelines, “I’m going to have to make a decision, and I only hope to God that it’s the right decision. But I would say, without question, it’s the biggest decision I’ve ever had to make.”
Key Stats
U.S. Tests Administered (Per Day): 157,745
U.S. Cases Confirmed: 496,535
Total U.S. Deaths: 22,333
Global Confirmed Cases: 1,657,929
Global Deaths: 106,311 -
Day 100: The 50th U.S. State is Under a Disaster Declaration
Key Coronavirus Developments
For the week ending on this day, 5.2 million Americans file unemployment claims.
U.S. Government Actions
The president approves a disaster declaration for the 50th state, Wyoming, to request one.
Key Stats
U.S. Tests Administered (Per Day): 138,547
U.S. Cases Confirmed: 526,396
Total U.S. Deaths: 24,342
Global Confirmed Cases: 1,736,025
Global Deaths: 112,422