The First 100 Days of the U.S. Government’s COVID-19 Response

(Photo of closure sign: U.S. Air Force / Senior Airman Seraiah Wolf; illustration: CJ Ostrosky / POGO)

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.

Each day will detail at least one of the following:

Key coronavirus developments regarding its spread internationally and in the U.S.; selected responses by other countries or international institutions; and selected scientific and medical advancements in understanding the virus. These developments put the U.S. federal government response in context by showing when it was learned the virus could spread quickly between people, successful tactics employed by other nations, and failed early responses by others.

U.S. government actions, including statements, announcements, and congressional oversight and legislation. These actions are categorized as “Surveillance,” “Healthcare System and Supply Chain Preparedness,” “Travel Restrictions and Warnings,” “Medical Countermeasures,” “Community Mitigation,” “Economic Response,” “Interagency Coordination, Resources, and White House Leadership,” and “Congress.” For more details on each category, see the methodology.

Presidential statements. The head of the executive branch has the power to accelerate or slow the functioning of and coordination within the bureaucracy. And no single person in the world has a larger bullhorn to raise concerns or downplay them. According to U.S. pandemic planning documents, accurate and consistent public communication by the government is vital to signaling to the public the seriousness of the threat and the urgency of action.

Key stats on the total number of confirmed cases and deaths globally and in the U.S., along with the number of tests administered in the U.S. per day.

Out of consideration for length, the timeline regularly uses several acronyms:

HHS: U.S. Department of Health and Human Services
CDC: U.S. Centers for Disease Control and Prevention. Many other governments use CDC to denote their equivalent agencies; foreign CDCs are identified with the relevant country information.
NIH: National Institutes of Health
NIAID: National Institute of Allergy and Infectious Diseases. A component of the NIH.
WHO: World Health Organization

More methodological information here.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.”