COVID-19 pandemic in the United States

On December 31, 2019, China announced the discovery of a cluster of pneumonia cases in Wuhan. The first American case of COVID-19 was reported on January 20, and Health and Human Services Secretary Alex Azar declared a public health emergency on January 31. Restrictions were placed on flights arriving from China, but the initial U.S. response to the COVID-19 pandemic was otherwise slow in terms of preparing the healthcare system, stopping other travel, and testing. The first known American deaths occurred in February and in late February President Donald Trump proposed allocating $2.5 billion to fight the outbreak. Instead, Congress approved $8.3 billion and Trump signed the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 on March 6. Trump declared a national emergency on March 13. The government also purchased large quantities of medical equipment, invoking the Defense Production Act of 1950 to assist. By mid-April, disaster declarations were made by all states and territories as they all had increasing cases. A second wave of infections began in June, following relaxed restrictions in several states, leading to daily cases surpassing 60,000. By mid-October, a third surge of cases began; there were over 200,000 new daily cases during parts of December 2020 and January 2021.

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

A fourth rise in infections began in March 2021 amidst the rise of the Alpha variant, a more easily transmissible variant first detected in the United Kingdom. That was followed by a rise of the Delta variant, an even more infectious mutation first detected in India, leading to increased efforts to ensure safety. The January 2022 emergence of the Omicron variant, which was first discovered in South Africa, led to record highs in hospitalizations and cases in early 2022, with as many as 1.5 million new infections reported in a single day. By the end of 2022, an estimated 77.5% of Americans had had COVID-19 at least once, according to the CDC.

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

In the United States, there have been 103,436,829 confirmed cases of COVID-19 with 1,234,749 confirmed deaths, the most of any country, and the 17th highest per capita worldwide. The COVID-19 pandemic ranks as the deadliest disaster in the country's history. It was the third-leading cause of death in the U.S. in 2020, behind heart disease and cancer. From 2019 to 2020, U.S. life expectancy dropped by three years for Hispanic and Latino Americans, 2.9 years for African Americans, and 1.2 years for White Americans. In 2021, U.S. deaths due to COVID-19 rose, and life expectancy fell.

Timeline

December 2019 to April 2020

In November 2019, COVID-19 infections had first broken out in Wuhan, China. China publicly reported the cluster on December 31, 2019. After China confirmed that the cluster of infections was caused by a novel infectious coronavirus on January 7, 2020, the CDC issued an official health advisory the following day. On January 20, the World Health Organization (WHO) and China both confirmed that human-to-human transmission had occurred. The CDC immediately activated its Emergency operations center (EOC) to respond to the outbreak in China. Also, the first report of a COVID-19 case in the U.S. was publicly reported, though the All of Us study (released in 2021) showed five states already had cases weeks earlier. After other cases were reported, on January 30, the WHO declared a Public health emergency of international concern (PHEIC) – its highest level of alarm – warning that "all countries should be prepared for containment". The same day, the CDC confirmed the first person-to-person case in the U.S. The next day, the country declared a public health emergency. Although by that date there were only seven known cases in the U.S., the HHS and CDC reported that there was a likelihood of further cases appearing in the country.

The Trump administration evacuated American nationals from Wuhan in January. On February 2, the U.S. enacted travel restrictions to and from China. On February 6, the earliest confirmed American death with COVID-19 (that of a 57-year-old woman) occurred in Santa Clara County, California. The CDC did not report its confirmation until April 21, by which point nine other COVID-19 deaths had occurred in Santa Clara County. The virus had been circulating undetected at least since early January and possibly as early as November.

On February 25, the CDC warned the American public for the first time to prepare for a local outbreak. The next day, New York City saw the sickening of its "patient zero", Manhattan attorney Lawrence Garbuz, then thought to be the first community-acquired case. Another case known as "patient zero" in Los Angeles was a man named Gregg Garfield, who spent 64 days in the Burbank Hospital, on a ventilator for 30 days, with a 1% chance to live. Contracting the virus from a ski trip, Garfield was able to return to the slopes, although with some fingers and toes amputated.

In February, Vice President Mike Pence took over for HHS Secretary Alex Azar as chair of the White House Coronavirus Task Force, with Trump saying, "We are very, very ready for this, for anything, whether it's going to be a breakout of larger proportions, or whether we're at that very low level". In late February Trump proposed allocating $2.5 billion to fight the outbreak, but Congress instead approved $8.3 billion with only Senator Rand Paul and Representatives Andy Biggs and Ken Buck voting against, and Trump signed the bill on March 6.

By March 11, the virus had spread to 110 countries, and the WHO began to refer to COVID-19 as a pandemic. The CDC had already warned that large numbers of people needing hospital care could overload the healthcare system, which would lead to otherwise preventable deaths. Director of the National Institute of Allergy and Infectious Diseases Anthony Fauci said the mortality from COVID-19 was ten times higher than the common flu. By March 12, diagnosed cases of COVID-19 in the U.S. exceeded a thousand. Trump declared a national emergency on March 13. On March 16, the White House advised against any gatherings of more than ten people. Three days later, the United States Department of State advised U.S. citizens to avoid all international travel.

By the middle of March, all fifty states were able to perform tests with a doctor's approval, either from the CDC or from commercial labs. However, the number of available test kits remained limited. As cases began spreading throughout the nation, federal and state agencies began taking urgent steps to prepare for a surge of hospital patients. Among the actions was establishing additional places for patients in case hospitals became overwhelmed.

Throughout March and early April, several state, city, and county governments imposed "stay at home" quarantines on their populations to stem the spread of the virus. By March 26, The New York Times data showed the United States to have the highest number of known cases of any country. By March 27, the country had reported over 100,000 cases. On April 2, at Trump's direction, the Centers for Medicare & Medicaid Services (CMS) and CDC ordered additional preventive guidelines to the long-term care facility industry. On April 11, the U.S. death toll became the highest in the world when the number of deaths reached 20,000, surpassing that of Italy. On April 19, the CMS added new regulations requiring nursing homes to inform residents, their families and representatives, of COVID-19 cases in their facilities. On April 28, the total number of confirmed cases across the country surpassed 1 million.