Abstract
As of November 2020, the United States leads the world in confirmed coronavirus disease 2019 (COVID-19) cases and deaths. Over the past 10 months, the United States has experienced three peaks in new cases, with the most recent spike in November setting new records. Inaction and the lack of a scientifically informed, unified response have contributed to the sustained spread of COVID-19 in the United States. This paper describes major events and findings from the domestic response to COVID-19 from January to November 2020, including on preventing transmission, COVID-19 testing and contact tracing, ensuring sufficient physical infrastructure and healthcare workforce, paying for services, and governance. We further reflect on the public health response to-date and analyse the link between key policy decisions (e.g. closing, reopening) and COVID-19 cases in three states that are representative of the broader regions that have experienced spikes in cases. Finally, as we approach the winter months and undergo a change in national leadership, we highlight some considerations for the ongoing COVID-19 response and the broader United States healthcare system. These findings describe why the United States has failed to contain COVID-19 effectively to-date and can serve as a reference in the continued response to COVID-19 and future pandemics.
Highlights
Ten months have passed since the first case of coronavirus disease 2019 (COVID-19) in the United States (US), yet the outlook remains bleak
Healthcare institutions in the US stock inventory very leanly (Rice et al, 2020), so as COVID-19 infections accelerated throughout February and March 2020, the existing supply of physical resources quickly fell behind demands
In September, administration officials in Health and Human Services (HHS) published testing guidelines on the Centers for Disease Control (CDC) website, stating that people who have been exposed to COVID-19 do not need testing if they are asymptomatic
Summary
Ten months have passed since the first case of coronavirus disease 2019 (COVID-19) in the United States (US), yet the outlook remains bleak. The US continues to lead the world in both COVID-19 cases and mortality. As of 25 November, there were nearly 13 million confirmed cases and greater than 262,000 deaths due to COVID-19 in the US (Dong et al, 2020). The first case of COVID-19, a recent traveller from Wuhan, China, was confirmed on 20 January in Washington state, 20 days after China had alerted the World Health Organization (WHO) of the new outbreak. The White House established a ‘Coronavirus Task Force’ and Despite these steps, the US fell behind in its fight against COVID-19 and has failed to recover. As of the same date, more than 1600 Americans die daily from COVID-19, though the mortality rate has improved since the onset of the pandemic (Dong et al, 2020). Given the pre-pandemic high ratings on pandemic preparedness and relative head start, why hasn’t the US has been able to contain COVID-19 effectively? This paper describes key events and findings on the domestic response to COVID-19 from January to November 2020, reflects on the response to-date, and presents short- and long-term considerations for the US moving forward
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