Coronavirus: How US went from one infection to one million

In just three months, the nation has moved from ‘Patient Zero’ to zero patience, writes Andrew Buncombe

A doctor and patient at a drive-through testing centre in the Bronx, New York City (Getty)

One of the consequences of the pandemic and the lockdown, affecting most of the US, is that one can lose track of time.

It feels like only yesterday that officials in Washington state were confirming the first case of Covid-19 in America, and trying to reassure the public everything was being done to keep it safe.

In truth, it has taken three traumatic months for the total – collated by the Johns Hopkins University tracker – to go from one infection to one million. During that period, at least 50,000 people have died from the novel coronavirus and 75,000 have recovered.

It appears clear that while social distancing and strict hygiene have helped control the spread, coronavirus remains a potent danger. Some states are pushing ahead to reopen their economies, desperate not to allow the health crisis to turn into total economic devastation as well.

Health officials were visibly anxious at such moves. They know if the dropping of social distancing happens too quickly, infections will spring back, and with it the number of deaths.

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We do not know when this is going to end. Or what the final tally will be.

Here are some key dates and events along the way:

21 January 2020 – America’s Patient Zero

There is lots we don’t know about the case of the first confirmed infection in the United States. We do not know, for instance, the identity of the 35-year-old from Snohomish County, north of Seattle. But there is an awful lot that has emerged. The man, who is Asian-American, started to feel ill after returning to the Pacific northwest, after visiting family in Wuhan, China. On 19 January, four days after his return, and aware of the virus, he visited a doctor’s clinic to report he had a raised temperature and cough.

An article in The New England Journal of Medicine, published by those who treated him and oversaw his quarantine, reveals he wore a mask in the clinic, where he gave a stool sample and staff took nasal and throat swabs. The clinic contacted state and county health officials, who flew the samples to the Centres for Disease Control (CDC) laboratory that same night. The results came back the next day – and the US had its first confirmed case. The individual was treated in an insolation unit reportedly developed for the Ebola visit, at the Providence Regional Medical Centre in Everett.

“On admission, the patient reported persistent dry cough and a two-day history of nausea and vomiting; he reported that he had no shortness of breath or chest pain,” said the article.

At a press conference, state governor Jay Inslee said: “This is certainly not a moment for panic or high anxiety, it is a moment for vigilance.” Heather Thomas, a spokesperson for the Snohomish County health department, this week told The Independent, upon the patient’s admission, officials began trying to identify and contact up to 70 people they believed the man had been in contact with – so-called “contact tracing”. These included the taxi driver who picked him up at Seattle-Tacoma International Airport. Such people needed to be informed of their potential exposure, what steps to take to stay safe and to keep in touch.

She said it was a challenge now to think back to the first infection and look where the nation now stands.

“Could we have looked forward and seen this? Probably not,” she said. “But we were also, from the very beginning, monitoring the news the CDC and WHO were sharing from Wuhan province, and we were watching it spread to other countries. We figured something similar would come this way.”

Washington state would go on to be the nation’s first hotspot. It has currently identified more than 13,000 infections and 760 deaths.

The 35-year-old man, who has denied all media requests for interviews, left hospital on 3 February and has fully recovered. In a statement, he thanked staff, adding: “I appreciate all of the concern expressed by members of the public, and I look forward to returning to my normal life.”

31 January 2020 – The shifting response of the Trump administration

From the outset, the president and his supporters, especially those with loud voices in right wing media, sought to play down the threat from the virus. His first public remarks about what he frequently termed the “Chinese virus” was in a TV interview with CNBC at the World Economic Forum in Davos, Switzerland, a day after the first US case was confirmed. He was asked if he was fearful of it becoming a global pandemic. “No. Not at all. And we have it totally under control,” he replied.

His first action was on 31 January, when the White House announced it would ban entry for most foreign nationals who had travelled to China within the last 14 days. Critics say the president continued to ignore its threat for weeks, saying it would disappear with warm weather and likening it to the common flu. Despite the terrible toll incurred on Americans, the president continues to insist almost daily that this travel ban, that would later be extended to include Britain and Europe, was evidence of his early decisiveness.

Along the way, the president startled and shocked people with his interventions at daily updates that can last more than two hours. Robbed of the chance to speak to supporters at rallies, he uses the events to argue with reporters and defend his record. He has also pushed various unproven and potentially deadly treatments for the virus, ranging from hydroxychloroquine and UV light, and most recently injections of detergent. As his approval numbers have slipped, so advisors have suggested he cut back on the briefings and leave it to the scientists.

26 February 2020 – What really happened in California?

On this day, officials in California revealed a deeply disturbing development – the first case of what is termed “community transmission”, that is when an infected person reports no history of foreign travel or interaction with someone who had been travelling.

The person was a resident of Solano County, west of Sacramento, and at the time there was just 60 confirmed cases nationally. “At this time, the patient’s exposure is unknown,” the CDC said in a statement. “It’s possible this could be an instance of community spread of Covid-19, which would be the first time this has happened in the United States.”

But new evidence suggests the virus had been spreading in the US west earlier than previously believed. New autopsy results show two Californians died of coronavirus in early and mid-February, three weeks before the previously believed first US death – a man in his 50s in Seattle on 29 February.

“There is a lot unknown about this visit and how it transmitted in the US,” said Dr William Moss, executive director of the International Vaccine Access Centre at Johns Hopkins Bloomberg School of Public Health in Baltimore.

“We know it spreads through the respiratory system, and we know it’s a novel coronavirus, so the entire population of the world is susceptible, that’s the basis of the problem we’re facing.”

He said officials would like to see “invisible” events, such as the first infection, rather than what becomes visible. He added: “We may never know, but there was probably more ongoing transmission within the United States than we previously believed… There were no doubt multiple entries of this virus into the US.”

As the number of infections in California began to grow, city and state officials announced lockdowns and stay at home orders. The state today has had more than 45,000 infections and 1,800 deaths, considerably less than some had projected. “We were the first state to do the stay-at-home order. Even before we did the stay-at-home order, we had a stay-at-home order for all of our seniors, 5.3 million seniors, 65 and over,” governor Gavin Newsom told NPR.

4 March 2020 – US infections hit 100 with 6 deaths

9 March 2020 – US infections hit 500 with 22 deaths

20 March 2020 – New York now epicentre of US crisis

It was always likely that America’s largest, most densely populated urban centre would be struck by the disease. Probably, nobody imagined it would be so devastating, and in so many ways.

Makeshift mortuaries were constructed outside hospitals, medical staff were obliged to reuse personal protective equipment (PPE) or make their own, and they sobbed on social media about the trauma they were dealing with.

Governor Andrew Cuomo would win plaudits for his calm, fact-based daily briefings, that people contrasted starkly with the self-aggrandisement and dishonesty on display at those of the president. Some wanted to draft him in as a ready-made Democratic challenger to the president in November, believing he may have a greater chance than Joe Biden.

Mayor Bill de Blasio has also earned praise for his actions, and it was on this day he revealed what the nation was seeing rapidly play out before its eyes – that New York City was the new epicentre with a third of all infections. A total of 5,151 people had been infected, and 29 had died.

“We are now the epicentre of this crisis,” he said. “If you feel afraid, you are not alone, if you’re anxious you are not alone. New Yorkers are so strong. There are other places in this country this might be a particularly shock to the system, but here… we’re tough people by nature.”

With hindsight, that was just a taste of what was coming. Soon, both infections and deaths in the city and state would soar. Many days, the number of deaths would be as high as 700.

Today, that number has long passed more than 250,000 infections and 15,000 deaths. Every day, Mr Cuomo urges people to dig in.

This week, he said the president had vowed to help the state double its testing capacity to 40,000 tests a day, a total that would include diagnostic and antibody tests. “It will take several weeks at best,” said the 62-year-old governor. “This is an enormous undertaking.”

26 March 2020 – Nation stares at economic calamity

Mr Trump had recommended social distancing measures on 15 March after persuasion and new projections of more than two million deaths in the US. He said elderly people should stay inside, and people should not gather in groups of more than 10. States would follows with their own, tougher rules. When the president said the initial two-week period may last until August, the markets crashed and people realised the health crisis was to be joined by economic meltdown.

Within two weeks, on 26 March 26, data revealed unemployment claims had jumped to 281,000, the highest since 2 September, 2017. Now that figure stands at more than 22 million, and the president is desperate to reopen the economy, having planned to campaign on the nation’s previously strong economy and low unemployment figures.

He claimed the situation would be back to normal by Easter, but was forced to extend the lockdown recommendations.

“We can’t have the cure be worse than the problem,” he said at the White House on 24 March. “We have to open our country because that causes problems that, in my opinion, could be far bigger problems.”

He added: “Life is fragile, and economies are fragile.”

Experts say the economy will suffer trillions of dollars in losses and that a recession could be as bad as that during the 1930s. Economist Ray Perryman told the Dallas Morning News that he and colleagues projected the disappearance of 11.4 million jobs annually, and a loss of $972.6 billion (£780bn) in real gross product.

29 March 2020 – Louisiana new hotspot as disease heads south

Louisiana governor John Bel Edwards did not mince his words. In the coming days, he believed his state’s healthcare system would be “overwhelmed” by the virus, as the number of infections grew. Some pointed to factors such as visitors to New Orleans partying, rather than observing social distancing measures. Whoever or whatever was to blame, the state became the third hotspot after Washington and New York.

“We remain on a trajectory, really, to overwhelm our capacity to deliver healthcare,” the Democrat told ABC News. “By the end of the first week in April, we think the first real issue is going to be ventilators. And we think it’s about the fourth or fifth of April before, down in the New Orleans area, we’re unable to put people on ventilators who need them. And then several days later, we will be out of beds.”

The current total in the state now stands at more than 27,000 infections and 1,750 deaths. While better social distancing has been introduced, some are continuing to ignore it. Pastor Tony Spell of the Life Tabernacle Church in Baton Rouge was arrested after allegedly driving his van at protesters demonstrating over his decision to continue to hold services.

Other states have followed in the wake of Louisiana. Michigan now has the third-highest number of deaths, 2,700, after New York and New Jersey, and the seventh largest number of infections, more than 33,000.

10 April 2020 – US infections hit 500,000 with more than 19,000 deaths

13 April 2020 – President says he has ‘ultimate authority’ as he launches fight with governors

Having seen the shutting of major sports leagues a month earlier, and having signed two stimulus packages, one an emergency measure of $83bn on 6 March when infections hit 100,000 and then a second, much larger measure of more than $2 trillion on 27 March, the president was determined to get the economy restarted as soon as possible.

At the White House on this day, as he discussed getting some things back to normal, he claimed governors would be obliged to obey his orders.

“When somebody is president of the United States, your authority is total,” he said, two days after the US had passed Italy to have the highest number of Covid-19 fatalities. “The president of the United States calls the shots. If we weren’t here for the states, you would have had a problem in this country like you’ve never seen before.”

Just a day later, as Democrats and constitutional experts dismissed his claim, the president drew away from the assertion and said any reopening would have to proceed in concert with the governors.

“I will be authorising each individual governor, of each individual state, to implement a reopening and a very powerful reopening plan of their state in a time and a manner as most appropriate,” he said. “Because certain states are in much different condition and in a much different place than other states.”

15 April 2020 – Public anger exploited by right-wing extremists

Thousands of people, many of them armed, brought gridlock to the centre of Michigan’s capital, Lansing, protesting what they termed Democratic governor Gretchen Whitmer’s “draconian” social distancing rules, which were among the most strict in the country. Many honked their horns and chanted “lock her up”, a slogan the president typically encouraged his supporters to shout at his rallies in reference to Hillary Clinton.

The protests in Michigan and Ohio that day were the first of a series of demonstrations in states across the country, including Colorado, Michigan, Ohio, Kentucky, Minnesota, North Carolina, Utah, New York and Washington.

One of the organising groups, the Michigan Conservative Coalition, which claims the Republican Party has taken an unhealthy turn to the left, said on its website: “Our governor and her allies are infecting ALL of us with their radical, progressive agenda. There is NO reasoned and public plan to promote our overall physical and economic health!”

Experts pointed out many of the protests featured far-right extremists, including the Michigan Liberty Militia and the Proud Boys, and white supremacist groups such as Patriot Front.

A number of protesters carried Make America Great Again banners, and were heartened by the president’s attacks on Ms Whitmer. In one tweet, he wrote: “LIBERATE MICHIGAN!”

JJ MacNab, a fellow at George Washington University and an expert on anti-government groups, told The Independent that the lines between extremists and anti-government protesters had been “increasingly blurred”.

19 April 2020 – US infections pass 750,000 with more than 40,000 deaths

20 April 2020 – Georgia says it is reopening as critics urge caution

It was always likely that a red state would be the first to seize the opportunity to end the social distancing measures. Georgia governor Brian Kemp opened the way, saying his order would first include bowling alleys, gyms, and hair and nail salons. The following week, restaurants and cinemas would be allowed to open as well.

At the same time, South Carolina governor Henry McMaster said he was permitting beaches and retail stores to open.

“Reports of emergency room (ER) visits for flu-like illnesses are declining, documented Covid-19 cases have flattened and appear to be declining, and we have seen declining ER visits in general,” Mr Kemp said. He called testing for the disease a “key component”.

Mr Trump praised the move in a call to the governor, reports said. Yet, there were also plenty of sceptics, as polls suggested two-thirds of the country wanted to hold off ending social distancing.

Albany mayor Bo Dorough, whose city has seen one of Georgia’s biggest outbreaks, told NBC News Mr Kemp’s decision was “dangerous”.

“We are not ready for this. It is misguided for the governor to prevent local governments from implementing measures to protect the health and safety of their citizens,” he said.

“It is a positive development that fewer people are being admitted with Covid symptoms. But we are not out of the woods, and it is irresponsible for the governor to take these measures.”