United States responses to the COVID-19 pandemic

Medical response

Initial response outside the U.S.

On January 6, a week after the U.S. was informed about the outbreak in China, both the Health and Human Services department and the CDC offered to send a team of U.S. health experts to China. According to CDC Director Robert R. Redfield, the Chinese government refused to let them in, which contributed to the U.S. getting a late start in identifying the danger of their outbreak and containing it before it reached other countries. Secretary Alex Azar said China did notify the world much sooner than it had after their SARS outbreak in 2003, but it was unexplainably turning away CDC help for this new one.

On January 28, the CDC updated its China travel recommendations to level 3, its highest alert. Azar submitted names of U.S. experts to the WHO and said the U.S. would provide $105 million in funding, adding that he had requested another $136 million from Congress. On February 8, the WHO's director-general announced that a team of international experts had been assembled to travel to China and he hoped officials from the CDC would also be part of that mission. The WHO team consisted of thirteen international researchers, including two Americans, and toured five cities in China with twelve local scientists to study the epidemic February 16–23. The final report was released on February 28.

In late January, Boeing announced a donation of 250,000 medical masks to help address China's supply shortages. On February 7, The State Department said it had facilitated the transportation of nearly eighteen tons of medical supplies to China, including masks, gowns, gauze, respirators, and other vital materials. On the same day, U.S. Secretary of State Mike Pompeo announced a $100 million pledge to China and other countries to assist with their fights against the virus.

On February 28, the State Department offered to help Iran fight its own outbreak, as Iran's cases and deaths were dramatically increasing. Iran said, however, that U.S. sanctions were hampering its battle with the disease, which the U.S. denied, saying that Iran had mishandled the crisis.

Testing

Testing for SARS-CoV-2 can allow healthcare workers to identify infected people. It is also an important component of tracking the pandemic. There are various types of tests currently on the market; some identify whether or not a patient is currently infected, while others give information about previous exposure to the virus.

A report published in January 2021 revealed that a Chinese firm, BGI Group, was attempting to distribute its COVID-19 testing kits to at least 11 states in the US. The U.S. intelligence and security officials raised warnings about the security risks involved in using these kits, as BGI was trying to use the patients' DNA, via the gene-sequencing machines that were being pitched to the U.S. labs. However, federal agencies, including the Food and Drug Administration and the Federal Emergency Management Agency, as well as the United States Department of Health and Human Services were pushing the states to use the BGI testing kits, despite such warnings. Besides the 11 states, Nevada received the Chinese-made testing kits from Abu Dhabi's data and artificial intelligence firm, Group 42, in collaboration with BGI. Some of the testing supplies were used in Nevada, but states like Alabama, South Dakota, Ohio, Rhode Island, Massachusetts, Arkansas, California, Indiana, Kansas, North Carolina, and Pennsylvania didn't purchase the BGI kits.

Contact tracing

Contact tracing is a tool to control transmission rates during the reopening process. Some states like Texas and Arizona opted to proceed with reopening without adequate contact tracing programs in place. Health experts have expressed concerns about training and hiring enough personnel to reduce transmission. Privacy concerns have prevented measures such as those imposed in South Korea where authorities used cellphone tracking and credit card details to locate and test thousands of nightclub patrons when new cases began emerging. Funding for contact tracing is thought to be insufficient, and even better-funded states have faced challenges getting in touch with contacts. Congress allocated $631 million for state and local health surveillance programs, but the Johns Hopkins Center for Health Security estimated that $3.6 billion will be needed. The cost rises with the number of infections, and contact tracing is easier to implement when the infection count is lower. Health officials are also worried that low-income communities will fall further behind in contact tracing efforts which "may also be hobbled by long-standing distrust among minorities of public health officials".

As of July 1, 2020, only four states used contact tracing apps as part of their state-level strategies to control transmission. The apps documented digital encounters between smartphones, so the users would automatically be notified if someone they had contact with tested positive. Public health officials in California claimed that most of the functionality could be duplicated by using text, chat, email, and phone communications.

Drug therapy development

In the United States, remdesivir is indicated for use in adults and adolescents (aged twelve years and older with body weight at least 40 kilograms (88 lb)) for the treatment of COVID-19 requiring hospitalization. In November 2020, the FDA issued an emergency use authorization (EUA) for the combination of baricitinib with remdesivir, for the treatment of suspected or laboratory confirmed COVID-19 in hospitalized people two years of age or older requiring supplemental oxygen, invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO). As of August 2020, there were more than 500 potential therapies for COVID-19 disease in various stages of preclinical or clinical research.

Hydroxychloroquine and chloroquine

In early March, President Trump directed the FDA to test certain medications to discover if they had the potential to treat COVID-19 patients. Among those were chloroquine and hydroxychloroquine, which have been successfully used to treat malaria for over fifty years. A small test in France by researcher Didier Raoult had given positive results, although the study was criticized for design flaws, small sample size, and the fact that it was published before peer review. One of Didier's COVID-19 studies was later retracted by the International Journal of Antimicrobial Agents.

On March 28, the FDA issued an Emergency Use Authorization (EUA) which allowed certain hospitalized COVID-19 patients to be treated with hydroxychloroquine or chloroquine. On June 15, the FDA revoked the EUA for hydroxychloroquine and chloroquine as potential treatments for COVID-19. The FDA said the available evidence showed "no benefit for decreasing the likelihood of death or speeding recovery". On July 1, the FDA published a review of safety issues associated with the drugs, including fatal cardiac arrhythmias among other side effects.

In late July, President Trump continued to promote the use of hydroxychloroquine for COVID-19. This contrasted with the position of the NIH, which stated the drug was "very unlikely to be beneficial to hospitalized patients with COVID-19".

Vaccine research, development, and deployment

From early 2020, more than 70 companies worldwide (with five or six operating primarily in the U.S.) began vaccine research. In preparation for large-scale production, Congress set aside more than $3.5 billion for this purpose as part of the CARES Act. On August 5, 2020, the United States agreed to pay Johnson and Johnson more than $1 billion to create 100 million doses of COVID-19 vaccine. The deal gave the U.S. an option to order an additional 200 million doses. The doses were supposed to be provided for free to Americans if they were used in a COVID-19 vaccination campaign.

BIO, a trade group including all makers of coronavirus vaccines except AstraZeneca, tried to persuade Secretary Azar to publish strict FDA guidelines that could help ensure the safety and public uptake of the vaccine. Politics impacted scientific practice, however, when the chief of staff Mark Meadows blocked the FDA when it was realized that the timing of the provisions would make it impossible for a vaccine to be authorized before the November election. Ultimately, the guidelines emerged from the Office of Management and Budget and were published on the FDA website.

On November 20, 2020, the Pfizer–BioNTech partnership submitted a request for emergency use authorization for its vaccine to the Food and Drug Administration (FDA), which was granted on December 11. On December 18, 2020, the FDA granted the Moderna vaccine emergency use authorization, which Moderna had requested on November 30, 2020.

Starting on December 14, 2020, the first doses of COVID-19 vaccine were administered. The CDC and each state keep track of the number of vaccines administered.

After taking office in January 2021, new president Joe Biden signed an executive order to increase production and distribution of vaccines, aiming to have a hundred million doses administered within his first 100 days in office. On February 13, 2021, the CDC published data showing that 50.6 million doses had been administered to 37 million people, 13 million fully vaccinated and the rest awaiting their second dose.

In an address on March 11, 2021, Biden announced that he would push for all states to make vaccination available universally to all adults no later than May 1 and announced other planned initiatives to enhance and widen distribution.

Medical supply shortages

The first known case of COVID-19 in the U.S. was confirmed by the CDC on January 21, 2020. The next day, the owner of the medical supply company Prestige Ameritech wrote to HHS officials to say he could produce millions of N95 masks per month. In a follow-up letter on January 23, the business owner informed the government that "We are the last major domestic mask company," without success.

On February 5, Trump administration officials declined an offer for congressional coronavirus funding. Senator Chris Murphy recalled that the officials, including Secretary Azar, "didn't need emergency funding, that they would be able to handle it within existing appropriations." On February 7 Mike Pompeo announced the administration donated more than 35,000 pounds of "masks, gowns, gauze, respirators, and other vital materials" to China the same day the WHO warned about "the limited stock of PPE (personal protective equipment)".

In February, the Department of Commerce published guidance advising U.S. firms on compliance with Beijing's fast-track process for the sale of "critical medical products", which required the masks shipped overseas to meet U.S. regulatory standards. According to Chinese customs disclosures, more than six hundred tons of face masks were shipped to China in February.

In early March, the country had about twelve million N95 masks and thirty million surgical masks in the Strategic National Stockpile (SNS), but the DHS estimated the stockpile had only 1.2 percent of the roughly 3.5 billion masks that would be needed if COVID-19 were to become a "full-blown" pandemic. A previous 2015 CDC study found that seven billion N95 respirators might be necessary to handle a "severe respiratory outbreak".

As of March, the SNS had more than 19,000 ventilators (16,660 immediately available and 2,425 in maintenance), all of which dated from previous administrations. Vessel manifests maintained by U.S. Customs and Border Protection showed a steady flow of the medical equipment needed to treat the coronavirus being shipped abroad as recently as March 17. Meanwhile, FEMA said the agency "has not actively encouraged or discouraged U.S. companies from exporting overseas" and asked USAID to send back its reserves of protective gear for use in the U.S. President Trump evoked the Defense Production Act to prohibit some medical exports. Some analysts warned that export restrictions could cause retaliation from countries that have medical supplies the United States needs to import.

By the end of March, states were in a bidding war against each other and the federal government for scarce medical supplies such as N95 masks, surgical masks, and ventilators. Meanwhile, as states scrambled to purchase supplies at inflated prices from third party distributors (some of which later turned out to be defective), hundreds of tons of medical-grade face masks were shipped by air freight to foreign buyers in China and other countries.

Medical organizations such as the American Medical Association and American Nurses Association implored Trump to obtain medical supplies, because they were "urgently needed". That led President Trump to sign an order setting motion parts of the Defense Production Act, first used during the Korean War, to allow the federal government a wide range of powers, including telling industries on what to produce, allocating supplies, giving incentives to industries, and allowing companies to cooperate. Trump then ordered auto manufacturer General Motors to make ventilators.

During this period, hospitals in the U.S. and other countries were reporting shortages of test kits, test swabs, masks, gowns, and gloves (collectively referred to as PPE.) The Office of Inspector General, U.S. Department of Health and Human Services released a report regarding their March 23–27 survey of 323 hospitals. The hospitals reported "severe shortages of testing supplies", "frequently waiting seven days or longer for test results", which extended the length of patient stays, and as a result, "strained bed availability, personal protective equipment (PPE) supplies, and staffing". The hospitals also reported, "widespread shortages of PPE" and "changing and sometimes inconsistent guidance from federal, state and local authorities". At a press briefing following the release of the report President Trump called the report "wrong" and questioned the motives of the author. Later he called the report "another fake dossier".

In early April, there was a widespread shortage of PPE, including masks, gloves, gowns, and sanitizing products. The difficulties in acquiring PPE for local hospitals led to orders for gowns and other safety items being confiscated by FEMA and diverted to other locations, which meant that in some cases states had to compete for the same PPE. Prices skyrocketed across the board, with PPE costing up to 10x more than normally. The shortages led in one instance of a governor asking the New England Patriots of the NFL to use their private plane to fly approximately 1.2 million masks from China to Boston. At that time, Veterans Affairs (VA) employees said nurses were having to use surgical masks and face shields instead of more protective N95 masks. In May, Rick Bright, a federal immunologist and whistleblower, testified that the federal government had not taken proper action to acquire the needed supplies.

An unexpectedly high percentage of COVID-19 patients in the ICU required dialysis as a result of kidney failure, about twenty percent. In mid-April, employees at some hospitals in New York City reported not having enough dialysis machines, were running low on fluids to operate the machines, and reported a shortage of dialysis nurses as many were out sick with COVID-19 due to lack of sufficient PPE.

On May 14, a Trump administration official told reporters "we do anticipate having 300 million" N95 masks by autumn; however, at the end of September, there were only 87.6 million N95 masks in the government stockpile.

Supply problems persisted in August 2020, when a survey reported 42 percent of nurses were experiencing widespread or intermittent shortages of personal protective equipment, with 60 percent using single-use equipment for five or more days. A September report by National Public Radio found some items were in short supply but others widely available, depending on the difficulty of manufacturing. The DPA was effective in producing ventilators but less so in producing N95s. As of September, the DPA had stimulated N95 production mainly by existing major manufacturers and less so by smaller companies. Additionally, the DPA's provision that exempts manufacturers from antitrust laws had not yet been used to encourage collaboration in N95 production.

In response to demand, many domestic businesses retooled and due to lack of federal coordination ended up producing a glut of hand sanitizer and face shields, some losing money due to oversupply or lack of distribution. Retooling and individual emergency supply making accounted for the production of at least 34.2 million pieces of PPE in the U.S., 14.5 million of which were face shields. The federal government used the Defense Production Act to get a small number of large manufacturers such as 3M and Honeywell to increase production of the more difficult to manufacture N95 masks, but supply was still falling hundreds of millions of units short of demand. NPR found the shortage could be resolved by providing government guarantees to small and medium-sized manufacturers so they could increase production of N95 masks without the risk of losing money or going out of business due to oversupply or drop in demand when the pandemic ends. President Trump denied the PPE shortages exist, calling them "fake news" in April and in September saying "we've opened up factories, we've had tremendous success with face masks and with shields." Demand also increased as various industries reopened, including medical and dental offices, construction, and trucking. The 2020 California wildfires further increased demand for N95 masks for agricultural and other outdoor workers, due to state regulations requiring protection during poor air quality conditions.

Exceeded hospital capacity

Uncontrolled community spread led some medical facilities to refuse new patients or start transferring patients out. In March and April, this happened in the Detroit, Michigan, area and New York City area; Yakima, Washington, in June; and in July, it happened in Houston, the Boise, Idaho, area, Lake Charles and Lafayette, Louisiana, and at dozens of hospitals across Florida. By August, some hospitals in Mississippi were transferring patients out of state.

Arizona declared crisis standards of care in July 2020, allowing hospitals to legally provide treatment normally considered substandard to some patients in order to save others.

In January 2021, Southern California hospitals began to be overwhelmed with patients. Officials in Los Angeles County, where some ambulances had to wait up to eight hours to discharge patients at emergency rooms, ordered EMTs not to bring a patient to the hospital if that patient had little chance of survival. They also directed crews to take measures to conserve medical oxygen.