| Daily Briefing

What's gone wrong with America's coronavirus response?

New cases of the coronavirus are surging throughout America, with many states in recent weeks reporting record single-day increases in their numbers of new cases—and the United States' response to the epidemic continues to be marred by testing shortages, a lack of federal leadership, and states reopening too soon.

10 takeaways: What America can learn from the world's coronavirus response

America's coronavirus epidemic resurges to a new peak

The United States had seen a downward trend in newly reported coronavirus cases for six consecutive weeks throughout May and June, as states had closed nonessential businesses, implemented stay-at-home orders, and imposed social distancing and other protocols to curb the virus' spread. However, the country's daily numbers of new coronavirus began to tick up again in mid-June, and those numbers have surged to a new peak in recent weeks.

During the first peak of America's coronavirus epidemic in April, officials had reported a high of 36,400 new coronavirus cases in a 24-hour period, both on April 9 and on April 24. In comparison, the United States on Thursday reported a new record high of more than 75,600 new coronavirus cases in a single day. Thursday marked the 11th time in a month that the country had reported a record-high number of new coronavirus cases in a single day.

Growth in America's national coronavirus-related death rate also had declined in June, but data has shown that rate's been rising in recent weeks, as well. As of Monday morning, U.S. officials had reported a total of 140,373 deaths linked to the coronavirus, which accounted for nearly 25% of the more than 602,000 reported deaths linked to the virus worldwide. According to data from Johns Hopkins University, the United States has the 10th-highest coronavirus fatality rate in the world.

What led to the resurgence?

Largely, public health experts and officials say there are three main factors that led to the resurgence of America's coronavirus epidemic and that continue to hinder the country's response:

1. States reopening too soon—and without stringent mask-wearing policies

In March and April, public health experts and the Trump administration called for Americans to help "crush the curve" of the country's coronavirus epidemic by adhering to social distancing policies, wearing face masks, and taking other precautions. Many states issued stay-at-home orders and closed nonessential businesses, though some states were quicker than others to implement those measures.

However, President Trump in mid-April began indicating that he was looking for states to loosen those restrictions relatively quickly, and his administration released guidelines laying out certain metrics that states should meet before reopening businesses and easing stay-at-home orders. Meanwhile, public health officials urged states not to reopen too quickly, saying doing so could lead to a resurgence in the country's coronavirus epidemic.

However, by the beginning of May, more than half of states had begun or were preparing to begin reopening nonessential businesses and relaxing social distancing measures, even though many hadn't met the metrics laid out in the White House's reopening guidelines. Within a few weeks, some states began to see their rates of newly reported coronavirus cases accelerate, and the country's coronavirus epidemic began reaching new peaks by the end of June.

NIH Director Francis Collins recently told the Washington Post that he believes part of the reason America's coronavirus epidemic has resurged is that many states started reopening and scaling back coronavirus-prevention measures too soon.

"We didn't have the stick-to-itiveness, the determination, to carry through what we started in March, April, and May, and now the virus is taking advantage of that," Collins told the Post—and that's partially due to a lack of stringent guidance from officials, he said. "If we'd had really strong guidance from local, state, and national leaders, maybe we could have sustained the determination to get the curve all the way down to zero. Now, we're on the upswing, and I don't quite see the top of the upswing yet."

Miami Mayor Francis Suarez (R) recently told the New York Times that the White House's main focus was reopening businesses, without providing guidance on how states and localities should respond if they saw new cases of the coronavirus start to resurge. "It was all predicated on reduction, open, reduction, open more, reduction, open," Suarez said. "There was never what happens if there is an increase after you reopen?"

Further, once states began reopening, many Americans were too quick to return to their pre-coronavirus behaviors, some officials and public health experts said.

"We just let our guard down," Ohio Gov. Mike DeWine (R) told the Post. "Some people when they heard, 'Hey, Ohio's open,' what they mentally processed is, 'It's safe. We can go out and do whatever we want to. It's back to normal,'" he said, adding, "[N]ow we start to see some flames."

DeWine said one practice that was especially important, but lacking, was widespread mask wearing, which public health experts say is critical to America gaining control of its worsening coronavirus epidemic.

DeWine said he's tried to emphasize to Americans that wearing masks is important for protecting everybody against the coronavirus. "[G]etting people to buy in and to understand—getting a 20-year-old to understand that he or she may feel invulnerable, nothing is going to happen to them, but they may get it. They may not know they have it. They may go home and see their grandmother. She may get it, and she may end up dying" is important, he said. "You wear the mask to protect your grandmother."

In recent weeks, some states have implemented mandatory mask-wearing policies and taken steps to pause or roll back their reopenings, which public health officials hope will help to reverse course on the country's coronavirus epidemic, though some say more stringent measures may be needed.

2. Testing delays and a lack of funding

Another factor that's derailed the United States' ability to control its coronavirus epidemic has been a lack of funding for efforts to curb the epidemic at the local, state, and federal levels.

Experts say public health agencies for years have faced dwindling funding and workforces, leaving them without the resources needed to adequately respond to the epidemic. For instance, agencies at every level have been struggling to keep up with growing demand for coronavirus testing and contact tracing.

The recent surges in America's number of new coronavirus cases has caused demand for coronavirus testing to outpace the country's capacity to both provide and process the tests. Throughout the country, state and local officials are reporting testing backlogs and limited testing supplies, with some Americans having to wait more than a week to receive their coronavirus test results if they're able to access a test at all.

Public health experts have raised concerns that the longer a person must wait to receive their test result, the less likely that someone who isn't experiencing severe symptoms of Covid-19, the disease caused by the novel coronavirus, will self-isolate.

Saskia Popescu, an epidemiologist at the University of Arizona, recently told the Post, "If you're waiting to go back to work and test results are taking seven to eight days, getting people to stay home is really hard. You worry about people saying what's the point of even getting tested. That would be disastrous."

The delays also make it difficult for public health officials to fully grasp the status of coronavirus outbreaks in their areas or to conduct adequate contract tracing.

Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Center for Health Security who leads the university's Covid-19 Testing Insights Initiative, told the Wall Street Journal, "You have no idea how many infections you have today. But it also just puts you behind the eight ball. It delays your ability to intervene, and that's the whole point. What's the point of doing a test if someone doesn't get a test result for two weeks?"

Crystal Watson, a public health expert at Johns Hopkins University, explained to the Post that, without adequate and quick coronavirus testing, contact tracing is "almost useless," because "[b]y the time a person is getting results, they already have symptoms, their contacts may already have symptoms and have gone on to infect others."

3. A lack of federal leadership

A lack of strong, clear leadership on how Americans, businesses, and localities should respond the epidemic also has obstructed the country's ability to keep and regain control of the coronavirus' spread, experts and officials have said.

Beth Cameron, who served as senior director for global health security and biodefense on the White House's National Security Council under former President Barack Obama, told the Post that the Trump administration for the most part has placed the responsibility of responding to the coronavirus epidemic on states, counties, and cities.

For instance, the Trump administration didn't implement country-wide stay-at-home orders or businesses closures, as several other high-income countries that have controlled their coronavirus outbreaks did. The administration also did not implement a federal coronavirus testing strategy.

Francis Phillips, Maryland's deputy health secretary, recently told the Times that she had contacted an NIH facility in the state to get more coronavirus tests but was told that the facility was experiencing a testing shortage and was unable to help. "It was clear that we were on our own and we need to develop our own strategy, which is very unlike the kind of federal response in the past public health emergencies," Phillips said.

Cameron told the Post, "I just never expected that we would have such a lack of federal leadership, and it's been deliberate." She added, "In a national emergency that is a pandemic, spreading between states, federal leadership is essential. And if there was any doubt about that, we ran that experiment from March and April until now. It failed. So we have to run a different experiment."

President Trump also has frequently downplayed the novel coronavirus' health risks, which has caused many Americans to not take precautions to protect themselves and others against the virus, public health experts have said.

Los Angeles Mayor Eric Garcetti (D) recently told CNN that the "lack of national leadership" in responding to the country's coronavirus epidemic has led some Americans to become complacent when it comes to combating the virus. "I think that there are people who are just … exhausted. They were sold a bill of goods" and told "this was under control. [Officials] said this would be over soon, and I think when leaders say that, people react and they do the wrong things. They stop distancing themselves. They stop washing their hands. They stop wearing masks."

James Grossman, executive director of the American Historical Association, said the Trump administration's response to the crisis has been an outlier when compared with how previous administrations responded to national emergencies.

"You look at the Great Depression and how Roosevelt made a concerted effort to unite the country—the fireside chats, the New Deal. That is the instinctive reaction of almost every president in crisis. Even if you don't succeed, you try to convince people that they're all in this together," Grossman said. "This presidency is the exception and anomaly."

But Sarah Matthews, a spokesperson for the White House, recently defended the administration's response to the coronavirus epidemic to the Post, saying Trump "has led an historic, whole-of-America coronavirus response—resulting in 100,000 ventilators procured, sourcing critical [personal protective equipment] for our frontline heroes, and a robust testing regime resulting in more than double the number of tests than any other country in the world."

According to the Post, Matthews added, "This strong leadership will continue as we safely reopen the economy, expedite vaccine and therapeutics developments, and continue to see an encouraging decline in the U.S. mortality rate" (Achenbach et. al., Washington Post, 7/19; McLaughlin/Maxouris, CNN, 7/19; Shear et. al., New York Times, 7/18; Primack/Johnston, Axios, 7/20; Weiner et al., Washington Post, 7/12; Abbott/Krouse, Wall Street Journal, 7/16).






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