A year after a new coronavirus was identified as the cause of a mysterious pneumonia outbreak in China, SARS-CoV-2 has redefined life around the world, but nowhere has it been more keenly felt than in the United States.
The United States was home to about one in four of the 97 million infected globally — more than 24 million. And it accounted for one in five of the world’s 2 million dead from COVID-19, startlingly more than 400,000 deaths.
The country has seen more than twice as many coronavirus infections as India, whose 10.6 million cases are the world’s second-most in a country with four times as many people. And U.S. deaths are almost twice the 212,000 in Brazil, with the world’s second-highest toll and about two-thirds of the U.S. population.
How in the world did it happen here?
“Something went desperately wrong here in the United States,” said Dr. John Swartzberg, clinical professor emeritus of infectious diseases and vaccinology at The UC Berkeley-UCSF Joint Medical Program.
Public health agencies have been underfunded here for decades. The U.S. federal government has a less direct role in public health than in many other countries, requiring significant leadership at the federal level to step up and coordinate a response. And that didn’t come from the Trump White House, Swartzberg said, with the president often bolstering skepticism toward science.
The U.S. experience with SARS and MERS, the new virus’s nearest cousins, also may have lulled officials into thinking it wouldn’t erupt into a global health crisis. Though deadlier than the new virus, the Severe Acute Respiratory Syndrome virus that first emerged in Asia in 2003 infected just 8,098 people worldwide, of whom 774 died, according to the U.S. Centers for Disease Control and Prevention. Most cases were in Asia, with only eight U.S. residents infected, none of whom died. Since 2004, there have not been any known SARS cases reported anywhere in the world, the CDC said.
The deadlier Middle East Respiratory Syndrome, first reported in Saudi Arabia in 2012, has infected a little over 2,200 people since and killed 791, according to the World Health Organization. It spread chiefly through infected camels, and the CDC reported only two U.S. cases, both people who survived.
So after the new coronavirus was identified with outbreaks in China a year ago, there was resistance in the United States to treating it as a significant threat. Even after the first Bay Area cases, events like San Francisco’s Chinese New Year celebration and professional hockey and basketball games continued.
“No one wanted this pandemic to interfere with their lives,” Swartzberg said. “That’s a great lesson for all of us — we need to respond with greater alacrity.”
By mid-March last year, the Bay Area and California would emerge as national leaders in the fight against the virus, implementing the first coordinated regional and then statewide stay-home orders. Those actions came just weeks after the first documented case of community transmission of the virus.
But things already were worse than health officials had feared. A 57-year-old San Jose woman who died at her home Feb. 6 after a short illness was determined two and a half months later to have been the virus’s first U.S. victim.
California’s early action earned praise after the state avoided massive deadly spring outbreaks like those in New York, where hospitals were overwhelmed. But the Golden State was criticized for easing restrictions on business and activities too soon last spring, leading to a summer case surge. And like most of the country, it has been hit hard by a wave of cases this winter.
Santa Clara County Health Officer Dr. Sara Cody, who led the Bay Area in enacting the original stay-home order, said the region’s and state’s quick action avoided a crush of infections early on when little was known about treating COVID-19. Though California has some of the country’s worst outbreaks now, improvements in treatment have helped more of the infected survive.
“Having a huge surge in the fall as compared to the spring when it was really new, we have experience taking care of COVID patients now, and in general, better outcomes,” Cody said.
A year after California reported some of the first U.S. infections, the state’s more than 3 million cases amount to one in eight in the country. But even after some of the nation’s worst outbreaks in recent months — nearly two-thirds of all of California’s COVID-19 cases and nearly half of the state’s deaths have been reported since Dec 1 — the Golden State has fared better than some others.
The per-capita infection rate in the nation’s most populous state is average, behind 23 other states, according to data compiled by the New York Times. The highest rates are in sparsely populated North and South Dakota.
And California’s 35,000 COVID-19 deaths, about one out of every 12 deaths in the U.S., are fewer than the more than 41,000 who have died in New York, the most of any U.S. state. New York, with half as many people as California, ranked second in deaths by population among the states, behind neighboring New Jersey, while California was 39th, according to New York Times data.
The virus has been as much an economic as a health disaster, and experts say California has paid a price in lost jobs for its aggressive efforts to control virus outbreaks by restricting business activity.
Nationally, even after a record $2.2 trillion economic stimulus bill last March and an additional $900 billion in relief last month, the U.S. shed nearly 10 million jobs since the pandemic hit, having recovered only 56% of those lost to lockdowns last spring.
The national unemployment rate, which was at a 50-year low of just 3.5% before the pandemic, was nearly twice that at 6.7% in December after spiking to 15% last spring. By comparison, the Euro area was at 8.3% in November, the most recent figure available.
But California’s 9% December unemployment rate is higher than the national average and that in other large states, including 8.2% in New York, 7.2% in Texas, and 6.1% in Florida. Michael Bernick, an employment attorney with law firm Duane Morris and a former director of the state Employment Development Department, said that’s due to the Golden State locking down business activity more than others.
“California’s economic lockdowns have been more severe than those imposed by other states,” Bernick said. “States like Texas and Florida that haven’t had such severe lockdowns have done better.”
Southern California’s virus outbreaks have been far worse than Northern California’s. Major Southern California counties including Los Angeles, San Bernardino, Imperial and Riverside have more than 10,000 cases per 100,000 residents. The case rate is less than half that in large Bay Area counties like Santa Clara, Alameda, Contra Costa, San Francisco and San Mateo, according to data compiled by this news organization. The pattern is similar for COVID-19 deaths.
Infectious disease experts have offered a variety of explanations — more poverty and population density and more lax observance of health orders in Southern California. Santa Clara County Health Officer Cody is at a loss to explain what’s behind the winter infection wave and why it’s been worse in Southern California.
Swartzberg, however, said that the Bay Area’s experience with HIV in the 1980s both tested and improved its public health systems.
“The Bay Area’s management of the HIV infection was a model for the rest of the world,” Swartzberg said. “That left us with a culture that is still with us.”
