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What is the history of SARS-CoV-2 and COVID-19 in America and other countries?

Updated September 22, 2023

disease history

On January 8, 2020, the U.S. Centers for Disease and Prevention (CDC) issued a health advisory alert regarding a cluster of pneumonia cases with links to a wholesale animal and fish market in Wuhan City, in the Hubei province of China. The initial health alert reported illness in 59 individuals with symptoms that included shortness of breath and fever. No deaths were reported and according to Chinese health officials, there were no reports of human-to-human transmission. 

Initial reports out of China that the virus was unlikely to spread between humans turned out to be inaccurate as more and more cases were confirmed by Chinese and international health authorities. Early news reports, such as one where a patient was suspected of having infected as many as 14 medical staff in one hospital, showed that the infection was spread more easily than initially thought. 

When the virus was first identified, the CDC stated that little was known about how the novel coronavirus, SARS-CoV-2, spread. Initially, beliefs about virus infectiousness were primarily based on what was known about similar coronaviruses – that most transmission occurs from person-to-person between close contacts (about six feet). 

Chinese health officials identified the virus as a novel coronavirus on December 31, 2019, and by the end of January 2020, 217 deaths among 9,776 cases had been confirmed. On January 30, 2020, the World Health Organization (WHO) declared the outbreak a “Public Health Emergency of International Concern” with health officials reporting an unsanitary food market in Wuhan City, China as the likely source. WHO officials suggested that infected individuals were exposed through consumption of infected bats and snakes from the city’s market. 

One day later, the U.S. DHHS Secretary Alex M. Azar declared the novel coronavirus a U.S. public health emergency.  U.S. citizens who had been in China’s Hubei Province in the previous 14 days would be subject to a 14-day mandatory quarantine prior to entering the U.S. In addition, the U.S. suspended entry for most travelers who were not U.S. citizens and had recently been in China. 

The COVID-19 U.S. public health emergency remained in effect until May 11, 2023.  

On February 1, 2020, the Secretary of Defense (DOD) Mark Esper approved a request from the U.S. Department of Health and Human Services (DHHS) for housing support at military bases for 1,000 people, including American citizens who arrived from other countries and could be subject to mandatory quarantine. 

The cruise line industry was one of the first to be adversely affected by government quarantine measures. Thousands of passengers and crew members were not permitted to disembark if anyone on the boat tested positive for SARS-CoV-2.     

On February 6, 2020, the New York Times reported that Chinese government authorities responding to the country’s SARS-CoV-2 epidemic ordered round-the-clock house-to-house police searches to take the temperatures of all Wuhan residents and detain anyone who was sick, or suspected of being sick, using force, if necessary, and then “warehousing them in enormous quarantine centers.” A senior Chinese official announced that both the city where the epidemic began and the whole country faced “wartime conditions” and that “There must be no deserters, or they will be nailed to the pillar of historical shame forever.”  

Videos emerged showing people suspected of being infected forcefully being dragged from their homes by officials wearing masks and white protective suits, as the men and women shouted out in protest and unsuccessfully struggled to break free. Another video showed officials wearing masks, dressed in black and carrying large metal sticks chasing a man suspected of being infected through the largely deserted streets of the city as he ran trying to escape being confined in one of the mass quarantine camps. 

Officials from the Wuhan City Central Hospital also announced that Li Wenliang, the 34-year old ophthalmologist who had been silenced for warning people about the virus in late December 2019, had died from the infection. CNN reported that Dr. Wenliang had been questioned by local authorities in December 2019 after he alerted colleagues and was “later summoned by Wuhan police to sign a reprimand letter in which he was accused of ‘spreading rumors online’ and ‘severely disrupting social order.’”   Chinese officials eventually exonerated Dr. Wenliang and apologized to his family in mid-March 2020.  

On February 11, 2020, the Director-General of WHO, Dr. Tedros Adhanom Ghebreyesus, declared that China’s SARS-CoV-2 outbreak posed a “very grave threat for the rest of the world.” He called for creation of a roadmap to accelerate development of drugs and vaccines “around which research and donors will align.”  By February 11, 2020, there had been 44,138 confirmed cases globally. All but a few hundred cases had occurred in mainland China with a total of 1,107 reported deaths. 

By mid-February 2020, new questions surfaced about whether the novel coronavirus could be traced back to scientific research conducted in Wuhan labs, a subject that had been widely discussed since January after the outbreak in China emerged.  According to a February 16, 2020 report in the Daily Mail, South China University of Technology scientists wrote a paper questioning whether research on bats and respiratory diseases at the Wuhan Institute of Virology and the Wuhan Centers for Disease Control (WCDC) had created a new chimeric coronavirus capable of infecting humans. The WCDC is located just 300 yards from the fish and wildlife food market thought to be the origin of the coronavirus and is adjacent to the Union Hospital where the first group of doctors were infected. 

On February 15, 2020, a paper was published in The Lancet by Chinese scientists, “Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.” In this paper, the authors stated that “In December, 2019, a series of pneumonia cases of unknown cause emerged in Wuhan, Hubei, China, with clinical presentations greatly resembling viral pneumonia” and they described 41 cases hospitalized by January 2, 2020, of which 66 percent (27 people) had been exposed to the food market and 15 percent (6 people) died.  

As questions about the origin of the virus began circulating, WHO quickly endorsed the theory that it had spontaneously jumped from animals, most likely bats, to humans in the Wuhan market selling seafood and wildlife animals, additionally, the WHO stated that online speculation to the contrary was “misinformation.” In early February 2020, it was reported that WHO had teamed up with Google to battle online “misinformation” about the SARS-CoV-2 epidemic,  and additional meetings included many big tech companies. 

In January 2021, Dr. John Dye, Chief of Viral Immunology for the U.S. Army Medical Research Institute of Infectious Diseases, was interviewed and asked what was known about the origins of SARS-CoV-2 and if the Wuhan lab in China had been ruled out. His response was “No, at this point, nothing has been ruled out. We do not know. It is undetermined whether it was from a laboratory or from an environmental exposure, at this point in time, and we probably never will know.” 

By mid-February 2021, controversy was fueled as revelations by a lead infectious disease expert traveling to Wuhan as a member of an international delegation from the WHO stated that only summary data on early cases were provided to the delegation. Dr. Dwyer added that it was standard practice in an outbreak investigation for raw data to be shared and had yet to be provided by China. 

In an interview on CNN in late March 2021, former CDC Director Robert Redford, MD stated that it was his opinion that the SARS-CoV-2 virus originated in a laboratory in Wuhan China, and transmission had already begun by September or October of 2019. 

Additional investigative reports have provided evidence to support the lab origin theory and have suggested that the U.S. and China were involved in research involving genetic manipulation of bat coronavirus in an attempt to create vaccines and therapeutics. From information uncovered, evidence has found that these projects were funded by U.S. taxpayers and paid out by National Institutes of Health (NIH), including the National Institute of Allergy and Infectious Diseases (NIAID), and the U.S. Agency for International Development (USAID). Reports have also noted that those who have fought hard to debunk the COVID-19 lab origin theory have ties to the vaccine research and funding partnerships with the Wuhan Institute of Virology (WIV).   

In early May 2021, multiple federal legislators requested that the lab origin theory be fully investigated and have requested information on the U.S funding of research completed at the WIV. 

In September 2021, The Intercept announced that it had received over 900 pages of documents outlining the work of EcoHealth Alliance, an organization based in the U.S. that used money from federal agencies to fund bat coronavirus research at the Wuhan Institute of Virology. The documents were made available to the public for review as part of ongoing Freedom of Information Act (FOIA) legislation. 

The released data revealed that experiments on bat coronaviruses took place at the biosafety Level 3 lab at the Wuhan University Center for Animal Experiment and not the WIV. Grant funding, which totaled $3.1 million, also included nearly $600,000 that was used by the WIV to identify and alter bat coronaviruses that had the capability to infect humans. 

NIAID Director Dr. Anthony Fauci has continually denied that his agency funded bat coronavirus research at the WIV.  However, in mid-October 2021, the NIH changed their story and confirmed that they had funded studies in Wuhan that made bat coronavirus more virulent. 

In September 2022, the Lancet published a paper which suggested that SARS-CoV-2 may have originated in a laboratory from experiments on similar coronaviruses.  This paper contradicted their conclusions from 2020, which stated that individuals who did not believe that the virus evolved from a bat were conspiracy theorists and spreading misinformation. 

In February 2020, information coming out of China suggested that some people were at high risk of complications from COVID-19 infections, but most people had mild symptoms and recovered without treatment.  WHO stated that: 

“Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirusMost people infected with the COVID-19 virus will experience mild to moderate respiratory illness and recover without requiring special treatment. Older people, and those with underlying medical problems like cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more likely to develop serious illness.”

Evidence published in the medical literature by early March 2020 characterizing the type of COVID-19 disease symptoms and risk factors for severe disease among the population in China revealed that common major symptoms (22-88 percent) included fever, cough, myalgia or fatigue, expectoration and difficulty breathing. Minor symptoms (less than 12 percent) included headache or dizziness, diarrhea, nausea and vomiting, with those aged 60 years or older at higher risk.  Another study published by Chinese scientists found that underlying cardiovascular disease, secondary infections, older age and elevated inflammatory indicators in the blood suggested that COVID-19 mortality might be due to “virus-activated ‘cytokine storm syndrome’ or fulminant myocarditis.” 

By the end of February 2020, WHO had not yet declared COVID-19 to be a pandemic,  but there had been daily reports in the media warning that COVID-19 was taking a foothold in the U.S.  and many concerned Americans had begun to prepare to protect themselves by buying masks, hand sanitizer and stocking up on food and household supplies. On March 1, 2020, former U.S. Surgeon General Dr. Jerome Adams sent out a message on Twitter: 

“Seriously people – STOP BUYING MASKS. They are NOT effective in preventing general public from catching coronavirus but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk! The best way to protect yourself and your community is with everyday preventive actions, like staying home when you are sick and washing hands with soap and water, to help slow the spread of respiratory illness. Get your flu shot – fewer flu patients = more resources for COVID-19.”

Former CDC Director Dr. Robert Redfield reported to the House Foreign Affairs Committee that, There is no role for these masks in the community. These masks need to be prioritized for health care professionals that as part of their job are taking care of individuals. 

WHO declared COVID-19 a global pandemic on March 11, 2020, and urged countries to take strong action to stop its spread.    Globally, governments quickly closed borders, restricted or halted travel between and within countries and ordered healthy people to eliminate physical contact with each other by staying in their homes.  The halt to travel and closure of schools, businesses, stores and shopping centers, restaurants, theaters, sports arenas, gyms, beaches, parks and recreation areas, churches, and other places, where children are educated and people conduct business, shop and engage in recreation, sent stock markets into a sudden nosedive   and crippled the world’s economy. 

Two days after WHO declared a COVID-19 pandemic, the New York Times published a widely-quoted article on March 13, 2020, titled “The worst-case estimate for U.S. coronavirus deaths” that raised even more concern about the potential lethality of COVID-19.  The article stated that the CDC had been conferring with epidemiologists at universities around the world and were modeling pandemic COVID-19 scenarios based on what was known about the transmissibility and severity of the new mutated SARS-CoV-2 virus to come up with “worst case” estimates if no actions were taken to slow transmission.  

An epidemic modeler at Johns Hopkins, Lauren Gardner, was quoted as saying, There is a lot of room for improvement if we act appropriately,” and urged people to “change their behavior” to alter the course of the pandemic. University of Nebraska infectious disease specialist, Dr. James Lawler, was quoted as estimating there would be 96 million Americans infected and 450,000 deaths. 

Testing for the virus, however, was not widely available in many countries. In the U.S., the initial test developed by the CDC was faulty. In most cases, the results came back as inconclusive due to an incorrectly formulated test ingredient. The faulty tests caused significant testing delays. Facilities testing for the virus were forced to send samples directly to the CDC, which resulted in diagnosis delays. Additionally, the CDC severely restricted testing criteria so that few people qualified – including many who presented with COVID-19 symptoms.   

In late February 2020, Science Magazine reported the CDC had only performed 459 tests for the SARS-CoV-2 virus in patients suspected to be infected due to faulty COVID-19 tests.  Additionally, the CDC, which had declined to follow testing guidelines compiled by the World Health Organization, chose to create a more complicated test that could identify additional viruses. This test, however did not work as anticipated. 

At a congressional hearing on March 12, 2020, Director of the National Institute for Allergy and Infectious Diseases (NIAID) Dr. Anthony Fauci admitted that the U.S. was unable to meet the required capacity for SARS-CoV-2 testing of everyone in the U.S. who needed it. The system is not really geared to what we need right now, he  said. That is a failing. Let’s admit it. 

On March 22, 2020, the FDA approved a 45-minute lab test to confirm SARS-CoV-2 infections,  however, the testing delays had significantly impaired the U.S. response to the virus. 

Former President Donald Trump declared the novel coronavirus outbreak a national emergency on March 13, 2020. The declaration permitted the president to access up to $50 Billion dollars which would be directed to assist states, localities, and territories impacted by the virus.  On March 15, 2020, Dr. Fauci said on NBC’s Meet the Press:  

“I think Americans should be prepared that they are going to have to hunker down significantly more than we as a country are doing…I think we should really be overly aggressive and get criticized for overreacting.

Dr. Fauci also reported that he had not received any pushback from government officials to his suggestions and stated thatin fairness, they listen and they generally go with what we say.” 

Results from the reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) test are used to identify individuals infected with the SARS-CoV-2 virus and reported as a simple “yes” or “no” answer to the question of whether someone is infected. 

However, the validity of COVID-19 testing has continually been questioned by some health experts. There are reports that the PCR testing for SARS-CoV-2, the virus associated with COVID-19 illness, is too sensitive and adjustments are needed to distinguish people who have insignificant amounts of harmless viral material in their system versus people who are clinically infected with live virus. The most significant concern is that the number of detection cycles for the test is so high that it reports a positive result for people who have infectious live virus as well as a positive result for people who have only a few genetic fragments left over from a past infection and no longer pose a risk to others.   

A New York Times review published on August 29, 2020 reported on three sets of testing data that included cycle thresholds (CT) values compiled by officials in Massachusetts, New York, and Nevada. The review found that “up to 90 percent of people testing positive barely carried any virus” and experts stated that tests using high CT values may be detecting not only live virus, but also genetic fragments; “leftovers from an infection that pose no particular risk” for contagiousness. The review reported that most tests used a CT value of 40, and noted the CDC’s acknowledgment that samples with a CT value above 33 cycles were unlikely to detect live virus. 

According to the U.S. Food and Drug Administration (FDA), cycle threshold ranges used to determine who is positive are set by commercial manufacturers and laboratories. 

A positive RT-qPCR test does not confirm whether a person is currently ill or will become ill in the future, whether they are infectious or will become infectious, whether they are recovered or recovering from COVID-19, or whether the RT-qPCR test identified a viral fragment from another coronavirus infection in the past. The RT-qPCR test is only capable of reporting that a person has come into contact with coronavirus RNA. 

Carl Heneghan, the director of the Centre for Evidence Based Medicine at the University of Oxford and editor of BMJ Evidence-Based Medicine has expressed concerns regarding the use of PCR testing to confirm a case of COVID-19 and noted: 

“In any other disease we would have a clearly defined specification that would usually involve signs, symptoms, and a test result… We are moving into a biotech world where the norms of clinical reasoning are going out of the window. A PCR test does not equal COVID-19; it should not, but in some definitions it does.”

A systematic review published in September of 2020 in Infectious Diseases and Therapy stated that lower CT values may be associated with severe COVID-19 outcomes and help in predicting the course of the illness. 

Another review published in December 2020 in Clinical Infectious Diseases focused on COVID-19 viral cultures from PCR samples and assessed their infectious potential. A key finding from this review noted that the data suggests that complete live viruses are necessary for transmission of COVID-19, and not fragments that may be identified by PCR tests utilizing a high CT value. The review also estimated that the recovery of live virus from specimens with a CT value greater than 35 was only 8.3 percent, with five studies in the review reporting no growth in specimens with a CT value ranging from 24 to 35. The review also found that infectious potential declined after day 8, including cases with ongoing high viral loads. 

The CDC reports that a person who has recovered from COVID-19 may have low levels of virus in their bodies for up to three months after diagnosis and may test positive, even though they are not spreading COVID-19. 

Addressing the controversial CT value aspect of COVID-19 PCR tests, on January 13, 2021, WHO issued a medical product alert and stated that persons who interpret results for specimens tested using PCR methodology should be aware that "careful interpretation of weak positive results is needed." 

A specimen may be considered weak if a high number of cycles are performed prior to virus detection. This may also mean that the person who provided the specimen might not be infectious.    WHO is advising that a positive PCR test that is not consistent with the clinical presentation of COVID-19 should be confirmed through retesting of a new specimen. 

In May 2021, the CDC issued new guidance to laboratories and recommended reducing the RT-PCR CT value to 28 when testing persons previously vaccinated with the COVID-19 vaccine. This guidance was issued in response to reporting of breakthrough cases of COVID-19 in fully vaccinated individuals. 

On May 19, 2021, the FDA announced that the use of antibody testing to evaluate immunity to SARS-CoV-2 from past infection or vaccination was not recommended.  

According to the FDA, the available authorized SARS-CoV-2 antibody tests are not validated to evaluate protection or immunity to the virus.  

The reliability of COVID-19 testing has also been called into question. Throughout the pandemic, many COVID-19 tests have been recalled for being faulty.         

Quarantine measures varied by state; however, most states implemented lockdown measures that significantly restricted Americans. Businesses deemed non-essential were forced to close, causing financial hardships and skyrocketing unemployment claims.      By the end of March 2020, schools in all 50 states had shut down. 

End-of-life care policies for infected individuals became a topic of discussion as hospitals tried to weigh the ethics of resuscitating critically-ill patients against the risk of exposing health care staff to the SARS-CoV-2, especially since most hospitals were ill-equipped to provide their staff with adequate personal protective equipment (PPE).   

By April 10, 2020, there had been more than 18,000 COVID-19 related deaths reported in the U.S.  According to the CDC, most cases were mild or asymptomatic, including in children,  unless an individual had an underlying chronic health issue such as asthma, obesity, diabetes, autoimmunity, immune suppression, high blood pressure, chronic obstructive pulmonary disease (COPD) or heart disease. 

Large mortality variations among different countries and similar wide variations in mortality among populations living in different states in the U.S. were noted.  At least one study published in early April 2020 found that air pollution subjecting individuals to long-term exposure to fine matter particulates greatly increased the risk for death from COVID-19, and noted that,

“The majority of the pre-existing conditions that increase the risk of death for COVID-19 are the same diseases that are affected by long-term exposure to air pollution.” 

Published data from the CDC confirmed that mortality in the U.S. was much higher among senior citizens over age 65, rising to 10 to 27 percent for those over age 85.  The CDC also stated that the risk of hospitalization and death increased with age. Persons over the age of 85  and those with underlying health conditions were noted to be at highest risk of severe illness and death. 

It was also reported that federal health officials were counting all deaths of persons with SARS-CoV-2 as ‘COVID-19’ deaths, regardless of whether they had underlying health issues that may have contributed. 

In the U.S., the pandemic hit New York City hard. By April 1, 2020, there were 76,049 cases and 1,941 COVID-19-related deaths.  Temporary hospitals were constructed, and the 1,000 bed U.S. Navy Ship Comfort docked to assist in the pandemic’s response. 

COVID-19 deaths in New York City continued to surge. At the same time, questions about the accuracy of the statistics surfaced. In mid-April, New York City added nearly 3,800 deaths to their COVID-19 death statistics, though these deaths were not confirmed. Health officials justified the addition of these unverified deaths, reporting that over 3,000 excess deaths had occurred in the previous month than what would have been typically expected.   

To free up hospital beds, New York health officials ordered nursing homes to accept COVID-19 positive patients. This decision was criticized by many long-term care advocates who expressed concerns that this would place many frail residents at high-risk of illness. Federal health officials had previously banned nearly all nursing home visits, leaving many residents isolated from loved ones. 

By July 2020, reports indicated that more than 6,300 SARS-CoV-2 positive patients had been discharged into nursing homes to recover, resulting in New York nursing home deaths from COVID-19 being highest in the U.S. Former New York Governor Andrew Cuomo denied any link between his administration’s order to return infected patients to nursing homes and the elevated death rates, and instead placed blame on staff members who continued to work while infected. 

In late August 2020, the U.S. Department of Justice announced that it was reviewing nursing home death rates in New York as well as Pennsylvania, New Jersey, and Michigan, to determine whether laws were broken when these states governors used their emergency powers authority to order nursing homes to accept SARS-CoV-2 positive patients.    By mid-February 2021, the media reported on the initiation of an investigation by the FBI and federal prosecutors on Former Governor Cuomo’s nursing home admission policies of March 2020.   

In late July 2021, the U.S. Department of Justice announced that it would not be opening a Civil Rights investigation into COVID-19 nursing home deaths in New York, Michigan, New Jersey, and Pennsylvania. 

Most states that implemented lockdown orders in March began reopening by early May 2020. Reopening plans varied by state, but most continued to restrict crowd size and imposed additional restrictions  including face mask mandates.  A small number of states, however, chose not to issue lockdown orders. These included Nebraska, Iowa, Arkansas, North and South Dakota. In South Dakota, Governor Kristi Noem refused to implement restrictive measures and stated: 

“Ultimately it is the people themselves that are primarily responsible for their safety,” Noem said. “They are the ones who are entrusted expansive freedoms. They are free to exercise their rights to work, worship, and to play or to stay at home and to conduct social distancing.”

Noem was widely criticized, but stood by her decision, stating that it was her duty to uphold the Constitution. 

According to a report published by the American Legislative Exchange Council (ALEC) on October 20, 2020, South Dakota was ranked 40th in death rates, with 182.3 deaths per 1 million population. In contrast, New Jersey, which issued strict lockdown orders that included penalties, fines, and even jailtime for violations, was ranked first in death rates, at 1,791.6 per 1 million population. 

A working paper published in April 2022 by the National Bureau of Economic Research concluded that lockdowns had essentially no impact on decreasing COVID-19 deaths, but led to significant educational and economic damage. On a state by state basis, Utah, Nebraska, and Vermont were rated highest for their response to COVID-19, while the District of Columbia, New York, and New Jersey were given the lowest rating. 

In the summer of 2021, the state of Florida experienced a surge in COVID-19 cases, hospitalization, and deaths, and was among the most impacted states in the nation. Government officials, however, chose not to implement any restrictive policies such as mask mandates or business closures. Instead, the state focused on making vaccines accessible to individuals who wanted them, and opened monoclonal antibody treatment centers throughout the state. Florida governor Ron DeSantis reported that the spike was seasonal and would wane. Additionally, DeSantis stated that this strategy would work to defeat the pandemic. By the end of October 2021, Florida had one of the lowest rates of COVID-19 cases and deaths. 

In contrast, New York State recorded the highest one-day case count of COVID-19 in mid-December 2021,  despite having one of the highest vaccination rates in the country. 

Globally, evidence suggests that lockdowns have not been as effective as hoped and countries that implemented strict restrictions did not fare any better than those who did not. Sweden, a country with a population of 10 million people chose not to lockdown its country because of COVID-19 despite heavy criticism. Although Sweden requested its citizens to stay home if sick and practice social distancing when possible, the government did not close businesses, primary schools, restaurants, shops, gyms and recreational facilities, which prevented the country from suffering the kind of economic meltdown being experienced by most other countries.  

Without lockdowns, Sweden still reported better mortality rate outcomes than Italy, the U.S and the U.K. and its rank in global COVID-19 death rates continues to decline. As of September 22, 2023, Sweden was ranked 44th among nations in population-adjusted deaths from COVID-19. 

In late March 2021, Reuters reported that infectious disease experts stated Sweden’s overall stance on fighting the pandemic had merits worth studying.  The article noted that the more moderate pandemic measures in use by Sweden had spared the country severe economic impacts in comparison to many European countries, and placed its overall excess mortality at 18 out of 26 countries, with Poland, Spain and Belgium ranking at the top. However, excess death rates should be used with caution and are impacted by overall health of the population, as Sweden’s population is healthier than the EU’s average. 

COVID-19 Travel Restrictions

Throughout the pandemic, the CDC issued travel advisories to many countries based on SARS-CoV-2 transmission rates and many foreign nationals were denied entry into the U.S. 

In December 2021, new travel policies went into effect requiring that all persons over the age of two entering the U.S. by air show proof of a negative COVID-19 test completed within one day of travel, regardless of vaccination status.  Testing requirements were lifted in June 2022.  Non-U.S. citizens and non-U.S. immigrants 18 years and older traveling to the U.S. by air were required to show proof of being fully vaccinated before boarding the airplane, with only limited exceptions.  Proof of vaccination for COVID-19 was also required for all non-U.S. citizens and non-U.S. immigrants 18 years and older for entry into the U.S. by land or ferry crossings, however, testing was not required.  On May 12, 2023, the CDC discontinued the proof of vaccination requirement for non-U.S. citizens and non-U.S. immigrants entering the U.S. by air. 

As of September 22, 2023, the CDC continues to recommends COVID-19 vaccination for all travelers. COVID-19 testing is also suggested for persons who develop symptoms of COVID-19 before, during, or after travel, if at a higher risk of exposure during travel, or if traveling to visit anyone considered to be at high risk for serious COVID-19 illness. 

While older adults and those with pre-existing medical conditions continue to be at a higher risk for severe disease, children remain at minimal risk of developing serious infection. Data has indicated that transmission of SARS-CoV-2 between children and from children to adults occurs infrequently  and in the U.S., children under the age of 14 have accounted for only 0.00035 of one percent of COVID-19 deaths.  Nationwide through September 20, 2023, the CDC reports that there have been 2,320 deaths attributed to COVID-19 in children ages 0-17. 

Schools, which closed in response to the pandemic, have reopened. Reopening, however, varied by state and school districts, with some school districts opting to provide only virtual schooling options for the 2021/2022 school year.  Many schools that were open during the pandemic imposed social distancing guidelines, facemask requirements, and additional cleaning protocols.  

In February 2021, CDC Director Dr. Rochelle Walensky publicly stated that schools could re-open safely for in-person learning by following guidelines that include social distancing, mask wearing, hand-washing, and contact tracing. Health officials reported that in-person learning did not increase community infection rates, and transmission of the virus between students rarely occurs.  The need to keep schools open during the increase in COVID-19 cases related to the Omicron variant was also emphasized by the White House in January 2022. 

In August 2022, the CDC revised their school recommendations and stated that school children exposed to COVID-19 would no longer need to quarantine or test to remain in school. 

A meta-analysis conducted in 2021 reported that children who developed COVID-19 had a 99.9973 percent chance of survival.  Additional studies have also concluded that children, especially those without co-morbidities, rarely suffer serious COVID-19 illness.   

In late December 2021, Dr. Anthony Fauci admitted that most COVID-19 positive hospitalization in children involved cases where the admissions were related to other causes.  The CDC also acknowledged in early January 2022 that they had not seen an increase in severe COVID-19 cases in children related to the Omicron variant. They also reported that most children were hospitalized with COVID-19 and not because of COVID-19. 

In April 2022, the CDC reported that by February 2022, 75 percent of children had COVID-19 antibodies. 

As of September 22, 2023, there have been over one hundred million cases and over 1.1 million COVID-19 related deaths reported in the US.  This data, however, includes both confirmed and probable cases. 

According to the CDC’s August 5, 2020 interim case definition for Coronavirus Disease 2019 (COVID-19), a confirmed COVID-19 case is one where laboratory evidence indicates the presence of the SARS-CoV-2 virus by a molecular amplification test  such as reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) or nucleic acid amplification test (NAAT). 

A probable COVID-19 case is a case where a person meets the clinical criteria for COVID-19 illness based on at least one symptom and the individual is also epidemiologically linked to another confirmed or probable case. The criteria for epidemiological linkage include close contact with a confirmed or probable case of COVID-19 disease or else being considered at risk based on criteria defined by public health officials during an outbreak. Probable cases are also cases confirmed by antigen testing, a rapid test considered less sensitive and not as reliable as molecular amplification tests.   

COVID-19 death counts also include both confirmed and probable cases. The CDC’s August 5, 2020 interim case definition for Coronavirus Disease 2019 (COVID-19) counts all deaths as a COVID-19 when the death certificate lists COVID-19 disease or SARS-CoV-2 as an underlying cause of death. Probable deaths are those where the death certificate list COVID-19 even without laboratory evidence to confirm the presence of the SARS-CoV-2 virus. 

In early April 2020, Dr. Deborah Birx, the former response coordinator for the White House coronavirus task force, reported that all deaths that occurred in SARS-CoV-2-positive individuals would be counted as a COVID-19 death regardless of whether the virus was responsible. As a result, the CDC’s data does not differentiate between persons who died as a direct result of COVID-19 illness and those who died from other causes but who tested positive for SARS-CoV-2. 

According to data released by the CDC in early September 2020, 94 percent of COVID-19 deaths occurred in persons with significant underlying health conditions. On average, there were 2.6 additional conditions or causes per COVID-related death. The most common respiratory conditions listed included influenza, pneumonia, respiratory failure, and adult respiratory distress syndrome. Comorbid circulatory diseases included hypertension, cardiac arrest, ischemic heart disease, heart failure, and cardiac arrhythmia. Approximately 16 percent of the death certificates listed diabetes, and 11 percent stated that vascular and unspecified dementia contributed or was the cause of death. Three percent had intentional or unintentional injury, poisoning or other type of adverse event listed. 

COVID-19 mortality rates have decreased since the beginning of the pandemic. One study published in October 2020 in the Journal of Hospital Medicine that involved 5,000 patients within New York’s Langone Health System reported an 18 percent mortality rate decrease between March and August 2020. Persons over the age of 75 years had the largest decrease in death rates, from nearly 45 percent in March to just under 10 percent in August. 

A study conducted by the Alan Turing Institute in the United Kingdom reported similar findings over the course of their research period, between March 1 and May 30, 2020. Researchers attribute the decrease in mortality rates to the introduction of effective treatment options and the decline in cases that require critical care interventions. 

On October 6, 2020, an international coalition of scientists, doctors and medical professionals created and signed a document expressing grave concern regarding the potential negative repercussions of lockdown measures imposed by governments in the wake of COVID-19 and called for a global policy change to what they call focused protection.152 The document, entitled The Great Barrington Declaration (GBD), was named for the Massachusetts town where organizers gathered and in which the petition was signed.153

The creators of the GBD expressed concerns that “current lockdown policies are producing devastating effects on short and long-term public health,” including fewer healthcare screening visits, worse outcomes for cardiovascular disease and other pre-existing conditions, and serious effects on mental health. Stating that vulnerability to death from COVID-19 is more than a thousand-fold higher in the old and infirm than the young and further, that for children, COVID-19 is less dangerous than many other harms, including influenza, the authors recommended that measures be put in place to protect vulnerable segments of society, while allowing all others to immediately return to normal life.154

Specifically, they suggested that nursing home staff be limited to those with acquired immunity, staff rotations minimized and staff and visitors frequently tested. Groceries and other essentials should be delivered to elderly who live in the community and the vulnerable should interact with people outside whenever possible. For everyone else, the authors recommended that:155

  • businesses and restaurants should open fully;
  • schools and universities should immediately reopen for in-person attendance, and offer all extracurricular activities;
  • sports, art, music, and other group events should resume; and
  • young low-risk adults should return to work instead of working from home.

Dr. Fauci and former NIH Director Dr. Francis Collins, however, called the authors fringe scientists and reported that if public health officials had followed the recommendations made in the GBD, more infections, hospitalizations, and deaths would have occurred.156

Rationale for Lockdowns Questioned

In mid-October 2020, the WHO’s Special Envoy, Dr. David Nabarro, stated that lockdowns should not be used as the primary method to control COVID-19 outbreaks. Dr. Nabarro noted that lockdowns will increase poverty and hunger globally and that it is likely that within a year, child malnutrition and poverty will double. Additionally, a study conducted in May 2020 reported that the anxiety and stress of lockdowns will likely “destroy seven times the years of life that lockdowns potentially save.” 

In January 2021, the European Journal of Clinical Investigation published a peer-reviewed paper conducted by Stanford University researchers that reported that their study failed “to find an additional benefit of stay-at-home orders and business closures." 

In an interview aired on May 20, 2021, former White House COVID-19 advisor, Dr. Scott Atlas, called the COVID-19 associated lockdowns a “heinous abuse of power” and did nothing to protect the most vulnerable populations at risk for the illness. Atlas criticized the response of public health officials, and stated that:

“the lockdowns failed, they still failed to protect the people who are high risk, and the lockdowns destroyed and killed. Many other people destroyed families, sacrificed our children out of fear for adults—even though the children do not have significant risk. And we didn’t care as a country. We kept them out of school.” 

The CDC reported that from March 2020 to March 2021, 96,779 drug overdoses occurred in the United States, an increase of nearly 30 percent from one year prior and was noted to be the largest single year increase ever in the U.S. National Institute on Drug Abuse Director Dr. Nora Volkow noted that the COVID-19 pandemic had "created a devastating collision of health crises in America."  The US reported a record number of drug overdoses in 2022, with 109,680 drug related deaths reported. 

More than 400 published studies have reported on the failure of COVID-19 lockdown and masking policies to slow transmission or reduce deaths.  A review of the available literature and a meta-analysis on the effects of lockdowns on COVID-19 mortality conducted by the Johns Hopkins Institute for Applied Economics, Global Health, and the Study of Business Enterprise published in January 2022 reported that the lockdowns in the U.S. and Europe reduced mortality rates by only 0.2 percent on average. Shelter in place orders were reported to have only reduced mortality rates by 2.9 percent. Non-pharmaceutical interventions were reported to have no noticeable effects on reducing COVID-19 mortality. 

In the fall of 2020, public health officials reported that multiple variants of the SARS-CoV-2 virus had emerged and were circulating worldwide. Like all viruses, SARS-CoV-2 continually evolve because genetic mutations happen during the genome’s replication. A variant is the result of one or more genetic mutations. 

In the United Kingdom, the B.1.1.7 variant (Alpha) emerged in September 2020, and by January 22, 2021 it was confirmed as the dominant circulating strain in England. The transmissibility of this variant was reportedly greater than other circulating SARS-CoV-2 virus variants.  Health officials reported that this variant appeared to be 30 to 80 percent more transmissible and increased a person’s risk of death by 30 percent.   

The B.1.351 variant (Beta) was initially detected in Nelson Mandela Bay in South Africa in early October 2020. By December 2020, this variant was found to be the predominant variant circulating in Zambia. 

The P.1.(Gamma) variant was first detected in Japan in four travelers from Brazil. In late December, 42 percent of positive samples collected in Manaus, the largest city in the Amazon region of Brazil, were the P.1. variant. Public health officials expressed concerns that this variant could be transmitted more effectively or be responsible for re-infection. 

On February 11, 2021, the Journal of the American Medical Association (JAMA) published a letter from researchers reporting on a novel SARS-CoV-2 variant, the CAL.20C variant (now B.1.427/B.1.429 or Epsilon), that had emerged in late 2020 in Southern California. By mid-January 2021, this variant was found to account for 35 percent of SARS-CoV-2 specimens from California, and 44 percent of specimens from Southern California.   

Another variant, the B.1.526 (Iota) variant, was identified by research teams from Columbia University and the California Institute of Technology (CalTech). Both teams of researchers found that the strain was detected in New York in November 2020 and that the variant may represent an antigenic drift in the virus with possible blunting of current vaccine effectiveness.   

On May 4, 2021, the CDC classified the SARS-CoV-2 variant B.1.617 (Delta) as a variant of interest.  This variant, which originated in India, was declared a variant of concern by the World Health Organization (WHO) on May 10, 2021. According to the WHO, the Delta variant was associated with increased transmissibility and decreased neutralization. As a result, vaccinated individuals and persons who have previously recovered from a COVID-19 infection could be at risk for infection from this variant. 

By the end of June 2021, almost 90 percent of COVID-19 cases in Israel were reported as being from the Delta variant, with 50 percent occurring in fully vaccinated adults.  Health experts reported the Delta variant to be more easily transmissible and that vaccinated individuals were capable of spreading the virus on to others, as COVID-19 vaccines were unable to stop viral transmission. 

The C.37 variant (Lambda), first identified in Peru in August 2020, was classified by WHO as a Variant of Interest on June 14, 2021.  The Lambda variant was reported to be highly contagious and more resistant to vaccines. 

On August 30, 2021, WHO designated the Mu variant a Variant of Interest.  Initially identified in Columbia in January 2021, this variant, also known as B.1.621, became increasingly prevalent in South America. WHO reported that "the Mu variant has a constellation of mutations that indicate potential properties of immune escape," but stated that further studies were needed on the variant. 

Resurgence of Cases related to the Omicron Variant

The B.1.1.529 variant (Omicron), which was initially identified in early November 2021 in South Africa, was labeled a Variant of Concern by WHO on November 26, 2021. According to WHO, the variant was concerning because it contained a significant number of mutations.  Many countries, including the U.S., announced that travel restrictions from eight African countries would be implemented by the end of November 2021 in an attempt to curb spread of the new variant.  Top South African health officials reported that while the variant appeared to be highly transmissible, symptoms were “extremely mild”. 

In late November 2021, health officials declared the Omicron variant a Variant of Concern. By December of 2021, health officials reported that cases associated with the variant would surge to record numbers and likely peak in mid-January 2022.  The variant, however, has been associated with lower rates of hospitalization, shorter in-patient stays, and lower fatality rates. 

As of August 27, 2023, the Omicron variant continues to be labeled a Variant of Concern by the CDC. 

IMPORTANT NOTE: NVIC encourages you to become fully informed about COVID-19 and the COVID-19 vaccine by reading all sections in the table of contents, which contains many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.


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