What is the history of SARS-CoV-2 and COVID-19 in America and other countries?
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.1
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.2
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).3
Public Health Emergency Declared
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.4 x
One day later, the U.S. HHS Secretary Alex M. Azar declared the novel coronavirus a U.S. public health emergency.5 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.6
Quarantine and Isolation Approved
On February 1, 2020, the Secretary of Defense (DOD) Mark Esper approved a request from the U.S. Department of Health and Human Services (HHS) 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.7 U.S. quarantine stations are located in Washington, D.C, Seattle, San Francisco, San Diego, Philadelphia, Newark, New York, Minneapolis, Miami, Los Angeles, Houston, Honolulu, El Paso, Detroit, Dallas, Chicago, Boston, Atlanta, Anchorage, and San Juan, Puerto Rico.8
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. In Italy, 6,000 cruise ship passengers were quarantined at the end of January after two guests were suspected of being infected but then tested negative for SARS-CoV-2. Japan ordered a lockdown and quarantine of more than 3,500 passengers and crew on the Diamond Princess cruise ship docked in Yokohama harbor after an 80-year old man from Hong Kong flew to Tokyo and spent a few days on the ship and later tested positive for SARS-CoV-2.9 Five days later, 70 passengers on ship had tested positive for SARS-CoV-2, including 14 Americans. Medication was distributed on board to those who needed it and some of the sick passengers were taken to hospitals.10
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.” 11
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. 12
New hospitals and makeshift medical treatment centers were erected within weeks. However, officials outside of China questioned whether the shelters were equipped with enough medical supplies and food or adequately staffed to provide basic care to patients. Concerns also included the potential that these crowded facilities could accelerate the spread of not only coronavirus, but also other bacterial and viral diseases.13 From the onset of the outbreak, Chinese officials censored all criticism of government officials and Chinese citizen journalists who had broadcasted real-time scenes from the epicenter of the outbreak via their cell phones were detained and arrested by authorities.14
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.’” 15 Chinese officials eventually exonerated Dr. Wenliang and apologized to his family in mid-March 2020.16
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.”17 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.18
Origin of SARS-CoV-2 Questioned
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.19 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.20
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:
“Most of the infected patients were men (30 [73% of 41); less than half had underlying diseases (13 [32%), including diabetes (eight [20%), hypertension (six [15%), and cardiovascular disease (six [15%). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98% of 41 patients), cough (31 [76%), and myalgia or fatigue (18 [44%); less common symptoms were sputum production (11 [28% of 39), headache (three [8% of 38), haemoptysis (two [5% of 39), and diarrhoea (one [3% of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%), RNAaemia (six [15%), acute cardiac injury (five [12%) and secondary infection (four [10%). 13 (32%) patients were admitted to an ICU and six (15%) died.”21
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, International Business Times reported that WHO had teamed up with Google to battle online “misinformation” about the SARS-CoV-2 epidemic.22 To that end, CNBC reported that the WHO hosted a meeting on February 14, 2020, at Facebook’s Menlo Park, California campus with Google, Amazon, You Tube, Twitter, Verizon and other big tech companies to discuss how to “tamp down on misinformation about the coronavirus.”23
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.”24
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.25
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. Redford stated:26
“I do not believe this somehow came from a bat to a human. And at that moment in time, the virus came to the human, became one of the most infectious viruses that we know in humanity for human to human transmission. Normally, when a pathogen goes from a zoonotic to human, it takes a while for it to figure out how to become more and more efficient in human to human transmission.”
Additional investigative reports have provided evidence to supports 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).27 28
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.29
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.30
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.31
NIAID Director Dr. Anthony Fauci has continually denied that his agency funded bat coronavirus research at the WIV.32
Risk Factors and Severity
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.33 WHO stated that:34
“Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus. Most 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.35 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.”36
By the end of February 2020, WHO had not yet declared COVID-19 to be a pandemic,37 but there had been daily reports in the media warning that COVID-19 was taking a foothold in the U.S.38 and many concerned Americans had begun to make preparations 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:39
“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.”40
WHO declared COVID-19 a global pandemic on March 11, 2020, and urged countries to take strong action to stop its spread.41 42 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.43 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 44 and crippled the world’s economy.45
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-19.46 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.
According to the New York Times:47
“Between 160 million and 214 million people in the U.S. could be infected over the course of the epidemic, according to one projection. That could last months or even over a year, with infections concentrated in shorter periods, staggered across time in different communities, experts said. As many as 200,000 to 1.7 million people could die. The calculations based on the CDC’s scenarios suggested 2.4 million to 21 million people in the U.S. could require hospitalization, potentially crushing the nation’s medical system, which has only about 925,000 staffed hospital beds. Fewer than a tenth of those are for people who are critically ill.”
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 said “changing behavior” would alter the course of the pandemic. A University of Nebraska infectious disease specialist, Dr. James Lawler, was quoted as estimating there would be 96 million Americans infected and 450,000 deaths.48
CDC Tests Faulty – U.S. Lags in Testing Ability
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.49 50
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:51
“The World Health Organization (WHO) has shipped testing kits to 57 countries. China had five commercial tests on the market 1 month ago and can now do up to 1.6 million tests a week; South Korea has tested 65,000 people so far. The U. S. Centers for Disease Control and Prevention (CDC), in contrast, has done only 459 tests since the epidemic began. The rollout of a CDC-designed test kit to state and local labs has become a fiasco because it contained a faulty reagent. Labs around the country eager to test more suspected cases—and test them faster—have been unable to do so. No commercial or state labs have the approval to use their own tests.
“In what is already an infamous snafu, CDC initially refused a request to test a patient in Northern California who turned out to be the first probable COVID-19 case without known links to an infected person. The problems have led many to doubt that the official tally of 60 confirmed cases in the United States is accurate.”
“As the highly infectious coronavirus jumped from China to country after country in January and February, the U.S. Centers for Disease Control and Prevention lost valuable weeks that could have been used to track its possible spread in the United States because it insisted upon devising its own test. The federal agency shunned the World Health Organization test guidelines used by other countries and set out to create a more complicated test of its own that could identify a range of similar viruses. But when it was sent to labs across the country in the first week of February, it didn’t work as expected.”
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.”53
On March 22, 2020, the FDA approved a 45-minute lab test to confirm SARS-CoV-2 infections;54 however, the testing delays had significantly impaired the U.S. response to the virus. USA Today reported on March 27, 2020:55
“From its biggest cities to its smallest towns, America’s chance to contain the coronavirus crisis came and went in the seven weeks since U.S. health officials botched the testing rollout and then misled scientists in state laboratories about this critical early failure. Federal regulators failed to recognize the spiraling disaster and were slow to relax the rules that prevented labs and major hospitals from advancing a backup…the nation’s public health pillars — the Centers for Disease Control and Prevention and the Food and Drug Administration — shirked their responsibility to protect Americans in an emergency like this new coronavirus, USA TODAY found in interviews with dozens of scientists, public health experts and community leaders, as well as email communications between laboratories and hospitals across the country. The result was a cascading series of failures now costing lives.”
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.56 On March 15, Dr. Fauci said on NBC’s Meet the Press:57
“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 that “in fairness, they listen and they generally go with what we say.”58
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.59
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.60 61
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.62
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.63
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.64
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:65
“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.66
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.67
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-19.68
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."69
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.70 71 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.72
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.73
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. In this press release, the FDA stated that:74
“Antibody tests can play an important role in identifying individuals who may have been exposed to the SARS-CoV-2 virus and may have developed an adaptive immune response. However, antibody tests should not be used at this time to determine immunity or protection against COVID-19 at any time, and especially after a person has received a COVID-19 vaccination.”
According to the FDA, the available authorized SARS-CoV-2 antibody tests are not validated to evaluate protection or immunity to the virus. 75
Differing Lockdown Approaches in U.S. and Abroad
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.76 77 78 By the end of March 2020, schools in all 50 states had shut down.79
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).80
These discussions followed reports out of Italy that doctors were only treating patients that were likely to have favorable outcomes. The Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) published guidelines for the criteria that doctors and nurses should follow, comparing “the moral choices Italian doctors may face to the forms of wartime triage and, rather than providing intensive care to all patients who need it, instead apply “distributive justice and the appropriate allocation of limited health resources.”81
The Italian approach was based on utilitarianism, which uses a mathematical model as a guide to public policy that justifies sacrificing the few in order to maximize benefits for a greater number of people. When making intensive care decisions, the doctors would follow criteria that guarantees only patients with “the highest chance of therapeutic success will retain access to intensive care” and the rules would apply to all patients, not only those infected with SARS-CoV-2. They also discussed that “it may become necessary to establish an age limit for access to intensive care” and “Those who are too old to have a high likelihood of recovery, or who have too low a number of ‘life-years’ left even if they should survive, would be left to die.”82
By April 10, 2020, there had been more than 18,000 COVID-19 related deaths reported in the U.S.83 According to the CDC, most cases were mild or asymptomatic, including in children,84 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.85
Large mortality variations among different countries and similar wide variations in mortality among populations living in different states in the U.S. were noted.86 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.”87
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 85.88 The CDC also stated that the risk of hospitalization and death increased with age. Persons over the age of 8589 and those with underlying health conditions were noted to be at highest risk of severe illness and death.90
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.91
Many Elderly Die – Department of Justice Reviews State’s with High Counts
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.92 Temporary hospitals were constructed, and the 1,000 bed U.S. Navy Ship Comfort docked to assist in the pandemic’s response.93
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.94 95
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.96
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.97
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.98 99
In early February 2021, Melissa DeRosa, a top aide to Former Governor Cuomo privately admitted to Democratic lawmakers that they had withheld the COVID-19 nursing home death toll for fear that federal prosecutors would launch an investigation. Instead of offering an apology to the families of those who died, DeRosa expressed remorse over the political inconvenience that Democratic lawmakers incurred as a result of the Former Governor’s actions.100 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 2020.101 102
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.103
Reopening After Lockdowns in U.S.
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 restrictions104 including face mask mandates.105 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:106
“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.107
“The facts on the ground here did not support shelter-in-place,” she said. “We just didn’t have the spread. For me personally, I took an oath to uphold our state Constitution. I took an oath when I was in Congress to uphold the United States Constitution. So, I believe in people’s freedoms and liberties, and I always balance that with every decision that I make as governor. I get overly concerned with leaders who take too much power in a time of crisis because I think that’s how we directly lose our country someday by leaders overstepping their proper role.”
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.108
Lockdowns and Reopening Globally
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 has prevented the country from suffering the kind of economic meltdown being experienced by most other countries.109
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 October 16, 2021, Sweden was ranked 52nd among nations in population-adjusted deaths from COVID-19.110
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.111
As of October 16, 2021, U.S public health officials report that international travel to most countries should be avoided. Additionally, most foreign nationals who have been to India, Iran, China, Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden, Switzerland, Monaco, San Marino, Vatican City, the U.K, Ireland, South Africa, and Brazil, in the previous 14 days are prohibited from entering the U.S.112
Persons traveling to the U.S. must continue to provide documentation of recovery from COVID-19 or a negative test result within 3 days of travel.113 Persons fully vaccinated with FDA Emergency Use Authorization (EUA) COVID-19 vaccines and traveling within the U.S. are not required self-quarantine or to test for COVID-19, unless their destination requires it, and are advised to follow CDC masking and social distancing recommendations.114
COVID-19 in Children
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 infrequently115 and in the U.S., children under the age of 14 have accounted for only 0.00035 of one percent of COVID-19 deaths.116 Nationwide through October 15, 2021, the CDC reported there were 676 deaths attributed to COVID-19 in children ages 0-17.117
In most states, schools, which closed in response to the pandemic, have reopened. Reopening, however, has varied by state and school districts, and some school districts have opted to provide only virtual schooling options.118 For those schools which have reopened, social distancing guidelines, facemask requirements, and additional cleaning protocols have been implemented.119
In February 2021, CDC Director Dr. Rochelle Walensky publicly stated that schools can re-open safely for in-person learning by following guidelines that include social distancing, mask wearing, hand-washing, and contact tracing. Health officials have reported that in-person learning does not increase community infection rates, and transmission of the virus between students rarely occurs.120
In September 2021, a Public Health England report suggested that children who had not received the COVID-19 vaccine had a lower death rate after developing COVID-19 than fully vaccinated adults in all age groups.121
COVID-19 Cases and Deaths
As of October 15, 2021, there have been over 44 million cases and over 720,000 COVID-19 related deaths reported to the CDC. This data, however, includes both confirmed and probable cases.122
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 test123 such as reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) or nucleic acid amplification test (NAAT).124
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.125 126
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.127
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-2.128
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.129
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.130
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.131
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.”132
The document, entitled The Great Barrington Declaration (GBD), named for the Massachusetts town where organizers gathered and in which the petition was signed, had already secured signatures from 10,233 scientists, 27,860 medical professionals and 504,875 concerned citizens by the end of October.133
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.134
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:135
- 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.
In mid-October, 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.”136
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."137 The researchers also reported that
"The data cannot fully exclude the possibility of some benefits. However, even if they exist, these benefits may not match the numerous harms of these aggressive measures. More targeted public health interventions that more effectively reduce transmissions may be important for future epidemic control without the harms of highly restrictive measures."138
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.”139
By October 16, 2021, The Great Barrington Declaration had secured signatures from 14,981 medical and public health scientists, 44,167 medical practitioners, and 805,155 from concerned citizens worldwide.140
In the fall of 2020, public health officials reported that multiple variants of the SARS-CoV-2 virus had emerged and were circulating worldwide.141
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.142 Health officials report that this variant appeared to be 30 to 80 percent more transmissible and increased a person’s risk of death by 30 percent.143 144
The B.1.351 variant (Beta) was initially detected in Nelson Mandela Bay in South Africa in early October. By December 2020, this variant was found to be the predominant variant circulating in Zambia. Health officials have stated that evidence suggests that the variant is not associated with an increase in disease severity.145
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 have expressed concerns that this variant may be transmitted more effectively or be responsible for re-infection.146
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. The infectiousness of this strain or its impact on disease severity was reported as unknown.147 148
Another variant, the B.1.526 (Iota) variant, was identified by research teams from Columbia University and the California Institute of Technology (CalTech). Findings by these teams have been pre-published separately and await peer review.149 150 Both papers indicate that the strain was detected in New York in November 2020 and that this variant may represent an antigenic drift in the virus with possible blunting of current vaccine effectiveness. The Columbia paper indicated that those impacted by this variant “were on average older and more frequently hospitalized”, 151 while the CalTech paper estimates that the variant accounted for approximately 25 percent of all specimens in February 2021.152 In an interview with ABC News published February 25, 2021, the Columbia research team stated they had identified 80 cases of the new variant across New York, New Jersey and Connecticut.
On May 4, 2021, the CDC classified the SARS-CoV-2 variant B.1.617 (Delta) and it’s three sub lineages, B.1.617.1, B.1.617.2, and B.1.617.3, as variants of interest.153 These variants, which originated in India, were declared variants of concern by the World Health Organization (WHO) on May 10, 2021. According to the WHO, these variants are associated with increased transmissibility and decreased neutralization. As a result, vaccinated individuals and persons who have previously recovered from a COVID-19 infection may be at risk for infection from this variant.154 A technical briefing published by Public Health England on June 11, 2021 noted that almost one third of individuals who died with the Delta variant were fully vaccinated.155 In the June 18, 2021 Public Health England Technical report, the death rate in fully vaccinated individuals was 6.6 times higher than among unvaccinated people.156
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.157 Health experts report the Delta variant to be more easily transmissible and have also acknowledged that vaccinated individuals are capable of spreading the virus on to others, as COVID-19 vaccines are unable to stop viral transmission.158
As of October 15, 2021, the CDC has reported the Delta variant to be the predominant strain in the U.S., and more than twice as contagious as previous variants.159 The Delta variant has been labeled a Variant of Concern and the CDC is continuing to monitor the spread of this variant.160 161
The C.37 variant (Lambda), first identified in Peru in August 2020, was classified by WHO as a Variant of Interest on June 14, 2021.162 A pre-print study posted on bioRxiv ahead of peer review in late July 2021 reported the Lambda variant to be highly contagious and more resistant to vaccines.163
On August 30, 2021, WHO designated the Mu variant a Variant of Interest.164 Initially identified in Columbia in January 2021, this variant, also known as B.1.621, has become increasingly prevalent in South America. WHO reports that "the Mu variant has a constellation of mutations that indicate potential properties of immune escape," but state that further studies are needed on the variant. As of September 2, 2021, nearly all US states had reported the Mu variant.165
Health experts admit that they are uncertain as to how effective the current authorized treatments and vaccines will be against these novel variants.166 167
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 contain 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.
« Return to Vaccines & Diseases Table of Contents
Updated October 20, 2021
1 U.S. Centers for Disease Control and Prevention. Outbreak of Pneumonia of Unknown Etiology (PUE) in Wuhan, China. In: Emergency Preparedness and Response. Jan. 8, 2020.
2 Griffiths J, Gan N. China confirms Wuhan virus can be spread by humans. CNN. Jan. 22, 2020.
3 U.S. Centers for Disease Control and Prevention. How COVID-19 Spreads. In: COVID-19. July 14, 2021.
4 Fisher BL. Coronavirus Vaccines on Fast Track as WHO Declares Global Public Health Emergency - NVIC Special Report: COVID-2019 Pandemic - Part 1. National Vaccine Information Center Feb. 5, 2020.
5 DHHS. Secretary Azar Declares Public Health Emergency for United States for 2019 Novel Coronavirus. Jan. 31, 2020.
6 Aubrey A. Trump Declares Coronavirus A Public Health Emergency and Restricts Travel from China. NPR Jan. 31, 2020.
7 Altman H. Pentagon Prepared to House Nearly 1,000 People Over Coronavirus Fears. Military Times Feb. 1, 2020.
8 U.S. Centers for Disease Control and Prevention. History of Quarantine – Quarantine Now. In: Quarantine & Isolation. July 20, 2020.
9 CNN Wire. Cruise Ship Quarantined in Japan After Passenger Diagnosed with Coronavirus. Feb. 4, 2020.
10 NBC News. Number of coronavirus deaths on mainland China climbs to 908. Feb. 9, 2020.
11 Qin A, Myers SL, Yu E. China Tightens Wuhan Lockdown in ‘Wartime’ Battle With Coronavirus. New York Times Feb. 6, 2020.
12 Carr J. Coronavirus death toll hits 811 as virus claims more lives than 2003 SARS outbreak – as Beijing starts rounding up sufferers and videos show hazmat suit-clad goons dragging people from their homes. Daily Mail. Feb. 8. 2020.
13 Fisher BL. Chinese Taken from Homes by Police to Coronavirus Quarantine Camps. The Vaccine Reaction Feb. 12, 2020.
14 Chen LY. Citizen Journalist Covering Virus Outbreak from Wuhan Goes Missing. Bloomberg News Feb. 7, 2020.
15 Xiong Y, Culver D, Paget S. Chinese hospital announces that whistleblower doctor is dead. CNN Feb. 6, 2020.
16 Stimson B. Who was Li Wenliang, the Chinese doctor who warned about the coronavirus? Fox News Mar. 20, 2020.
17 Nebehay S, Farge E. Coronavirus emergency is 'Public Enemy Number 1': WHO. Reuters Feb. 11, 2020.
18 Jiang S., Register L. Worldwide coronavirus death toll rises to 1,107. CNN Feb. 11, 2020.
19 Fisher BL, Parpia R. Coronavirus Vaccines on Fast Track as WHO Declares Global Health Emergency. The Vaccine Reaction Feb.18, 2020.
20 Ibbetson R. Did coronavirus originate in Chinese government laboratory? Scientists believe killer disease may have begun in research facility 300 yards from Wuhan wet fish market. Daily Mail Feb.16, 2020.
21 Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet Feb. 2020; 395(10223): 497-506.
22 Ghosh P. Coronavirus Update: WHO Teams Up With Google To Battle Online Misinformation. International Business Times Feb. 3, 2020.
23Farr C. Facebook, Amazon, Google and more met with WHO to figure out how to stop coronavirus misinformation. CNBC Feb. 14, 2020.
24 Attkisson S. Watch: Evolving science on COVID-19 and the vaccines. Jan. 17, 2021.
25 Goh B. China refused to provide WHO team with raw data on early COVID cases, team member says. Reuters Feb. 13, 2021.
26 Cáceres M. Former CDC Director Believes Coronavirus Was Made in a Lab. The Vaccine Reaction Apr. 11, 2021.
27 Attkisson S. (VIDEO) Exclusive Investigation: Separating rumor from fact on Covid-19's origin. SharylAttkisson.com May 7, 2021.
28 Wade N. Origin of Covid — Following the Clues. May 2, 2021.
29 Payne D. House Republicans target Fauci, Blinken in effort to investigate Wuhan coronavirus lab-leak theory. Just The News May 10, 2021.
30 Lerner S, Hvistendahl M. New Details Emerge About Coronavirus Research at Chinese Lab. The Intercept Sept. 6, 2021.
31 Lerner S, Hvistendahl M. New Details Emerge About Coronavirus Research at Chinese Lab. The Intercept Sept. 6, 2021.
32 Ballasy N. Sen. Paul says new report shows 'Fauci lied again' about U.S.-funded research at Wuhan lab. Just The News Sept.7, 2021.
33 Zimmer K. Emerging data as well as knowledge from the SARS and MERS coronavirus outbreaks yield some clues as to why SARS –Cov-2 affects some people worse than others. The Scientist Feb. 24, 2020.
34 World Health Organization. Coronavirus. No Date. (Accessed Oct. 10, 2021).
35 Li LQ, Huang T, et al. 2019 novel coronavirus patients’ clinical characteristics, discharge rate and fatality rate of meta-analysis. J Med Virol Mar. 12, 2020.
36 Ruan Q. Yang K. Wang W. et al. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med March 2020; 3:1-3.
37 Bacon J, Ortiz JL. Coronavirus live updates: 9th US. death is confirmed as WHO rejects pandemic. USA Today Mar. 3, 2020.
38 Darnell T. 15 confirmed U.S. coronavirus cases, CDC preparing for American foothold. Atlanta Journal Constitution Feb. 13, 2020.
39 Langlois S. Surgeon general wants you to stop buying masks to protect yourself from coronavirus: ‘They are NOT effective.” MarketWatch Mar. 1, 2020.
40 Langlois S. Surgeon general wants you to stop buying masks to protect yourself from coronavirus: ‘They are NOT effective.” MarketWatch Mar. 1, 2020.
41 BBC News. Coronavirus confirmed as pandemic by World Health Organization. Mar. 11, 2020.
42 Mangan D, Higgins-Dunn N, Feuer W. Coronavirus is ‘Public Enemy No. 1’: WHO chief warns final death toll depends on future actions. CNBC Mar. 25, 2020.
43 Kaplan J, Frias L, McFal-Johnson M. Our ongoing list of how countries are reopening, and which ones remain under lockdown. Business Insider Aug. 25, 2020.
44 CNN Business. U.S. stocks plummet on coronavirus fears. Mar. 9, 2020.
45 Jones L, Palumbo D, Brown D. Coronavirus: A visual guide to the economic impact. BBC June 30, 2020.
46 Fink S. The worst-case estimate for U.S. coronavirus deaths. The New York Times Mar. 13, 2020.
47 Fink S. The worst-case estimate for U.S. coronavirus deaths. The New York Times Mar. 13, 2020.
48 Fink S. The worst-case estimate for U.S. coronavirus deaths. The New York Times Mar. 13, 2020.
49 Woodward A., Bendix A. Delays and errors have put the US far behind other countries in testing and treating coronavirus patients: 'We are trotting along while they're racing'. Business Insider. Mar. 2, 2020.
50 Bendix A. The US decided to make its own coronavirus test, but the process was plagued by errors and delays. Here's a timeline of what went wrong. Business Insider Mar. 11, 2020.
51 Cohen J. The United States badly bungled coronavirus testing – but things may soon improve. Science Feb. 28, 2020.
52 Chen C. Allen M. et al. Key Missteps at the CDC Have Set Back Its Ability to Detect the Potential Spread of Coronavirus. ProPublica Feb. 28, 2020.
53 Chuck E. Fauci testifies coronavirus testing in U.S. is ‘failing.’ NBC Mar. 12, 2020.
54 MSN. US approves 45-minute coronavirus test. Mar. 22, 2020.
55 Murphy B, Stein L. The coronavirus test that wasn’t: How federal health officials misled state scientists and derailed the best chance at containment. USA Today Mar. 27, 2020.
56 Singman B. Trump declares national emergency over coronavirus, enlists private sector. Fox News Mar. 13, 2020.
57 Oprysko C. Fauci: Americans should be prepared to ‘hunker down’ even more. Politico Mar. 15, 2020.
58 Oprysko C. Fauci: Americans should be prepared to ‘hunker down’ even more. Politico Mar. 15, 2020.
59 Mandavilli A. Your Coronavirus Test Is Positive. Maybe It Shouldn’t Be. The New York Times Aug. 29, 2020.
60 Lenthang M. Experts: US COVID-19 positivity rate high due to ‘too sensitive’ tests. Daily Mail Aug. 30, 2020.
61 Tom MR., Mina MJ. To Interpret the SARS-CoV-2 Test, Consider the Cycle Threshold Value. Clin Infect Dis Nov. 2020: 71(16):2252-2254.
62 Mandavilli A. Your Coronavirus Test Is Positive. Maybe It Shouldn’t Be. The New York Times Aug. 29, 2020.
63 Mandavilli A. Your Coronavirus Test Is Positive. Maybe It Shouldn’t Be. The New York Times Aug. 29, 2020.
64 Cáceres B. Coronavirus Cases Plummet When PCR Tests Are Adjusted The Vaccine Reaction Sept. 29, 2020.
65 Mahase E. Covid-19: the problems with case counting. BMJ Sept. 3, 2020; 370:m3374.
66 Rao SN, Manissero D, Steele VR, et al. A Narrative Systematic Review of the Clinical Utility of Cycle Threshold Values in the Context of COVID-19. Infect Dis Ther. September 2020: 9(3): 573-486.
67 Jefferson T, Spencer EA, Brassey J, et al. Viral cultures for COVID-19 infectious potential assessment – a systematic review. Clinical Infectious Diseases December 2020; ciaa1764.
68 U.S. Centers for Disease Control and Prevention. Interim Guidance on Ending Isolation and Precautions for Adults with COVID-19. In: COVID-19. Sept 14, 2021.
69 WHO. WHO Information Notice for IVD Users 2020/05. Jan. 13, 2021.
70 Payne D. WHO warns of 'false positives' in COVID tests, says some patients might not be 'truly infected'. Just the News Jan. 22, 2021.
71 Cáceres M. WHO Issues New Guidance for Determining PCR Test Results. The Vaccine Reaction Feb. 21, 2021.
72 Lee M. WHO changes CCP Virus Test Criteria in Attempt to Reduce False Positives. The Epoch Times Jan. 23, 2021.
73 U.S. Centers for Disease Control and Prevention. How to send CDC sequence data or respiratory specimens from suspected vaccine breakthrough cases. In: COVID-19 Breakthrough Case Investigations and Reporting. Oct. 5, 2021.
74 U.S. Food and Drug Administration. FDA In Brief: FDA Advises Against Use of SARS-CoV-2 Antibody Test Results to Evaluate Immunity or Protection From COVID-19, Including After Vaccination. May 19, 2021.
75 U.S. Food and Drug Administration. FDA In Brief: FDA Advises Against Use of SARS-CoV-2 Antibody Test Results to Evaluate Immunity or Protection From COVID-19, Including After Vaccination. May 19, 2021.
76 Kochhar R. Unemployment rose higher in three months of COVID-19 than it did in two years of the Great Recession. Pew Research Center June 11, 2020.
77 Jenco M. Study: COVID-19 pandemic exacerbated hardships for low-income, minority families. AAP News June 3, 2020.
78 Chiwaya N, Wu J. The coronavirus has destroyed the job market in every state – See the per-state jobless numbers and how they’ve changed. NBC News Aug. 27, 2020.
79 Education Week. Map: Coronavirus and School Closures in 2019-2020. June 30, 2021.
80 Washington Post. US hospitals considering blanket ‘do not resuscitate’ orders for Covid-19 patients. The Independent Mar. 26, 2020.
81 Mounk Y. The Extraordinary Decisions Facing Italian Doctors. The Atlantic Mar. 11, 2020.
82 Mounk Y. The Extraordinary Decisions Facing Italian Doctors. The Atlantic Mar. 11, 2020.
83 Watts A. More than 18,000 people have died from coronavirus in the US. CNN Apr. 10, 2020.
84 Mole B. CDC releases first US data on COVID-19 cases in children. Ars Technica Apr. 7, 2020.
85 Stokes EK, Zambrano LD, Anderson KN, et al. Coronavirus Disease 2019 Case Surveillance — United States, January 22–May 30, 2020. MMWR June 19, 2020;69:759–765.
86 Worldometer. U.S. Coronavirus cases and deaths by state.
87 Wu X., Nethery RC. et al. Exposure to air pollution and COVID-19 morality in the United States. medRxiv Apr. 5, 2020.
88 U.S. Centers for Disease Control and Prevention. Severe outcomes among patient with Coronavirus disease 2019 (COVID-19) – United States, February 12 – March 16, 2020. MMWR Mar. 26, 2020. 69(12): 343-346.
89 U.S. Centers for Disease Control and Prevention. Older Adults. In: COVID-19. Aug. 2, 2021.
90 U.S. Centers for Disease Control and Prevention. People with Certain Medical Conditions. In: COVID-19. Oct. 14, 2021.
91 Casiano L. Birx says government is classifying all deaths of patients with coronavirus as 'COVID-19' deaths, regardless of cause. Fox News Apr. 7, 2020.
92 Condon A, Vaidya A, Paavola A. New York is the epicenter of the COVID-19 pandemic + 21 other updates from the 6 hardest-hit states. Becker’s Hospital Review Apr. 1, 2020.
93 Viadya A, Paavola A. Navy ships arrive in New York, California + 25 other updates from the hardest-hit states. Becker’s Hospital Review Mar. 30, 2020.
94 McCarthy A. The Problem with New York City’s COVID-19 Death-Rate Estimates. National Review Apr. 15, 2020.
95 Goldman H. NYC Adds 3,800 Probable Virus Victims to Death Toll. Bloomberg Apr. 14, 2020.
96 Schoch D. Nursing Homes Balk at COVID Patient Transfers From Hospitals. AARP Apr. 21, 2020.
97 Barone, V. Gov. Cuomo sent 6,300 COVID-19 patients to nursing homes during pandemic. New York Post July 8, 2020.
98 Crist C. Dept of Justice Looks Into 4 States' Nursing Home Deaths. WebMD Aug 31, 2020.
99 U.S. Department of Justice (DOJ). Department of Justice Requesting Data From Governors of States that Issued COVID-19 Orders that May Have Resulted in Deaths of Elderly Nursing Home Residents. Justice News Aug. 26, 2020.
100 Hogan B, Campanile C, Golding B. Cuomo aide Melissa DeRosa admits they hid nursing home data so feds wouldn’t find out. New York Post Feb. 11, 2021.
101 Milton P. Linton C. FBI and U.S. attorney investigating Cuomo administration's handling of nursing home COVID cases. CBS News Feb. 18, 2021.
102 Washington Examiner Staff Cuomo and elderly deaths: Public missteps mounting. Washington Examiner Feb. 18, 2021.
103 Choi J. DOJ won't investigate nursing home deaths in New York, other states: letter. The Hill July 25, 2021.
104 Ascarelli S. U.S. states slowly reopen after coronavirus lockdowns — some now permit visits to nursing homes. Market Watch June 11, 2020.
105 Kim A, Andrew S, Froio J. These are the states requiring people to wear masks when out in public. CNN Aug. 17, 2020.
106 Justice T. Although Never Officially Shut Down, South Dakota Governor Unveils ‘Back To Normal’ Plan. The Federalist Apr. 29, 2020.
107 Miller AM. 'I took an oath to uphold the United States Constitution': South Dakota governor defends rejecting coronavirus lockdown. Washington Examiner Apr. 23, 2020.
108 Laffer AB, Arduin D, Moore S. et al. Grading America’s 50 Governors – 2020 – The Laffer-Alec Report On Economic Freedom. American Legislative Exchange Council Oct. 20, 2020.
109 Sticklings T. Sweden sees just 77 new deaths from coronavirus and number of new infections drops by a quarter to just 544 as nation continues to resist lockdown. Daily Mail Apr. 10, 2020.
110 WorldOMeter. COVID-19 CORONAVIRUS PANDEMIC. Oct. 16, 2021.
111 Ahlander J. Sweden saw lower 2020 death spike than much of Europe - data. Reuters Mar. 24, 2021.
112 U.S. Centers for Disease Control and Prevention. COVID-19 Travel Recommendations by Destination. In: COVID-19. Oct. 12, 2021.
113 U.S. Centers for Disease Control and Prevention. Requirement for Proof of Negative COVID-19 Test or Recovery from COVID-19 for All Air Passengers Arriving in the United States. In: COVID-19. July 6, 2021.
114 U.S. Centers for Disease Control and Prevention. Domestic Travel During COVID-19. In: COVID-19. Oct. 4, 2021.
115 Lee B., Raszka WV. COVID-19 Transmission and Children: The Child Is Not to Blame. Pediatrics August 2020; 146 (2) e2020004879.
116 Cáceres B. New CDC Data Shows 94 Percent of COVID-19 Death Cases Had Underlying Poor Health Conditions. The Vaccine Reaction Sept. 7, 2020.
117 U.S. Centers for Disease Control and Prevention. Demographic Trends of COVID-19 cases and deaths in the US reported to CDC. In: COVID Data Tracker. Oct. 15, 2021.
118 Capoot A, Cicchiello C. When will school open? Here's a state-by-state list. Today Aug. 10, 2020.
119 U.S. Centers for Disease Control and Prevention. Operational Strategy for K-12 Schools through Phased Prevention. In: COVID-19. May 15, 2021.
120 Binkley C. Stobbe M. CDC: Strong evidence in-person schooling can be done safely. Associated Press Feb. 12, 2021.
121 Phillips J. Unvaccinated Children at Lower Risk of COVID-19 Death Than Fully Vaccinated Adults: England Report. The Epoch Times Sept. 10, 2021.
122 U.S. Centers for Disease Control and Prevention. United States COVID-19 Cases and Deaths by State. In: COVID Data Tracker. Oct. 15, 2021.
123 U.S. Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19) 2020 Interim Case Definition, Approved August 5, 2020. In: National Notifiable Diseases Surveillance System (NNDSS). Apr. 16, 2021.
124 U.S. Food and Drug Administration (FDA). Coronavirus Disease 2019 Testing Basics. Sept. 22, 2021.
125 U.S. Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19) 2020 Interim Case Definition, Approved August 5, 2020. In: National Notifiable Diseases Surveillance System (NNDSS). Apr. 16, 2021.
126 U.S. Centers for Disease Control and Prevention. Interim Guidance for Antigen Testing for SARS-CoV-2. In: COVID-19. Sept. 9, 2021.
127 U.S. Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19) 2020 Interim Case Definition, Approved August 5, 2020. In: National Notifiable Diseases Surveillance System (NNDSS). Apr. 16, 2021.
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