COVID-19 cases surge past 1 million in the US just as some states start reopening

Meanwhile, CDC reports show that the death count might be largely under reported.
an american flag face mask on a black background
The United States remains the epicenter of the COVID-19 pandemic. Unsplash

Follow all of PopSci’s COVID-19 coverage here, including travel advice, grocery-cleaning tips, and how vulnerable communities are getting medical care during the pandemic.

This post has been updated.

The US now has more than 1 million confirmed cases of COVID-19, the disease caused by a novel coronavirus first detected in Wuhan, China, in December and now spreading on every continent save for Antarctica. The States became the epicenter of the new pandemic in late March, with the case count surging past China’s and the hardest-hit European nations’ as New York increased its testing capacity. The country now has more than double the number of cases detected in Italy and Spain combined, which are both also experiencing devastating outbreaks, though the rate per million people is just about on par with Italy’s, and still sits below Spain’s. The US now has more cases per million residents than France, Germany, the UK, and dozens of other affected countries.

“Had we had done more testing from the very beginning and caught cases earlier,” Jennifer Nuzzo, an epidemiologist at Johns Hopkins, recently told The New York Times, “we would be in a far different place.”

Experts suspect the actual number of US cases is higher than currently reported: While President Donald Trump has repeatedly claimed the country is leading the pack in testing its residents, the US only recently reached a per capita testing rate on par with similarly affected nations. So far the US has dispatched around 5.6 million COVID-19 tests.

The New York Times reported in mid-April that many of the tests initially sent out by the Centers for Disease Control and Prevention were in fact contaminated with the virus, making their results inconclusive.

“It was just tragic,” Scott Becker, executive director of the Association of Public Health Laboratories, told The New York Times. According to Baker, many public health labs realized almost immediately that the CDC’s testing kits were useless, and began reporting the problems to him. He alerted both the CDC and the Food and Drug Administration, but labs were left without a working test in the meantime. “All that time when we were sitting there waiting, I really felt like, here we were at one of the most critical junctures in public health history, and the biggest tool in our toolbox was missing,” he said.

Case numbers in the US are further clouded by the fact that the majority of tests have occurred within the New York area, which is considered the national hotspot for the disease. Infection rates in other regions are almost certainly under reported.

Testing has increased in recent weeks, but a diagnosis is still hard to come by outside of a hospital visit—and hospitals in hotspots are increasingly overwhelmed. A recent surge in at-home deaths in the New York City area could also be artificially deflating COVID-19 fatality rates; even if the deceased showed relevant symptoms, they aren’t being tested for the virus. At-home deaths are now being added to the COVID-19 death tally for people known to have been exhibiting symptoms before their demise. False-negative test results could also lead to an underestimation of the number of cases, given the country’s large population and high rates of infection.

A recent report by Harvard University researchers argues that the US may need to conduct more than 500,000 tests a day from now until mid-May before safely reopening the country. Some states are relaxing social-distancing rules, despite expert recommendations; overseas, nations like China, Italy, and New Zealand are gradually reversing shutdowns.

“Without national unity and global solidarity, trust us, the worst is yet ahead of us,” World Health Organization Director-General Tedros Adhanom Ghebreyesus said during a news briefing last week. “Let’s prevent this tragedy. It’s a virus that many people still don’t understand.”

What is COVID-19?

COVID-19 is the disease caused by the novel coronavirus. You can read more about the virus and what we know about its origins here. Common symptoms of COVID-19 include fever, shortness of breath, and a dry cough. Symptoms are mild in the vast majority of cases, and the virus may spread even with no noticeable symptoms present. This is part of why COVID-19 has spread so prolifically: The CDC reports that as many of 25 percent of contagious COVID-19 carriers may feel totally fine. These individuals likely spread the disease to others while carrying out normal activities like working, shopping, and socializing without keeping proper distance.

While COVID-19 is mild for most, the virus can lead to deadly pneumonia or heart problems in some patients. This is especially common in those over the age of 60, as well as people with underlying health problems. But hospitals around the world are also reporting many life-threatening and even fatal cases in young, otherwise healthy patients. There’s now evidence that COVID-19 can cause deadly strokes in healthy young people, some of whom never experience serious respiratory symptoms.

The risk may be lower for a teenager than it is for a senior, but that risk is far from nonexistent. No one should assume that COVID-19 would not put their life in peril.

How serious is COVID-19 in the US?

As of April 29, the US had confirmed far more COVID-19 cases than anywhere else in the world. The country has at least 1 million confirmed cases, according to tracking by Johns Hopkins University, and at least 53,000 deaths. More than 5,000 additional fatalities are presumed to be from COVID-19 because of reported symptoms in the deceased, but were not confirmed with testing.

New York is the current epicenter of the disease in the US, with hospitals reporting shortages of protective gear for workers and life-saving ventilators for patients. Some states, including New York, are working on solidifying guidelines that determine who should receive life-saving care when there aren’t enough resources to go around.

But while New York is still facing a healthcare crisis, COVID-19 cases are starting to level off in the area. The virus isn’t done spreading elsewhere, however. Outbreaks in prisons and assisted care facilities are proving particularly difficult to contain. Confirmed cases are currently on the rise in Massachusetts, Illinois, Maryland, Indiana, Virginia, Colorado, Tennessee, North Carolina, Missouri, Arizona, Iowa, Wisconsin, Delaware, Kentucky, Utah, Minnesota, Nebraska, Kansas, New Mexico, New Hampshire, Puerto Rico, and Wyoming, and holding steady in more than a dozen other states. Even people living in areas with no known cases of COVID-19 should stay home as much as possible and adhere to the rules of social distancing.

New York’s density, large population, and high rate of tourists and business travelers makes it an obvious place for the virus to crest first, but COVID-19 will likely hit other cities—and even rural areas—just as hard. At least 17 states now have more than 10,000 cases, and at least 42 have more than 1,000. Meanwhile, areas that previously saw a drop in cases, like LA County, are now seeing them surge again.

More than 26.5 million people in the US have filed for unemployment since mid-March due to the temporary shuttering of businesses across the country. The Senate voted unanimously to pass an unprecedented $2.2 trillion stimulus bill on March 25, which was then approved by the House of Representatives. You can read more about what the stimulus bill would mean for you here.

Current projections suggest that if most Americans stay home and avoid contact with others, the worst of the country’s first wave of COVID-19 will pass by June. See when your state is projected to see the most cases.

Should I be staying at home to avoid catching or spreading COVID-19?

Yes. Everyone should be practicing social distancing to limit the spread of COVID-19 and flatten the curve. Even people who live outside the current hotspots for the disease should stay home as much as possible.

Ideally, you should remain at least six feet away from all other people, but maintaining contact with your family members is okay as long as you’re all doing your best to avoid getting close to individuals outside the household. Even if you don’t have symptoms, spending as much time alone as possible means you’re lowering the risk that you will catch and spread COVID-19 to someone vulnerable.

Implementing preventative social-distancing measures will reduce the number of people who are sick at one time. Without such measures, many people get sick all at once, leading to a tall, narrow curve. Social distancing can flatten the curve—just as many people may get sick overall, but they’ll be spread out over time. For a health care system, especially an overwhelmed one, it’s far better to have a million people sick over the course of a year than have that same million sick in the span of three months.

Several states have seen anti-lockdown protests this month, where crowds gathered in close proximity—sometimes seeking to block traffic on roads near hospitals—in opposition of curfews and business shutdowns. Polls suggest the majority of Americans support stay-at-home orders and expect them to continue for at least several more weeks. Meanwhile, Georgia, Texas, Iowa, and Tennessee have begun to reopen many businesses, which experts have warned could backfire. One projection shows Georgia’s COVID-19 fatalities doubling by early August due to the premature relaxing of social distancing measure.

The Washington Post has an excellent interactive graphic to demonstrate the importance of social distancing, if you don’t understand why it’s important.

a man walking alone on the brooklyn bridge with the NYC skyline and an American flag visible
New York has been almost completely shut down to prevent the spread of COVID-19. Pexels

How serious is COVID-19 globally?

There are now around 3.1 million confirmed cases of COVID-19 worldwide, affecting at least 177 countries on every continent except for Antarctica; in total, some 211,000 people have died. While diagnoses and fatalities have long since tapered off in China, where COVID-19 originated in December, and South Korea, which was one of the first concerning hotspots for the disease, they continue to rise rapidly in several other places. There are also concerns that largely recovered countries could see multiple waves of the disease, as cities ease restrictions and people begin to behave more normally.

President Donald Trump announced earlier this month that he would halt funding for the WHO, which leads global responses to outbreaks such as COVID-19, arguing that the organization had kept vital information on COVID-19 secret from the US government. But American researchers, physicians, and public health experts working for the WHO reportedly provided real-time information updates on the novel coronavirus as early as late 2019.

ProPublica reports that an internal White House memo warned Trump that cutting WHO funding would “erode America’s global standing, threaten US lives, and hobble global efforts to combat the coronavirus pandemic.”

What can I do to prevent the spread of COVID-19?

Proper hand washing (instructions here) is still the best defense we have against a disease like COVID-19. While hand sanitizer is less effective, it’s a good substitute in a pinch—here’s a DIY recipe if your local stores are sold out.

While the evidence for the efficacy of face masks remains murky, the CDC now recommends that everyone in the US wear them when leaving the house. The hope is that this low-cost, low-risk intervention—implemented en masse—will help cut down disease spread from asymptomatic carriers of COVID-19. Here is a guide to buying or making a mask with whatever material you’ve got.

It is also important to practice social distancing if you’re able, even if your area is not yet considered to be in the midst of an active outbreak, and to be diligent about washing your hands if you have to go out and interact with people. Do not go out to bars or restaurants; ordering takeout (or, even better, delivery left at your front door) is the best way to get food from your favorite local business. Trips outside the home should be limited to isolated exercise (jogging by yourself in an area without crowds, for example) and getting essential medicine and groceries, while maintaining six feet of distance from other people. You should clean your hands frequently and avoid touching your face while out conducting essential errands.

It’s possible to help people working on the front lines, even while limiting your time outside your home. Find out if you have any supplies you can donate to your local hospital here.