America’s uniquely bad Covid-19 epidemic, explained in 18 maps and charts
A man wears a mask as he sits in Times Square in New York City on March 12, 2020. | Gary Hershorn/Corbis via Getty Images The US’s coronavirus epidemic is among the worst. Here’s what you need to know. It’s now clear the United States has failed to contain its Covid-19 epidemic, with case counts far ahead of other developed nations and more than 1,000 deaths reported a day for over two weeks and counting. Asked if America’s coronavirus outbreak is the worst in the world, White House adviser and National Institute of Allergy and Infectious Diseases director Anthony Fauci admitted it was on August 5: “Yeah, it is. Quantitatively, if you look at it, it is. I mean, the numbers don’t lie.” It didn’t have to be this way. In March and April, other developed countries had significant Covid-19 outbreaks, but they did a much better job than the US in containing the coronavirus and keeping it down after the virus arrived. So while some other developed nations have experienced upticks, they all pale in comparison to the massive surge in cases, hospitalizations, and deaths that the US has seen since May and June. The result is a large disparity between the US and other developed nations in terms of getting life back to normal. Schools reopened in Denmark and other places. Taiwan’s baseball league allows fans in stadiums, and Germany’s soccer league may allow fans in soon too. Spain, France, and Italy — all of which were hit very hard by Covid-19 in the spring — are also reopening bit by bit. Meanwhile, the US is still dealing with a resurgence of the coronavirus that has led some states to close down bars and other indoor spaces, cast doubt on whether schools will be able to reopen for in-person teaching, and strained hospitals nationwide (with another flu season looming, to boot). “It’s a situation that didn’t have to be,” Jaime Slaughter-Acey, an epidemiologist at the University of Minnesota, told me. “For almost three months, you had opportunities to be proactive with respect to mitigating the Covid-19 pandemic and to help normalize culture to adopt practices that would stem the tide of transmissions as well as the development of Covid-19 complications.” But the US didn’t take advantage of those opportunities. The country did bring Covid-19 cases to a plateau, but not a significant decline, by April and May. But then several states rushed to reopen, with a significant portion of the public not following recommendations for masking and physical distancing. The original hot spots were the New York region, but over time, as states moved to reopen, the virus shifted to the South, West, and eventually, the rest of the country. Now America is stuck with the consequences, with the death toll likely to climb by the tens of thousands in the next few weeks and the possibility of another shutdown looming larger as the country heads into the fall and winter. Here are 18 maps and charts showing the depth of America’s Covid-19 epidemic, how it got so bad, and what can be done about it. 1) America is among the worst-hit countries for coronavirus cases 91-DIVOC The US is truly one of a kind among developed nations for its number of Covid-19 cases. The chart above, made with 91-DIVOC and based on data from Johns Hopkins University, shows the US, other top 10 countries for coronavirus cases (after adjusting for population), and the European Union for comparison. While America’s developed peers have suppressed the coronavirus, the US case count has continued to climb to levels only seen in developing countries with weaker government institutions and shakier public health infrastructure. 2) The US has a very high Covid-19 death toll Our World in Data The US is also in the top 10 countries for Covid-19 deaths after adjusting for population, with more than 490 deaths per million people. In this sense, America remains comparable to some of its developed peers; Belgium, the United Kingdom, Spain, Italy, and Sweden have all suffered higher death rates, and France is only a bit behind. But others have done much better, with Germany and Denmark reporting less than a fourth the death rate of the US, and Japan and South Korea reporting between 1 and 2 percent of the death rate of the US. With deaths in the US totaling more than 1,000 a day in late July and August, America’s rank on this metric could get even worse in the coming weeks. 3) Even with high case counts, the US is still likely undercounting coronavirus cases German Lopez/Vox While President Trump insists that the US leads the world in Covid-19 cases because it tests more than any other country in the world, the evidence suggests that America tests too little, especially compared to its developed peers. The positive rate — or the percent of tests that come back positive for the coronavirus — is perhaps the best way to track whether testing is adequate. If a place tests enough, it should have a low positive rate, because it should be testing lots and lots of people, including those who don’t have serious symptoms. High positive rates indicate that only people with obvious symptoms are getting tested, which suggests a need to ramp up testing to match the scope of an outbreak. The goal is, ideally, to get the positive rate to 0 percent, since that would mean Covid-19 is vanquished. More realistically, experts say the acceptable maximum is 5 percent, although some have recently called for below 3 percent. Anything above 5 percent indicates that a country doesn’t have enough testing to pick up all its cases — and America is currently at 7.6 percent for the most recent week of data available (via Our World in Data), meaning the US is likely missing a lot of cases. This hinders America’s ability not just to track the epidemic but to respond to it too. Paired with contact tracing, testing lets officials track the scale of an outbreak, isolate those who are sick, quarantine those with whom the sick came in contact, and deploy community-wide efforts as necessary. Aggressive testing and tracing are how other countries, such as South Korea and Germany, got their outbreaks under control. 4) The US closed down at first, but much of it then quickly reopened German Lopez/Vox Back in April and May, the news looked good for Covid-19 in the US — as cases and deaths started to fall under the weight of stay-at-home orders, physical distancing, more masking, and other public health recommendations. It looked like America might get Covid-19 under control, with studies showing that lockdowns suppressed the spread of the coronavirus. Then, with President Trump’s insistence that states “LIBERATE” their economies, every state moved to reopen — at times before they even recorded drops in cases within their borders. Many states “never got to flat,” Pia MacDonald, an epidemiologist at the research institute RTI International, told me. “That means the states didn’t get to very good compliance with the public health interventions that we all need to take to make sure the outbreak doesn’t continue to grow.” The reopenings led cases, hospitalizations, and then deaths to surge in June, July, and now August. Many states have had to pause or reverse their reopenings, based on the New York Times’s tracker — losing some or all the progress they made toward getting life back to normal. 5) America’s coronavirus outbreak has gone national German Lopez/Vox In the beginning, America’s Covid-19 epidemic was largely concentrated in the Northeast, particularly the New York City area. To this day, New York and New Jersey have had by far the highest Covid-19 death tolls in the US, according to data gathered by the New York Times. In the recent resurgence of the coronavirus, though, Covid-19 has gone national, with the vast majority of states now reporting more than four new coronavirus cases each day per 100,000 people (which some experts consider the acceptable maximum for containing the spread of the virus). Some states have far surpassed that, at times reporting more than 20, 30, and even 50 new cases per 100,000 people a day. 6) Coronavirus is still spreading too quickly in many states German Lopez/Vox Meanwhile, the coronavirus appears to be spreading too quickly in many states. The Rt, or effective reproduction number, measures how many people are infected by each person with Covid-19. If the Rt is 1, then an infected person will, on average, spread the coronavirus to one other person. If it’s 2, then an infected person will spread it to two on average. And so on. The goal is to get the Rt below 1; if each new infection doesn’t lead to another, that would over time lead to zero new Covid-19 cases. According to Rt.live, many states are above an estimated Rt of 1 — which means that the virus is continuing to spread in much of the US. It’s an improvement from the early stages of the pandemic, when the Rt was above 2 in most states, but it’s still high enough to allow the coronavirus to spread and for the epidemic to continue. 7) Hospitalizations have fallen from their previous peaks but are still very high German Lopez/Vox During the ongoing resurgence of Covid-19, total hospitalizations in the US for the virus in a single day appeared to reach a new peak of nearly 60,000 — around the same as the previous peak in mid-April, according to data collected by the Covid Tracking Project. (Weeks after a nationwide system change, this data still has problems, but it’s the best we have.) The good news is the US has started to come down from that peak, as states reverse their reopening plans and the public follows recommended precautions like physical distancing and masking. But just as was true during the previous peak, experts say it’s important that the country not get complacent and make sure the virus is truly suppressed — which the country is still nowhere near — before we try to get life back to how it was before the Covid-19 pandemic. 8) The US has dramatically improved its testing capabilities German Lopez/Vox One good development in the past few months: The US has truly built up its testing capacity. Some experts at first suggested that the country would need 500,000 tests a day; the US now regularly surpasses that — with more recent daily counts regularly topping 700,000, according to the Covid Tracking Project. 9) But most states still don’t have enough testing to match their outbreaks German Lopez/Vox That said, the US still doesn’t have enough testing, with reported delays in testing results now spanning a week or more as labs are slammed with rising demand and a shortage of supplies necessary to run the tests (swabs, kits, reagents, and so on). That delay makes it impossible to trace and contain the infected before they spread the virus to more people, especially because the coronavirus often spreads before people show symptoms. Part of the problem is that, while the country surpassed 500,000 tests, its coronavirus outbreak since then got much worse, so it now requires far more tests to cover all the new cases. As a result, most states have positive rates that are too high. While the recommended max is 5 percent, some states’ rates for the most recent week of data now go beyond 10, 15, and even 20 percent, based on Covid Tracking Project data. (Washington state is excluded due to recent reporting problems.) So most states don’t have enough tests to match their outbreaks, meaning they’re still significantly undercounting their cases — and ill-equipped to actually deal with their epidemics. 10) The public is social distancing less, but many are still doing it Gallup During the beginning of the pandemic, Americans were told to stay at home — and even before any government orders, many started to do so to avoid the risk of infection. Gallup surveys found that the vast majority of Americans social distanced; between March 30 and April 5, 79 percent said they avoided public places, and 91 percent avoided travel. Over time, however, Americans started to ease up, as they became exhausted with social distancing and government orders were relaxed. People started to wander out more — and subsequently spread the virus. To the extent people are still social distancing, it helps. A review of the research published in The Lancet concluded that “evidence shows that physical distancing of more than 1 m is highly effective.” And a preliminary Health Affairs study found stay-at-home orders slowed the spread of the disease, likely preventing millions of cases. But to the extent people are social distancing less, particularly while the virus is already rapidly spreading in many US communities, it’s contributing to a resurgence of Covid-19. 11) The public has embraced masking Gallup Although there’s a lot of talk about the politicization of masks, the majority of Americans have embraced masking — with 44 percent saying they “always” wear masks outside their home and 28 percent saying they do so “very often” in Gallup’s late June and July surveys. That doesn’t mean mask use is perfect. Using this kind of polling, the New York Times calculated that mask use still varies dramatically from community to community, from percentages in the 90s to the single digits. And based on surveys from YouGov and Imperial College London, Americans are much more likely to go out without a mask than Germans, Spaniards, and the French — although less likely than Brits, Swedes, and Danes. Still, it seems the majority of Americans at least believe in masks and are willing to wear them in public. It’s yet another way that the country has had to adapt as the outbreak has continued in the US. Along with physical distancing, there’s good reason to believe masking will suppress the virus: The review of the research in The Lancet found that “face masks are associated with protection, even in non-health-care settings.” 12) More state governments have mandated masks German Lopez/Vox So far, 34 states plus Washington, DC, have mandated the use of masks in public, according to AARP. According to some surveys, there’s public appetite for a broader mandate: In a July Hill-HarrisX poll, for example, 82 percent of US voters said they’d support a national mask mandate. There’s some scientific evidence behind the mandates. One study in Health Affairs concluded that state mask mandates likely prevented hundreds of thousands of cases by May 22 in the US. Another study published by the research institute IZA found mandates in Germany “reduced the cumulative number of registered Covid-19 cases between 2.3% and 13% over a period of 10 days after they became compulsory” and “the daily growth rate of reported infections by around 40%.” But enforcement of these mandates in the US is uneven, with some local officials refusing to enforce them. Trump and some state officials have rejected mask mandates altogether, characterizing them as a violation of freedom and civil liberties. 13) Many schools aren’t fully reopening in the fall German Lopez/Vox Meanwhile, governments have also enforced social distancing measures to try to control the virus. Among those measures, some state and local officials aren’t letting schools open for in-person learning in the fall. According to Education Weekly, most states are leaving it up to local communities, but some have imposed statewide or regional closures or delays at the state level. This, again, reflects how poorly the US has handled the epidemic: If communities had the virus under control, it would be safer to reopen schools (with certain precautions). But since the virus continues to infect and kill people at a rapid rate across the US, many places don’t feel safe adding yet another potential source of transmission by reopening schools. 14) The economy has been crushed Bureau of Economic Analysis America’s economy has suffered greatly under the coronavirus, as people are forced to stay home, losing work and not patronizing the businesses that rely on a steady flow of in-person customers. The result: According to the Bureau of Economic Analysis, the US GDP, which measures economic output, tanked by more than 30 percent in the second quarter of 2020 — the worst decrease on record by a large margin. The economy has bounced back somewhat in recent months, but the resurgence of Covid-19 and expiration of federal stimulus has made a rapid full recovery impossible. 15) The US unemployment rate skyrocketed US Bureau of Labor Statistics The collapsing economy has led to millions of people losing their jobs — with the seasonally adjusted unemployment rate skyrocketing past 10 percent in recent months, according to the US Bureau of Labor Statistics. It’s yet another way the pandemic has hurt so many Americans. 16) Trump’s job approval rating has dropped Gallup The coronavirus pandemic has also damaged Trump’s standing, with his approval ratings and reelection prospects falling as the US continues to suffer greatly. At practically every turn, Trump has failed on the virus. After experts called for federal leadership, he left cities and states to solve national problems with testing and hospital supplies. When the federal government released a phased plan for reopening, Trump called on states to reopen faster — to supposedly “LIBERATE” them from economic calamity. After the Centers for Disease Control and Prevention recommended people in public wear masks, Trump said it was a personal choice, refused for months to wear a mask in public, and even suggested people who were wearing masks were doing it to spite him (though he’s recently shifted his views on masks). He’s promoted ineffective and even dangerous treatments — at one point advocating for injecting bleach. Meanwhile, Trump has refused to admit any fault. Asked about testing problems in March, he said, “I don’t take responsibility at all.” Asked about rising deaths in July, he responded, “It is what it is.” The public, however, seems to take a different view, blaming Trump for the ongoing crisis, and disapproving of the job he’s doing. 17) To get back to normal, America has to control the virus German Lopez/Vox For all the talk about getting the US back to normal, there’s only one safe way to do that: defeating the virus. This is what’s worked in all the other countries that have managed to get a little bit closer back to normal — after they suppressed the spread of Covid-19. You can see that in the restaurant data: According to OpenTable, seated diner reservations in Germany — which has a fraction of the cases and deaths of the US — are back up to pre-pandemic levels. In the US, seated diner reservations remain down nearly 60 percent. It shows controlling the epidemic and an economic recovery are linked. As a preliminary study of the 1918 flu pandemic found, the cities that emerged economically stronger back then took more aggressive action that hindered economies in the short term but better kept infections and deaths down overall. With cases only recently plateauing (again) and deaths still rising, the US is not there yet. 18) A vaccine is the main way out, but it’s likely months away German Lopez/Vox The main way out of the pandemic is likely a vaccine. But a vaccine still appears to be months away — with only a few in the late stages of trials necessary to prove their safety and efficacy. According to the New York Times, eight vaccines are in Phase III trials. That’s the final step necessary for approval. But getting through that phase can take months, and there’s no guarantee that every or even most vaccines that reach this stage will prove safe and effective. (The one vaccine with approval is only allowed for limited use by China’s military.) Even once a vaccine is proven to be safe and effective in trials, the US will need to scale up production and distribution to get the vaccine out to hundreds of millions of people — an enormous logistical challenge that could add more time, possibly months, to the process. So as much as everyone wants to get back to normal, chances are the US is still months away from that. In the meantime, the best hope is to suppress the coronavirus with other means, like social distancing and masking, as much as possible. But America has so far failed to do that. Support Vox’s explanatory journalism Every day at Vox, we aim to answer your most important questions and provide you, and our audience around the world, with information that has the power to save lives. Our mission has never been more vital than it is in this moment: to empower you through understanding. 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