It’s been a year since the Covid-19 pandemic upended normal life, and just as long since restrictive measures closed schools, restaurants and other businesses to curb the spread of the coronavirus.
The pandemic’s ebbs and flows, awash with a shattered economy and lost lives, culminated in January when more than 3,000 people per day, on average, died due to the virus.
But the coronavirus came in waves, hitting regions at different seasons and creating scenes of lockdowns in one state while beaches remained open in another.
While the first confirmed case of Covid-19 in the United States was recorded in January 2020 in Washington state, it was the Northeast that bore the brunt of the disease that spring. New York, New Jersey, Connecticut, Massachusetts and Rhode Island recorded the highest per-capita cases and deaths, among all states in that time, between March and May 2020.
“It was hell,” said Dr. Brian Strom, chancellor of Rutgers biomedical and health sciences in New Jersey, who said that health care facilities in the region were overwhelmed, dealing with shortages of tests, personal protective equipment for staff, ventilators and beds for patients, and even space for the dead.
“It got so bad that we asked for parking lot space for body bags,” he said.
Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases who would be thrust into the spotlight, said the coronavirus could kill 100,000 to 200,000 people in the U.S. while infecting "millions" of others.
By March 2020, cases popped up in more than a dozen states and countries across the world, and the World Health Organization declared the outbreak a pandemic. While the Trump White House sought to downplay the severity of the outbreak, many state officials had enacted drastic measures to curb the spread of the virus.
California issued the first stay-at-home order March 19, and within a week, 21 more states issued similar orders.
Dr. Brad Spellberg, the chief medical officer at the Los Angeles County-University of Southern California Medical Center, said that he believes the stay-at-home order helped stave off a spring outbreak in the state.
“That kept us from becoming what happened to New York in the spring. I think if we had waited one or two more weeks, we would have ended up completely overwhelmed like New York was,” he said.
The stay-at-home orders, which shuttered bars, restaurants, schools, and every business other than those deemed “essential” by states, sent unemployment skyrocketing. Just under 300,000 people filed for unemployment benefits the week before California’s stay-at-home order. The week of the order, that number jumped to more than 3 million.
In Louisiana, cases exploded following Mardi Gras celebrations. Those cases would portend what was to come as spring break gatherings spread the virus deeper into the country.
As some states attempted reopening measures, officials ran into obstacles that would repeat in the months to come: Lockdown fatigue would spur many to disregard protective measures and gather in large groups.
"If you look at the data, as soon as the county locked down in March of last year, cases began to slow. And they really did slow throughout April and into May," Spellberg said. "And then, in June, things started to pick up, presumably because people got lockdown fatigue."
June-August 2020: The map shifts
The map shifted in the summer as cases receded in the Northeast and surged in the South and the West. Florida, Georgia, South Carolina, Alabama and Mississippi led the nation in new cases between June and August 2020, with Mississippi and Arizona logging the highest death rates when adjusted for population.
Several of those states were among the first in the country to emerge from stay-at-home orders. South Carolina began easing restrictions April 20, with Georgia, Mississippi and Alabama following by the end of that month.
In contrast, the pandemic-scarred Northeast held restrictions longer. New York state began reopening its economy May 15, with New York City delaying its reopening until June. The later move coincided with a drop in new cases in the Northeast. And New York City, the pandemic’s epicenter in the spring, would go on to experience its first day without a Covid-19 death in July.
But while cases were declining on the East Coast in July, the virus had exploded in Florida, which saw more than 15,000 cases in a single day that month. Gov. Ron DeSantis, a Republican, resisted calls for a statewide mask mandate.
That month, the country would see states smash daily case records. Arizona would see 45,000 new cases by then and lose almost 500 residents to the virus, a number that would grow far beyond that in the months to come.
September-November 2020: Rural communities hit
Having initially hit urban areas, the virus spread to rural communities in the Great Plains in the fall. States stretching from Idaho to Indiana and from North Dakota to Oklahoma saw cases surge above the rest of the country from September to November, with the Dakotas seeing the highest population-adjusted rate of new confirmed cases for any state during any quarter.
In South Dakota, the Centers for Disease Control and Prevention linked dozens of Covid-19 cases to a motorcycle rally in Sturgis in the summer.
“This pandemic was a true crisis from a health standpoint, across the country, and especially here in western South Dakota,” said Dr. Shankar Kurra, the vice president of medical affairs for Monument Health in South Dakota.
“We had the luxury of planning [for] all of this. So, when we were seeing the numbers in March and April in New York City, we already made a plan by the end of March and into April,” he said.
“Despite all that planning, you know when it actually hits us. Reality is something that makes you wake up and realize we're in it.”
Kurra said that his hospital saw increases in cases after the Sturgis motorcycle rally, and that no rural community was spared.
“As long as there was movement, and people moving freely across the country, across state lines ... the virus, all it needed was human contact.”
And fall presented many opportunities for that to happen with the holidays around the corner.
While cases in Wisconsin swelled, Gov. Tony Evers, a Democrat, ran into political and legal opposition to mask mandates. By Halloween, more than 2,000 Wisconsinites would be killed by the virus.
December 2020-February 2021
The winter has been bad just about everywhere.
Unlike previous quarters, rising cases were not confined to a geographic region. Except for Hawaii, every state recorded more than 1,000 cases per 100,000 people between December and February, levels of infection only the Northeast had reached back in the spring.
Cases in the U.S. had continued to rise into December in almost every state with governors enacting new restrictions as colder weather drove most indoors. December would prove to be one of the deadliest months as the country lost 77,000 people to the disease.
The increases came after people shook off multiple warnings from the CDC against holiday travel and sent air traffic to several post-pandemic highs right as new, more infectious variants of the coronavirus began circulating in the country.
Spellberg, from USC, said they knew that it was going to be bad in the winter.
“I think that human beings have limits to what they can sustain,” he said. “If you tell [people], they're going to have to socially isolate for 12 months, that's not realistic. That's not going to happen. So, I think at some point, you have to start easing off to reset.
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“You want to have people reset their clocks, so you can lock down again when you truly need to.”
December also brought cause for hope, as states began distributing Pfizer-BioNTech vaccine doses to front-line health workers and residents of long-term care facilities. That effort would increase after the Food and Drug Administration authorized the emergency use of a second vaccine, this one made by Moderna.
Spellberg said that one of the takeaways from this pandemic is the country’s health care system, which he said is abysmal.
“It underperforms all wealthy nations pre-Covid, based on outcomes and costs. We have the worst performing health care system in the world, relative to all of our wealthy peers. And Covid exposed it.”