With more than 600 000 confirmed cases and close to 27 000 deaths, the USA has become the current centre of the global coronavirus disease 2019 (COVID-19) pandemic. Fewer than 3 months have elapsed since the first severe acute respiratory syndrome coronavirus 2 infection in Washington State was confirmed by the US Centers for Disease Control and Prevention (CDC). Initially appearing slow moving and constrained in contrast to the scale of outbreaks in China and Italy, COVID-19 has given way to a nationwide public health catastrophe. For the first time in US history, a disaster declaration has been put in place for all 50 states and most US territories, and 95% of Americans are at least temporarily under some form of stay at home order. The increasing gravity of the situation in the USA has drawn public health and infectious disease experts, policy makers, and partisans across state and federal government into a fitful clash for control and direction of the COVID-19 response. Putting the USA at odds with the international community and global pandemic strategy efforts, President Trump announced his intention to withdraw funding from WHO (about 22% of its budget). Caught amid the chaos are the American people grappling with the fear of a deadly and poorly understood virus, conflicting messaging around their protection and safety, fear of financial fallout, absence of a cohesive national strategy, and volatile, incompetent leadership.

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In hard-hit states such as New York, although hundreds of COVID-19 deaths are still occurring daily, hospital admissions appear to have plateaued. Credit might be due to effective physical distancing measures that limit community mobility. But progress in preventing the spread of COVID-19 has come with economic havoc—at least 17 million Americans are unemployed, a number that could ultimately surpass the Great Depression, and take years to correct. A new impasse is forming around the Trump administration's eagerness to boost the economy by lifting restrictions, just as mitigation efforts by the states are yielding results. The degree to which the USA stalled in taking aggressive action to curtail the spread of COVID-19 is directly the product of an administration marked by consistently poor timing, intent on making decisions in favour of economic interests instead of those that are guided by science and to protect health. The rush to reopen the country puts dollars over deaths.