The United States now leads the world in confirmed coronavirus cases

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Scientists warned that the United States would one day become the country most affected by the coronavirus pandemic. That moment came on Thursday.

In the United States, at least 81,321 people are known to have been infected with the coronavirus, including more than 1,000 deaths, more cases than China, Italy, or any other country has seen, according to data compiled by The New York Times.

With 330 million residents, the United States is the third most populous nation in the world, which means it provides a large number of people who can potentially contract Covid-19, the disease caused by the virus.

And it is a sprawling, cacophonous democracy, where states set their own policies and President Trump has sent conflicting messages about the magnitude of the danger and how to combat it, ensuring there is no consistent and unified response to a serious threat to public health. .

A series of missteps and missed opportunities chased the nation's response. Among them: a failure to take the pandemic seriously, even when it engulfed China, a deeply flawed effort to provide comprehensive evidence for the virus that left the country blind to the extent of the crisis, and a severe shortage of masks and equipment. protection to protect front-line doctors and nurses, as well as ventilators to keep critically ill patients alive.

China's leaders, affected by the 2003 SARS epidemic and several bird flu scares since then, were slow to respond to the outbreak that started in Wuhan City, as local officials suppressed the news of the outbreak.

But China's autocratic government acted with fierce intensity after the late start, and finally closed swaths of the country. Singapore, Taiwan, South Korea, and Japan quickly began preparing for the worst.

The United States, on the other hand, remained concerned about business. usual. The dismissal process. Harvey Weinstein. Brexit and the Oscars.

Only a few virologists recognized the threat for what it was. The virus was not influenza, but had the characteristics of the Spanish flu: relatively low case fatality, but relentlessly transmissible.

Cell phone videos coming out of China showed what was happening as it spread in Wuhan: corpses on the hospital floor, doctors crying in frustration, rows of neglected coffins outside the crematoriums.

What the cameras missed, in part because Beijing made life difficult for Western journalists by withholding visas and imposing quarantines, was the slow and unrelenting way in which the Chinese public health system was hunting the virus, case by case, group by group, city by city.

For now, at least, China has contained the coronavirus with draconian measures. But the pathogen had embarked on a Grand Tour of most countries on Earth, with devastating epidemics in Iran, Italy, and France. More videos emerged of bedridden victims, exhausted nurses, and casket lines.

The United States, which should have been ready, was not. This country has an unmatched medical system backed by trillions of dollars from insurers, Medicare and Medicaid. Armies of doctors transplant hearts and cure cancer.

The public health system, limping on local tax receipts, kills mosquitoes and tracks contacts of people with sexually transmitted diseases. It has been overcome by the pandemic.

There was no Pentagon ready to fight the war against this pandemic, there was no war bill. Eventually there was a White House Coronavirus Task Force, but it was led by politicians, not medical experts.

The Centers for Disease Control and Prevention is one of the largest disease detection agencies in the world, and its doctors have contributed powerfully in skirmishes against Ebola, Zika, and any other health threat.

But the agency quietly withdrew, its director, Dr. Robert Redfield, almost invisible, humiliated by a fiasco in the impossibility of producing basic diagnostic tests.

Now at least 160 million Americans have been ordered to stay at home in states from California to New York. Schools are closed, often alongside bars, restaurants, and many other companies. Hospitals are dealing with large numbers of patients in New York City, even as supplies of essential protective equipment and equipment decrease.

Other hospitals, other communities fear what may come.

The world will be a different place when the pandemic ends. India can overtake the United States as the country with the most deaths. Like the United States, it is also a vast democracy with deep internal divisions. But its population, 1.3 billion, is much larger, and its people are even tighter in megacities.

China could still stumble on a new round of contagion as its economy restarts and be forced to do it all over again.

Meanwhile, with the virus on the streets as millions of Americans huddle inside, when will it be safe to get out and back to work?

"The virus will tell us," said Dr. William Schaffner, a preventive medicine specialist at Vanderbilt University School of Medicine.

When a daily testing baseline is established across the country, a decrease in the percentage of positive tests will indicate that the virus has found as many hosts as possible at the moment, and is starting to roll back.

When hospital admissions peaked and began to stabilize, "we can feel optimistic," said Dr. Schaffner. "And when they start to fall, we can start to smile."

That time may come this summer. But as soon as the first of the Americans begins to venture cautiously, we will have to start planning the second wave.

Check back for updates to this unfolding story.

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