What went wrong during the Northeast's first COVID-19 spike, and is the region ready for another?

In early March, Dr. Jeffrey Shaman watched from his New York City home as political leaders debated how best to control the first cases of the new coronavirus.

It soon led to screaming at the television.

Shaman, an infectious disease expert at Columbia University, said he thought city schools should have been closed right then, in the first week of March, or at least by the second week of the month.

"It was definitely too slow," he told the USA TODAY Network. "I could not believe the schools were still open."

Schools in New York ultimately closed March 16 when the state had 950 COVID-19 cases and nine deaths.

New York and New Jersey have gone on to have the most coronavirus deaths in the nation, nearly 32,600 (including 4,600 probable deaths in New York City) and 15,700, respectively.

That was followed by 8,500 in Massachusetts; 8,400 in California; 7,600 in Illinois; and 7,100 in Pennsylvania. Maryland had about 3,500 deaths, while Delaware had 580, according to federal data.

US coronavirus map:Tracking the COVID-19 outbreak nationwide

Infection rates in the Northeast have fallen to record lows in recent weeks even as they have soared to record highs in more than 30 other states, mostly in the South and West.

Now the question is: How well prepared are Northeast states for another spike of COVID-19?

Nowhere in the country is a region more aware of the virus' impact than the Northeast.

And that experience – with thousands of deaths, overwhelmed hospitals and a shuttered economy – is working to inform how officials respond to an anticipated second wave.

The states have been working together to try to thwart a spike but at the same time making independent decisions on when to open or close certain industries.

"We see the second wave in the distance," New York Gov. Andrew Cuomo said July 17. "It will have an effect on New York. How bad? We don’t know. But we cannot stop the virus at our borders. We’re trying everything we can."

Late shutdowns, European travel and nursing homes fueled virus' early days

Shaman's early warnings about the need for a quick shutdown were not heeded. New York didn't close to nonessential workers until March 22, when the state had 114 deaths and more than 15,000 cases.

Shaman co-wrote a study in May that said New York could have saved as many as 17,000 lives if it instituted its stay-at-home order two weeks earlier.

"We didn’t pick up and learn quickly from seeing what was happening in China," Shaman said.

"We didn’t follow the leads of South Korea and Vietnam and Taiwan to control it, and we dithered and doubted the evidence and worried about the economic repercussions of it, which I can understand." 

New York's stay-at-home order:Should state leaders have acted sooner?

He added, "It’s an uncertain time and it’s difficult, but this is one of the few instances where leadership really matters."

Cuomo has put the blame squarely on the federal government, saying it let more than 3 million Europeans travel to the U.S., mainly the Northeast, at least six weeks before the pandemic became apparent.

A U.S. Centers for Disease Control and Prevention report July 17 noted that by the time travel restrictions from Europe were put in place March 13, "importation and community transmission of SARS-CoV-2 had already occurred in NYC."

A faster shutdown may also have saved more lives among the most vulnerable population, those in nursing homes and extended care facilities.

About 43% of New Jersey's deaths occurred in nursing homes, while nearly 6,300 deaths in New York, or 25% of the total, were in the facilities. Nursing home deaths made up nearly 70% of COVID-19 deaths in Pennsylvania.

The nursing home deaths have drawn heavy scrutiny over whether states should have better insulated residents from COVID-19 cases, but New York has insisted the problem was the result of staff spreading the infection through the homes.

U.S. Rep. Tom Reed, R-N.Y., is among those calling for an independent investigation of nursing home deaths.

He said in a statement July 6 that blaming staff "when the state knowingly created COVID hotspots by forcing homes to accept COVID-positive patients is a slap in the face to those who lost a loved one."

New Jersey nursing home deaths:Police find 18 bodies in 'makeshift' facility

What Northeast states learned from the first wave of the pandemic

New York's daily death toll hit as high as 800 in early April, but now daily deaths are in the single digits, and there have been a few days without any deaths reported.

The Northeast is trying to keep it that way: New York, New Jersey and Connecticut are requiring a 14-day quarantine for visitors from states with high infection rates and requiring they fill out questionnaires when they enter New York.

And the states' phased reopening has been largely successful compared with states in the South and West that now are shutting down businesses after a broad reopening last month.

"The only way we can keep our positivity rate and our RT, or rate of transmission, low is by taking the precautions that we have across the past four months," New Jersey Gov. Phil Murphy said July 17.

The pandemic, in many ways, has laid bare fundamental flaws in American society.

'We're witnessing history':Why George Floyd's death, COVID-19 inequality sparked protests

COVID-19 racial disparities:Black people dying from coronavirus at much higher rates in cities across the USA

Watching the coronavirus spread like wildfire through low-income communities plagued by overcrowded housing underscored the systemic racism fueling disparate health outcomes for generations of Black and Hispanic people.

Stories of nurses and doctors being infected with COVID-19 and dying as hospitals struggled to secure protective masks and gowns exposed gaping holes in emergency preparedness plans and government stockpile systems.

And in the face of new surges across the country, renewed fears of shortages of personal protective equipment and COVID-19 testing supplies further revealed the faults in a medical supply chain over-reliant on Chinese imports.

Yet efforts in the Northeast to shore up regional manufacturing of basic medical goods and COVID-19 testing infrastructure show promise against a second wave.

New public health responses targeting zip codes hit hardest by COVID-19 deaths also offered a glimmer of hope that key resources, including contact tracing, testing and medical care, would better reach communities of color.

Meanwhile, politically charged debates over reopening plans and mask wearing in public, which New York ordered April 15 to help turn the tide in its coronavirus outbreak, endangered the entire undertaking nationally, experts said.

“We are seeing unnecessary tens of thousands of deaths and illnesses and disruption because people do not want to believe the evidence,” said Dr. Gregory Poland, an Infectious Diseases Society of America and Mayo Clinic expert.

“They make it into a political or cultural or economic or faith-based issue, and it’s not,” he said. “The virus knows nothing of those areas. The virus knows one thing: Find the next susceptible person and infect them.”

Delaware's meat plants, nursing homes hit hard as testing lagged

That was the case in Delaware: State health officials saw a significant outbreak in April in small towns in Sussex County, particularly among Hispanics and Haitian immigrant communities.

Many of those residents work in the county’s largest industry – chicken processing plants – where to complete their jobs, workers must stand close together, not adhering to social distancing guidelines.

Cheap chicken, beef came at a cost:How American meat plants bred coronavirus hot spots.

Many of the low-income workers can't afford to lose a paycheck, leading to hesitation about whether they should get tested – even if they have been exposed to the virus.

Language barriers led to challenges when the residents tried to access emergency resources and learn what safety precautions they needed to take.

Delaware nursing homes were also devastated in the early weeks of the pandemic, particularly because it was difficult for facilities to obtain protective equipment for employees and they have been historically understaffed.

Because of limited testing in Delaware at the time, only residents with symptoms could receive a COVID-19 test. 

Deaths in long-term care facilities have contributed to more than 60% of the cumulative number of COVID-19 deaths in Delaware. It has led to Gov. John Carney requiring all long-term care employees to be tested on a weekly basis. 

"One of the biggest problems across the country and every state in America from the beginning of this COVID crisis was the lack of availability of testing," Maryland Gov. Hogan said June 10. 

A quick, cheap test would help stop COVID-19:So why don't we have one?

While Delaware has seen a decrease in the number of daily COVID-19 cases and hospitalizations, the Rehoboth-Dewey Beach ZIP code saw a spike in cases in late June. Many of these cases involved young people and residents.

In late June, Carney announced that he is pausing Delaware's plans to reopen its economy. Not long after, he mandated that, in eastern Sussex County, customers will no longer be able to sit or stand at a bar. Instead, beachgoers will have to sit at a table and be served.

“Too many Delawareans and visitors are not following basic public health precautions," Carney said June 25. "Now’s not the time to let up." 

Pennsylvania sees harsh economic effects

When the coronavirus pandemic hit Pennsylvania in March, Gov. Tom Wolf scrambled to prevent his biggest fear: overwhelmed hospitals that had no beds for patients.

Pennsylvania never ran out of hospital beds or lifesaving ventilators, even when the virus peaked in April.

But businesses opened in defiance of state orders. Republican lawmakers tried to end the emergency powers of Wolf, a Democrat.

Millions lost jobs. Businesses struggled to survive. Without a bailout, the restaurant industry could end up a shadow of its former self, especially now that the governor has ordered them to either cut back to 25% of their dine-in capacity or close again. 

And now, as administrators, parents and politicians argue about whether to send children back to school, Pennsylvania is seeing a surge of fresh cases.

Back to school? Despite CDC recommendations, most major schools going online as COVID-19 cases spike

This pandemic steered Pennsylvania toward a recession. The Pandemic Unemployment Assistance and the Paycheck Protection Program helped, but they have an expiration date, and right now “this virus doesn’t,” Labor and Industry Secretary Jerry Oleksiak said

So even as the state crawls out from economic lock-down, high unemployment and the lingering public health crisis slow the process, leaving economists to agree on one thing: Pennsylvania won't to recover from this disaster for years.

"Ultimately, what’s going to work is not enforcement," Wolf said May 26. "What’s going to work is each and every individual Pennsylvanian, each and every business owner doing everything they can to protect their employees and their customers and protect each other from this disease."

'We don’t really have a clear national policy on this'

Many experts and health officials attributed the most glaring missteps to the lack of federal government leadership.

The criticism spanned from the CDC distributing faulty test kits to states, which delayed the pandemic response in January and February, to mixed messages coming from the Trump administration on the threat posed by spikes in COVID-19 cases.

“We don’t really have a clear national policy on this, and that’s been pretty evident,” said Dr. Michael Mendoza, health commissioner of Monroe County in upstate New York.

In the absence of a universal plan, some states ignored, or shunned, lessons learned in the Northeast, threatening to undo the communal sacrifices that helped reduce infections in New York and New Jersey.

“When our messages and our data became politicized and distorted … that’s when it became very difficult for us,” Mendoza said.

Amid the chaotic early weeks of the pandemic this spring, the politically fueled confusion proved especially harmful because of limited scientific understanding at the time of how the coronavirus stealthily spread before symptoms appeared in many people.

More:The White House has sent conflicting messages on wearing masks and the new coronavirus cases

As intensive care units filled up, state officials scrambled to boost hospital bed capacity. Fears that hospitals would run out of lifesaving breathing machines ignited interstate competition over ventilators as opposed to a coordinated national response.

Ultimately, the flawed preparedness plan and scattershot emergency response helped delay the revelations unfolding today, such as the prospect that all Americans wearing face coverings in public could dramatically decrease the virus’ spread in four to six weeks.

In dissecting the myriad of pandemic-related failures, Poland of the Mayo Clinic evoked findings of the 9/11 Commission report that delved into the terrorist attacks of Sept. 11, 2001.

“We believe the fundamental problem was one of imaginability, though we had been warned many times and many ways, we failed to imagine it was possible and therefore failed to prepare,” he said, recounting the report.

“I think that singular statement is precisely applicable to the pandemic,” Poland said, adding, “I hope that one thing that has happened is that our deniability has been stripped away and our imaginability enlivened.”

Northeast states continue to limit reopening

New York and New Jersey have reopened many businesses but have kept some closed.

New Jersey has not allowed the resumption of indoor dining, while New York has outside New York City.

Malls, casinos and amusement parks have remained shuttered in New York, but New Jersey and Pennsylvania have opened them with safety precautions.

And New York tightened restrictions on outdoor dining, requiring alcohol purchases to be accompanied by food to cut down on large drinking scenes.

It's a process that Northeast governors continue to evaluate based on daily monitoring of the rates of infection. The concern is that the rapid spread of disease in the bulk of the country will eventually cause a spike in states that have tamped down the virus.

"This second wave is just going to be other states infecting us again for a second time," Cuomo said July 16 on MSNBC. 

"There's no vaccine yet," New Jersey's Murphy warned July 17. "All we've got is social distancing, wearing a face covering whenever you are out in public, and certainly whenever you're indoors, washing your hands frequently with soap and water for at least 20 seconds." 

Republican lawmakers in New Jersey say Murphy cut state lawmakers out when he crafted coronavirus-related orders, unfairly allowing big-box retailers to remain open while forcing smaller stores to close.

He limited outdoor gatherings, then showed up at Black Lives Matters rallies where protesters were not socially distanced. Those rallies, however, were not shown to result in spikes of COVID-19 cases.

But, as in other Northeast states, Murphy’s strategy began to look smarter in July.

As states like California, Texas and Florida, which reopened sooner than New Jersey, began to see virus cases surge, their governors hastily closed businesses they had allowed to reopen. Now, Murphy hopes to not join those states in having to change course.

"We should all take pride in the fact we want to get this exactly as right as we can," he said.