Arundhati Roy observed: “Historically, pandemics have forced humans to break with the past and imagine their world anew”。然而,我设置我的期望降低有限公司VID-19, hoping that this pandemic will provide the motivation to make the changes we always knew needed to happen, but lacked the political will and motivation to implement them.

The United States’ failed response to the COVID-19 pandemic is multifaceted and started with a lack of infectious disease infrastructure and the failure to learn from outbreaks of multi-drug resistant organisms (MDROs) and past epidemics. Of overriding importance, was a failure to conceptualize that we all live in the same biosphere. Whether we are confronting global warming, antibiotic resistance, or a pandemic; everyone’s actions affect the health and welfare of all. We cannot hope to control the spread of infectious diseases without international cooperation and universal access to healthcare.

That We Need to be Prepared and Maintain a Robust Infectious Disease Infrastructure

Over the past two decades, the world has seen major epidemics from EBOLA, SARS and MERS. Singapore learned from experience and upgraded their infectious disease infrastructure, Their stockpile housed almost three N95 masks per residentat the start of the COVID-19 pandemic,although not every country was so well prepared.

The United States went in the opposite direction and stepped back from its leadership role in pandemic preparedness and response, largely ignoring the advice of its scientific community. CDC funding was cut in 2019 and hada projected decrease for 2020从2017年至2020年，CDC的中国工作人员从大约47人砍伐到约14个人，包括流行病学家和其他卫生专业人员.

In the Spring of 2018, the United States’ pandemic响应团队解散和its activities were largely reassigned to other agencies. Crimson Contagion, a pandemic response scenario, predicted a confused uncoordinated response,which aptly foretold what took place.Our strategic reserves of N95 masks were all but depleted but even at maximum capacity, the stockpile was only designed to provide预计35亿个面具的预计需求的2.4％.

Early detection of community spread is vital to generate the ‘Data-for-Action’ which is needed to stop the spread of dangerous pathogens.

Testing and Surveillance of Community Spread is Key to Stopping An Epidemic
Early detection of community spread is vital to generate the ‘Data-for-Action’ which is needed to stop the spread of dangerous pathogens.

During the Ebola epidemic of 2014, the Government of Guinea, changed the case definition by requiring a positive laboratory test to diagnose an infection and document spread. The country had limited testing capability and because of this, the number of reported cases fell. The world thought the epidemic was under control, but instead it spread into surrounding regions and countries,在整个单词中未被响应机构发现。

Similarly, the United States had inadequate testing early in the COVID-19 pandemic. The virus entered our pacific Northwest. A decision was made not to adopt the World Health Organization test which was developed in Germany, and prohibit independent labs from performing Laboratory-Developed Tests. Instead, the United States was to rely on a test developed by the Centers for Disease Control and Prevention (CDC),which was found to be defective.这导致了何时获得测试的测试能力和限制性标准。未检测到无症状的传播，病毒在美国的整个社区中传播。

The United States has limited data on community spread for all of the pathogens你所列的疾病预防控制中心gent and Serious Threats. For the most part, what we know is based upon small studies which generate data from skewed populations admitted or seen within our healthcare system, and there is even limited data regarding MRSA, the most common organism responsible fordangerous co-infection in COVID-19 patients. The CDC does collect data regarding MRSA infections which occur within the first three days of hospitalization; this data is felt to be a surrogate for community infections, but it is not released to the public.

CDC guidance was also changed to no longer recommend screening for asymptomatic SARS-CoV-2 carriers. There was a resultant outcry from public health officials regarding how ill-advised this was; and who quickly retorted that without knowing community spread and identifying asymptomatic carriers,一个人无法控制大流行. The CDC quickly revised their guidance again andrecommended testing for asymptomatic carriers, but in the United States, the opposite holds true for prevention of Methicillin-resistant Staphylococcus aureus (MRSA). There is opposition to identification of carriers and the screening of patients on admission to hospitals, and even with isolation and decoloniziation of those who harbor the organisms (for more, clickhere,here和here)

国家报告系统需要涵盖所有类型的感染和共同感染。

The Need for a National Reporting System for Dangerous Pathogens
A major deficiency in the United States’ infrastructure was the absence of a national reporting system for infectious diseases. In 2012, the requirement for hospitals to keep an infection control log was eliminate, and the excuse given was that hospitals already track infectionsthrough other reporting systems.

However, of the CDC’s five contagions designated as ‘Urgent Threats’ onlyClostridioides difficile强制性地报道了国家一级的报道，以及仅耐甲氧西林的“严重威胁”Staphylococcal Aureus(MRSA) is mandatorily reported on a national level and only for acute care hospitals.

这一大流行的关键课程之一是需要为所有危险病原体实施强制性的国家报告系统，该系统包括所有类型的healthcare facilities and providers.这是针对SARS-COV-2实现的，对于CDC的所有“紧急”和“严重威胁”，情况也是如此。国家报告系统需要涵盖所有类型的感染和共同感染。此外，还需要报道特定类型的感染，包括与导管相关的尿路感染，相关的血流感染和呼吸机相关感染。

The system also needs to be real-time and transparent. In response to COVID-19,nursing home interim guidance in the United States requires facilities to, “Inform residents, their representatives, and families of those residing in facilities by 5 p.m. the next calendar day following the occurrence of either a single confirmed infection of COVID-19, or three or more residents or staff with new-onset of respiratory symptoms occurring within 72 hours of each other.” The same needs to be true for all dangerous pathogens in all types of healthcare facilities.

What lessons have been learned?
Many lessons have been learned from COVID-19. We have learned that case definitions can be rapidly created and a reporting system which comprises all types of healthcare facilities can be implemented. The same needs to be done for other dangerous pathogens, including the CDC’s Urgent and Serious Threats, and strategies need to be standardized across all types of facilities. SARS-CoV-2 does not vary its lethality or infectivity based upon the facility type or region of the country.

South Korea embraced public health strategies early on and to date has lost less than 500 residents in their country. If the United States would have followed this strategy early on, it would have lost approximately 3000 individuals (corrected for population), a far cry from the over 220,000 residents which have died from COVID-19.

每个公民都需要照顾和保护他人。在预防传染病时，需要放弃旧的心态。这意味着采用一项国家战略，该战略具有强大的接触跟踪和愿意自我汇率的联系。

Of utmost importance in controlling this pandemic, we need a robust infectious disease infrastructure, a national reporting system for all dangerous pathogens to allow for strategic resource production and allocation, along with extensive contact tracing for SARS-CoV-2 and contacts being willing to give up personal freedoms and self-quarantine for the benefit of others.