[craftyguy]

> The concern is people have not been taking this seriously for the past two months. This has resulted in the US being on the back foot and only acting in a reactive manner. The CDC has fallen flat on its face and now state public health departments need to try to pick up the slack. I hope they do.

Oh please. There's likely absolutely nothing the CDC could have done to prevent it from entering and spreading within the US, given the nature of the virus. What would have been an ideal situation in your mind, have the CDC order a complete halt to domestic/international travel early January?

[simonh]

Over the last 3 years the CDC funding for participation in international epidemic detection and management programs was cut by 80%. In addition the several most senior positions responsible for pandemic preparation and response were cut. The budget proposed just a few weeks ago again included significant cuts in CDC funding, so the governments eye has not been on the ball for quite some time.

Having said that you’re right that the CDC and health systems in general have mainly and advisory and coordination, rather than a direct role in preventing the spread of a disease. However they need to have the funding, focus and senior representation in order to do that quickly and effectively.

[eqdw]

What differences in behaviour would you have expected to see in the CDC if their budget wasn't cut? I'm not seeing it. This thing spreads too fast to meaningfully stop it, China, Korea, Singapore, Japan, are all examples of this

[simonh]

Understanding the disease quickly and slowing down the spread of the disease is incredibly valuable work. Knowing more about it lets us prepare more effectively. If we can reduce the rate at which it spreads, that gives us more the time to prepare for it by training staff and building up stockpiles. Also even if the number of cases ultimately stays the same, if they are spread out over a longer period that means the number of patients needing care at any one time can be dramatically lower, reducing the strain on the health care system and allowing more resources to be devoted to the care of each patient.

The CDC, or some agency in each country anyway, has four roles in this I think.

The first is as part of international monitoring, research and co-ordination efforts. Pandemics are by definition international phenomena and the countries they are most likely to start in are the ones with weak governments or health care infrastructure. This is the first line of defence.

The second line of defence is advice and information, supporting other government institutions and agencies in co-ordinating their resources. Medical expertise is needed to support border control, diplomatic efforts, internal transit networks, government policy, law enforcement, logistics, the list is endless. These all have a role to play in limiting the transmission of the disease and preparing for the eventuality that is reaches populations. They all need expert advice and that advice needs to be prepared in advance and consistent.

Thirdly if the disease does take a grip, co-ordinating local and regional medical resources and efforts. Collecting data from health care networks to track the disease and direct resources where they are needed most, and ensure those resources are used in the most effective and efficient way possible.

Finally, research. This is a long term commitment to developing new equipment, treatments and techniques. This, and all the previous functions operate at the national or even really international level and can't effectively be progressed by fragmented regional or local health care systems. If it's not the CDC it needs to be somebody.

[craftyguy]

Care to explain what "on the ball" would realistically look like for this specific situation we are in right now? Because everyone else seems to be avoiding the question.

[erentz]

If you're genuinely interested go read how other countries such as Singapore have been handling it. For example Singapore has done a thorough job of testing, tracing, and quarantining individuals and it's slowed the spread dramatically there. They've also been communicating opening and honestly with the public so that the public knows what is happening, knows the right things are being done, and knows what their role is to play.

[simonh]

The CDC used to have a unit in China coordinating with local health care experts to identify and manage epidemics and new diseases. This was cut a few years ago.

Also there used to be a CDC expert on the National Security Council until 2018. Of course you can bring in an advisor as needed, but that’s not the same as having someone you know, and that knows you and how you work, and knows the resources and capabilities you have right there on staff in the NSC.

On the ball would be treating the CDC and pandemic response as national defence, not charity welfare.

[conradev]

Since fixed, but this was Thursday: https://www.nytimes.com/2020/02/27/health/coronavirus-testin...

[pmoriarty]

"There's likely absolutely nothing the CDC could have done to prevent it from entering and spreading within the US"

The point isn't to prevent it from entering and spreading within the US, but to slow down its spread to give the medical community more time to study it and develop treatments and vaccines, and for the US health care system to prepare by increasing capacity, equipment, training, and staffing.

Sadly, little preparation has been happening because people haven't been taking it seriously, and have been squandering the advanced warnings we've gotten from China.

Something else to consider is that a slowly spreading disease is much easier to manage than a fast-spreading, uncontrolled outbreak. The latter leads to an overwhelmed health care system and many more unnecessary deaths.