[2006alum]

And it has to be national: even if the Santa Clara Health Commissioner were the world's finest, he or she can't isolate cases coming from outside Santa Clara all on her own. 

Yes she can (not personally, but with an adequate, trained staff). It is inherently a mostly "local" action anyway. One of the real encouraging aspects of this whole thing is how well the Bay Area counties have worked together to start a community response. This type of tracing activity needs to be "national" only in the sense that people who are determined as likely to be ill have to be traced even if they cross state lines. Theoretically, the USPHS is responsible for making sure this happens. The "within California cases" can be handled within California. It doesn't require (or really benefit from) getting the USPHS directly involved tracing local cases. We do need a national data base of un-located contacts/potentially exposed persons, but not much more. Without this data base, it will be more difficult but not impossible to keep the disease under control. The elimination of outbreak "pockets" will be a continuing requirement in any case.

The problem may very well be (is, IMHO) that the Santa Clara County Health Department doesn't have the trained staff to do so. If this were a "small" outbreak, the USPHS might have enough trained people they could send to help us do it/do it for us, although even then I think it is a bit "iffy". Given the size of the outbreak, that isn't feasible. We need to slap together enough people to do this, and quickly. The cavalry isn't going to ride in and save us. In this case, it doesn't really exist.

I guess my point was simply that unless every county health commissioner is doing this, if others aren't, and those contagious patients go across county and state lines, it starts all over again. In this sense, the spillovers are unavoidable and the only way to fix it is a consistent, nationwide response. Taiwan wouldn't have simply 1/2 the success it's having if 1/2 the island declined to test, contact trace, and isolate, because it only takes a few rotten/contagious apples to re-spoil the whole barrel.

[2006alum]

And it has to be national: even if the Santa Clara Health Commissioner were the world's finest, he or she can't isolate cases coming from outside Santa Clara all on her own. 

Yes she can (not personally, but with an adequate, trained staff). It is inherently a mostly "local" action anyway. One of the real encouraging aspects of this whole thing is how well the Bay Area counties have worked together to start a community response. This type of tracing activity needs to be "national" only in the sense that people who are determined as likely to be ill have to be traced even if they cross state lines. Theoretically, the USPHS is responsible for making sure this happens. The "within California cases" can be handled within California. It doesn't require (or really benefit from) getting the USPHS directly involved tracing local cases. We do need a national data base of un-located contacts/potentially exposed persons, but not much more. Without this data base, it will be more difficult but not impossible to keep the disease under control. The elimination of outbreak "pockets" will be a continuing requirement in any case.

The problem may very well be (is, IMHO) that the Santa Clara County Health Department doesn't have the trained staff to do so. If this were a "small" outbreak, the USPHS might have enough trained people they could send to help us do it/do it for us, although even then I think it is a bit "iffy". Given the size of the outbreak, that isn't feasible. We need to slap together enough people to do this, and quickly. The cavalry isn't going to ride in and save us. In this case, it doesn't really exist.

I guess my point was simply that unless every county health commissioner is doing this, if others aren't, and those contagious patients go across county and state lines, it starts all over again. In this sense, the spillovers are unavoidable and the only way to fix it is a consistent, nationwide response. Taiwan wouldn't have simply 1/2 the success it's having if 1/2 the island declined to test, contact trace, and isolate, because it only takes a few rotten/contagious apples to re-spoil the whole barrel.