[Goose]

Much of the CDC's strategy for dealing with novel pathogens of zoonotic infections has hinged on early detection and containment at the source (hence the CDC's global presence).  This is not a bad thing.  Unfortunately, recent federal policy defunded, deprioritized, and all but eliminated that capability.

I fully support the CDC having a global presence. Being "forward deployed", they can at worst provide us with data on new threats as they emerge and can sometimes help the country involved to contain the outbreak. However, if the outbreak happens in a country that does not allow outsiders access to data, the value of the observers is reduced. Further, if the outbreak occurs in a country with good direct or indirect air connections to the US, the "early warning" is greatly diminished. If the outbreak is in Liberia, it will help a lot. If it is in Italy, it won't. We can't count on a complete victory or even significant retardation of spread. That doesn't mean give up, but it does mean have a "plan B"

It may be argued that even with the forward-deployed CDC and national security assets that SARS-CoV-2 would have made its way to US shores anyway, but even in that situation, we would probably have been much better prepared (testing, tracing, etc.) than we actually were.

I am not sure why you believe we would be better prepared. We are still working madly to piece together our tracking and tracing capability, after being very aware of the problem for several months. I do wish that the CDC had had observers in Wuhan. However, given that the CCP wouldn't cooperate with the WHO inspectors, I doubt that the CDC guys would have got much data either. The real question is if we knew more about the threat a few weeks sooner would we have done anything much differently? The observers in Wuhan wouldn't have known that New York was going to get infections from Europe.

The CDC hasn't had to deal with a novel direct-contact disease since H1N1 afaik, and that response was brilliant compared to the muck-up that we have today: https://www.cdc.gov/flu/pandemic-resourc...eline.html.  There was less than a month between first detected case to global shipments of tests.  It was about six months from first detected case to first deployed vaccine doses.

I too had thought that the CDC response to H1N1 was pretty good until I started to look into it in response to your post. Turns out, it had a lot of the same problems they had this time. Take a look at https://www.cdc.gov/h1n1flu/diagnostic_t...lic_qa.htm. You will see that the PCR test was only available if you were in the hospital or pregnant. It also took days to get a response. Since the mortality rate and hospitalization rate for H1N1 is significantly less than for COVID-19, this lack of testing, while annoying, was not critical. As the cited document points out, the clinical treatment of the flu was the same no matter what kind you had, so the specific test was almost never necessary. For more insight into that situation, look at https://www.cdc.gov/h1n1flu/cdcresponse.htm. In that document it states "The transition away from CDC lab confirmation testing didn’t happen overnight though - between April 23 and May 31, 2009, CDC influenza laboratory analyzed about 5,000 influenza virus samples, five times the number that were processed in a similar timeframe in 2008, and more than during any previous influenza season." The CDC is trying to give themselves a BZ for doing 5,000 tests in 37 days. I kind of think we would laugh at that today.

The above testing approach is important because it is the exact strategy the CDC attempted to use against COVID-19. The fact they did not have a proper QC procedure bit them this time, but even if it hadn't, they were replicating what they did in 2009. Unfortunately that would have been entirely inadequate for COVID-19 even if it had been executed according to plan. There is evidence that to some degree the CDC knew that. In
https://www.aphl.org/AboutAPHL/publicati...ndemic.pdf
you will see references to laboratory developed tests and some references to what PCR testing challenges existed going forward. This was in 2011, and there was the usual disclaimer that the conclusions were not official policy etc. The fact they trotted out the same approach in 2020 makes one believe nothing significant was done.

Additionally, the vaccine developed in six months was not manufactured in sufficient quantity to be generally useful and turned out to be fairly ineffective. It was promptly replaced. This is from the CDC documents as well. Fortunately in 2009 "it was just the flu".

So, all in all, it doesn't look like we improved much from 2009. Fortunately for us, the CDC monitors influenza and attempts to trace the sources, at least to some degree. They jumped on H1N1, but not COVID-19. The lab at UW used some such samples to find COVID-19 cases despite some regulatory obstacles. Sometimes, a few people do (or don't) make a big difference.

[Goose]

Much of the CDC's strategy for dealing with novel pathogens of zoonotic infections has hinged on early detection and containment at the source (hence the CDC's global presence).  This is not a bad thing.  Unfortunately, recent federal policy defunded, deprioritized, and all but eliminated that capability.

I fully support the CDC having a global presence. Being "forward deployed", they can at worst provide us with data on new threats as they emerge and can sometimes help the country involved to contain the outbreak. However, if the outbreak happens in a country that does not allow outsiders access to data, the value of the observers is reduced. Further, if the outbreak occurs in a country with good direct or indirect air connections to the US, the "early warning" is greatly diminished. If the outbreak is in Liberia, it will help a lot. If it is in Italy, it won't. We can't count on a complete victory or even significant retardation of spread. That doesn't mean give up, but it does mean have a "plan B"

It may be argued that even with the forward-deployed CDC and national security assets that SARS-CoV-2 would have made its way to US shores anyway, but even in that situation, we would probably have been much better prepared (testing, tracing, etc.) than we actually were.

I am not sure why you believe we would be better prepared. We are still working madly to piece together our tracking and tracing capability, after being very aware of the problem for several months. I do wish that the CDC had had observers in Wuhan. However, given that the CCP wouldn't cooperate with the WHO inspectors, I doubt that the CDC guys would have got much data either. The real question is if we knew more about the threat a few weeks sooner would we have done anything much differently? The observers in Wuhan wouldn't have known that New York was going to get infections from Europe.

The CDC hasn't had to deal with a novel direct-contact disease since H1N1 afaik, and that response was brilliant compared to the muck-up that we have today: https://www.cdc.gov/flu/pandemic-resourc...eline.html.  There was less than a month between first detected case to global shipments of tests.  It was about six months from first detected case to first deployed vaccine doses.

I too had thought that the CDC response to H1N1 was pretty good until I started to look into it in response to your post. Turns out, it had a lot of the same problems they had this time. Take a look at https://www.cdc.gov/h1n1flu/diagnostic_t...lic_qa.htm. You will see that the PCR test was only available if you were in the hospital or pregnant. It also took days to get a response. Since the mortality rate and hospitalization rate for H1N1 is significantly less than for COVID-19, this lack of testing, while annoying, was not critical. As the cited document points out, the clinical treatment of the flu was the same no matter what kind you had, so the specific test was almost never necessary. For more insight into that situation, look at https://www.cdc.gov/h1n1flu/cdcresponse.htm. In that document it states "The transition away from CDC lab confirmation testing didn’t happen overnight though - between April 23 and May 31, 2009, CDC influenza laboratory analyzed about 5,000 influenza virus samples, five times the number that were processed in a similar timeframe in 2008, and more than during any previous influenza season." The CDC is trying to give themselves a BZ for doing 5,000 tests in 37 days. I kind of think we would laugh at that today.

The above testing approach is important because it is the exact strategy the CDC attempted to use against COVID-19. The fact they did not have a proper QC procedure bit them this time, but even if it hadn't, they were replicating what they did in 2009. Unfortunately that would have been entirely inadequate for COVID-19 even if it had been executed according to plan. There is evidence that to some degree the CDC knew that. In
https://www.aphl.org/AboutAPHL/publicati...ndemic.pdf
you will see references to laboratory developed tests and some references to what PCR testing challenges existed going forward. This was in 2011, and there was the usual disclaimer that the conclusions were not official policy etc. The fact they trotted out the same approach in 2020 makes one believe nothing significant was done.

Additionally, the vaccine developed in six months was not manufactured in sufficient quantity to be generally useful and turned out to be fairly ineffective. It was promptly replaced. This is from the CDC documents as well. Fortunately in 2009 "it was just the flu".

So, all in all, it doesn't look like we improved much from 2009. Fortunately for us, the CDC monitors influenza and attempts to trace the sources, at least to some degree. They jumped on H1N1, but not COVID-19. The lab at UW used some such samples to find COVID-19 cases despite some regulatory obstacles. Sometimes, a few people do (or don't) make a big difference.