[akiddoc]

To break it down, it essentially will ask how can we be more like New Zealand, Australia, Thailand, Vietnam, Japan, South Korea and Taiwan and less like Brazil and Mexico for the NEXT global pandemic?

Goodness I hope they don't approach it that way. While I think it will be useful to look at the approaches used in areas that were relatively successful in containing the epidemic, it is abundantly clear IMHO that the approaches used in these nations would be largely ineffective in the USA. New Zealand, Australia, and Taiwan are islands that are relatively easily isolated from outside infections. They also have much smaller populations than the USA. Thailand, Vietnam, Japan, and South Korea are relatively homogeneous culturally so obtaining compliance is much easier than in the USA. Thailand, Vietnam, and South Korea also have governments that have frequently used major force to control the population.

I believe that we need to first look very hard at what will work here in the USA to prevent us from getting in a situation where we have community spread in many places. We have avoided previous pandemics by doing this, but in fact we were aided by the type of disease and some very good luck. We need to greatly beef up our capability to do this. This will include plans to safely repatriate US travelers when epidemics start in other nations. It may involve considerable inconvenience to travelers, but we are going to need the capability. We have too many people and too many points of entry to just ignore the issue. Once it gets going inside the USA, controlling it isn't ever going to be easy.

We also need to improve our local health departments ability to respond to outbreaks and control them early. IMHO the public needs to be educated to the idea that public health enforcement exists and will be used! We have the legal mechanisms in place because we previously used them to deal with localized epidemics. Our current politicians seem to believe that the population will simply revolt if they try to enforce isolation/quarantine. That has to change. The public has to know that these steps will be taken and will be enforced. In all the nations you cited as better examples (except Japan), that is the case. The local tracking and tracing capability needs to be maintained adequately to handle an outbreak, but that is pointless if there is no enforcement. We are experiencing that right now and have been for months.

The third arm of the changes we need was outlined by Tony Fauci in his conversation with the Dean of the medical school. We need to develop the capability to create antivirals "on demand" to attack things like COVID-19 early on. The "warp speed" effort to develop a vaccine is great, but this type of effort will always take many months because you have to vaccinate a large percentage of the population to gain an effect. In the meantime, you can't have people dying in large numbers. The only way to avoid lockdowns is to treat the disease successfully. We are getting there with COVID-19. 
https://www.medpagetoday.com/infectiousd...definition

However, right now things like this take too long. We need more "generic" methodologies that deliver an effective treatment in weeks or at most two months. Is this easy? No. Can it be done? Probably. We are on the edge of being able to do it. Make it a priority and it will happen. This is the type of  approach that the public will like, because they don't have to do anything but fund it. No loss of freedoms or annoying isolation requirements. Money will be made as well. What's not to like? As a side benefit, we may actually cure the common cold.

The monoclonals do not decisively end the progression of Covid. They have to be given IV. It isn't a very practical approach when you need to treat 10,000,000 people or more in a short period. I believe we have a lot further to go than you are thinking. Effective treatments for viruses have been difficult to develop after decades of intense research. The most cost effective intervention in these diseases is the early intense public health intervention that occurred with SARS and MERS, but was botched by China in this instance.

---

It probably would have meant consolidating international travelers into a handful of locations (maybe NY, Atlanta, Miami, Houston, Chicago, and LA) and closing to international flights outside of the dedicated ports of entry.  That is not a trivial task, and would have required massively reducing the number of flights and travelers to cope (of course, the volume of travelers would have reduced dramatically anyways had people known they would have to quarantine for 14 days).

BC

I've never understood the post-facto blame game.  It's impossible to determine with any accuracy what might have been had the country done X, or had leadership been Z instead of F.  Speculating on excess deaths or any other kind of horror is just that:  speculation.  Way too many unknowns.  

Here's what I'm pretty sure I know:

1.  The White House leadership on Covid could not have been much worse.  Even a consistent message about the gravity of virus, the need to be smart, etc. - which could even have been coupled with optimistic comments, such as "We're going to shelter in place for X weeks to see if we can buy some time and gain a better understanding, and then we'll get back to normal as circumstances allow" (or some other reasonable/non-extreme messaging) - would have done wonders for American mindset and conformity to a basic set of precautions that would have reduced the numbers . . . by some unknown amount.

2.  The local governments - where the rubber hits the road on contact tracing - screwed the pooch on that very important task. Maybe this was a function of the horses having left the barn and a sense of hopelessness by the time their $hit was remotely together; a lack of $$; a lack of will; whatever.  I'm really not pointing fingers, just saying that contact tracing and quarantining in the US has been pretty much abject failure.

This is what I suspect:

1.  That the virus was loose in the US prior to the generally accepted arrival date of late January/early February 2020.  Don't know if we'll ever know for sure on that, but it would be interesting to find out.  [This belief informed by that one study potentially showing 2019 presence in Italy, as well as anecdotes from friends who reported folks having "the worst flu of their lives" in late 2019].



Lastly, the US has a LOT of work to do at all levels of government to be in better position to respond to the next pandemic when (not if) it happens.  Goose has generally covered the terrain very well, so I'll just say +1 to his commentary.

Those anecdotes have proven to be likely just that - anecdotes. When California researchers went back and checked antibodies to Covid (IgG) in people who had those symptoms in late December and in January, and had not been sick after that, none of them had had Covid. That testing was done as soon as the antibody test was available in April. There is still no evidence that Covid came to the USA prior to the new year.

[akiddoc]

To break it down, it essentially will ask how can we be more like New Zealand, Australia, Thailand, Vietnam, Japan, South Korea and Taiwan and less like Brazil and Mexico for the NEXT global pandemic?

Goodness I hope they don't approach it that way. While I think it will be useful to look at the approaches used in areas that were relatively successful in containing the epidemic, it is abundantly clear IMHO that the approaches used in these nations would be largely ineffective in the USA. New Zealand, Australia, and Taiwan are islands that are relatively easily isolated from outside infections. They also have much smaller populations than the USA. Thailand, Vietnam, Japan, and South Korea are relatively homogeneous culturally so obtaining compliance is much easier than in the USA. Thailand, Vietnam, and South Korea also have governments that have frequently used major force to control the population.

I believe that we need to first look very hard at what will work here in the USA to prevent us from getting in a situation where we have community spread in many places. We have avoided previous pandemics by doing this, but in fact we were aided by the type of disease and some very good luck. We need to greatly beef up our capability to do this. This will include plans to safely repatriate US travelers when epidemics start in other nations. It may involve considerable inconvenience to travelers, but we are going to need the capability. We have too many people and too many points of entry to just ignore the issue. Once it gets going inside the USA, controlling it isn't ever going to be easy.

We also need to improve our local health departments ability to respond to outbreaks and control them early. IMHO the public needs to be educated to the idea that public health enforcement exists and will be used! We have the legal mechanisms in place because we previously used them to deal with localized epidemics. Our current politicians seem to believe that the population will simply revolt if they try to enforce isolation/quarantine. That has to change. The public has to know that these steps will be taken and will be enforced. In all the nations you cited as better examples (except Japan), that is the case. The local tracking and tracing capability needs to be maintained adequately to handle an outbreak, but that is pointless if there is no enforcement. We are experiencing that right now and have been for months.

The third arm of the changes we need was outlined by Tony Fauci in his conversation with the Dean of the medical school. We need to develop the capability to create antivirals "on demand" to attack things like COVID-19 early on. The "warp speed" effort to develop a vaccine is great, but this type of effort will always take many months because you have to vaccinate a large percentage of the population to gain an effect. In the meantime, you can't have people dying in large numbers. The only way to avoid lockdowns is to treat the disease successfully. We are getting there with COVID-19. 
https://www.medpagetoday.com/infectiousd...definition

However, right now things like this take too long. We need more "generic" methodologies that deliver an effective treatment in weeks or at most two months. Is this easy? No. Can it be done? Probably. We are on the edge of being able to do it. Make it a priority and it will happen. This is the type of  approach that the public will like, because they don't have to do anything but fund it. No loss of freedoms or annoying isolation requirements. Money will be made as well. What's not to like? As a side benefit, we may actually cure the common cold.

The monoclonals do not decisively end the progression of Covid. They have to be given IV. It isn't a very practical approach when you need to treat 10,000,000 people or more in a short period. I believe we have a lot further to go than you are thinking. Effective treatments for viruses have been difficult to develop after decades of intense research. The most cost effective intervention in these diseases is the early intense public health intervention that occurred with SARS and MERS, but was botched by China in this instance.

---

It probably would have meant consolidating international travelers into a handful of locations (maybe NY, Atlanta, Miami, Houston, Chicago, and LA) and closing to international flights outside of the dedicated ports of entry.  That is not a trivial task, and would have required massively reducing the number of flights and travelers to cope (of course, the volume of travelers would have reduced dramatically anyways had people known they would have to quarantine for 14 days).

BC

I've never understood the post-facto blame game.  It's impossible to determine with any accuracy what might have been had the country done X, or had leadership been Z instead of F.  Speculating on excess deaths or any other kind of horror is just that:  speculation.  Way too many unknowns.  

Here's what I'm pretty sure I know:

1.  The White House leadership on Covid could not have been much worse.  Even a consistent message about the gravity of virus, the need to be smart, etc. - which could even have been coupled with optimistic comments, such as "We're going to shelter in place for X weeks to see if we can buy some time and gain a better understanding, and then we'll get back to normal as circumstances allow" (or some other reasonable/non-extreme messaging) - would have done wonders for American mindset and conformity to a basic set of precautions that would have reduced the numbers . . . by some unknown amount.

2.  The local governments - where the rubber hits the road on contact tracing - screwed the pooch on that very important task. Maybe this was a function of the horses having left the barn and a sense of hopelessness by the time their $hit was remotely together; a lack of $$; a lack of will; whatever.  I'm really not pointing fingers, just saying that contact tracing and quarantining in the US has been pretty much abject failure.

This is what I suspect:

1.  That the virus was loose in the US prior to the generally accepted arrival date of late January/early February 2020.  Don't know if we'll ever know for sure on that, but it would be interesting to find out.  [This belief informed by that one study potentially showing 2019 presence in Italy, as well as anecdotes from friends who reported folks having "the worst flu of their lives" in late 2019].



Lastly, the US has a LOT of work to do at all levels of government to be in better position to respond to the next pandemic when (not if) it happens.  Goose has generally covered the terrain very well, so I'll just say +1 to his commentary.

Those anecdotes have proven to be likely just that - anecdotes. When California researchers went back and checked antibodies to Covid (IgG) in people who had those symptoms in late December and in January, and had not been sick after that, none of them had had Covid. That testing was done as soon as the antibody test was available in April. There is still no evidence that Covid came to the USA prior to the new year.