[Goose]

I have no knowledge of the Australian public health apparatus. Why do you think its so much better than the US? The CDC WAS thought of as preeminent, at least before this debacle.

The CDC is (granted my opinion, but I think others support it) still the very best there is on the theory of controlling disease. They are actually pretty good in practice as well, as their help in several recent African outbreaks has been valuable. However, the focus of the CDC has clearly become other people's epidemics. We haven't had a real "bad" one in the US is a very long time. It may be argued we were "lucky", but that is what actually happened. They are great at creating a PCR test for a novel virus. However, as they proved they are not resourced or prepared to make enough tests for the entire US, or anything close to it. They also were not plugged in to what the practical problems of mass testing would be because they hadn't ever done it and had apparently never simulated it. They couldn't do it and didn't know (apparently) that they couldn't do it. They didn't have a plan to actually use the high capacity testing machines for example. Furthermore, the State and County health departments had also lost the ability to do track and trace on anything like a large enough scale. The CDC always has relied on being the administrative and theoretical lead but having most of the "foot soldiers" come from elsewhere. As we are finding out, there aren't anywhere near enough and we are scrambling to create that force.

Australia on the other had has ongoing and active concerns about epidemics from nearby countries. They have a health service in place that has the numbers and the focus on a possible epidemic spread, because for them it is a very real thing. The state governments also have relatively large organizations that are pretty active. I remember a few years ago having to detour on my way to work for a few days because of a health quarantine. They do have disease outbreaks, and the public knows that keeping them under control is important. So it isn't that they are "better". It is that they are focused on the problems that they actually have. None of this is really "rocket science". It is having the ability to implement epidemiology on an adequate scale continuously.

The USA used to be equally focused, particularly on TB. All that pretty much went away when TB could be controlled without isolating people. We don't have a big focus on preventing epidemic spread because we haven't needed it. It isn't just the current administrations (at all levels) "fault" either. While it is obvious that something like COVID-19 could happen, the average person wasn't worried. Therefore, the government (at all levels) had no public pressure to maintain a large public health response capability for events that haven't happened. As I have said previously, everybody thinks they are over insured until they have a claim. Then they think the opposite.

[Goose]

I have no knowledge of the Australian public health apparatus. Why do you think its so much better than the US? The CDC WAS thought of as preeminent, at least before this debacle.

The CDC is (granted my opinion, but I think others support it) still the very best there is on the theory of controlling disease. They are actually pretty good in practice as well, as their help in several recent African outbreaks has been valuable. However, the focus of the CDC has clearly become other people's epidemics. We haven't had a real "bad" one in the US is a very long time. It may be argued we were "lucky", but that is what actually happened. They are great at creating a PCR test for a novel virus. However, as they proved they are not resourced or prepared to make enough tests for the entire US, or anything close to it. They also were not plugged in to what the practical problems of mass testing would be because they hadn't ever done it and had apparently never simulated it. They couldn't do it and didn't know (apparently) that they couldn't do it. They didn't have a plan to actually use the high capacity testing machines for example. Furthermore, the State and County health departments had also lost the ability to do track and trace on anything like a large enough scale. The CDC always has relied on being the administrative and theoretical lead but having most of the "foot soldiers" come from elsewhere. As we are finding out, there aren't anywhere near enough and we are scrambling to create that force.

Australia on the other had has ongoing and active concerns about epidemics from nearby countries. They have a health service in place that has the numbers and the focus on a possible epidemic spread, because for them it is a very real thing. The state governments also have relatively large organizations that are pretty active. I remember a few years ago having to detour on my way to work for a few days because of a health quarantine. They do have disease outbreaks, and the public knows that keeping them under control is important. So it isn't that they are "better". It is that they are focused on the problems that they actually have. None of this is really "rocket science". It is having the ability to implement epidemiology on an adequate scale continuously.

The USA used to be equally focused, particularly on TB. All that pretty much went away when TB could be controlled without isolating people. We don't have a big focus on preventing epidemic spread because we haven't needed it. It isn't just the current administrations (at all levels) "fault" either. While it is obvious that something like COVID-19 could happen, the average person wasn't worried. Therefore, the government (at all levels) had no public pressure to maintain a large public health response capability for events that haven't happened. As I have said previously, everybody thinks they are over insured until they have a claim. Then they think the opposite.

[fullmetal]

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. 

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.  The ability of the virus to spread through asymptomatic transmission exploits American notions of personal responsibility and individual exceptionalism, and the backlash against public health measures has been counterproductive to say the least.

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.

[fullmetal]

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. 

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.  The ability of the virus to spread through asymptomatic transmission exploits American notions of personal responsibility and individual exceptionalism, and the backlash against public health measures has been counterproductive to say the least.

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.

[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.

[fullmetal]

So I can see where you're coming from with your responses, but you should note that all the missteps with H1N1, the recent Ebola outbreaks, et al. were probably addressed in that nifty pandemic playbook that the previous administration handed to the current administration.  Too bad the current administration willfully neglected to attend the transition team pandemic exercise and also declined to use the pandemic playbook for this current crisis.  

I would argue that the CDC response to H1N1 has been about an order of magnitude more organized, faster, and certainly better backed by the rest of the federal apparatus.  The response was coordinated between several agencies across multiple states, and progress was faster, and that saves lives.  We didn't cure H1N1 in two months, but that's not the point.  The point is that the H1N1 response was materially better than the SARS-CoV-2 response, and that's an indication that lessons of the past were ignored.  That is tantamount to criminal negligence when about 100,000 deaths are projected.

Finally, yes, it is well-known that the CDC staff in China would have had better access to data, viral genomic samples, and embedded observations regarding the severity and spread of SARS-CoV-2 in the early days, probably in the first week of January at latest.  The staff build relationships with their Chinese CDC counterparts, not through the WHO but directly.  A real signal would have been sent from the staff to CDC HQ, and measures would have been activated from there that probably would not have been blocked by White House political appointees.  I believe this red alert klaxon would have been nearly impossible to silence if we had gotten data from trusted federal staff and activated CDC operations sooner.

Testing and tracing should be a federally-directed responsibility, or at least, it requires federal leadership.  We know those efforts are being hamstrung politically.  In any case, those are measures that are of little use now that the virus is in full community spread mode.  As the curve flattens and declines and communities re-open, we will need to go back to contact tracing.  That time is really not here yet, despite the wishes of politicians.

[fullmetal]

So I can see where you're coming from with your responses, but you should note that all the missteps with H1N1, the recent Ebola outbreaks, et al. were probably addressed in that nifty pandemic playbook that the previous administration handed to the current administration.  Too bad the current administration willfully neglected to attend the transition team pandemic exercise and also declined to use the pandemic playbook for this current crisis.  

I would argue that the CDC response to H1N1 has been about an order of magnitude more organized, faster, and certainly better backed by the rest of the federal apparatus.  The response was coordinated between several agencies across multiple states, and progress was faster, and that saves lives.  We didn't cure H1N1 in two months, but that's not the point.  The point is that the H1N1 response was materially better than the SARS-CoV-2 response, and that's an indication that lessons of the past were ignored.  That is tantamount to criminal negligence when about 100,000 deaths are projected.

Finally, yes, it is well-known that the CDC staff in China would have had better access to data, viral genomic samples, and embedded observations regarding the severity and spread of SARS-CoV-2 in the early days, probably in the first week of January at latest.  The staff build relationships with their Chinese CDC counterparts, not through the WHO but directly.  A real signal would have been sent from the staff to CDC HQ, and measures would have been activated from there that probably would not have been blocked by White House political appointees.  I believe this red alert klaxon would have been nearly impossible to silence if we had gotten data from trusted federal staff and activated CDC operations sooner.

Testing and tracing should be a federally-directed responsibility, or at least, it requires federal leadership.  We know those efforts are being hamstrung politically.  In any case, those are measures that are of little use now that the virus is in full community spread mode.  As the curve flattens and declines and communities re-open, we will need to go back to contact tracing.  That time is really not here yet, despite the wishes of politicians.