阿伦达蒂·罗伊（Arundhati Roy）观察到：“从历史上看，大流行者迫使人类与过去打破并重新想象他们的世界。” I however, have set my expectation lower for COVID-19, hoping that this pandemic will provide the motivation to make the changes we always knew needed to happen, but lacked the political will and motivation to implement them.

The United States’ failed response to the COVID-19 pandemic is multifaceted and started with a lack of infectious disease infrastructure and the failure to learn from outbreaks of multi-drug resistant organisms (MDROs) and past epidemics. Of overriding importance, was a failure to conceptualize that we all live in the same biosphere. Whether we are confronting global warming, antibiotic resistance, or a pandemic; everyone’s actions affect the health and welfare of all. We cannot hope to control the spread of infectious diseases without international cooperation and universal access to healthcare.

我们需要做好准备并维持强大的传染病基础设施

在过去的二十年中，世界已经看到了来自埃博拉病毒，萨尔斯和梅尔斯的主要流行病。新加坡从经验中学到的知识并升级了他们的传染病基础设施，他们的储藏室容纳了近三个N95面具在COVID-19大流行的开始时，虽然并非每个国家都有如此充分的准备。

美国朝着相反的方向前进，退后了其在大流行准备和反应中的领导作用，在很大程度上忽略了其科学界的建议。CDC资金于2019年削减了2020年预计减少从2017年至2020年，CDC的中国工作人员从大约47人砍伐到约14个人，包括流行病学家和其他卫生专业人员。

在2018年春季，美国大流行响应团队解散它的活动在很大程度上被重新分配给其他机构。深红色传染病是一种大流行反应的情况，预测了混乱的不协调响应，恰当地预言了发生的事情。我们的N95口罩的战略储量几乎已经耗尽预计35亿个面具的预计需求的2.4％。

Early detection of community spread is vital to generate the ‘Data-for-Action’ which is needed to stop the spread of dangerous pathogens.

Testing and Surveillance of Community Spread is Key to Stopping An Epidemic
Early detection of community spread is vital to generate the ‘Data-for-Action’ which is needed to stop the spread of dangerous pathogens.

在2014年的埃博拉病毒流行期间，几内亚政府通过要求进行阳性实验室测试来诊断感染和文件传播，改变了案件的定义。该国的测试能力有限，因此，报告的病例数量下降。世界认为流行病受到控制，但相反，它传播到周围地区和国家，在整个单词中未被响应机构发现。

Similarly, the United States had inadequate testing early in the COVID-19 pandemic. The virus entered our pacific Northwest. A decision was made not to adopt the World Health Organization test which was developed in Germany, and prohibit independent labs from performing Laboratory-Developed Tests. Instead, the United States was to rely on a test developed by the Centers for Disease Control and Prevention (CDC),发现有缺陷。这导致了何时获得测试的测试能力和限制性标准。未检测到无症状的传播，病毒在美国的整个社区中传播。

The United States has limited data on community spread for all of the pathogens你所列的疾病预防控制中心gent and Serious Threats。For the most part, what we know is based upon small studies which generate data from skewed populations admitted or seen within our healthcare system, and there is even limited data regarding MRSA, the most common organism responsible forCOVID-19患者的危险共感染。疾病预防控制中心确实收集了有关住院前三天内发生的MRSA感染的数据；这些数据被认为是社区感染的代孕，但并未向公众发布。

CDC guidance was also changed to no longer recommend screening for asymptomatic SARS-CoV-2 carriers. There was a resultant outcry from public health officials regarding how ill-advised this was; and who quickly retorted that without knowing community spread and identifying asymptomatic carriers,一个人无法控制大流行。The CDC quickly revised their guidance again and建议无症状载体测试，但在美国，相反的情况是预防耐甲氧西林金黄色葡萄球菌（MRSA）。反对识别承运人和在医院入院时对患者进行筛查，即使是对藏有生物体的人进行隔离和非宗教信仰（有关更多的人，请单击这里,这里和这里)

国家报告系统需要涵盖所有类型的感染和共同感染。

The Need for a National Reporting System for Dangerous Pathogens
A major deficiency in the United States’ infrastructure was the absence of a national reporting system for infectious diseases. In 2012, the requirement for hospitals to keep an infection control log was eliminate, and the excuse given was that hospitals already track infections通过其他报告系统。

However, of the CDC’s five contagions designated as ‘Urgent Threats’ onlyClostridioides difficile强制性地报道了国家一级的报道，以及仅耐甲氧西林的“严重威胁”金黄色葡萄球菌（MRSA）强制性地报告了国家一级，仅针对急诊医院。

这一大流行的关键课程之一是需要为所有危险病原体实施强制性的国家报告系统，该系统包括所有类型的healthcare facilities and providers.这是针对SARS-COV-2实现的，对于CDC的所有“紧急”和“严重威胁”，情况也是如此。国家报告系统需要涵盖所有类型的感染和共同感染。此外，还需要报道特定类型的感染，包括与导管相关的尿路感染，相关的血流感染和呼吸机相关感染。

该系统还需要实时和透明。响应于19，疗养院临时指导e in the United States requires facilities to, “Inform residents, their representatives, and families of those residing in facilities by 5 p.m. the next calendar day following the occurrence of either a single confirmed infection of COVID-19, or three or more residents or staff with new-onset of respiratory symptoms occurring within 72 hours of each other.” The same needs to be true for all dangerous pathogens in all types of healthcare facilities.

学到了什么课？
从Covid-19中学到了许多教训。我们已经了解到，可以迅速创建案例定义，并且可以实施包括所有类型的医疗机构的报告系统。对于其他危险病原体，包括疾病预防控制中心的紧急和严重威胁，以及在所有类型的设施中都需要标准化策略，还需要做同样的事情。SARS-COV-2不会根据该国的设施类型或地区改变其致命性或感染性。

South Korea embraced public health strategies early on and to date has lost less than 500 residents in their country. If the United States would have followed this strategy early on, it would have lost approximately 3000 individuals (corrected for population), a far cry from the over 220,000 residents which have died from COVID-19.

每个公民都需要照顾和保护他人。在预防传染病时，需要放弃旧的心态。这意味着采用一项国家战略，该战略具有强大的接触跟踪和愿意自我汇率的联系。

在控制这一大流行方面，我们最重要的是，我们需要一种强大的传染病基础设施，这是所有危险病原体的国家报告系统，以允许战略资源生产和分配，以及对SARS-COV-2的广泛接触，并愿意提供联系。为他人的利益增强个人自由和自我汇率。