From “quietly” to “big outbreak”, what happened in the United States?

Home Health From “quietly” to “big outbreak”, what happened in the United States?

Original title: What happened to the United States from “quietly” to “big outbreak”?

Source: Lookout think tank

According to “Fox News” on April 4, several patients infected with the new crown virus were mistakenly transferred from the Javits Center in New York to the USNS Comfort hospital ship. Previously, federal officials said that this naval hospital ship can only be used to treat patients with non-new coronary pneumonia, thereby relieving hospital pressure.

Officials called the risk of the crew of the hospital ship “very low”. The reason for the “low” risk may be because the number of people on board the ship is very small, and most of the beds are empty. According to a previous report by the New York Post, later on April 2, Captain Patrick Amersbach said the number of patients “increased to 20”; another US military hospital ship in Los Angeles was “benevolent” No. (USNS Mercy) only admitted 15 patients on that day.

A hospital executive commented: “This is a joke.”

According to real-time statistical data released by Johns Hopkins University in the United States, as of 6:05 on April 5, Beijing time, there have been more than 1.19 million confirmed cases of new coronary pneumonia worldwide, with a total of 11192028 cases. The cumulative number of diagnoses in the United States has exceeded 300,000, reaching 305,820 cases; 8,291 deaths; and 14,520 people recovering.

On April 4, US President Trump declared Wisconsin a “major disaster zone” for the new coronary pneumonia epidemic. So far, 36 US states, the capital Washington DC, and 4 overseas territories have been declared “major disaster zones” for the new coronary pneumonia epidemic. At the White House press conference that day, Trump said that the next two weeks will be the most severe moment for the US anti-epidemic situation, and the number of deaths will surge.

From the “silent” to the “big outbreak”, what happened to the United States?

Text | Xu Jianmei Xu Wang think tank researcher in Washington

  1

  Diffusion

Since March 26, the United States has become the world’s most severe country with a new coronary disease. US President Trump said on March 29 that in order to slow the spread of the virus, the federal government’s guidance on the nationwide response to the new coronary pneumonia epidemic will be extended to April 30. On the same day, Anthony Fudge, director of the National Institute of Allergy and Infectious Diseases, predicted that the new coronary pneumonia epidemic could cause 100,000 to 200,000 American deaths.

Looking back at the timeline, in the past month, the epidemic in the United States has gone from “quiet” to “big outbreak”, and the rate and scale of the spread were almost unexpected before March.

On January 3, the US Centers for Disease Control learned from China that there was a new outbreak of pneumonia in Wuhan.

On January 7, the US Centers for Disease Control established the “New Coronavirus Incident Management System” (COVID-19 Incident Management System).

On January 20, the first confirmed case of imported new coronary pneumonia appeared in the United States.

On February 25, the US Centers for Disease Control first warned that community transmission might be inevitable, but the epidemic notice still clearly stated that “there is no current transmission in the US community.”

On February 26, Trump held the first White House outbreak press conference, saying that there are only 15 confirmed patients in the United States who have not yet recovered (excluding the cases of evacuation from Wuhan and Diamond Princess). Approaching zero.

On the same day, the first dark cloud appeared, and the West Coast reported the first case of unknown source of infection in the United States, which means that the new coronavirus may spread in the United States in the community, that is, “human-to-human.”

On February 29, including the putative cases reported by the states, the US National Centers for Disease Control and Prevention collected 22 cases of the new domestic coronavirus infection, plus 47 confirmed cases from the evacuation of overseas Chinese from Wuhan and the “Princess Diamond”. 69 cases.

On the same day, the United States first reported two new cases of death from new pneumonia, states reported more cases of unknown source of infection, and the clouds spread by the community emerged from the sky. In the epidemic notice on the website of the US Centers for Disease Control and Prevention, the expression “currently, this virus has not spread in the American community” disappeared from this day.

On March 1, the Mayor of New York reported the first confirmed case in New York City. The patient lives in Manhattan and recently returned from Iran.

On March 11, there were more than 1,000 cases of new coronavirus infections in the United States.

On March 16, Trump admitted for the first time that the epidemic was “uncontrolled” in the United States and the situation was “very bad.” Americans would be disturbed in their daily lives in the coming months, and the US economy might experience a recession.

On March 17, all 50 states in the United States experienced outbreaks.

On March 20, there were more than 10,000 new coronavirus infections in the United States.

On March 24, there were more than 50,000 confirmed cases of new coronary pneumonia in the United States.

On March 26, more than 80,000 cases became the country with the most confirmed cases in the world.

On March 27, the number of confirmed cases within 4 hours exceeded 90,000 and 100,000.

On March 28, there were still more than 110,000 and 120,000 cases within a few hours; the number of deaths exceeded 2,000, doubling in two days, and the first infant death occurred.

……

Obviously, during China’s difficult national anti-epidemic period, the United States missed the golden window of prevention and control for more than a month.

As stated in a report in the New York Times, in this “lost month”, “Americans turn a blind eye to the scale of an imminent public health disaster.” “The richest country in the world, with a group of the most sophisticated scientists and infectious disease experts, wasted the best opportunity to curb the spread of the virus.”

  2

  Mistakes

against the United States’ response to mistakes in the early stages of the epidemic, all parties criticized and analyzed There are already many, and American media and public health experts are constantly “rewinding” from all angles. Combining Uncle Ku’s personal knowledge and feelings, the following points are summarized.

The first one fell on the virus detection.

Although two confirmed cases occurred in Italy on January 31, until the end of February, the U.S. Centers for Disease Control and Prevention’s virus testing was strictly limited to those with a history of Chinese travel or close contact with diagnosed patients with suspected fever and cough symptoms; The technical issues of the kits issued by the control center have been unresolved, and in this case, the US Food and Drug Administration (FDA) still strictly regulates and restricts the state and local agencies to detect viruses themselves. Until February It was only on the 29th that local medical laboratories and private companies were allowed to perform their own tests.

In the early days of the epidemic, the procedures for approval of medical screening for new coronavirus in the United States were cumbersome, testing and treatment costs were high, and the medical insurance policy was unclear. On social media, some nurses reported that they had applied for testing several times and could not be approved. Many people were unwilling to test because they were worried about high personal expenses. In mid-February, data from the US Centers for Disease Control showed that the number of daily tests in the United States at that time was only about 100. A number of American media also reported that by the end of February and early March, information such as test data and other information released by the White House, the State Department, the Department of Health, and the Centers for Disease Control of the United States were inconsistent or inaccurate.

The convergence of these factors has caused the United States to have fewer detection agencies, kit shortages, too narrow a detection range, and strict detection supervision in the early stages of the epidemic, and found that community transmission (that is, person-to-person) is too late. By the time it was discovered, the epidemic had spread throughout the United States, presenting a simultaneous outbreak of multiple points in multiple states, and the situation was difficult to understand. Harvard Business School professors Robert S. Kaplan and Berenberg Capital Markets LLC (Berenberg Capital Markets LLC) US and Asian chief economists Mickey D. Levy believe that the United States has virus detection capabilities Delayed for six weeks. The New York Times’ review report at the end of March blamed the combined efforts of “technical defects, regulatory obstacles, bureaucracy, and lack of leadership.”

The second mistake, the response to China’s epidemic was faster, but the response to the epidemic in Europe and the Middle East was slow and failed to effectively prevent imported cases.

On January 31, the day after the WHO declared the new coronary pneumonia epidemic as an international public health emergency, the Trump administration issued a travel ban on China, one of the first countries in the world to issue a travel ban on China. In contrast, when dealing with the epidemic situation in South Korea and Italy, the response of the United States was obviously not so rapid. Italy first reported two imported cases on January 31, but the U.S. government did not issue a three-level warning about avoiding “non-essential travel” to Italy until February 29, and only implemented a 30-day trip to the European Schengen countries on March 13. The ban, and international airports such as New York at least until mid-March quarantine measures for non-Asian international passengers are still very loose, resulting in uncontrolled import cases.

The cluster epidemic in the Washington State Nursing Home stems from caregivers returning from visiting relatives in South Korea; the first confirmed patient in New York City was a woman returning from Iran, and the second confirmed patient was a Jewish lawyer returning from a family trip from Israel; the first patient in western New York State was Returning from Italy; among the first patients in Texas, many traveled in Egypt and took a Nile cruise.

The third heel fell on American domestic politics.

After the Trump administration took office, the global health and safety team established by the former Obama under the White House Presidential National Security Council was abolished, and the budget and personnel of federal agencies such as the US Centers for Disease Control and Prevention were drastically reduced. The “deep state” has also spread to the American intelligence community who insist that Russia intervenes in the 2016 US election.

2020 is the year of the US election. Against the background of the US election and the polarization of party struggles, the US new crown epidemic and its response have been politicized from the beginning. The White House and the Democratic Party accuse each other of their standpoints regarding the epidemic, which has political motives. Trump tried his best to seek re-election, and especially did not want the epidemic to cause public panic to affect the economy. Until the beginning of March, he had downplayed the threat of the new crown virus, describing it as a “large flu” and calling the epidemic “a Democrat scam.” Due to the spread of infectious diseases, the hardest hit areas in the United States are concentrated on the east and west coasts and large cities, where the Democratic Party ’s votes are often stored. Today, in the epidemic response, the Trump White House’s disputes with the Democratic governor and Congressional Democrats are still frequently reported.

In addition to the party struggle, under the searchlights of the epidemic situation, many problems of the “Washington Marsh” surfaced and deepened the people’s mistrust. Congressional Senate Intelligence Committee Chairman, Republican Burr was exposed to grab a large number of stocks dumped a few weeks ago due to the epidemic; and when the federal government downplayed the epidemic, privately issued an outbreak risk warning to those who provided political donations to their home state But it has not been publicly developed. A report in the “Washington Post” stated that members of both parties in the US Congress have been slow to take the new crown epidemic seriously.

The fourth mistake, which greatly underestimated the risk of the exponential spread of the epidemic in the United States and globally, failed to prepare in time.

In the first two months of this year, from the industrial policy, medical insurance policy, medical staff training to the production of medical supplies, no effective measures have been issued in time. As early as January 3, the US Centers for Disease Control learned from the Chinese side of the new coronary pneumonia epidemic; from the end of January to early February, the US intelligence agencies continued to submit epidemic reports to the White House and the Congressional Intelligence Committee; at the end of January, US shopping sites and physical stores There has been a general shortage of medical supplies such as masks and protective clothing.

But until the beginning of March, the US National Strategic Reserve Mechanism was still satisfied with the strategic inventory level of 30 million medical N95 masks, and no measures were taken to increase production capacity. In early March, the Trump administration applied to Congress for only US $ 2.5 billion in anti-epidemic appropriations. Although more than US $ 8 billion was approved, the amount of medical supplies planned to be used for the purchase of masks was very limited, which reflected to a certain extent the Trump at that time. The government underestimates the scale of the US epidemic.

  3

  Difficulties It

should be pointed out that there are also many objective factors in the development of the US epidemic.

First of all, the United States has a population of 330 million and is the third most populous country in the world, after China and India, with a huge population base. In assessing a country ’s epidemic situation, it is not only necessary to look at the absolute value. It is also necessary to comprehensively consider the detection rate and the diagnosis rate per million population, especially if the epidemic development curves of the New York metropolitan area and other regions of the United States are reviewed separately. At present, according to US media reports, the outbreak curve in the Seattle area where the outbreak was first discovered has stabilized.

Second, the number of diagnoses depends first on the number of virus tests. At present, the problem of virus detection in the United States has been basically solved, the supervision has been rapidly relaxed, the detection capacity has been rapidly improved, and the scale of detection has expanded rapidly. On March 27, the US Food and Drug Administration urgently approved the 45-minute, 15-minute, and 5-minute test kits for new coronaviruses developed by the three companies, of which the daily capacity of the 5-minute rapid test kit developed by Abbott Up to 50,000. The number of confirmed cases in the United States has skyrocketed, first of all because of the rapid and large increase in the number of new coronavirus daily tests across the United States. The White House said on March 30 that the total number of tests has exceeded 1 million. Judging from media reports, the accuracy of detection is currently high, and it is no longer necessary to confirm the diagnosis repeatedly and repeatedly as many times as early.

Third, the development of the epidemic in the United States is roughly consistent with the global spread cycle and trajectory of the new coronavirus. World Health Organization Director General Tedros Adhanom Ghebreyesus said on the 27th: “The pandemic is accelerating.” “From the world’s first confirmed case to 100,000 cases, it took 67 days; from 100,000 cases to 200,000 cases worldwide , 11 days; from 200,000 to 300,000 cases, 4 days. “Over the past few days, the number of confirmed cases in the United States has increased by more than 20,000 a day, reflecting the characteristics of the exponential spread of New Coronavirus after missing the golden window for epidemic prevention and control. Infectious disease prevention and control measures are unlikely to be immediate, and it will take some time to smooth out the epidemic curve.

Fourth, New Coronavirus Syndrome is an unprecedented new type of infectious disease. From China to the United States, Europe, and other countries in the world, its own recognition requires a process. In fact, when this cognitive process is still ongoing, much information about the spread of the epidemic has not been consistent so far, such as whether ordinary people should wear masks; whether the new crown virus will be transmitted through the air; whether the viral infectivity is increasing or decreasing; The role of asymptomatic infected persons in the spread of the epidemic, etc., the information is still confusing.

Fifth, during the national anti-epidemic period in China, in general, regardless of China itself, Europe, the United States and the international community, it is quite confident that China will succeed in fighting the epidemic with the nationwide system. Looking back, in light of the “old experience” of the SARS epidemic, the international community has overly optimistic expectations of the prospect of “China’s successful anti-epidemic disease = most areas of the world are free from the threat of the epidemic”.

At the same time, the United States and other Western countries have not suffered from infectious diseases for a long time. Many Western people subconsciously believe that major infectious disease outbreaks will only occur in developing countries with relatively backward social and economic development. In the United States, many people attribute the spread of China ’s epidemic to the particularity of China ’s national conditions and system design, thinking that if the epidemic occurs in its own country, it will not evolve to such a serious extent as Wuhan, ignoring China ’s In the city’s anti-epidemic situation, among the various factors and considerations, the “new” of the new coronary pneumonia epidemic situation and the law of infectious diseases itself have to be forced, and also account for an important part. Symptoms of New Coronavirus infection are easily confused with influenza but cannot be equated to influenza treatment; the incubation period is infectious; asymptomatic infected persons are difficult to identify and isolate, and they grow exponentially when they reach a certain scale, etc. Now, it seems that these characteristics are not Stress politics and ignore national borders.

In short, despite the national conditions of one country and one country, one country has one mistake, but in the early stage of the epidemic, there were decent acquaintances, fluke mentalities of varying degrees and levels, negligence of mentality, bureaucratic procrastination, and artificial delays; detection standards have all occurred The situation is too strict and the number of detections is too small to detect the scale of the epidemic situation as early as possible. As a result, they have to face the problems of exponential growth of epidemic situation in large cities, tight medical resources and exhaustive treatment.

  4

  Concepts

As far as the United States is concerned, looking back, during the national anti-epidemic period in China, the Trump administration seems to be more concerned about using the epidemic to promote the “return of manufacturing” in the United States and the decoupling of global supply chains from China; and US media reports also Often focusing on the political and ideological interpretation of China’s anti-epidemic, neglecting the huge public health challenges posed by the new coronavirus itself.

Among them, we must say that there are also zero-sum thinking, ideological factors, and America’s own sense of superiority in the competition of great powers.

According to Hopkins University’s research rankings, the United States is the “most prepared” country in the world to deal with epidemic diseases. In terms of various indexes such as national strength, technical and medical level, and medical resources, it is not a false word. But the New Coronary Pneumonia epidemic appears to be lifting the lid of all national social governance systems and public health systems. Looking back, the US Centers for Disease Control and Prevention began issuing early warnings in early January, but the final implementation was not satisfactory.

Uncle Ku once reviewed the early outbreak reporter briefings at the White House and the US Centers for Disease Control. February 25, in answer to a reporter’s question about the adequacy of the US government prepared to deal with the epidemic, the CDC issued by the United States, Dr. Meisel Fournier American community will inevitably spread the warning, said:

“Having said that, we never It ’s impossible to be completely prepared to deal with any inevitable situation. We always find that the disease surprises us, and some considerations are slightly different from our original plan … I still hope that when we finally look back, we will feel We are too well prepared, but this is better than insufficient preparation … Any preparations we make as a country, a school, a business and a family will always be beneficial no matter what the next accident is. Yes. So I think that, overall, preparations will not be wasted. “To

deal with infectious diseases, it is a race against time. Hopefully, before the next epidemic, all countries in the world will be able to confidently say that we are too well prepared.

Editor in charge: Zhang Yu