[Goose]

The key in Germany is they tested early and they tested a lot.

Yes they did, mostly because they had the professionals ready to act from day 1. It is also true that Charité – Universitätsmedizin Berlin had at least a 7 day lead on the CDC in generating their test. More importantly, there were people who knew how to administer that type of test ready to go. As it turned out, there were not quite enough of them to actually contain the disease, but for sure it helped.

The countries that struggled (Spain, Italy, the US) struggled because they were flying blind until lots of people started showing up in the hospital.  Italy was caught unawares as one of the first countries outside of China to be hit hard.  In the US, having a poorly developed and fractured public health response certainly didn't help, but the testing screw up compounded all the problems.

In the US, the testing screw-up was at least partially foreseeable. The CDC was using the same model they did for H1N1, distributing the tests to state health department labs, qualifying those labs, and then letting them do the rest of the testing. The CDC's own documents showed that this was a slow process and that the actual number of tests the state labs could do was quite limited. Other CDC documents discuss this problem, and some possible avenues to explore, but nothing was changed. Best case, our testing would have been slow to come on line and have very inadequate capacity for COVID-19. The double whammy was that the CDC's production ability was not designed with adequate Q/A procedures. They didn't validate everything, and as a result their kits initially didn't work. This second problem arguably should have also been foreseen, but it was not. At least in that case it wasn't already documented as a problem in any CDC documents I am aware of.

Spaniards and Italians are not exactly known for compliance and following government orders.  Their response was much too late, but when instituted was effective.  Italy had 584 cases and 117 deaths in the last 24 hours, Spain had 510 cases and 1(!) death.  And while the high death rate might have made them more willing to listen to their governments, UK has had similar death rates (plus news of their PM in the ICU) and is still struggling to get the epidemic under control (2013 new cases/412 new deaths).

Yes, and why is that? My Italian friends are still bitching about people who didn't comply, but despite it all, they finally got the numbers down. Why can't we? How are people getting the disease? What can we change to fix the problem? Santa Clara County got hit with a pile of cases from a fish processing plant. Did they trace the source? I also heard nothing about anybody being quarantined. Looks like they just sent both the positives and the (at the present time) negatives home. I assure you their are fish processing plants in Italy, so that isn't the story.

[Goose]

The key in Germany is they tested early and they tested a lot.

Yes they did, mostly because they had the professionals ready to act from day 1. It is also true that Charité – Universitätsmedizin Berlin had at least a 7 day lead on the CDC in generating their test. More importantly, there were people who knew how to administer that type of test ready to go. As it turned out, there were not quite enough of them to actually contain the disease, but for sure it helped.

The countries that struggled (Spain, Italy, the US) struggled because they were flying blind until lots of people started showing up in the hospital.  Italy was caught unawares as one of the first countries outside of China to be hit hard.  In the US, having a poorly developed and fractured public health response certainly didn't help, but the testing screw up compounded all the problems.

In the US, the testing screw-up was at least partially foreseeable. The CDC was using the same model they did for H1N1, distributing the tests to state health department labs, qualifying those labs, and then letting them do the rest of the testing. The CDC's own documents showed that this was a slow process and that the actual number of tests the state labs could do was quite limited. Other CDC documents discuss this problem, and some possible avenues to explore, but nothing was changed. Best case, our testing would have been slow to come on line and have very inadequate capacity for COVID-19. The double whammy was that the CDC's production ability was not designed with adequate Q/A procedures. They didn't validate everything, and as a result their kits initially didn't work. This second problem arguably should have also been foreseen, but it was not. At least in that case it wasn't already documented as a problem in any CDC documents I am aware of.

Spaniards and Italians are not exactly known for compliance and following government orders.  Their response was much too late, but when instituted was effective.  Italy had 584 cases and 117 deaths in the last 24 hours, Spain had 510 cases and 1(!) death.  And while the high death rate might have made them more willing to listen to their governments, UK has had similar death rates (plus news of their PM in the ICU) and is still struggling to get the epidemic under control (2013 new cases/412 new deaths).

Yes, and why is that? My Italian friends are still bitching about people who didn't comply, but despite it all, they finally got the numbers down. Why can't we? How are people getting the disease? What can we change to fix the problem? Santa Clara County got hit with a pile of cases from a fish processing plant. Did they trace the source? I also heard nothing about anybody being quarantined. Looks like they just sent both the positives and the (at the present time) negatives home. I assure you their are fish processing plants in Italy, so that isn't the story.