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From the Abstract: As the COVID-19 [coronavirus disease 2019] pandemic intensified in the spring of 2020, many Americans were shocked to see how quickly hospitals were overwhelmed in affected cities Our medical and public health infrastructure was clearly not prepared, leading to problems with emergency medical services, acute care hospitals, nursing homes, access to adequate protective equipment, and mortuary capacity How could this be? For several decades, the United States government has run pandemic simulations and this outcome-- overwhelmed health care systems--has been identified as a possible scenario time and time again Yet preparations for this eventuality were halting and inadequate at best In this essay we review the historical and policy contexts of pandemic preparedness to understand why we have been caught off-guard by something we had repeatedly foreseen We explore the reasons for our current predicament and whether alternative approaches ought to be pursued It is not that preparedness is impossible: the federal government invests substantial resources in military preparedness, seemingly with good effect The problem is specific to health care and bears the imprint of our fragmented systems of financing and government oversight COVID-19 (Disease);Disaster preparedness--Plans;Crisis management;Military readiness;Health planning
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