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Victor J. Blue, The New York Times / A hospital worker puts on gloves in the Intensive Care Unit at the Brooklyn Hospital Center in New York on Monday. The 175-year-old facility, a small, independent hospital, has been transformed as it tries to cope with an exploding number of patients suffering from COVID-19.

The "what if ... ?" has become "now what?"

That's the gist of an insightful article Wednesday in The Atlantic titled ominously "How the Pandemic Will End: The U.S. may end up with the worst COVID-19 outbreak in the industrialized world. This is how it's going to play out."

The virus is here with a vengeance, thanks in part to our government's and our collective national psyche's slow response. The economy is in free-fall because the contagion has ground social and economic life as we've known it to a halt. And in emerging hot spots, hospitals and medical workers are overwhelmed. All because of a virus that no one knew existed until three months ago.

"It [COVID-19] has disrupted modern society on a scale that most living people have never witnessed. Soon, most everyone in the United States will know someone who has been infected. Like World War II or the 9/11 attacks, this pandemic has already imprinted itself upon the nation's psyche," The Atlantic's science writer Ed Yong writes.

Sure we all heard the warnings, even years ago. But no one really listened, meaning no one prepared.

The introduction to a paper released in October about the results of a Johns Hopkins Center for Health Security tabletop "war game" of just such a global pandemic reads like this:

"The disease starts in pig farms in Brazil, quietly and slowly at first, but then it starts to spread more rapidly in health care settings. When it starts to spread efficiently from person to person in the low-income, densely packed neighborhoods of some of the megacities in South America, the epidemic explodes. It is first exported by air travel to Portugal, the United States and China, and then to many other countries. Although at first some countries are able to control it, it continues to spread and be reintroduced, and eventually no country can maintain control. There is no possibility of a vaccine being available in the first year. There is a fictional antiviral drug that can help the sick but not significantly limit spread of the disease.

"Since the whole human population is susceptible, during the initial months of the pandemic, the cumulative number of cases increases exponentially, doubling every week. And as the cases and deaths accumulate, the economic and societal consequences become increasingly severe."

Sound familiar? It should.

Despite America's supposed score of 83.5 — the world's highest — on the Global Health Security Index report card that grades countries on pandemic preparedness, we have thus far flunked the real test. And we flunked it at an early and vulnerable time.

To contain a stealthy pathogen like this novel coronavirus, nations had to develop a test quickly and use it to identify infected people, isolate them and trace those with whom they'd had contact. That's what South Korea, Singapore and Hong Kong did to great effect. But we didn't. In fact, we're still are not doing it.

We turned down already tweaked tests and developed — at the Centers for Disease Control and Prevention — a faulty one. Then we mired independent labs that created alternatives in bureaucratic red tape. In a crucial time when the virus was and is spreading to tens of thousands of Americans, we have tested too few people. It is proving to be a fatal error.

When hurricanes strike our coastlines, our health care system can "surge" to help by sending professionals from unaffected states. With this pandemic already growing by leaps in all 50 states, region-based triage plans already are obsolete.

Partly, as The Atlantic's Yong notes, "that's because the White House is a ghost town of scientific expertise. A pandemic-preparedness office that was part of the National Security Council was dissolved in 2018. On January 28, Luciana Borio, who was part of that team, urged the government to 'act now to prevent an American epidemic,' and specifically to work with the private sector to develop fast, easy diagnostic tests. But with the office shuttered, those warnings were published in The Wall Street Journal, rather than spoken into the president's ear. Instead of springing into action, America sat idle."

We let the disease spread largely on its own terms while we didn't gear up supply chains and other industries to make tests, masks, swabs — you get the picture. And we're still not acting: The president invoked the Defense Production Act last week, but so far he's failed to actually use it. Now he's wavering on the one last tool we have: social distancing. He wants to "reopen" the country and pack churches by Easter.

As for the conclusion of the Johns Hopkins tabletop fictional pandemic exercise? Here's the spoiler alert:

"The scenario ends at the 18-month point, with 65 million deaths. The pandemic will continue at some rate until there is an effective vaccine or until 80-90% of the global population has been exposed. From that point on, it is likely to be an endemic childhood disease."

The global death count from COVID-19 on Thursday afternoon was just under 25,000 — stemming from a worldwide confirmed case count in COVID's first three months of more than 500,000. We know there are many more cases than that, simply by virtue of there being not enough tests to determine the true number. In the U.S. alone, our roughly 75,000 confirmed cases have thus far resulted in about 1,100 deaths.

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