With the current pandemic, once cases began spreading throughout the

nation, federal and state agencies began taking urgent steps to prepare for a
surge of hospital patients. Among the actions was establishing additional
places for patients in case hospitals became overwhelmed. That included
transforming buildings normally used for sports and entertainment events by
turning them into field hospitals. The Coachella Valley Music and Arts Festival,
for instance, was cancelled and the fairgrounds where it is normally held was
turned into a medical center.[153] To prepare housing for homeless persons,
states such as California have procured private hotels and motels as
emergency shelters and isolation spaces.[154]
Manpower from the military and volunteer armies were called up to help
construct the emergency facilities.[155][156] In addition, unoccupied former
clinics and hospitals were being converted with retired and active physicians
and nurses were brought in. The CEO of Beth Israel Deaconess Medical
Center in Boston, saw the problem:
Anybody with eyes in their head, anybody who is watching what is
happening in New York and Washington and elsewhere would be
foolish not to get ready now. We are not wasting any time to get as
prepared as possible for the surge that is almost certainly coming.
[157]

Pandemic simulation tests

Scenario testing can help create models of potential epidemics and
pandemics, which can be achieved through large-scale computer simulations.
The models can incorporate mitigation measures, seasonality, randomness,
and other factors that can vary during a real epidemic. Similar tests are used
by the insurance industry to understand risks posed by infrequent natural
disasters such as hurricanes and earthquakes.[158]
The Trump administration simulated a series of pandemic outbreaks from
China in 2019 and found that the U.S. government response was
"underfunded, underprepared, and uncoordinated". Among the conclusions of
the test was the lack of certain medical supplies to meet demand due to their
needing to be imported. It led President Trump to issue an executive order to
make flu vaccines more readily available and of higher quality, and he provided
additional funds for the pandemic threats program in the Department of Health
and Human Services (HHS).[159] White House economists published a study
in September 2019 that warned a pandemic could kill half a million Americans
and devastate the economy.[160]
In 2018, the WHO also ran a simulation exercise of a global pandemic
response involving more than 40 countries, although the results appear to be
unavailable.[161]
Centralized biodefense strategy
Citing lessons learned from the swine flu pandemic, Ebola outbreak, and
the 2001 anthrax attacks, President Trump released a National Biodefense
Strategy on September 18, 2018 in response to a Congressional directive.
[162][163][164][165] According to Trump, the new strategy was designed to
strengthen the nation's defenses against disease outbreaks and bioterrorism
and to make responses to them more efficient and better coordinated. [162]
[163] Concurrently, he released a National Security Presidential Memorandum
that appointed Secretary of HHS Alex Azar to oversee implementation of the
government's new biodefense strategy and directed National Security
Advisor John Bolton to assist in reviewing and improving the nation's
biodefenses.[166][167][162] At a time when multiple agencies and
departments shared responsibility for biodefense,[165] Bolton and Azar
claimed this centralization of primary authority for biodefense in the HHS would
provide greater accountability.[168]
Reorganization and departures
In May 2018, Bolton reorganized the executive branch's United States National
Security Council (NSC), largely merging the group responsible for global health
security and biodefense into a bigger group responsible for counter-
proliferation and biodefense. Along with the reorganization, the leader of the
global health security and biodefense group, Rear Admiral Timothy Ziemer, left
to join another federal agency, while Tim Morrison became the leader of the
combined group.[169][170] There were critics of this reorganization, who
referred to it as "disbanding" a pandemic preparedness group; and later,
Trump berated a reporter for asking if the reorganization had slowed the
government response.[170][171] Also in 2018, Homeland Security
Advisor Tom Bossert left the administration; reportedly at Bolton's request.
Bossert had helped to create the Trump administration's biodefense plans, and
it was his responsibility to coordinate the government's response in the event
of a biological crisis.[172] Bossert's successor, Doug Fears, and Fears'
successor Peter J. Brown, took over the biodefense responsibilities of the
DHS. Bloomberg News reported in January 2020 that biodefense was by then
a "less prominent" part of the Homeland Security Advisor's responsibilities.
[173][174] The NSC created a pandemic playbook (called "Playbook for Early
Response to High-Consequence Emerging Infectious Disease Threats and
Biological Incidents") in 2016 which laid out strategies and recommendations
that an administration should take, including moving swiftly to fully detect
potential outbreaks, securing supplemental funding and considering invoking
the Defense Production Act, and making sure there are sufficient personal
protective equipment available for healthcare workers. The Trump
administration was briefed on it in 2017, but administration officials ignored it,
and it never became official policy.[175] Azar and Morrison, then a special
assistant to the President and senior director for weapons of mass destruction
and biodefense on the National Security Council, listed the threat of a
pandemic as the issue that worried them most at the BioDefense Summit in
April 2019.[176]
In other departures, Luciana Borio, the National Security Council director for
medical and biodefense preparedness, left her post in March 2019. The
Washington Post reported in March 2020 that the White House would not
confirm the identity of Borio's replacement.[169] Meanwhile, in July 2019,
Linda Quick, a U.S. CDC expert working within the Chinese Center for Disease
Control and Prevention, left her post without a replacement, as her position
would have been eliminated in September 2019 due to the China–United
States trade war. Reuters reported Quick's departure in March 2020; her role
was training Chinese field epidemiologists to respond to disease outbreaks at
their hotbeds; the post had existed since 2007 or earlier. [177] The
Administration ended funding for the PREDICT pandemic early-warning
program in China, which trained and supported staff in 60 foreign laboratories,
with field work ceasing September 2019.[178] The scientists tasked with
identifying potential pandemics were already stretched too far and thin. [179]
Abandoned and delayed efforts to improve mask and ventilator supply
Since 2015, the federal government has spent $9.8 million on two projects to
prevent a mask shortage in the event of a pandemic, but abandoned both
projects before completion.[180] The first was a contract from the Biomedical
Advanced Research and Development Authority (BARDA, which in 2020 had a
budget of $1.5 billion) with Halyard Health (now a subsidiary of Owens &
Minor) to design a machine capable of rapid manufacture of N95-rated masks.
The design, intended to solve the problem of stockpile waste and decay, was
completed in 2018. Halyard requested funding to build a prototype, but this
was not granted.