In Rhode Island, USA, where two cases of nCoV were reported, patients with mild symptoms were tested in a hospital parking lot instead of inside.

Covid-19 appeared on Rhode Island, the smallest US state since last week, when two people from Italy returned positive for nCoV. In the wake of widespread anxiety across the state, suspects appointed by health officials to hospital tests were asked to stay in the vehicles until the doctor came to check on them.

Meanwhile, King County, Washington, local authorities account for the majority of Covid-19 deaths in the United States, saying they had to buy an inn to accommodate isolated patients. In rural Texas and elsewhere, small hospitals don't have test kits, and laboratories sample hours and hours away.

This means that hospitals are unable to ascertain whether Covid-19 patients are being confused with the number of seasonal flu patients that are very crowded at this time of year. "Nowhere is there enough kit to confirm or eliminate nCoV cases, or isolate and control those patients," said John Henderson, director of the Texas Rural Hospital Association.

These limitations reveal many gaps in the ability of the US health system to cope with a serious disease. The number of nCoV infections in the country has reached more than 200, occurring in at least 19 states, with 14 deaths, including 13 in Washington state and one in California.

People on the front lines fighting epidemics are trying to improve the old methods used to deal with global health threats in the past, such as SARS (severe acute respiratory syndrome), MERS (respiratory syndrome). Middle East), H1N1 and Ebola flu. However, Covid-19 appears to pose a new challenge, as it spreads rapidly with mild symptoms similar to influenza.

The bewilderment that plagues the United States, stems from a shortage of patient beds, ventilators, and specialized care rooms, as they are concentrated mainly in large hospitals and research centers in urban areas. Large medical centers also often have no vacancy even when Covid-19 has not yet appeared.

"Our hospital and healthcare systems cannot afford to cope with a large wave of patients, and isolate them," said Gerard Anderson, professor of health and management policy at Johns University. Hopkins, said.

Despite weeks of preparing to respond, the United States still lacks masks and protective clothing for health workers, as well as ventilators for serious illnesses, angering health planners. "We need facemasks and ventilators for health facilities right now," said Sen. Patty Murray of Washington State on March 3.

US officials in 2005 estimated that if a serious disease outbreak, such as the Spanish flu in 1918, more than 740,000 people would need ventilators. However, experts say there are only about 200,000 ventilators at US health facilities and national reserves.

"If the situation is serious, we will not have enough ventilators. I don't think nCoV is a serious threat. But if that statement is wrong, we will have to make some tough decisions," says Crystal Watson. , senior scholar at the Johns Hopkins Health Security Center, said.

"We, like all stakeholders, are seeing increasing demand for ventilators," said Elijah A. White, president of ZOLL, the medical device company. "Not just China, America, but everywhere."

Severe cases require a ventilator, but not every hospital has it. According to Christopher Greene, an emergency physician at the University of Alabama in Birmingham, USA, many rural hospitals have to move patients to higher-level health facilities. This situation poses additional challenges for health workers and ambulance operators.

The World Health Organization (WHO) warns that the fight for stockpiling of protective gear is causing a dangerous shortage globally, especially when China, where Covid-19 started, stopped exporting its face. this row. Meanwhile, the US "measuring and counting" health apparatus that does not maintain large amounts of reserves for pandemic risks makes the system very vulnerable, said William Jaquis, president. American Emergency Association, said.

The US federal budget for emergency medical emergencies is decreasing. According to scholar Watson, this budget has been cut in half or more over the years.

"All governments from the local to the federal cut these programs. That trend has been going on for a long time," Watson said. In 2003, the US government provided $ 1.4 billion in preventive medicine through two major programs, but this year, the figure was only $ 662 million.

At least 8 of the 14 Covid-19 deaths in the United States have been linked to Life Care nursing centers in Kirkland, Washington, causing concern to more than 15,000 nursing homes and 20,000 care homes. of America. It is estimated that more than 2 million elderly Americans are being cared for in these locations.

Lisa Sweet, clinical director of the National Association for Health Care Support, said some nursing homes have prepared scenarios for dealing with the disease. Managers carry out a series of special measures, such as checking employee's temperature, reminding family members and service providers to stay away from the facility if they feel unwell, raising awareness of virus control.

However, many establishments still seem indifferent. "They are unprepared and are putting elderly people at risk," Sweet said.

In addition to the fact that nCoV is easy to target the elderly, another challenge for nursing homes is that if one employee is ill, he or she can become a "super-infectious" patient, Lauren Ancel Meyers, a professor at Dai. Texas study, warning. In addition, many nursing assistants may hesitate to take leave if they are unwell, as they do not have many days off.

Research published in the Journal of the American Medical Association in 2008, based on the results of a survey of hundreds of nursing homes, found that more than half of these locations lacked a plan to cope with a pandemic. Only about half of facilities have medical supplies such as gloves, alcohol, medical masks and antiviral drugs.

"All facilities need to develop an infection control plan, including a strategy to monitor new cases, to report fully, and to take steps to limit the spread of virus and manage infected people." , Recommends Beth Martino, vice president for public affairs at the American Health Care Association.