IPM Take
Preparedness documents are reassuring because pathogens cannot walk into them.
A patient can.
CDC’s unannounced drills show the difference between having infection-control guidance and executing it under normal clinical conditions. Most facilities recognised symptoms. Much fewer asked the exposure question that actually mattered, isolated the patient quickly and protected staff consistently.
Executive Summary
Seventy-three unannounced infectious-disease preparedness drills were conducted across emergency departments, hospital outpatient clinics and urgent-care centres in New York, New Jersey and the US Virgin Islands between January and June 2026.
Professional patient actors presented with symptoms and a history compatible with avian influenza A(H5). Facilities conducted symptom screening in 93% of drills, but specific questions about avian-influenza exposure were asked in only 9.6%.
The simulated patient was masked and isolated in 44 of 73 drills, or 60%. Among drills involving a clinician encounter, clinicians wore all required personal protective equipment in only 25%. Infection-prevention teams were notified or scheduled to be notified in 55%.
Why it matters
- Hospitals: Readiness should be tested through real workflow rather than inferred from the existence of written protocols.
- Clinicians: Exposure histories must evolve with emerging threats instead of relying excessively on travel questions designed around previous outbreaks.
- Non-clinical staff: Receptionists, security personnel and registrars are part of infection control because they often encounter potentially infectious patients first.
The simulated patient did everything a real pathogen carrier might do. They entered a healthcare facility, approached the front desk, described fever, cough, muscle aches and conjunctivitis and waited to see whether the institution’s preparedness system recognised what was happening.
There was one difference: nobody was actually infected.
That made the failures more useful.
The CDC report on 73 unannounced drills across New York, New Jersey and the US Virgin Islands offers a rare look at preparedness without the distortions of a known exercise. Facilities did not simply demonstrate a protocol to evaluators. Professional actors moved through normal workflows while recording what staff actually did.
The results contain both reassurance and warning. Symptom screening occurred in the overwhelming majority of drills, and patients were usually offered masks. But only 60% of exercises achieved the combined objective of masking and isolation. Fewer than half met the target time for isolation. Full recommended PPE was used by clinicians in only one quarter of applicable encounters.
The most revealing weakness was exposure history.
The scenario deliberately avoided recent international travel. Instead, the patient had handled a sick bird in Central Park without gloves. That detail was clinically decisive, yet exposure-specific questions related to avian influenza were asked in fewer than one in ten drills.
This demonstrates the danger of preparedness becoming anchored to the previous crisis. Travel questions became deeply embedded in screening systems during Ebola, MERS and COVID-era responses. But emerging infections do not all arrive on international flights. Zoonotic exposure can occur domestically, and a clinician asking the wrong highly standardised questions can complete the protocol without identifying the risk.
The drills also show why hospital preparedness cannot be owned only by infection-control specialists. Reception staff, security personnel and registrars conducted many of the earliest screenings and frequently provided the first mask. A pathogen can spend crucial minutes in a waiting area before a physician ever enters the pathway. Training the person at the front desk is therefore not administrative housekeeping; it is source control.
Urgent-care and outpatient settings deserve particular attention. Health systems increasingly encourage patients to seek acute care outside hospital emergency departments. Yet preparedness funding and high-consequence infectious-disease training have historically concentrated on hospitals. A person with an unusual transmissible infection does not know which facility has received the specialist grant.
There are limitations: participation was voluntary, the number of sites outside New York was limited and actors cannot reproduce every physical sign perfectly. The results should not be projected mechanically across every American health facility.
But that is not the point.
The study demonstrates a method governments should use much more often: stop asking facilities whether they are prepared and test what happens when a patient arrives.
Preparedness is a performance.
It should be audited like one.
