Yikes
Patient-zero drill put health facilities to the test—40% of them failed
Actors with makeup and fake symptoms staggered into 73 healthcare facilities.
COVID-19 made the weaknesses in our pandemic preparedness at national and global levels painfully clear. But a new study highlights that even at the first, local steps of an outbreak with pandemic-potential, we are worryingly underprepared.
Health officials in New York set up a regional test of healthcare facilities to identify and respond to a patient with a mystery infection that could pose a pandemic-level threat. But things didn’t go well. Overall, responses were slow, appropriate use of personal protective equipment was spotty, and only 60 percent of facilities passed the basics of the test—an overall failing grade.
“These drills identified needs for health care workers and health care facility staff member training to achieve earlier identification, masking, and isolation of potentially infectious febrile patients,” the officials wrote in the study, which was published in the Morbidity and Mortality Weekly Report.
The drill centered on “professional patient actors,” who staggered into healthcare facilities feigning expected symptoms of an H5 bird flu infection—a virus type thought to have pandemic potential. The actors wore makeup to look unwell, used eye drops and petroleum jelly to mimic having conjunctivitis (aka pink eye), and had a fake cough. They complained about feeling weak and feverish and reported taking a Motrin (fever reducer) before coming in. When questioned, they said they hadn’t traveled out of the country and, if asked about any sick contacts, would respond, “Does a sick bird count?” They would tell a sad tale of trying to save a sick duck they found in a park. In the story, the duck doesn’t make it, and the now-ill patient didn’t wear any gloves while handling it. The chatty actor would tell this story without prompting.
To pass the test, a healthcare facility needed to mask the patient and put them in an isolation room. Ideally, the masking would occur within a minute or less of the patient walking in, and isolation would occur in 10 minutes or less. For this drill, both masking and isolation were enough to pass, regardless of timing.
In the drill, which ran between January and June 2026, actors visited 73 healthcare facilities. Most were in New York City (52), with 15 in New York outside the city, three in New Jersey, and three in the US Virgin Islands (which the US considers part of the same health region).
Actors mostly visited emergency departments (42 of 73), but also hospital outpatient clinics (19 of 73), and urgent care centers (12 of 73). The facilities had agreed to be part of the drills but didn’t know when they would occur.
Failing grades
Overall, only 60 percent (44 of 73) of the facilities both masked and isolated the actors. Only about 55 percent of emergency departments did both, while 68 percent of clinics and 67 percent of urgent cares passed. Eighteen percent of facilities didn’t offer a mask to the coughing patient who said they had a fever.
Of those that masked and isolated, fewer than half (43 percent) did so within the one-minute goal, and less than half (48 percent) moved the patient to an isolation room within the 10-minute goal. Outpatient clinics had a median time to isolation of 20 minutes, with at least one clinic taking nearly an hour. Overall, the median time to mask was 2 minutes, and the median time to isolation was 11 minutes.
Most of the healthcare facilities (93 percent) screened the actor for symptoms. But—despite the dead duck tale—staff at only seven of the 73 facilities asked questions specific to bird flu exposure.
Clinicians interacting with the actors inconsistently wore recommended personal protective equipment (gloves, mask, gown, and eye protection). Only 25 percent wore all the recommended PPE; 6 percent wore none. Nineteen percent of clinicians didn’t wear a mask or respirator. Staff at only 40 of the 73 facilities (55 percent) notified or planned to notify internal Infection Prevention and Control (IPC) staff as recommended.
The poor pass rate and the lengthy times spell trouble. “Health care facility waiting areas can be high-risk settings for transmission of respiratory viruses if appropriate IPC measures are not implemented,” the authors highlight.
These substandard results may also overestimate preparedness. Not all the healthcare facilities invited to participate in the drills agreed to do them—and those facilities that declined may have scored even worse. Also, although the drills were unannounced, some facilities may have had a heads-up, which could have boosted their results.
