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You indirectly mentioned it in passing (through the corollary), but it's a very real issue: hospitals simply would not report anything. This would even encourage hospitals to do things such as ensuring that things such as this are not detected. No need to report an outbreak if you don't/can't detect it! This is a particularly great example of unforeseen consequences. Though in this case (and many) these unforeseen consequences can actually be quite foreseen if you just consider practical reactions to things.

And as a consequence of the above, the current system is also likely more beneficial for patients as well because hospitals need not worry about anything other than doing as optimal a job as possible. Something like this sounds like it stands a good chance of eventually spreading everywhere. And so would you be safer at a place that has or has not detected it? Obviously you'd be better off in a place without it, but again once we introduce those unforeseen consequences a place not detecting it is absolutely not the same as a place not having it. By contrast the place that has it has indicated that they are actively screening for it and presumably doing all they can to try to manage it.

coudn't that be solved with standardized testing procedures, mandatory compliance inspections, and criminal penalties for willful negligence?

> This would even encourage hospitals to do things such as ensuring that things such as this are not detected

Trial lawyers in New York created an organization [0] that systematically maps sidewalks and streets to identify cracks and holes that cause slip-and-fall accidents.

They provide these maps and supporting data to the city for free, and in the process they can prove that the city had constructive knowledge of the risk.

That way the city can't avoid liability by claiming they didn't know.

It seems that a similar "service" could alert hospital managers to the risk of C. auris, and thereby neutralize intentional ignorance as a defense.

[0] https://en.wikipedia.org/wiki/Big_Apple_Pothole_and_Sidewalk...

City streets and sidewalks are readily publicly viewable, though, while medical facilities go to great lengths to not let people see whether they've screwed up.

I agree it'd be extremely useful, but it's a harder problem to get visibility into.

Mandate the visibility and let's see how hard it is.

Your guess on the rationale of not requiring disclosure of outbreaks is correct, according to the LA Times [1]. In some states, hospitals face no penalty for failure to report outbreaks to even the CDC. This does result in preventable deaths.

[1] https://www.latimes.com/business/la-fi-hospital-outbreaks-se...

CDC's habit of coverups will feed into anti vax fears.

Anti-vaxxers aren't known for their critical thinking skills.

If the CDC was completely transparent, they'd find a way to spin that into evidence of anti-vax claims.

Irrational people sometimes hold a certain position. We should avoid making it so that rational parties could also reasonably come to hold that position.

To be fair, we don't vaccinate against smallpox anymore because the risks of the vaccine outweigh the benefits.

It's not prima facie irrational to believe that the risks of other vaccines outweigh the benefits. I've never heard of anyone being persuaded by being insulted, so perhaps we should instead approach the anti-vaxxers with hard data showing how yes, their concerns are in fact grounded in fact, but there are also other facts that make vaccination the right decision in most, but not all, cases.

Concern over making things worse by spreading the infection, or by doing more harm by scaring patients into moving to another hospital when that move is itself risky?

There aren't that many hospitals. Eventually all of them will be infected.

Remember the great 2001 anthrax scare? Emergency rooms got flooded with people thinking they had anthrax (they didn't) and it caused serious problems because it used up resources needed to help people with real problems.

The scary part is the people with these infections ultimately come from the community. They have been walking around and these bugs are at the grocery stores you shop, the restaurants you eat, and the gym you visit. The hospitals just test regularly so we know about it. But ultimately these bugs will do their rounds and people who are susceptible will run into it. I worry about the future with antibiotic resistance. Imagine an eye infection that would not go away. Or a toothache that just got worse. I hope one day we can solve all the issues around antibiotics.

You're right. They're called communicable diseases for a reason after all.

Fortunately for us, antibiotic resistance is maladaptive when antibiotics are not present. Using them intelligently will cause resistant strains to be out-competed.

I can imagine issues like this, and I'm psyched, because I know firsthand what the natural reaction is when the magic medicine doesn't work:

To actually give a fuck about your nutrition, sleep, and what you do with your body.

As a proponent of a more informed, and introspective society, let's get started.