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A 2026 CDC report found that 29 of 73 unannounced patient-actor drills (39.7%) did not meet the exercise’s combined success measure: the simulated patient had to be both masked and isolated. The other 44 drills (60.3%) achieved both, regardless of how quickly staff acted. These results describe participating sites in New Jersey, New York and the U.S. Virgin Islands—not 40% of all health facilities in those places.

What the “40% failed” result means

The CDC’s October 1, 2026 report counted 73 drills. In 44, the actor was both masked and isolated; in 29, at least one of those two steps did not happen. The combined measure did not require staff to meet the separate time targets. A drill could therefore count as a success even if masking or isolation took longer than the target.

The word “patient-zero” is shorthand, not a description of an actual case. Each exercise used a patient actor portraying a person who might have an infectious disease. No real H5 infection or outbreak was tested.

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How the patient-actor drills worked

The New York University Standardized Patient Program conducted unannounced drills from January through June 2026 in emergency departments, hospital outpatient clinics and urgent care centers. The 73 drills covered 69 facilities or settings. The distribution was 52 in New York City, 15 elsewhere in New York, three in New Jersey and three in the U.S. Virgin Islands. Puerto Rico did not participate.

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The actor portrayed a 20- to 28-year-old adult with pink eye, fever, malaise, muscle aches and cough, but no recent travel. If asked about sick contacts, the actor said they had direct contact with a sick duck in Central Park. That detail tested whether staff asked about relevant exposure rather than relying only on travel history.

The exercise examined screening, masking, isolation, personal protective equipment (PPE), risk assessment and notification. The CDC authors describe drills as an opportunity to identify training needs and evaluate readiness; they are not a measure of actual transmission or patient outcomes. Read the CDC MMWR report.

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Where the response slowed or fell short

Screening and exposure questions

Symptom screening occurred in 68 of 73 drills (93.2%). But only 7 of 73 (9.6%) included questions specific to avian influenza A(H5) exposure. The contrast suggests that general symptom checks were much more common than questions that could connect symptoms to a particular exposure.

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Masking and isolation

The actor was masked in 60 of 73 drills (82.2%); the median time from arrival to masking was two minutes. Isolation occurred in 52 of 73 drills (71.2%), with a median arrival-to-isolation time of 11 minutes. CDC selected one minute to mask and ten minutes to isolate as drill targets to encourage prompt infection-control measures at the point of entry. These were exercise targets, not universal legal standards or results from a patient-care trial.

Among the 58 drills with a timestamped masking measure, 25 (43.1%) met the one-minute target. Among the 52 isolation drills, 25 (48.1%) met the ten-minute target. These timing denominators differ from the 73-drill combined outcome because timestamp data and applicable encounters varied by measure.

Differences by setting

Isolation was slower in hospital outpatient clinics than in the other reported settings. Median arrival-to-isolation time was 20 minutes in outpatient clinics, compared with 9.5 minutes in emergency departments and 9 minutes in urgent care centers. Urgent-care masking took a median of five minutes. The urgent-care comparison rests on just 12 drills, so it should be read cautiously.

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PPE and internal notification

Clinicians used all recommended PPE in 25% of applicable encounters. The report’s examples of PPE include gloves, a mask, a gown and eye protection. Internal infection prevention and control staff were notified or scheduled for notification in 40 of 73 drills (54.8%). The findings point to multiple links in readiness: recognizing risk, having supplies available, knowing who acts, moving a patient to an appropriate space and alerting infection-prevention staff.

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What the findings can—and cannot—show

The figures are from participating sites in three jurisdictions, not a nationally representative inspection. The total number of facilities invited to participate was unavailable, so the response rate cannot be calculated. The authors also note that a facility might have learned about a drill beforehand or during its conduct.

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Because the exercise used a simulated H5-compatible scenario, it does not establish how facilities would perform during an actual outbreak. The results are best read as a snapshot of specific readiness steps in these drills, with different denominators for different measures.

Why the drill’s gaps matter

The CDC report’s authors say health care workers and facility staff need training to identify, mask and isolate potentially infectious febrile patients earlier. They also warn that waiting areas can be high-risk settings for respiratory-virus transmission if appropriate infection-prevention and control measures are not implemented. In practical terms, a screening script alone is not enough if staff lack a clear exposure-question pathway, mask access, isolation procedures or notification roles.

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