A faulty CDC coronavirus test delays monitoring of disease’s spread

A faulty CDC coronavirus test delays monitoring of disease’s spread

Problems with a government-created coronavirus test has limited the U.S. capacity to rapidly increase testing, just as the outbreak has entered a worrisome new phase in countries around the world.

While South Korea has run more than 35,000 coronavirus tests, the U.S. has tested only 426 people for the virus, not including people who returned on evacuation flights. Only a handful of state laboratories can currently run tests outside of the Centers for Disease Control and Prevention in Atlanta because the CDC kits sent out nationwide a week and a half ago included a faulty component.

Currently, U.S. guidelines recommend testing for a very narrow group of people - those who display respiratory symptoms and have recently traveled to China or had close contact with an infected person.

But many public health experts believe that in light of evidence the disease can take root and spread in Singapore, South Korea, Iran, and Italy, it's time to broaden testing in the United States. The small number of U.S. cases thus far may be a reflection of limited testing, not of the virus' spread. Infectious disease experts fear that aside from the 14 cases picked up by public health surveillance, there may be other people, undetected, mixed in with colds and flu. What scares them the most is that the virus is beginning to spread locally in countries outside China, but no one knows if that's the case here, because they aren't checking.

Who Does WHO (World Health Organization) Work For

Is there a requirement the WHO takes only the betterment of the world into consideration with their decision and judgements?  I mean, will a regulatory overseer come in and put the WHO officials in jail if they cater to the nation's political leaderships instead "doing good" for the whole world?Remember when Trump threatened to not fund the WHO for not following his agenda. So WHO is set up to cater to their members, not necessarily their populations  Especially for the great powers who fund most of the WHO. You see how important china is to the WHO?  

First City In USA Declares a Coronavirus State of Emergency

San Francisco declares local emergency amid coronavirus outbreak

AN FRANCISCO, Calif. (KRON) — San Francisco Mayor London Breed declared a local emergency Tuesday amid the global coronavirus outbreak.

This declaration will help the city get resources they need to respond to an outbreak.

“We need to allocate more resources to make sure that we are prepared,” Breed said in a news conference Tuesday afternoon. “This declaration is all about preparedness.”

Three people have been treated for the coronavirus in the city. None of the patients are San Francisco residents.

Two patients from San Benito County were hospitalized in San Francisco. They have since been discharged in good health and are no longer in the city.

Another patient who tested positive for the virus was brought to the city from Travis Air Force Base, where the patient was quarantined after leaving a cruise ship.

Santa Clara County, where there are two confirmed coronavirus cases, has also declared a local emergency due to the outbreak.

“CDC On Coronavirus In USA: Disruption To Everyday life might be severe

CDC expects ‘community spread’ of coronavirus, as top official warns disruptions could be ‘severe’

The Centers for Disease Control and Prevention on Tuesday warned that it expects the novel coronavirus that has sparked outbreaks around the world to begin spreading at a community level in the United States, as a top official said that disruptions to daily life could be “severe.”

“As we’ve seen from recent countries with community spread, when it has hit those countries, it has moved quite rapidly. We want to make sure the American public is prepared,” Nancy Messonnier, director of CDC’s National Center for Immunization and Respiratory Diseases, told reporters.

“As more and more countries experience community spread, successful containment at our borders becomes harder and harder,” she said.

There have been 14 cases of the virus diagnosed in the U.S., all in people who traveled recently to China or their close contacts. Another 39 U.S. residents have been infected in other parts of the world before being repatriated and quarantined. But CDC officials say the country could soon see more cases as the virus starts to spread through communities in areas outside China, including Iran, South Korea, and Italy.

The CDC urged American businesses and families to start preparing for the possibility of a bigger outbreak. Messonnier said that parents should ask their children’s schools about plans for closures. Businesses should consider whether they can offer telecommuting options to their employees, while hospitals might need to look into expanding telehealth services, she said.

“Disruption to everyday life might be severe,” Messonnier said, adding that she talked to her children about the issue Tuesday morning. “While I didn’t think they were at risk right now, we as a family ought to be preparing for significant disruption to our lives.”

The CDC’s messaging seemed to be at odds with the position of the World Health Organization, which reiterated Tuesday that countries could stop transmission chains if they acted swiftly and aggressively.

A new type of coronavirus is responsible for the outbreak of respiratory illnesses that began in Wuhan, China in December 2019. While experts are still unclear how exactly these viruses are transmitted, coronaviruses such as those that caused the SARS and MERS outbreaks in years past offer clues. Hyacinth Empinado and Alex Hogan/STAT

Bruce Aylward, a senior WHO official who led a recent international mission to China to see how that country had dealt with Covid-19, the disease caused by the coronavirus, said the lesson from China was that the impact of the new virus can be dramatically curtailed. But countries have to be prepared to wage a full-on assault, he insisted.

“Think it’s going to be there tomorrow,” Aylward said during a briefing for journalists at WHO headquarters in Geneva. “The thing you’ve got to think is: If it hits us, we’re going to stop it. You have to think that way. I keep hearing, ‘Oh, if it hits us we just have to accept it and it’s going to spread.’ Why? You’ve lost before you’ve started.”

Messonnier said the CDC is evaluating data on measures that could be used to stem the spread of the virus, including school closures and other social distancing strategies, voluntary home quarantines, and surface cleaning methods. The CDC is using data from past flu outbreaks to study those strategies, but will tailor its recommendations for the new virus.

Messonnier said the CDC is also in conversation about whether to change the case definition that triggers a sick patient to be tested for the virus. Currently, health officials recommend testing only for people who have respiratory symptoms and have recently traveled to China, or those who have been in close contact with someone who was infected. But as community spread picks up in other countries, the case definition could change.

Malicious Big Powers Competition In the Era of Coronavirus

Why wouldn't a big power seed coronavirus into our population? We screwed up containment, now the virus got us shutting down our economy. It has got us on our knees. So in order to maintain our relative big power status and reputation, we got to intentionally weaken our competitor who maintained coronavirus containment by seeding their population with coronavirus. 

What country is going to end up getting strengthened by coronavirus and what once a great country is going to permanently weakened by coronavirus.     

Evidence The Chinese Coronavirus Fatality Rate Is Being Gamed.

The reason for this is the virus is so infectious and deadly it would immediately crater the world 's economy and stock market. I am betting the coronavirus fatality rate is between 25% and 50%. I would say there are two panic stages. These panic stages just might be more damaging than the virus.

Stage one panic: When the country or world first appreciates the dangerousness of a particular virus. Everyone would reorganize their lives and money for a particularly dangerous virus. Panic would set in, vast shortages of basic commodities and much business failures. The dropping dead bodies right in front of your eyes might be many months ahead.  

Stage two panic: The dead bodies would tremendously increase, everyone would be terrified by the possibility of their own death or the sickness and death of their loves one. This panic would be primordial. This panic has the highest probability of societal destabilization.  

These two doctors worked at a nearby hospital in Wuhan. They died helping these very sick people. I wonder how many medical buddies they seen die in recent  days. What were their ages? The suspicion is why are these doctors so young. The whole world thinks the majority of the dead are  the old agers such as in 80s and 90s years old.

These rock star coronavirus doctors were  highly popular. They would be suspicious if they were just disappeared. So the Chinese authorities would want to release the deaths of these doctors and their infection for their own protection. The authorities are desperate to maintain their public credibility.

This is my evidence the coronavirus is killing a lot of young and middle age people. The majority of the dead people killed by the virus are rather no name people and the elderly. Nobody would care if the dead weren't added or taken off the list. This is how the whole system is artificially keeping the fatality rate low. They just aren't adding by the correct percentage the young or middle age people to the dead person list.  

 
Dr. Huang Wenjun 42 years old

Dr Xia Sisi 29

Military Troops Heading To The Mexican Boarder to Combat Cororavirus

This country is a prime example of a poor and poorly organized country. The drug cartels aren't going to help their country. As a result of the infections with little resources,  the fatality rate and serous illness are just going to explode. The hospitals are going to instantly fill up and become overwhelmed. All they will have left is the USA to help them? What about the rest of south America? 

This is the American way. Build a set of military coronavirus medical installation along the boarder. We treat all these Mexicans very good, treat, house and feed them until they are cured. Then they go back to Mexico. 

We are sitting here in la-la land in the USA. Our world and nation is radically change in 6 months because of coronavirus.  

Will HIPAA Impair Our Ability To Fight Coronavirus?

This is much like military secrecy. This kind of secrecy generally is to protect our troops and technology. Todays military secrecy is generally about protecting the politicians and brass's incompetence and mistakes.  National cohesiveness and trust in government is our highest national security even beyond the military. Now if you clamp down on  secrecy to protect the brass and policians you just might demoralize the country. 

If in explaining massive contagion, HIPPAA seems to be the go-too tool to not explain what is going on in a contagion...then the government will lose trust in the eyes of the public. 

Believe me at this point, we need the politicians and our medical officials to always tell us the truth, even the  horrible truths, much more than we need a coronavirus vaccine.    

The Health Insurance Portability and Accountability Act of 1996 (HIPAA or the Kennedy–Kassebaum Act^[1][2]) was enacted by the 104th United States Congress and signed by President Bill Clinton in 1996. It was created primarily to modernize the flow of healthcare information, stipulate how Personally Identifiable Information maintained by the healthcare and healthcare insurance industries should be protected from fraud and theft, and address limitations on healthcare insurance coverage.^[3]

The act consists of five titles. Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs.^[4] Title II of HIPAA, known as the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers.^[5] Title III sets guidelines for pre-tax medical spending accounts, Title IV sets guidelines for group health plans, and Title V governs company-owned life insurance policies.

Cities and firms begin disclosing patients' workplaces as Japan records third Diamond Princess death

Kyodo, Staff Report

Feb 23, 2020

Japan on Sunday recorded the third death of a Japanese national who had been on the coronavirus-hit Diamond Princess cruise ship as infections linked to the virus continued to rise nationwide.

Some municipalities and companies have also started disclosing information about where infected people work.

The health ministry said Sunday a man in his 80s who had been on board the cruise ship had died of pneumonia. However, the ministry did not say whether the man was infected with the COVID-19 virus nor whether he was a passenger or crew member because it had not obtained consent from the deceased’s family....

Coronavirus To Cause Drug And Medical Device Shortage In USA

Well, now you are going to have to think about if China locks down an area around a drug plant and the worker can't get to the plant.

Fox news: Experts are warning America has become too dependent on China for its medicine -- everything from painkillers, to antibiotics, and even aspirin can all be sourced back to a country the Department of Defense considers an adversary.

The Food and Drug Administration estimates that at least 80 percent of the active ingredients found in all of America's medicines come from abroad – primarily China.

"Imagine if China turned off that spigot," said Rosemary Gibson, author of "China RX: The Risks of America's Dependence on China for Medicine." "China's aim is to become the global pharmacy to the world -- it says that. It wants to disrupt, to dominate, and displace American and other Western companies."

In 2015, China unveiled "Made in China 2025," a national plan to make it the world's leader in 10 high-tech manufacturing sectors, including bio-medicine, by 2025.

The new national security warning comes as China is threatening to weaponize its dominance in mining rare earth minerals against the United States, in an escalation of the ongoing trade war.

How many deaths will this cause if this Pandemic deepens in China and/or throughout the world? 

Can you even imagine how high they will increase their prices!     

FDA: China's coronavirus might disrupt 'critical medical products' including drugs and devices

Ken Alltucker Jayne O'Donnell

USA TODAY

The Food and Drug Administration has pulled inspectors from China amid the rapidly-spreading coronavirus and has warned Americans might face shortages of “critical medical products” if the outbreak persists.

The federal agency halted inspections of drug and device factories due to the State Department warning against travel to China. The FDA has faced Congressional scrutiny for its oversight of overseas factories following high-profile recalls of blood pressure-lowering medications and reports revealing fewer overseas inspections in recent years.

Although the coronavirus outbreak seems to put the federal agency behind schedule on routine safety and quality checks of drug and device factories, Commissioner Stephen Hahn said the agency can still monitor China-made products through testing, records requests and "import bans" that forbid products from entering the U.S.

“The robust and multi-layered compliance process at the FDA is helping to protect American patients and consumers even though we are not able to conduct inspections in China at this time,” Hahn said in a statement.

The FDA’s database of inspections, current as of Feb. 7, shows the agency has not listed any inspections of a Chinese factory since last December. Inspections in China typically slow down in January around the time of Chinese New Year, but the absence of on-site safety and quality checks will now extend into March.

The FDA inspects when an overseas factory seeks approval to supply drugs or drug ingredients for the American market. Factories are also subject to periodic “surveillance” inspections to gauge whether they are meeting quality standards. When the agency becomes aware of a possible safety problem with a drug or manufacturing process the FDA conducts “for cause” inspections.

Hahn said all inspections scheduled for February were postponed or the agency used "other information to inform decisions allowing the products to enter our U.S. market." He said 90% of those inspections were routine surveillance. The agency also delayed this month's scheduled for-cause inspections after analyzing information for each factory in question. Most surveillance inspections scheduled for March at drug and medical device factories already have been postponed, he said. The agency did not address inspections in January. 

We will continue to closely monitor the situation in China so that as the situation improves, we will be prepared to resume routine inspections,” he said.

The FDA has faced questions from lawmakers about how the coronavirus outbreak has affected the agency’s oversight of drug and device factories. And last December, before the outbreak was known, a Government Accountability Office report revealed the number of inspections at overseas factories dropped 10% from 2016 to 2018 and found "persistent challenges" such as not hiring and retaining enough inspectors. 

Michael Carome is director of Public Citizen's health research group and an expert on drug safety and FDA oversight.

"The fact that the FDA has suspended inspections is worrisome," Carome said. "We start from a baseline position of they are not doing enough inspections in China, where the active ingredients for a lot of our drugs are made. Any further delay or suspension in their inspections makes the problem worse."

Carome said a short suspension probably won't make a huge difference. However, if the outbreak delays inspections for several weeks or months "that’s going to impact drug safety," he said.

Another potential problem: The U.S. might need to navigate drug or medical product shortages if the coronavirus outbreak continues to snarl production in China, a pivotal supplier for American consumers, doctors and hospitals.

Hahn said the agency is "keenly aware" the coronavirus outbreak "will likely impact the medical product supply chain, including potential disruptions to supply or shortages of critical medical products in the U.S."

The agency has reached out to manufacturers and shifted resources to identify potential medical product shortages. He said the agency is tracking reports of increased orders of medical devices such as masks, gloves, respirators and surgical gowns.

Howard Sklamberg, a former FDA deputy commissioner overseeing foreign inspections during the Obama administration, said the agency tries to take action to avert drug and medical device shortages. Some strategies might include finding other suppliers, possibly in another country, or accelerating approval of a drug from another manufacturer awaiting FDA review.

Some drug or device supply disruptions can be predicted, such as when a company alerts the FDA of plans to discontinue a drug or suspend production due to a manufacturing problem. Other times, the change can be sudden. In 2017, Hurricane Maria slammed Puerto Rico and shut down production at drug factories that made critical supplies such as saline solution.

“This type of thing happens more frequently than one might think,” Sklamberg said of drug shortages. “It happens when there is a weather problem. Oil spills. Or there could be a situation like a civil war," which can disrupt production or make it impossible for inspectors to access a factory.

Even if inspectors are shut out of routine surveillance or “for-cause” checks, the FDA has other options to protect consumers from receiving tainted products. The agency can halt overseas shipments of problem drugs, devices or food through “import alerts” coordinated with customs and border enforcement officials.

Whether the coronavirus disrupts drug supplies “largely depends on how long the emergency continues and how broad the geographic area is,” said Sklamberg, now a partner in the law firm Akin Gump.  

“The supply chain and the level of inventory in the US already varies a lot by drug. It’s hard to make an overall statement, other than it depends on how long this goes on.”

Tom Cosgrove, a former director of FDA’s office of manufacturing quality, said the FDA's inspection system is very flexible. 

“The issue is, how will the FDA inspection regime fare if they can’t access China?" said Cosgrove, now a partner in the law firm Covington & Burling.  

If the quarantine succeeds and inspections resume “within a couple of months, I don’t think there will be a major impact on the FDA. But if it’s more than a couple months, the FDA could fall behind on its inspection program and it would take a long time to catch up."

Worldwide Coronavirus Conspiracy To Not DiscloseThe True Death Rate

This simulation took place in Nov 2019. It mostly focuses on the private sector. But in a pandemic of this scale, all that is going to matter is how effective and trustworthy governments are?  

Pandemic simulations: Event 21. These video's set up the Pandemic. Check out the highlights video. Catastrophic economic devastation worldwide lasting for decades. Enough for the nations of the world to lie about!  We primed the pump of the coming panic with the Cruise Ship infections. It set in our minds the mistrust of our officialdoms. This is a high intensity virus media experience and it has painted the outcome of the pandemic. Every time a member of the public think they gotten exposed, or think their family got the exposed, they are going to remember the Cruise Ship experience. The horror stories about this. The Cruise ship experience already set in stone a certain level of economic damage. Sixty five million dead. That is bad enough, but the economic damage of the pandemic is going to be many times worst than the severe illness and fatality cost. The worldwide economic and panic damage as a result of the pandemic  is going to do most the hurting on the planet for a very long time.         

I think there  is a worldwide conspiracy surrounding the fatality rate with coronavirus infections. What do all these nations have in common with this conspiracy...the conspiracy. What strong connections do they need  to implement such a large scale conspiracy. Basically it is money and social order. How would we feel if the fatality rate was 10% to 50%. Basically the stocks markets and economies would collapse or be much lower if the truth came out. There would be hording of necessities on a world wide scale. Many millions of people would have no incomes. The planet would become a war zone before the  actually dearth toll showed up.       

How do you intrepid the surge in new cases and the adjustment of the testing methods other than the  Chinese are trying to dilute the fatality rate.  The fatality rate is all the infected population  divided by the amount of deaths. The death rate is the simplest to falsify. 

Maybe the nations think we got to lie to the public in order to stay strong until the actual death tally becomes apparent to everyone to see. We deny everything until the eventuality comes right upon us. Then our economies would collapse, eventually the virus will burn out. This scenario would lead to a lesser economic and social damage. Then the world would recover.

Maybe everyone is planning on a hail Marry pass with a new vaccine.    

Feb 13 2020 Coronavirus Infections In China Surge As Officials Add New Testing Methods To Tally

China’s Hubei Province reported nearly 15,000 new infections on Thursday, a day after health officials said the number of new patients appeared to be falling.

So now we got thirty people in medical isolation because of the virus. We got thousands in military isolation at four bases in the USA. These guys only got suspicions they are infected and most would not even catch the virus. So you can't use the  people in military facility for the fatality rate. But the thirty in specialized hospital isolation is really important for the fatality rate. Do you think the specialized hospital's real function is to control the disclosure of the deaths and severe illness  in the specialized hospitals. 

Is the USA's coronavirus pandemic plans really: strict containment to the maximum extent possible and the total control with disclosures on the severity of the illness and its death rate.  Of course it is really a national security plant.

I would be really interested on how the initial stage to the pandemic to when  WHO declared a pandemic was modeled?         

ATLANTA (CBS46) – As nations around the world prepare to deal with the new coronavirus from China, a simulation of a pandemic surrounding a coronavirus put together late last year doesn’t instill a lot of confidence.

The simulation, called Event 21, was put together by the Center for Health Security at Johns Hopkins, the World Economic Forum, and the Bill and Melinda Gates Foundation. The mythical virus used in the simulation was called CAPS and was a coronavirus.

In the simulation, the virus was resistant to vaccine, deadlier than SARS, and easily transmittable, Yahoo! News reported. The pandemic started with farmers coming down with symptoms and then spreading through crowded and poor neighborhoods as the global community started to fight back. Yahoo! reported the simulation showed after six months, the fake virus had spread around the world and one year later had killed 65 million people.

For comparison, the last major global pandemic was the Spanish flu in 1918. That pandemic claimed 50 million lives including hundreds of thousands in the United States. The CDC said an estimated 500 million people, or one-third of the world’s population at the time became ill with the Spanish flu.

According to Yahoo! News, the simulated pandemic “also triggered a global financial crisis” that saw stock markets collapse and “global domestic product plunged by 11 percent.” Eric Toner, senior scholar at Johns Hopkins’ Center for Health Security told Axios the threats from infectious disease outbreaks and another pandemic are “very real.”

“As we demonstrated in our Event 201 exercise in October, the world is ill-prepared for a severe pandemic. Such a global disease outbreak would not only cause widespread illness and death but there would be severe societal and economic consequences as well,” Toner told Axios.

As of January 22, the World Health Organization said the outbreak of the new Chinese coronavirus “did not constitute a PHEIC (public health emergency of international concern).” The WHO did not human-to-human transmission was occurring and of the confirmed cases, 25 percent are “reported to be severe.”

Health security

Pandemic simulation exercise spotlights massive preparedness gap

Event 201, hosted by the Johns Hopkins Center for Health Security, envisions a fast-spreading coronavirus with a devastating impact

By Katie Pearce / Published Nov 6, 2019

Back in 2001, it was a smallpox outbreak, set off by terrorists in U.S. shopping malls. This fall, it was a SARS-like virus, germinating quietly among pig farms in Brazil before spreading to every country in the world.

With each fictional pandemic Johns Hopkins experts have designed, the takeaway lesson is the same: We are nowhere near prepared.

"Once you're in the midst of a severe pandemic, your options are very limited," says Eric Toner, a senior scholar at the Center for Health Security at Johns Hopkins University. "The greatest good can happen with pre-planning."

"Once you're in the midst of a severe pandemic, your options are very limited. The greatest good can happen with pre-planning."

Eric Toner

Senior scholar, Johns Hopkins Center for Health Security

That center's latest pandemic simulation, Event 201, dropped participants right in the midst of an uncontrolled coronavirus outbreak that was spreading like wildfire out of South America to wreak worldwide havoc. As fictional newscasters from "GNN" narrated, the immune-resistant virus (nicknamed CAPS) was crippling trade and travel, sending the global economy into freefall. Social media was rampant with rumors and misinformation, governments were collapsing, and citizens were revolting.

For those participating in New York City on Oct. 18—a heavyweight group of policymakers, business leaders, and health officials—Event 201 was a chance to see how much catch-up work is needed to bolster our disaster response systems. Full videos of the discussion are available online.

"It really does shake up assumptions and change thinking about how we can prepare for a global pandemic," says Tom Inglesby, director of the Center for Health Security.

Video credit: Johns Hopkins Center for Health Security

Event 201 is the fourth such exercise hosted by the Johns Hopkins center, which works to prepare communities for biological threats, pandemics, and other disasters. The simulations started with 2001's Dark Winter, which gathered national security experts for its simulated smallpox outbreak. The groundbreaking event turned out to be influential in shaping U.S. efforts around pandemic preparedness—particularly due to its timing, right before 9/11.
"Dark Winter resulted in more than a dozen congressional hearings, was briefed to the White House, and ultimately influenced the decision to stockpile enough smallpox vaccine for all Americans," Inglesby says.

That simulation and its two successors—Atlantic Storm, conducted in 2005, and last summer's Clade X—have also demonstrated lasting value as educational and advocacy tools, with reenactments or modified versions taking place in settings including universities, the CDC, and Capitol Hill, according to Inglesby. "These exercises have a long fuse," he says.

For Event 201, hosted in collaboration with the World Economic Forum and the Bill & Melinda Gates Foundation, the experts added a new layer of realism by reaching beyond government and NGOs to leaders in the private sector and business community. Participants included representatives from NBCUniversal, UPS, and Johnson & Johnson.

"Very few people have included the private sector in pandemic preparedness, but that's where most of the resources are," Toner says.

That's particularly true when it comes to vaccine development. The CAPS virus—which Toner describes as a cousin of SARS, "but slightly more transmissible, like the flu, and slightly more lethal"—was presented as resistant to any existing vaccine, as scientists scrambled to come up with one. Citizens, meanwhile, were rioting over scarce access to the next best thing: a fictional antiviral known to treat some CAPS symptoms.

That scenario, Toner says, is utterly realistic. "We don't have a vaccine for SARS, or MERS, or various avian flu viruses that have come up in the past decade," he notes. "That's because vaccine development is slow and difficult if there isn't an immediate market for it."

In the simulation, CAPS resulted in a death toll of 65 million people within 18 months—surpassing the deadliest pandemic in history, the 1918 Spanish flu.

From the discussions Event 201 inspired, the Center for Health Security plans to release a set of formal recommendations within the coming weeks.

Shortly after the simulation, the center released the Global Health Security Index, the first-ever comprehensive ranking of countries on their pandemic preparedness. All in all, the picture was discouraging: The average score, across 195 countries, was 40 out of a possible 100.

"It's our hope," Inglesby says, "that countries will use this to consider where they are strong and where they are weak."