You forgot lack of leadership and direction. In Canada, if the provinces don't get it right, the federal government steps in. So far the provinces have had excellent medical leadership(looking at you BC) with the full support of their respective governments. You are fortunate that at least at the state level, those officials have been on the ball for the most part. If the feds say it's business as usual, you know, gotta get all those chocolate bunnies sold, the state can tell them to pound sand.The reasons are known. CDC budgets cut. CDC pandemic response team cut. Advance CDC epidemiologist in China, cut. Stock piles of masks, ventilators, cut. Just in time supply chains sound good when one wants to maximize efficiency and profit, but that model doesn't fit for health care. The lesson being learned is that we need to take healthcare as seriously as national defense (which has lots of stockpiles of things it will never use).