Last week I wrote about new research into when COVID-19 cases entered the country which led to massive spread of the virus. It isn’t the first case that matters. Many people don’t spread the virus at all, so it may enter and peter out. What matters is when a superspreader brings it in or catches it.
The research shows us that the ban on travel from China by non-U.S. residents didn’t work. I had thought it came too late because the virus was already here, but looking at details of the virus itself it appears that wasn’t true. The virus cases that actually spread came after the ban. So the ban didn’t work.
Many readers took that as a political point (“Trump bad”) but it actually isn’t. I wanted to understand the role of travel bans, and in this case a new New York Times investigation shows that it’s the CDC bureaucracy that failed.
Even after the ban was put into place U.S. residents were allowed to return, but were supposed to self-quarantine and the government was supposed to monitor this. That never happened.
Americans returning from China landed at U.S. airports by the thousands in early February, potential carriers of a deadly virus who had been diverted to a handful of cities for screening by the Centers for Disease Control and Prevention.
Their arrival prompted a frantic scramble by local and state officials to press the travelers to self-quarantine, and to monitor whether anyone fell ill. It was one of the earliest tests of whether the public health system in the United States could contain the contagion.
But the effort was frustrated as the C.D.C.’s decades-old notification system delivered information collected at the airports that was riddled with duplicative records, bad phone numbers and incomplete addresses. For weeks, officials tried to track passengers using lists sent by the C.D.C., scouring information about each flight in separate spreadsheets.
“It was insane,” said Dr. Sharon Balter, a director at the Los Angeles County Department of Public Health. When the system went offline in mid-February, briefly halting the flow of passenger data, local officials listened in disbelief on a conference call as the C.D.C. responded to the possibility that infected travelers might slip away.
“Just let them go,” two of the health officials recall being told.
It is possible that the virus entered the West Coast via Vancouver, British Columbia – suggesting that a China ban wouldn’t have kept it out if it had been managed properly. However the CDC wouldn’t have had the capability of managing a broader ban that included Canada either.
The research also shows that the virus which ultimately led to spread in New York entered on or about February 20 (95% likelihood between February 14 – 26) so the President’s March 11 ban on non-resident travel from Europe beginning March 13 did come too late. However the CDC failures suggest that even if the President had made this decision weeks earlier, it likely wouldn’t have mattered, just as it didn’t on the West Coast.
With each arriving China flight, the CDC “sent emails to state officials, one at a time, ..so they could download a list of targeted passengers.”
In California, state health officers received as many as 146 notification emails a day, forcing them to spend time forwarding them to the appropriate local health departments. In some cases, the information, collected for the C.D.C. by the Department of Homeland Security, listed incorrect dates or times; in other cases, passenger data was sent to the wrong state or came more than a week after the travelers had entered the United States.
“We got crappy data,” said Fran Phillips, Maryland’s deputy health secretary. “We would call them up and people would say, ‘Well, I was in China, but that was three years ago.’”
And then a week into the process the CDC “stopped sending notices entirely, even though flights kept coming.” They did this intentionally “to ‘improve data quality.'”
None of this should be surprising. The FDA only permitted use of the CDC test, which was faulty. We still don’t have good data that really tells us who is testing positive for the SARS-CoV-2 virus (rather than just how many and where). The CDC recommended against testing people who were exposed to the virus but who were asymptomatic. They’re keeping data backups of virus testing data on DVDs. The public health bureaucracy wasn’t up to this challenge and failed the country greatly.
And don’t blame this on the Trump administration, either. Real CDC funding did fall between 2010 and 2014 (during the Obama administration) but is back to prior levels during the Trump administration. The President’s budget, which is a political document never expected to become law, did recommend cuts to the agency. Those never happened.