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 The federal government sought help from a team at the University of
Nebraska Medical Center, including Dr. James Lawler, an experienced
infectious disease specialist. Lawler told Reuters he immediately
asked the world-renowned U.S. Centers for Disease Control and
Prevention (CDC) for permission to test the quarantined group,
deeming it crucial to know whether people without symptoms were
infected and could spread the deadly pathogen.
Agency officials worried that detained people couldn’t give proper
consent because they might feel coerced into testing. “CDC does not
approve this study,” an official at the quarantine site wrote to
Lawler in a Feb. 8 email obtained by Reuters. “Please discontinue
all contact with the travelers for research purposes.”
More than two months passed before the CDC expanded its testing
guidelines to include all asymptomatic people, saying soon afterward
that this silent spread “may meaningfully contribute to the
propagation of the COVID-19 pandemic.” By November, the agency
estimated that more than half of cases were spread by people not
currently experiencing symptoms.
Critics have widely asserted that the CDC fumbled key decisions
during the coronavirus scourge because then-President Donald Trump
and his administration meddled in the agency’s operations and
muzzled internal experts. The matter is now the subject of a
congressional inquiry. Yet Reuters has found new evidence that the
CDC’s response to the pandemic also was marred by actions - or
inaction - by the agency’s career scientists and frontline staff.
At a crucial moment in the pandemic when Americans were quarantined
after possible exposure to the virus abroad, the agency declined or
resisted potentially valuable opportunities to study whether the
disease could be spread by those without symptoms, according to
previously undisclosed internal emails, other documents and
interviews with key players.
Soon after balking at testing the returnees from Wuhan, the agency
delayed testing asymptomatic passengers among 318 evacuees from the
Diamond Princess, a contaminated cruise ship in Japan. In addition,
the agency failed at that time to make effective use of outside
experts and appeared at times unprepared for the crisis on the
ground, lacking adequate personal protective gear and ignoring
established protocols, Reuters found.
“Yes, they were interfered with politically,” said Lawrence Gostin,
director of the O'Neill Institute for National and Global Health Law
at Georgetown University, referring to alleged meddling by the Trump
administration. “But that’s not the only reason CDC didn’t perform
optimally during COVID-19. There are a lot of things that went
wrong.”
Four top public health experts or ethicists told Reuters that the
question of whether to test or engage in research on detained people
has always been a sensitive topic. But all said the CDC should have
proceeded given the fast-moving public health emergency.
Moreover, the CDC finalized rules in 2017 providing that medical
testing was expressly allowed in quarantine, as long as participants
were given the opportunity to give “informed consent” or opt out.
Informed consent means giving people adequate information to
understand the risks and benefits of a test or procedure.
Gostin said the CDC’s argument against testing was “unreasonable”
under the circumstances. “You are asking for consent and not
imposing any harm,” he said. “There is a good reason to do it.”
It’s difficult to know whether more aggressive early testing among
asymptomatic people would have significantly altered the trajectory
of the pandemic in the United States, which has infected 24 million
people and killed more than 400,000.
The CDC was not the only agency that struggled with this issue.
Notably, an official with the World Health Organization called
asymptomatic spread “very rare” in June, only to say a day later “we
don’t actually have that answer yet.” In recent months, the WHO has
said infected people without symptoms can be contagious, but “it is
still not clear how frequently this occurs.”
Still, some countries such as South Korea and Singapore used
widespread testing early on to identify infected people with or
without symptoms and, unlike the United States, broadly required or
distributed masks.
CDC scientists infamously botched the creation of a test for the
coronavirus and took weeks trying to fix it, making widespread
testing - well beyond those with symptoms - impossible during the
pandemic’s first months.
In response to detailed inquiries from Reuters, a CDC spokesman said
the agency declined to comment.
In the final weeks of the Trump administration, White House
officials did not respond to requests for comment on reports of
political interference.
The problems within the CDC, which has suffered from a decade of
declining funding, point to the steep challenge faced by newly
inaugurated President Joe Biden and his CDC director, Rochelle
Walensky, to rehabilitate the agency in the eyes of scientists,
other public health officials and the public.
Walensky “acknowledges that work has to be done to restore public
confidence” in the CDC, according to a Biden spokesperson.
Dr. Sonja Rasmussen, who worked at the CDC for 20 years and at one
point was responsible for pandemic influenza preparedness, said the
agency’s staff are “among the most dedicated professionals in the
world and they were doing the best they could under the toughest
circumstances.”
“This has been an incredibly challenging pandemic and it would have
been hard for anyone to guess what would have happened,” she said.
But she and other public health specialists also told Reuters that
Americans deserve a thorough examination of the agency’s
shortcomings in the crisis.
“We have to figure out what needs to be fixed before this happens
again,” said Rasmussen, now a professor at the University of
Florida.
REQUEST DENIED
On Feb. 7, a group of Americans arrived from Wuhan and the
surrounding province at Camp Ashland, a National Guard base near
Omaha and the University of Nebraska Medical Center, a major outpost
in the nation’s defenses against bioterrorism and infectious
diseases.
Infectious disease specialist Lawler, who worked in the George W.
Bush and Obama administrations on pandemic response, suspected that
some of the evacuees might be infected with the coronavirus and
shedding it despite having no symptoms. His suspicions were based
partly on scientific reports from Asia and Europe.
Starting on Feb. 8, Lawler pressed the CDC to greenlight voluntary
and limited coronavirus testing among this group, according to
emails obtained by Reuters through the Freedom of Information Act.
Lawler had already won support for such testing from the U.S. Health
and Human Services (HHS) officials in charge of the returnees at
Ashland, the Nebraska health department and his university’s medical
faculty, emails show. HHS oversees the CDC.
Later that Saturday, Eric Kasowski, the CDC’s representative at Camp
Ashland, emailed Lawler to tell him that his request to test the 57
people in quarantine “was very quickly elevated to Dr. (Anne)
Schuchat, Principal Deputy Director, CDC,” who had worked at the
agency for 32 years.
Schuchat referred questions from Reuters to the CDC press office,
which declined to comment.
The CDC’s answer to Lawler was no.
According to the Feb. 8 email: “It is CDC’s position that since the
research is being proposed for a group of individuals who are
detained under a federal quarantine order, the circumstances of
voluntary participation would be extremely difficult to assure and
therefore, CDC does not approve this study.”
Lawler said he kept pressing Kasowski. But Kasowski told Lawler the
next morning that the testing proposal had been rejected again, this
time by officials up to and including CDC director Robert Redfield.
“This is absurd,” Lawler recalled telling Kasowski.
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Kasowski declined to comment, referring questions to the CDC.
Instead of having everyone tested during the two-week quarantine,
only one returnee who became ill and was hospitalized got tested;
the results were negative for coronavirus, Lawler said. The other 56
left quarantine without knowing whether they carried the virus, and
Lawler said he knows of no CDC follow up with that group.
In a Feb. 10 email to Kasowski, Lawler warned that the federal
government, by not testing symptomless individuals, “may be missing
the submerged iceberg in the U.S.”
MAJOR PROBLEMS
Within days, Lawler got a new federal assignment: to help evacuate
more than 300 Americans stranded on the Diamond Princess cruise ship
docked in Yokohama, Japan.
He was joined there by Dr. Michael Callahan, a veteran infectious
disease specialist from Massachusetts General Hospital, who had just
been appointed a special advisor to HHS on COVID-19. Callahan, who
says his two years of physician scientist training at the CDC in the
mid-1990s inspired him to forgo academia for a field career battling
disease outbreaks, had just treated coronavirus patients in China
weeks earlier.
Major problems emerged soon after Lawler and Callahan arrived in
Yokohama on Feb. 14.
The U.S. team, including HHS and other U.S. personnel, had to borrow
walkie talkies from Japanese authorities because they didn’t have
mobile phones that worked internationally, according to an
“after-action” report submitted by Lawler and Callahan in March to
HHS and obtained by Reuters.
Japan had to lend the U.S. team basic protective gear because the
Americans’ supplies didn’t arrive in time, the report said. Some
team members were not trained for handling a “highly contagious
disease.”
According to Callahan, he had to turn back two CDC staffers seeking
to board the Diamond Princess in Japan because they had no current
experience in emergency medicine and infection control.
Callahan said the problem was not isolated to the CDC’s coronavirus
response. In his regular interactions in the field with CDC staff in
recent years, he said, he has seen “a progressive degradation of
clinical expertise and incident management,” particularly during
Ebola outbreaks in Africa.
The CDC needs “people that can actually do public health when bad
stuff happens,” Callahan said.
NOT ENOUGH PROOF
On Feb. 17, Lawler flew with 151 cruise passengers to Lackland Air
Force Base near San Antonio, Texas. An isolation bubble was created
using a plastic curtain in the rear of the plane for five passengers
who had tested positive for COVID-19 in Japan.
During the flight, Lawler moved two passengers who had become
feverish to the isolation area, planning to take them to Nebraska
Medical Center. But those precautions went awry when CDC personnel
greeted the plane in Texas.
“The CDC officer in charge boarded the aircraft without consulting
the flight crew regarding safety or contamination issues,” according
to the after-action report.
The officer’s personal protective equipment “was grossly
insufficient due to the high level of contamination that likely
existed on the aircraft. This likely put CDC personnel and other
responders on the ground at risk.”
What’s more, the CDC official moved the two people who had developed
symptoms mid-flight back with the group of healthy passengers, and
the CDC’s handling of the flight violated disaster medicine
protocols, according to the report. The CDC official is not named in
the report.
Similar problems occurred when Callahan arrived with another group
of 167 Diamond Princess passengers at Travis Air Force Base in
Northern California and a CDC officer boarded the plane, the report
said.
Meantime, officials at Nebraska’s public health laboratory, who had
been working with Lawler, asked the CDC for permission to test
passengers from the Diamond Princess while they were under
quarantine, even if they didn’t have symptoms, emails show.
A CDC influenza expert, Dr. Tim Uyeki, wrote back on Feb. 17 to the
director of the Nebraska Public Health Laboratory that the agency
only wanted to test symptomatic individuals and those who had
previously tested positive in Japan, citing a lack of detail on the
accuracy of the Japanese tests.
Uyeki declined to comment and referred questions to the CDC press
office.
Lawler and Callahan said they flew in late February to CDC
headquarters in Atlanta to meet with Redfield and other senior
officials, to raise concerns about the flawed evacuation and
potential for asymptomatic spread based on their observations from
the Diamond Princess. Lawler said CDC officials
replied that there wasn’t enough proof yet that people without
symptoms spread the disease.
Redfield did not return requests for comment.
Meanwhile, at both quarantine sites in Texas and California, CDC
staff began to test some cruise passengers without symptoms who
previously had tested positive in Japan, according to Dr. Bela
Matyas, the local health officer in California’s Solano County, as
well as emails between the Nebraska hospital personnel and the CDC.
The CDC officials had doubts about the accuracy of testing done by
Japanese authorities, but the results confirmed that at least some
of the passengers were indeed positive - 16 at the California base
alone, Matyas said. Texas numbers were not available.
During the second week of quarantine in late February, the CDC and
local health officials began offering tests to all of the cruise
passengers. In California, where most sought testing, 10 more people
were found to have COVID-19, Matyas said.
Despite this evidence of infections without symptoms, the CDC made
no immediate changes in its public guidance on asymptomatic
infection.
‘FAIRLY COMMON’
By March, signs of asymptomatic spread were mounting in the United
States and abroad.
A tipping point for the CDC came when staffers were deployed to the
outskirts of Seattle to handle an outbreak at the Issaquah Nursing
and Rehabilitation Center, a relatively confined setting. King
County and CDC officials tested 76 of the 82 residents, regardless
of whether they exhibited symptoms, beginning on March 13, according
to the CDC.
They found 23 infected, 13 asymptomatic at the time. Ten of those
went on to develop symptoms.
 “That was really ... our first hint that asymptomatic transmission
was fairly common, especially in those settings,” said Dr. James
Lewis, an official with the county health department’s COVID-19
response, in an interview.
Two weeks later, on March 27, the CDC published the case study as
evidence of asymptomatic infection. That same week, for the first
time, the agency recommended testing health workers and first
responders, even without symptoms.
In a radio interview that aired on March 31, Redfield said, “We have
learned that in fact” symptomless individuals “do contribute to
transmission.”
Based on that evidence, the CDC recommended that even asymptomatic
people wear cloth face coverings in public areas. Almost a month
later, on April 27, the agency expanded its testing guidelines to
include “persons without symptoms.”
That was 11 weeks after Lawler’s first request to test the Wuhan
group in Nebraska.
(Ned Parker reported from New York and Chad Terhune from Los
Angeles. Editing by Michele Gershberg and Julie Marquis)
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