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Internal Emails Show How Chaos at the CDC Slowed the Early Response to Coronavirus
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Ubiquitous
Mar 29, 2020, 5:47:25 PM3/29/20
to
On Feb. 13, the U.S. Centers for Disease Control and Prevention sent out an
email with what the author described as an “URGENT” call for help.
The agency was struggling with one of its most important duties: keeping
track of Americans suspected of having the novel coronavirus. It had “an
ongoing issue” with organizing — and sometimes flat-out losing — forms sent
by local agencies about people thought to be infected. The email listed job
postings for people who could track or retrieve this paperwork.
“Help needed urgently,” the CDC wrote.
https://assets.propublica.org/images/articles/_threeTwo400w/20200327-Urgent-
Job-Posting-PUI-lightline.jpg
This email is among hundreds of pages of correspondence between federal and
state public health officials obtained by ProPublica through a records
request in Nevada.
During the period in which the correspondence was written, from January to
early March, health officials were trying to stay ahead of the coronavirus
outbreak underway in China. By mid-February, when the CDC job postings email
went out, the virus had a toehold in the United States, where there were
already 15 confirmed cases. In another two weeks, the first case of community
transmission would be reported in California, followed shortly by cases in
Washington.
The documents — mostly emails — provide a behind-the-scenes peek into the
messy early stages of the U.S. response to the coronavirus, revealing an
antiquated public health system trying to adapt on the fly. What comes
through clearly is confusion, as the CDC underestimated the threat from the
virus and stumbled in communicating to local public health officials what
should be done.
The same week the CDC sent out the email about the job openings, the agency
sent Nevada officials alerts about 80 potential coronavirus patients to
monitor, documents show. Four were not Nevada residents.
A state epidemiologist, in each instance, corrected the agency, informing the
CDC that the person was from New York, not Nevada. (The CDC then redirected
each report to New York, the documents show.)
The confusion sometimes went both ways. On March 4, a program manager in the
Nevada Health Department reached out to the CDC to ask about congressional
funding for COVID-19, the disease caused by the novel coronavirus.
“There seems to be a communications blackout on this end,” the program
manager wrote, wondering if funds would be distributed based on the number of
cases in each state or by population.
“Unfortunately, there is no clear answer to your questions,” responded a CDC
staffer, apologizing for the lack of information. “We are hearing all of the
rumor mills as well.”
“Thank you,” the Nevada program manager replied. “It’s good to be confused
together.”
https://assets.propublica.org/images/articles/_threeTwo400w/20200326-
Confused-Together-to-publish-1-line.jpg
Chaotic Coordination
For much of February, the CDC kept a tight grip on who should be tested for
the coronavirus, a strategy that has been criticized by epidemiologists for
limiting the ability to track the spread of the disease.
In a Feb. 19 presentation to state health officials, the CDC described the
definition of a person who ought to be tested: You had to have had close
contact with someone confirmed to have COVID-19, or to have traveled from
China and then had respiratory symptoms and a fever at the same time.
However, the CDC’s own guidance from a month prior, distributed to the states
on Jan. 17, had a footnote that said that “fever may not be present in some
patients,” such as people who had taken fever-lowering medications, according
to one of the documents obtained by ProPublica. That caveat was not on the
slides presented to the states in mid-February.
In a statement to ProPublica, the CDC said clinicians could always use their
judgment to decide who received a test. “CDC never declined a request for
testing that came from a state or local health department,” the agency said.
The CDC designed a flawed test for COVID-19, then took weeks to figure out a
fix so state and local labs could use it. New York still doesn’t trust the
test’s accuracy.
In mid to late February, the CDC was trying to move responsibility for
coronavirus testing from itself to state health departments — a critical
step, since the CDC does not have the capacity to be the nation’s testing
lab. Slides from the Feb. 19 presentation describe the process for
transitioning from “Phase 1,” in which the CDC determined who was a potential
COVID-19 patient and conducted all the testing, to “Phase 2,” in which local
health departments would do that work and report data back to the CDC.
Because of delays with test kits, Phase 2 had to be “redesigned,” the
presentation said, so the CDC would continue to test specimens and return
results. The CDC told ProPublica that all states have now transitioned to the
original Phase 2 plan, where they can run their own tests.
The CDC presentation also directed the states to use a web platform called
DCIPHER, which the agency was already using for food-related outbreaks, to
report potential COVID-19 patients and confirmed cases.
But it wasn’t until the week of Feb. 24 — the same week that the U.S. would
discover its first case of community-acquired COVID-19 — that the CDC
scheduled a training for states on how to use the platform, according to the
documents.
On March 1, the CDC emailed Nevada’s Health Department, requesting that it
send a list of users and email addresses to connect to the DCIPHER system, to
“ensure that we can onboard your jurisdiction.”
“We sent a spread sheet a couple weeks ago which I thought covered this,” a
state epidemiologist responded.
Four days later, Nevada announced its first confirmed case of the
coronavirus. It’s unclear when the state managed to successfully get on the
DCIPHER system. Officials from Nevada declined to comment.
“Maybe Just Kidding”
A key part of the CDC’s strategy during the early days of the outbreak was
identifying infected travelers returning from China. The process for
screening passengers arriving at Los Angeles International Airport did not go
smoothly, the correspondence obtained by ProPublica indicates.
On Feb. 16, a CDC staff member sent a message to colleagues about a buggy
electronic traveler screening questionnaire that wouldn’t save correctly,
among other issues. Also, the tool’s drop down field auto-populated with
“United Kingdom” instead of “United States,” forcing users to type “United
States of America.”
The CDC staffer also said the agency was struggling to interview non-English
speakers in a timely manner and needed additional interpreters.
“Hello Team,” another CDC staff member responded, offering a solution: “The
Google translate App has a real-time voice translation option.”
The screening protocol also wasn’t always clear. On Feb. 29, a CDC officer at
LAX sent an email to her colleagues, saying: “In case this comes up again, we
are not screening private flights. These would be flights that land at LAX
but don’t arrive into the regular terminal … mainly for rich people.”
Just over two hours later, the officer emailed again. “And, maybe just
kidding,” she wrote. Information from headquarters seemed to contradict what
she had said about private flights, she said.
The CDC told ProPublica that it scaled up the screening almost overnight, so
it focused on vetting the largest segment possible of high-risk passengers
coming from places like Wuhan, China. The agency trained staff and dealt as
best it could with limited staffing and translation services, it said.
“Protecting Americans Is What We Do”
The CDC’s initial response to COVID-19, particularly its failure to initiate
swift, widespread testing, has drawn intense criticism.
Nonetheless, the correspondence ProPublica obtained shows that the CDC
director, Dr. Robert Redfield, exuded confidence in communications with
others at the agency.
On Jan. 28, when the CDC had confirmed five cases of the coronavirus, all in
travelers who arrived from outside the country, he emailed colleagues to
acknowledge it posed “a very serious public health threat,” but he assured
them “the virus is not spreading in the U.S. at this time.”
https://assets.propublica.org/images/articles/_threeTwo400w/20200326-
Redfield-Jan-28-Email-email-lightline.jpg
That actually may not have been the case. The CDC confirmed the first case of
COVID-19 in Washington on Jan 20. Trevor Bedford, a computational
epidemiologist at the Fred Hutchinson Cancer Research Center in Seattle, has
said he believes that the virus could have begun circulating in the state
immediately after the traveler arrived in mid-January, based on his analysis
of genetic data from the initial Washington cases.
The CDC said in its statement that Redfield’s comments were based on the data
available at the time. “At no time, did he underestimate the potential for
COVID-19 becoming a global pandemic,” the agency’s statement said. “He stated
consistently that more cases, including person to person spread, were
likely.”
On March 3, Redfield wrote to his staff again, stressing the agency’s
readiness, despite the growing evidence that it wasn’t. “We anticipated and
prepared for the possible spread of COVID-19 in communities across the United
States,” he said in an email.
The CDC said in its statement that Redfield was telling staffers that the
agency would continue to be engaged in a sustained response to COVID-19.
Redfield’s email was not characterizing the state of the outbreak, the CDC
said.
By that point, it was clear that the coronavirus was gaining ground within
the country, even if the inability to test for it was obscuring the true
numbers. Physicians and public health experts begged for more tests while
warning that thousands of cases would soon emerge.
Still, Redfield’s March 3 email struck a reassuring note.
“Confronting global outbreaks and protecting Americans is what we do,”
Redfield wrote in the message. “More and more, people are turning to us for
guidance, and we respond consistently with evidence-based information and
professionalism.”
--
Every American should want President Trump and his administration to
handle the coronavirus epidemic effectively and successfully. Those who
seem eager to see the president fail and to call every administration
misstep a fiasco risk letting their partisanship blind them to the
demands not only of civic responsibility but of basic decency.
email with what the author described as an “URGENT” call for help.
The agency was struggling with one of its most important duties: keeping
track of Americans suspected of having the novel coronavirus. It had “an
ongoing issue” with organizing — and sometimes flat-out losing — forms sent
by local agencies about people thought to be infected. The email listed job
postings for people who could track or retrieve this paperwork.
“Help needed urgently,” the CDC wrote.
https://assets.propublica.org/images/articles/_threeTwo400w/20200327-Urgent-
Job-Posting-PUI-lightline.jpg
This email is among hundreds of pages of correspondence between federal and
state public health officials obtained by ProPublica through a records
request in Nevada.
During the period in which the correspondence was written, from January to
early March, health officials were trying to stay ahead of the coronavirus
outbreak underway in China. By mid-February, when the CDC job postings email
went out, the virus had a toehold in the United States, where there were
already 15 confirmed cases. In another two weeks, the first case of community
transmission would be reported in California, followed shortly by cases in
Washington.
The documents — mostly emails — provide a behind-the-scenes peek into the
messy early stages of the U.S. response to the coronavirus, revealing an
antiquated public health system trying to adapt on the fly. What comes
through clearly is confusion, as the CDC underestimated the threat from the
virus and stumbled in communicating to local public health officials what
should be done.
The same week the CDC sent out the email about the job openings, the agency
sent Nevada officials alerts about 80 potential coronavirus patients to
monitor, documents show. Four were not Nevada residents.
A state epidemiologist, in each instance, corrected the agency, informing the
CDC that the person was from New York, not Nevada. (The CDC then redirected
each report to New York, the documents show.)
The confusion sometimes went both ways. On March 4, a program manager in the
Nevada Health Department reached out to the CDC to ask about congressional
funding for COVID-19, the disease caused by the novel coronavirus.
“There seems to be a communications blackout on this end,” the program
manager wrote, wondering if funds would be distributed based on the number of
cases in each state or by population.
“Unfortunately, there is no clear answer to your questions,” responded a CDC
staffer, apologizing for the lack of information. “We are hearing all of the
rumor mills as well.”
“Thank you,” the Nevada program manager replied. “It’s good to be confused
together.”
https://assets.propublica.org/images/articles/_threeTwo400w/20200326-
Confused-Together-to-publish-1-line.jpg
Chaotic Coordination
For much of February, the CDC kept a tight grip on who should be tested for
the coronavirus, a strategy that has been criticized by epidemiologists for
limiting the ability to track the spread of the disease.
In a Feb. 19 presentation to state health officials, the CDC described the
definition of a person who ought to be tested: You had to have had close
contact with someone confirmed to have COVID-19, or to have traveled from
China and then had respiratory symptoms and a fever at the same time.
However, the CDC’s own guidance from a month prior, distributed to the states
on Jan. 17, had a footnote that said that “fever may not be present in some
patients,” such as people who had taken fever-lowering medications, according
to one of the documents obtained by ProPublica. That caveat was not on the
slides presented to the states in mid-February.
In a statement to ProPublica, the CDC said clinicians could always use their
judgment to decide who received a test. “CDC never declined a request for
testing that came from a state or local health department,” the agency said.
The CDC designed a flawed test for COVID-19, then took weeks to figure out a
fix so state and local labs could use it. New York still doesn’t trust the
test’s accuracy.
In mid to late February, the CDC was trying to move responsibility for
coronavirus testing from itself to state health departments — a critical
step, since the CDC does not have the capacity to be the nation’s testing
lab. Slides from the Feb. 19 presentation describe the process for
transitioning from “Phase 1,” in which the CDC determined who was a potential
COVID-19 patient and conducted all the testing, to “Phase 2,” in which local
health departments would do that work and report data back to the CDC.
Because of delays with test kits, Phase 2 had to be “redesigned,” the
presentation said, so the CDC would continue to test specimens and return
results. The CDC told ProPublica that all states have now transitioned to the
original Phase 2 plan, where they can run their own tests.
The CDC presentation also directed the states to use a web platform called
DCIPHER, which the agency was already using for food-related outbreaks, to
report potential COVID-19 patients and confirmed cases.
But it wasn’t until the week of Feb. 24 — the same week that the U.S. would
discover its first case of community-acquired COVID-19 — that the CDC
scheduled a training for states on how to use the platform, according to the
documents.
On March 1, the CDC emailed Nevada’s Health Department, requesting that it
send a list of users and email addresses to connect to the DCIPHER system, to
“ensure that we can onboard your jurisdiction.”
“We sent a spread sheet a couple weeks ago which I thought covered this,” a
state epidemiologist responded.
Four days later, Nevada announced its first confirmed case of the
coronavirus. It’s unclear when the state managed to successfully get on the
DCIPHER system. Officials from Nevada declined to comment.
“Maybe Just Kidding”
A key part of the CDC’s strategy during the early days of the outbreak was
identifying infected travelers returning from China. The process for
screening passengers arriving at Los Angeles International Airport did not go
smoothly, the correspondence obtained by ProPublica indicates.
On Feb. 16, a CDC staff member sent a message to colleagues about a buggy
electronic traveler screening questionnaire that wouldn’t save correctly,
among other issues. Also, the tool’s drop down field auto-populated with
“United Kingdom” instead of “United States,” forcing users to type “United
States of America.”
The CDC staffer also said the agency was struggling to interview non-English
speakers in a timely manner and needed additional interpreters.
“Hello Team,” another CDC staff member responded, offering a solution: “The
Google translate App has a real-time voice translation option.”
The screening protocol also wasn’t always clear. On Feb. 29, a CDC officer at
LAX sent an email to her colleagues, saying: “In case this comes up again, we
are not screening private flights. These would be flights that land at LAX
but don’t arrive into the regular terminal … mainly for rich people.”
Just over two hours later, the officer emailed again. “And, maybe just
kidding,” she wrote. Information from headquarters seemed to contradict what
she had said about private flights, she said.
The CDC told ProPublica that it scaled up the screening almost overnight, so
it focused on vetting the largest segment possible of high-risk passengers
coming from places like Wuhan, China. The agency trained staff and dealt as
best it could with limited staffing and translation services, it said.
“Protecting Americans Is What We Do”
The CDC’s initial response to COVID-19, particularly its failure to initiate
swift, widespread testing, has drawn intense criticism.
Nonetheless, the correspondence ProPublica obtained shows that the CDC
director, Dr. Robert Redfield, exuded confidence in communications with
others at the agency.
On Jan. 28, when the CDC had confirmed five cases of the coronavirus, all in
travelers who arrived from outside the country, he emailed colleagues to
acknowledge it posed “a very serious public health threat,” but he assured
them “the virus is not spreading in the U.S. at this time.”
https://assets.propublica.org/images/articles/_threeTwo400w/20200326-
Redfield-Jan-28-Email-email-lightline.jpg
That actually may not have been the case. The CDC confirmed the first case of
COVID-19 in Washington on Jan 20. Trevor Bedford, a computational
epidemiologist at the Fred Hutchinson Cancer Research Center in Seattle, has
said he believes that the virus could have begun circulating in the state
immediately after the traveler arrived in mid-January, based on his analysis
of genetic data from the initial Washington cases.
The CDC said in its statement that Redfield’s comments were based on the data
available at the time. “At no time, did he underestimate the potential for
COVID-19 becoming a global pandemic,” the agency’s statement said. “He stated
consistently that more cases, including person to person spread, were
likely.”
On March 3, Redfield wrote to his staff again, stressing the agency’s
readiness, despite the growing evidence that it wasn’t. “We anticipated and
prepared for the possible spread of COVID-19 in communities across the United
States,” he said in an email.
The CDC said in its statement that Redfield was telling staffers that the
agency would continue to be engaged in a sustained response to COVID-19.
Redfield’s email was not characterizing the state of the outbreak, the CDC
said.
By that point, it was clear that the coronavirus was gaining ground within
the country, even if the inability to test for it was obscuring the true
numbers. Physicians and public health experts begged for more tests while
warning that thousands of cases would soon emerge.
Still, Redfield’s March 3 email struck a reassuring note.
“Confronting global outbreaks and protecting Americans is what we do,”
Redfield wrote in the message. “More and more, people are turning to us for
guidance, and we respond consistently with evidence-based information and
professionalism.”
--
Every American should want President Trump and his administration to
handle the coronavirus epidemic effectively and successfully. Those who
seem eager to see the president fail and to call every administration
misstep a fiasco risk letting their partisanship blind them to the
demands not only of civic responsibility but of basic decency.
Baghdad Bob
Mar 29, 2020, 6:22:40 PM3/29/20
to
Ubiquitous wrote
> On Feb. 13, the U.S. Centers for Disease Control and Prevention sent out
> an email with what the author described as an "URGENT" call for help.
Trump was right. Another good reason to defund the bastards.
> On Feb. 13, the U.S. Centers for Disease Control and Prevention sent out
> an email with what the author described as an "URGENT" call for help.
Baghdad Bob
Apr 19, 2020, 5:45:57 PM4/19/20
to
Ubiquitous wrote
> On Feb. 13, the U.S. Centers for Disease Control and Prevention sent out
> an email with what the author described as an "URGENT" call for help.
> On Feb. 13, the U.S. Centers for Disease Control and Prevention sent out
> an email with what the author described as an "URGENT" call for help.
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