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California’s Plan to Trace Travelers for Virus Faltered When Overwhelmed, Study Finds California’s Plan to Trace Travelers for Virus Faltered When Overwhelmed, Study Finds
(about 13 hours later)
In the early days of the coronavirus outbreak, the United States, like many countries, had a very brief chance to limit the spread of the disease at its borders. Identifying travelers from high-risk countries and tracing their contacts with others would have been critical measures, if put in place early enough.In the early days of the coronavirus outbreak, the United States, like many countries, had a very brief chance to limit the spread of the disease at its borders. Identifying travelers from high-risk countries and tracing their contacts with others would have been critical measures, if put in place early enough.
In California, the largest state and a point of entry for thousands of travelers from Asia, a program was established to do just that. But its tracing system was quickly overwhelmed by a flood of passengers, many with inaccurate contact information, and was understaffed in some cases, rendering the program ineffective, according to a study released on Monday by the Centers for Disease Control and Prevention, which looked exclusively at California.In California, the largest state and a point of entry for thousands of travelers from Asia, a program was established to do just that. But its tracing system was quickly overwhelmed by a flood of passengers, many with inaccurate contact information, and was understaffed in some cases, rendering the program ineffective, according to a study released on Monday by the Centers for Disease Control and Prevention, which looked exclusively at California.
“Despite intensive effort, the traveler screening system did not effectively prevent introduction of Covid-19 into California,” the report said.“Despite intensive effort, the traveler screening system did not effectively prevent introduction of Covid-19 into California,” the report said.
In early February, over 11,000 travelers from China — and later Iran — who landed in California were identified for contact tracing. The hope was to keep track of people traveling from high-risk countries, enabling public health officials to identify possible cases of the coronavirus, quarantine them and contact people who were exposed to them to limit the spread of the contagion.In early February, over 11,000 travelers from China — and later Iran — who landed in California were identified for contact tracing. The hope was to keep track of people traveling from high-risk countries, enabling public health officials to identify possible cases of the coronavirus, quarantine them and contact people who were exposed to them to limit the spread of the contagion.
But when the program was begun on Feb. 5, several weeks had already passed since the disease was first identified in Wuhan, China. On March 17, the program was abandoned so that health care officials could shift their focus to mitigating the spread of the disease within the state. By mid-March, the coronavirus had already established a foothold in California; preventing further introduction from overseas was seen as less important than fighting it on the ground.But when the program was begun on Feb. 5, several weeks had already passed since the disease was first identified in Wuhan, China. On March 17, the program was abandoned so that health care officials could shift their focus to mitigating the spread of the disease within the state. By mid-March, the coronavirus had already established a foothold in California; preventing further introduction from overseas was seen as less important than fighting it on the ground.
“This report is a good example of the challenge of trying to use travel screening to contain and prevent pandemic transmission,” said Dr. Timothy Brewer, a professor of medicine and epidemiology at the University of California, Los Angeles.“This report is a good example of the challenge of trying to use travel screening to contain and prevent pandemic transmission,” said Dr. Timothy Brewer, a professor of medicine and epidemiology at the University of California, Los Angeles.
The report was prepared by the California Department of Public Health for the C.D.C., which also provided similar passenger information to other states.The report was prepared by the California Department of Public Health for the C.D.C., which also provided similar passenger information to other states.
A spokesman for California’s health department said the report spoke for itself. When asked if traveler monitoring is a useful tool in fighting a pandemic, the spokesman referred to a passage in the report noting that it can be effective if begun early enough, but that it is particularly difficult with a respiratory disease like the coronavirus, with which transmission can occur before symptoms arise.A spokesman for California’s health department said the report spoke for itself. When asked if traveler monitoring is a useful tool in fighting a pandemic, the spokesman referred to a passage in the report noting that it can be effective if begun early enough, but that it is particularly difficult with a respiratory disease like the coronavirus, with which transmission can occur before symptoms arise.
The report also said that traveler monitoring is most effective when there is accurate information about passengers and when the number of passengers does not overwhelm the system. None of those conditions existed in this case.The report also said that traveler monitoring is most effective when there is accurate information about passengers and when the number of passengers does not overwhelm the system. None of those conditions existed in this case.
Strict measures in smaller countries like New Zealand and Taiwan are believed to have helped contain outbreaks there, Dr. Brewer said. New Zealand instructed everyone coming into the country after the outbreak to spend two weeks in quarantine, and Taiwan instituted similar measures.Strict measures in smaller countries like New Zealand and Taiwan are believed to have helped contain outbreaks there, Dr. Brewer said. New Zealand instructed everyone coming into the country after the outbreak to spend two weeks in quarantine, and Taiwan instituted similar measures.
But those are island nations with much smaller populations, and Dr. Brewer noted that Taiwan began installing its restrictions “within one or two days after becoming aware that Covid-19 existed.”But those are island nations with much smaller populations, and Dr. Brewer noted that Taiwan began installing its restrictions “within one or two days after becoming aware that Covid-19 existed.”
The California program began two days after President Trump ordered restrictions on travel from China. But nearly 40,000 travelers from China, of various nationalities, were still permitted to enter the country two months after the ban was imposed. Many were returning home, and many of them went through Los Angeles and San Francisco.The California program began two days after President Trump ordered restrictions on travel from China. But nearly 40,000 travelers from China, of various nationalities, were still permitted to enter the country two months after the ban was imposed. Many were returning home, and many of them went through Los Angeles and San Francisco.
When passengers arrived in California on flights from China during the study period, their information was recorded by customs and border patrol officers and then forwarded to the C.D.C., which in turn sent the contact information to California health officials. Those names were then given to health departments in local jurisdictions throughout the state for contact tracing and follow-ups.When passengers arrived in California on flights from China during the study period, their information was recorded by customs and border patrol officers and then forwarded to the C.D.C., which in turn sent the contact information to California health officials. Those names were then given to health departments in local jurisdictions throughout the state for contact tracing and follow-ups.
Travelers from Iran were included in the program, called Return Traveler Monitoring, beginning on March 5. The study found that three of the passengers, including two from Iran, were later reported to California’s health department as Covid-19 patients.Travelers from Iran were included in the program, called Return Traveler Monitoring, beginning on March 5. The study found that three of the passengers, including two from Iran, were later reported to California’s health department as Covid-19 patients.
In theory, after their arrival, the travelers would be contacted to see if they developed symptoms and find out whom they had seen in person. If any of the passengers developed symptoms or tested positive for the coronavirus, they could be isolated to prevent further transmission, and anyone they came into contact with could be isolated as well.In theory, after their arrival, the travelers would be contacted to see if they developed symptoms and find out whom they had seen in person. If any of the passengers developed symptoms or tested positive for the coronavirus, they could be isolated to prevent further transmission, and anyone they came into contact with could be isolated as well.
The C.D.C. report said that, in California, incomplete information made it hard to fully institute the plan. Sometimes names, addresses or phone numbers were inaccurate, and passengers could not be found for follow-ups.The C.D.C. report said that, in California, incomplete information made it hard to fully institute the plan. Sometimes names, addresses or phone numbers were inaccurate, and passengers could not be found for follow-ups.
Also, the number of people to keep track of was overwhelming. During the seven weeks of the program, a median of 1,431 people from Asia entered California per week, the study said. By comparison, passenger identification during the Ebola outbreak of 2014-15 was effective in California, in part, because only 21 people per week came from affected countries in Africa.Also, the number of people to keep track of was overwhelming. During the seven weeks of the program, a median of 1,431 people from Asia entered California per week, the study said. By comparison, passenger identification during the Ebola outbreak of 2014-15 was effective in California, in part, because only 21 people per week came from affected countries in Africa.
Updated June 12, 2020 Updated June 16, 2020
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
The study also cited the issue of asymptomatic patients, who can spread the disease before showing signs of illness.The study also cited the issue of asymptomatic patients, who can spread the disease before showing signs of illness.
Still, the C.D.C. report endorsed traveler-monitoring programs, although they are “likely more effective during the initial containment phase” of the outbreak.Still, the C.D.C. report endorsed traveler-monitoring programs, although they are “likely more effective during the initial containment phase” of the outbreak.
Once California’s current outbreak is under control, the study said, public health officials should still try to put in place the tracing program, if another wave of disease emerges. But it recommended that it be done in a more efficient and comprehensive way, particularly in collecting accurate information about the passengers.Once California’s current outbreak is under control, the study said, public health officials should still try to put in place the tracing program, if another wave of disease emerges. But it recommended that it be done in a more efficient and comprehensive way, particularly in collecting accurate information about the passengers.
The C.D.C. called on airlines to provide flight passenger lists to federal officials and for health departments to use text messaging to communicate with passengers after they leave the airport. It said all of that might be useful to “maintain low disease incidence.”The C.D.C. called on airlines to provide flight passenger lists to federal officials and for health departments to use text messaging to communicate with passengers after they leave the airport. It said all of that might be useful to “maintain low disease incidence.”
“The critical words there are ‘low disease incidence,’” Dr. Brewer said. “What they are saying is, this could work if you got on top of it early before your system gets overwhelmed. That’s what Taiwan did.”“The critical words there are ‘low disease incidence,’” Dr. Brewer said. “What they are saying is, this could work if you got on top of it early before your system gets overwhelmed. That’s what Taiwan did.”
He added, “In order to do it correctly, you will have to have significantly more resources than are typically available in public health departments.”He added, “In order to do it correctly, you will have to have significantly more resources than are typically available in public health departments.”
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