Covid-19: U.S. Efforts to Retrieve Americans Overseas in Early Outbreak Threatened Their Safety, Report Says – The New York Times

Heres what you need to know:Americans arriving from Wuhan, China, disembarked from a State Department-chartered plane to board buses at March Air Reserve Basenear Los Angeles in January 2020.Credit...Mike Blake/Reuters

The governments confused effort to retrieve Americans overseas during the early weeks of the coronavirus outbreak compromised the safety of the evacuees, federal employees and communities near where Americans returned to, according to a new report published on Monday by Congresss nonpartisan watchdog.

The effort was so dysfunctional that federal health agencies could not even agree on the purpose and terms of the mission, contradicting one another about whether it was classified as an evacuation or repatriation.

The more-than-yearlong investigation by the Government Accountability Office concluded that the evacuation of Americans from China bogged down badly as different divisions within the Department of Health and Human Services argued over which was responsible. That fighting undermined the earliest attempts to protect those Americans after they returned from China, where the coronavirus was believed to have originated.

The G.A.O. said three agencies within the department the Centers for Disease Control and Prevention, the Office of the Assistant Secretary for Preparedness and Response, and the Administration for Children and Families did not follow plans or guidance delineating their roles and responsibilities for repatriating individuals during a pandemic an event these agencies had never experienced.

The report built on previous reviews of the repatriation effort by health department lawyers and a whistle-blower complaint filed early last year. Last April, the departments top lawyer concluded that federal health employees without adequate protective gear or training interacted with Americans quarantined at the base, validating the whistle-blowers central complaint.

According to the G.A.O. report issued Monday, as the Administration for Children and Families, or A.C.F., began its role overseeing the repatriation of the evacuees, lawyers at H.H.S. determined that the flights from Wuhan, China, constituted an evacuation, not a repatriation, and therefore were the C.D.C.s responsibility.

For that reason, A.C.F. officials said resources from the federal governments repatriation program were not used. But the decision from H.H.S. lawyers was not communicated to the C.D.C., the report said, and G.A.O. investigators were not given an explanation of the distinction between a repatriation and evacuation.

A focus of the report is the federal governments response at March Air Reserve Base, near Los Angeles, where the health agencies functioned independently and without coordination, the G.A.O. said. As the A.C.F. prepared for the evacuees in late January, the Office of the Assistant Secretary for Preparedness and Response was abruptly put in charge on the day they arrived.

A.S.P.R.s Incident Management Team was not mobilized until after the flight landed and did not deploy to the site until January 31, the report said. That led to broad confusion about who was in charge, with A.S.P.R. officials believing they were only supporting other agencies there.

The report describes other significant missteps, some of which had already been made public. It cites last years report from H.H.S. lawyers describing a scene at the base in which an A.C.F. official told health department employees to remove personal protective gear at a meeting with evacuees, lest there be bad optics.

Federal health agencies also struggled to stop those on the base from leaving in the absence of a federal quarantine order, which lasted several days, the report said. One person with the potential to spread Covid-19 attempted to leave the base.

The G.A.O. also wrote that federal health officials disagreed on which agency was responsible for infection control on the base, while the use of personal protective gear was uneven among poorly-trained federal employees there. The dispute led to an almost comical bureaucratic tangle.

At first, A.C.F. and A.S.P.R. officials viewed the C.D.C. as the body with more expertise and authority, including under a section of the federal governments guidance on repatriation procedures related to Ebola. But C.D.C. officials told their colleagues that section was not applicable to other diseases, and that the agency was not responsible for managing the employees of other agencies. Still, the C.D.C. offered training after it was requested.

According to H.H.S., C.D.C. personnel on the ground provided inconsistent and informal infection prevention and control guidance for the first 3 days of the mission because of a lack of clear roles, the report said.

The G.A.O. noted that H.H.S. did not feature repatriation in its planning exercises for a pandemic, and therefore was not equipped to coordinate such an effort. Until H.H.S. conducts such exercises, it will be unable to test its repatriation plans during a pandemic and identify areas for improvement, the office wrote.

H.H.S. agreed with its recommendations, the G.A.O. said.

All adults in every U.S. state, Washington, D.C., and Puerto Rico are now eligible for a Covid-19 vaccine, meeting the April 19 deadline that President Biden set two weeks ago.

For months Ive been telling Americans to get vaccinated when its your turn. Well, its your turn, now, Mr. Biden said Sunday on a program called Roll Up Your Sleeves on NBC. Its free. Its convenient and its the most important thing you can do to protect yourself from Covid-19.

The United States is administering an average of 3.2 million doses a day, up from roughly 2.5 million a month before. More than 131 million people, or half of all American adults, had received at least one shot as of Sunday, according to the Centers for Disease Control and Prevention, and about 84.3 million people have been fully vaccinated.

Hawaii, Massachusetts, New Jersey, Oregon, Rhode Island and Vermont were the last states to expand eligibility, opening vaccinations to all adults on Monday.

Its truly historic that we have already reached this milestone, said Dr. Nandita Mani, the associate medical director of infection prevention and control at the University of Washington Medical Center.

After a slow start, the pace of vaccinations has risen considerably in recent months. Mr. Biden, who initially said he wanted states to make all adults eligible for a vaccine by May 1, moved the deadline up as vaccinations accelerated. Mr. Biden has also set a goal of administering 200 million doses by his 100th day in office, which the nation is on pace to meet.

The expansion of eligibility comes as medical officials investigate whether Johnson & Johnsons one-shot Covid-19 vaccine is linked to a rare blood-clotting disorder. All 50 states suspended administration of the vaccine last week, after federal health officials recommended a pause.

Dr. Anthony S. Fauci, the nations leading infectious disease expert, said on Sunday that federal regulators should come to a decision on Friday about whether to resume Johnson & Johnson vaccinations. Although he said he did not want to get ahead of the C.D.C. and the Food and Drug Administration, he said he expected experts to recommend some sort of either warning or restriction on the use of the vaccine.

Even if there is a link between the vaccine and the clotting disorder, the risk is exceedingly low, experts say.

Still, Dr. Mani said the pause was likely to harden the hesitancy of some Americans to get vaccinated.

At the same time, with the virus resurgent, public health experts are warning Americans not to let their guards down. The United States is averaging more than 67,000 new cases a day over the past seven days, up from over 54,000 a month ago, according to a New York Times database.

Seventy thousand cases a day is not acceptable. We have to get that down, said Barry Bloom, a research professor and former dean of the Harvard T.H. Chan School of Public Health. He said more vaccinations would help, but people must remain vigilant about wearing masks and social distancing.

At its current pace, the United States will vaccinate 70 percent of its population by mid-June. But vaccine hesitancy could slow progress toward herd immunity, which will also depend on vaccinating children.

Were making tremendous progress, but were still in the race against this virus, and we need to vaccinate tens of millions more Americans, Mr. Biden said on Sunday. We could have a safe and happy Fourth of July with your family and friends in small groups in your backyard. Thats going to take everyone doing their part. Get vaccinated.

Pfizer announced this month that it had applied for an emergency use authorization to make children ages 12 to 15 eligible for its vaccine. Moderna is expected to release results from its trial in young teenagers soon, and vaccinations in this age group could begin before school starts in the fall.

Trials in younger children are underway. Dr. Fauci also said on Sunday that he expected children of all ages to be eligible for vaccination in the first quarter of 2022.

Although vaccinations have picked up in the United States, many countries still face dire vaccine shortages. About 83 percent of Covid-19 vaccinations have been administered in high- and upper-middle-income countries, while only 0.2 percent of doses have been administered in low-income countries, according to a New York Times vaccine tracker.

Dr. Funmi Olopade, the director of the Center for Global Health at the University of Chicago, said it was crucial for the United States to step up its role in the global vaccination campaign as supply increases. The virus, left to spread around the world, could continue to mutate and threaten the nations economic recovery, she said.

It is in everybodys self-interest to provide whatever we can in the way of excess vaccines to low- and middle-income countries, Dr. Bloom said.

President Bidens top pandemic advisers indicated on Monday that preventive measures to keep the coronavirus at bay, including mask wearing, might need to continue while the threat of another virus surge looms.

While were making extraordinary strides in the number of people vaccinated, we still have an extraordinary amount of disease out there, Dr. Rochelle Walensky, the director of the Centers for Disease Control and Prevention, said at a White House news conference. If we have a lot of circulating virus today, the vaccines will work in a month, but they may not work today. So we need to continue to keep the prevention measures up to prevent ongoing cases today.

Individuals are considered fully vaccinated two weeks after the last dose in either the two-shot vaccines from Pfizer-BioNTech or Moderna, or the one-shot vaccine from Johnson & Johnson. The Centers for Disease Control and Prevention said on Monday about 132.3 million people have received at least one dose of a Covid-19 vaccine, including about 85.4 million people who have been fully vaccinated.

But while new coronavirus cases, hospitalizations and new deaths have declined from their peaks in January, they have stayed at a stubbornly high level in recent weeks, according to a New York Times database. The country is averaging more than 67,000 new cases a day, comparable to last summers surge, with high concentrations in Michigan and the Northeast. And new deaths have remained near an average of more than 750 a day over the last week.

Just before he took office, President Joseph R. Biden Jr. said that he would ask Americans to wear masks for 100 days from the first day of his presidency. But even as that day fast approaches, and as more half of all American adults have received at least one vaccine shot as of Sunday, federal health officials have continued to urge caution as more contagious variants of the virus spread.

The more contagious and deadly B.1.1.7. virus variant first found in Britain recently became now the dominant version in the United States and has slammed Europe. The three U.S.-authorized vaccines Pfizer-BioNTech, Moderna, Johnson & Johnson, have been shown to be effective against B.1.1.7.

Dr. Anthony S. Fauci, the nations leading infectious disease expert, said that the level of virus circulating in the United States was still at much higher levels than in Israel. When you talk about the Israelis pulling back and getting to normal, their level of infection now is extremely low, Dr. Fauci said. Thats what were aiming for.

GLOBAL ROUNDUP

NEW DELHI Delhi enacted a weeklong citywide lockdown on Monday, as infections and deaths in India hit new daily records and several local governments, including in the national capital, reported shortages of oxygen, beds and drugs.

India reported more than 272,000 cases and 1,619 deaths on Monday, as a second wave of the coronavirus continued to spread across the country. The worsening situation has caused Prime Minister Boris Johnson of Britain to cancel a planned trip to the country next week, a decision the British and Indian governments announced on Monday. Britain also said that most people who have traveled from India in the last 10 days will be refused entry beginning Friday.

Arvind Kejriwal, the chief minister of Delhi, announced on Monday a citywide lockdown beginning at 10 p.m. and ending around 5 a.m. on April 26.

Our health systems have reached its limit, he said. We have almost no I.C.U. beds left. We are facing a huge shortage of oxygen.

All essential services, including grocery stores, pharmacies and food delivery, will be allowed, he said. Wedding ceremonies will be restricted to 50 people.

If we dont place a lockdown now, it could lead to a big tragedy, Mr. Kejriwal said.

Also on Monday, a court in the northern state of Uttar Pradesh ordered lockdown-like restrictions in the cities of Prayagraj, Lucknow, Varanasi, Kanpur Nagar and Gorakhpur until April 26. Government offices, hotels, restaurants, shopping malls and grocery stores with more than three workers will be closed in those cities.

Last week, the state government of Maharashtra, which includes the financial hub Mumbai, banned public gatherings and ordered most businesses to close for the next few weeks after hospitals there started being overwhelmed. Its chief minister appealed to Prime Minister Narendra Modi to use the Indian Air Force to airlift oxygen cylinders to meet the states demand.

The shortages have resulted in squabbles between opposition-led state governments and Mr. Modis government, which controls the supply of badly needed medical oxygen and drugs.

Mr. Modi and his top lieutenants have also come under pressure for holding political rallies gathering thousands of people, with almost no regard for social distancing, at a time when coronavirus cases in the country are spiraling out of control.

In other news from around the world:

Hong Kong said it would ban flights from India, Pakistan and the Philippines for two weeks starting on Tuesday after detecting its first local case involving a variant of the coronavirus. A man who tested positive on Friday, after returning from Dubai and then completing his mandatory 21 days of quarantine, is the Asian financial hubs first case outside quarantine found to carry the N501Y spike mutation.

Airports in Australia and New Zealand were filled with emotional scenes on Monday as thousands of passengers were allowed to travel freely between the two countries for the first time in more than a year. The travel bubble, among the first of its kind in the world, establishes reciprocal quarantine-free movement between the two Pacific nations, subject to certain conditions.

The Democratic Republic of Congo started its vaccination campaign on Monday with the AstraZeneca vaccine after delaying inoculations over clotting concerns in Europe. Congo received 1.7 million doses of the AstraZeneca vaccine through Covax, an international effort to procure and distribute vaccines.

Concerns over clotting from the Johnson & Johnson vaccine have led to a suspension of the shots rollout in Greece. Inoculations with the vaccine were set to start in Greece on Monday but were paused pending the European Medicines Agencys review of the rare effects, set to be released on Tuesday, Reuters reported. Greece is lifting quarantine restrictions beginning Monday for arrivals from within the European Union and several other countries, including the United States and Britain.

It can still be tough to find a vaccine appointment in France, but a data scientists app is helping. Guillaume Rozier started a website on April 1 that, in less than a minute, scans all available appointments at certified vaccination centers throughout the country and helps users access booking sites. Powered by the work of a dozen volunteers, the search engine, Vite Ma Dose (My Dose Quickly), has drawn 2.5 million unique visitors in just days.

Emergent BioSolutions, the company whose Baltimore manufacturing facility ruined up to 15 million doses of the Johnson & Johnson coronavirus vaccine, said Monday that it has temporarily shut down operations at the plant at the request of the Food and Drug Administration and acknowledged that the company must make improvements to restore confidence in its work.

The unusual acknowledgment came as regulators continue to inspect Emergents Bayview facility, as the Baltimore plant is known. The New York Times reported earlier this month that the F.D.A. was initiating a for cause audit of the Baltimore facility and that production of new batches of the Johnson & Johnson vaccine would be put on hold while the review was underway.

In Mondays announcement, the company said that the F.D.A. inspection began a week ago and production stopped on Friday; the company also notified the Securities and Exchange Commission on Monday of the changes.

In a brief statement to reporters, Emergent also said it was quarantining existing vaccine substance produced at Bayview until after the inspection is over and it has had a chance to fix any problems that turn up in the review. The companys stock has tumbled in recent weeks; it closed at $69.37 on Friday, down from $90.98 a month earlier.

We recognize the confusion these recent events may have caused our customers, our employees, and the public, the statement said. We are steadfastly committed to full compliance with the F.D.A.s strict requirements. We acknowledge that there are improvements we must make to meet the high standards we have set for ourselves and to restore confidence in our quality systems and manufacturing processes.

Beyond the ruined doses, Emergent has manufactured the equivalent of up to 62 million doses of Johnson & Johnsons single-shot vaccine, but the drug substance cannot be released for bottling until the F.D.A. certifies the Baltimore plant. The delay is yet another setback for Johnson & Johnson after injections were halted as federal health officials investigate reports of rare blood clots among a small number of vaccine recipients. It is unclear whether the vaccine was responsible for the clots.

Johnson & Johnson said in a statement on Monday that it is working with the F.D.A. and Emergent to address the findings of the inspection, and that it was premature to speculate on any potential impact this could have on the timing of our vaccine deliveries.

Emergent is a longtime government contractor that has spent much of the last two decades cornering a lucrative market in federal spending on biodefense. The Times reported last month that sales of its anthrax vaccines to the Strategic National Stockpile accounted for nearly half of the stockpiles half-billion-dollar annual budget throughout most of the last decade, leaving the federal government with less money to buy supplies needed in a pandemic.

The companys Bayview plant is one of two federally designated Centers for Innovation in Advanced Development and Manufacturing that were supposed to be at the ready in the event of a pandemic. The Times reported earlier this month that the Trump administration awarded a $628 million contract to the company, mostly to reserve space in the Baltimore facility, despite a history of problems.

The plant was supposed to make two similar, but not identical, vaccines: one by Johnson & Johnson and the other by AstraZeneca. But sometime in February, workers accidentally mixed the ingredients of the two vaccines, ruining the doses and prompting the F.D.A. audit.

The Biden administration then stepped in and ordered Johnson & Johnson to take charge of manufacturing at the facility, and told Emergent to stop manufacturing the AstraZeneca vaccine to avoid future mix-ups.

This inspection is ongoing, the company said Monday. While we await the F.D.A.s full feedback, we are working with J.&J. and the F.D.A. on strengthening the supply chain for this vitally important vaccine.

Federal health officials are investigating a handful of new, unconfirmed reports that have emerged after Johnson & Johnson injections were paused nationwide, to determine whether they might be cases of a rare, serious blood clotting disorder that caused the pause, the director of the Centers for Disease Control and Prevention said Monday. It is unclear as yet whether the vaccine was responsible for the original few cases.

Right now, we are encouraged that it hasnt been an overwhelming number of cases but we are looking and seeing what has come in, the director, Dr. Rochelle Walensky, said at a White House news conference on the pandemic.

Last week, federal health officials said they wanted vaccine recipients and medical providers to be aware of the original cases and to report any incidents of serious adverse reactions to the shots. Health officials called for the pause after six women ages 18 to 48 developed the blood clotting disorder within about one to three weeks after Johnson & Johnson injections. One died, and as of last week, a second remained hospitalized in critical condition.

On Wednesday, two more cases were added to the list: a seventh woman, and a man who participated in Johnson & Johnsons clinical trial. Seven of the eight recipients had blood clots in the brain. The clotting disorder seemed to be combined with low levels of platelets, blood cells that typically prevent clotting. The cases were reported either to the C.D.C.s database or directly to Johnson & Johnson.

Dr. Walensky said Monday that officials are pursuing the more recent reports and verifying whether they do in fact reflect a true case.

In a follow-up statement, the C.D.C. said: At this time, no additional cases of the rare form of blood clots post-vaccination with the Johnson & Johnson vaccine have been confirmed. If any new cases are confirmed, the agency said it would present that data to a C.D.C. advisory committee that is scheduled to meet on Friday.

The committees experts could recommend lifting the pause, modifying it or limiting the use of the vaccine.

Dr. Anthony S. Fauci, a White House medical adviser, said on the NBC program Meet the Press on Sunday that he seriously doubts the vaccine will be permanently pulled. But he said, I do think that there will likely be some sort of warning or restriction or risk assessment.

Experts are trying to determine whether the rare blood clotting disorder is in fact linked to the Johnson & Johnson vaccine. The investigation follows actions by European regulators who concluded that another vaccine developed by AstraZeneca and based on a similar technology may be linked to a rare clotting disorder.

An earlier version of this item incorrectly described blood platelets. They are components of blood that are needed for clotting, not blood cells that typically prevent clotting.

The New York State attorney general has opened an investigation into Gov. Andrew M. Cuomos use of state resources in relation to his recent book, a chronicle of the states battle against coronavirus.

The word of the investigation came days after the attorney general, Letitia James, received a referral on the matter from the state comptroller. On Monday, a spokeswoman for Ms. James confirmed that the office had received the referral.

The investigation follows a March 31 report in The New York Times and subsequent reporting in other publications that detailed how junior staff members and senior aides worked on the book.

The governor, a third-term Democrat, has insisted that any work by government employees was voluntary, allowing that some minor work may have been incidental.

Mr. Cuomos office rejected any assertion of criminality in regards to the book, suggesting it was a politically motivated attack.

The investigation deepens the legal and political woes confronting Mr. Cuomo, who faces scandals involving his personal behavior and professional conduct, including a federal investigation into his handling of the states nursing homes during the pandemic.

Ms. James is already overseeing an inquiry into multiple allegations of sexual harassment against the governor.

The United States military will begin offering to vaccinate the detainees at Guantnamo Bay on Monday in an effort to protect troops stationed there and help restart the stalled war crimes hearings, an administration official with knowledge of the Pentagon plan said.

The U.S. Southern Command, which has oversight of the prison, sought permission during the Trump administration to vaccinate the detainees, who include Khalid Shaikh Mohammed and four other men accused of conspiring to carry out the attacks of Sept. 11, 2001. A memo dated Dec. 23 described the detainees as a high-risk community, and invoked both the Geneva Convention and Department of Defense guidance.

But the Pentagon postponed plans to start the vaccinations on Feb. 1, after elected officials and victims of the attacks accused the Defense Department of putting terrorism suspects ahead of the American people, who were only just starting to get access to the vaccines in substantial numbers then.

By Monday, the official said, all of the adults at the remote base in Cuba had been offered a vaccine, including the troops and civilian Defense Department employees 1,500 in all who work at the detention operation. An undisclosed number of staff members at the prison had declined.

The vaccines are not mandatory for the military or civilian Defense Department employees.

The administration official said the decision to vaccinate the detainees was intended in part to protect those service members who had declined to be vaccinated. As of Monday, all adults in every U.S. state, Washington, D.C., and Puerto Rico are now eligible for a Covid-19 vaccine, meeting the April 19 deadline that President Biden set two weeks ago.

New Yorkers will soon be able to get vaccinated against the coronavirus under the 94-foot-long model of a blue whale at the American Museum of Natural History, Mayor Bill de Blasio announced on Monday, as the museum long popular with tourists and students on field trips is set to be one of the citys newest mass vaccination sites.

Vaccinations at the museum on the Upper West Side will begin on April 23 and be open to all city residents, with special appointments set aside for public housing residents and people who work at cultural institutions like museums, Mr. de Blasio said. People can register for appointments starting on Tuesday, and appointments will be available from 8 a.m. to 6 p.m. on Friday through Tuesday every week.

The whale, which is made of fiberglass and polyurethane and was renovated in 2003, has been on display since 1969. The museum said that anyone who got vaccinated there would get a voucher for complimentary future admission for a group of four people.

The announcement on Monday came as the city crossed 5.7 million vaccination doses on Sunday, and as the city recorded some positive signs in the fight against the pandemic. Mr. de Blasio said on Monday that the seven-day average rate of positive test results citywide was 4.91 percent, down from 6.64 percent at the beginning of April. The seven-day average number of hospitalizations has also been trending downward over the last few months, from 337 on Feb. 14 to 162 on Apr. 14.

Officials hoped that the opening of the new site would bolster the vaccination effort and be a symbol of the citys economic and cultural revitalization.

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Covid-19: U.S. Efforts to Retrieve Americans Overseas in Early Outbreak Threatened Their Safety, Report Says - The New York Times