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11 new COVID-19 cases confirmed in Luzerne County; no new deaths

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DHS encourages choices to protect individuals with disabilities

By STEPHEN BRAUN and JASON DEAREN 
 President Donald Trump has repeatedly credited his February as his signature move against the advance of the -- a “strong wall” that allowed only U.S. citizens inside, he boasted in May. 
 But was more like a sieve. 
 Exempted were thousands of residents of the Chinese territories of Hong Kong and Macau. Efforts to track U.S. residents returning from mainland China were riddled with errors and broken communications.
 An analysis of Commerce Department travel entry records and private aviation data obtained by The Associated Press shows that nearly 8,000 Chinese nationals and foreign residents of Hong Kong and Macao entered the U.S. on more than 600 commercial and private flights in the first three months after the ban was imposed.
 When U.S. residents flying from mainland China arrived at U.S. airports, the system meant to flag and monitor them for the development of symptoms lost track of at least in just the first few days the ban went into effect, according to internal state government emails obtained by the AP.
 Trump’s continuing travel restrictions on China, which he followed with a in March and a new prohibition on entry from last month, remain the administration’s first line of defense against foreign sources of the pandemic. 
 “We did a great job on CoronaVirus, including the very early ban on China,” Trump tweeted last week. “We saved millions of U.S. lives!” 
 Trump on Jan. 31 announced the original travel ban on any non-U.S. residents who had recently been in mainland China. His action came weeks after Chinese officials acknowledged a new highly contagious and deadly virus was spreading through the city of Wuhan. 
 Travelers from Hong Kong and Macau were exempted from that ban, and they did not face the same enhanced screening and quarantine procedures required of Americans and others returning from Wuhan and China’s mainland. 
 Flight records provided to the AP by FlightAware, an international aviation tracking company, show that more than 5,600 Chinese and foreign nationals from the two administrative zones flew to the U.S. in February. Those totals dropped to 2,100 in March and just 150 in April, Commerce Department travel entry records show. 
 There is no clear evidence that the small but steady flow of people from Hong Kong and Macau introduced COVID-19 cases inside the U.S. in January or in the four months since, but the exemptions “certainly undercut the purpose of the ban,” said Dr. Ronald Waldman, a professor of Global Health at George Washington University.
 Waldman, who dealt with international quarantines as a Centers for Disease Control and Prevention official during a cholera outbreak in Africa in the 1990s, said travel bans can temporarily hobble the pace of a surging virus. Such moves “slow down the transmission and buy you time, but they have to be structured properly and followed with other strong measures,” he said.
 Hong Kong had struggled to quell influenza outbreaks earlier in the 2000s, but has won praise for strict health precautions in recent months that minimized its virus caseload in the wake of Wuhan’s flare-up. But when it exempted Hong Kong from the China travel ban, Trump administration officials had no way of knowing whether Hong Kong’s anti-virus regimen would succeed or if any infected travelers entered the U.S. from the Chinese territory.
 None of the agencies involved in crafting and announcing the China ban -- the National Security Council, the State Department, the CDC and the Department of Health and Human Services -- would comment publicly to the AP about why Hong Kong and Macau were exempted. In a brief statement, the State Department said it would not “comment on internal policy decisions,” and deferred to the White House.
 The White House did not respond to repeated requests for an explanation.
 Officials familiar with the internal discussions that took place in late January before the China ban was announced cited concerns that a ban that was too broad might jeopardize trade talks and harm the travel industry. One official said the intent was to craft a ban that was “surgical” and would limit disruption.
 A second administration official noted that the decision to impose a travel ban came after hundreds of thousands of travelers had entered the U.S. from China in January. That same month, more than 12,700 people entered the U.S. from the two Chinese territories, Commerce records show.
 The officials were not authorized to discuss the matter publicly and spoke on condition of anonymity.
 Hong Kong and Macau have long been given preferential economic and trade treatment from the U.S. because of their financial importance and their status as independent enclaves within China’s orbit. 
 A 2019 State Department report on Hong Kong said more than 1,300 U.S. firms operated there, including nearly every major U.S. financial company, “with hundreds of billions of dollars in assets under management.” Macau is a world-renowned island of casinos, some owned by U.S.-based companies.
 Former Ambassador Richard Boucher, who was Hong Kong consul general in the 1990s, said that under the Hong Kong Policy Act passed by Congress in 1992, “we are obligated to treat Hong Kong as a special jurisdiction as long as it functions independently.”
 When Trump’s China travel restrictions went into effect on Feb. 2, at least 15 cases of the new coronavirus had already been detected in Hong Kong, along with one death, and seven more cases had been found in Macau. All the initial Macau cases were later traced to the outbreak in Wuhan. 
 As of this week, the former British colony had registered 1,248 cases and seven deaths and Macau had 46 cases. Even with those low totals, Hong Kong has struggled with at least three spikes of COVID-19 cases: one in late February. another in mid-March, and a surge of 130 cases over the past two weeks. 
 Hong Kong’s virus surges led both the CDC and the State Department to issue a series of warnings to Americans considering flights to Hong Kong -- actions that would appear to be at odds with the continuing travel ban exemptions allowing travelers from Hong Kong and Macau to enter the country.
 “Once we see that there is significant human to human transmission so it’s not just, hey, there is something going on there we go to what is called a level one. And right now that’s Hong Kong,” the CDC's director, Dr. Robert Redfield, testified during a House hearing on Feb. 27.
 The CDC’s warnings on Hong Kong and Macau have since been raised to the agency’s highest alert level, urging Americans to “avoid all nonessential travel.” Separately, a less-heightened warning from the State Department urges Hong Kong travelers to “exercise increased caution.” 
 Since that time, there has been a turnabout. Hong Kong has banned U.S. citizens and other international travelers from arriving by air, as more than 2.7 million Americans have tested positive and more than 128,000 have died of COVID-19. 
 If the flow of Americans going to Hong Kong and Macau was stifled, the stream of Americans and others coming back to the U.S. from mainland China was unabated. And the program to screen them had real problems.
 Federal health officials planned to funnel the thousands of people returning from China through 11 airports for health screenings over the several weeks. Those with symptoms would be quarantined by the CDC. Others would be allowed to go on their way, but be monitored by state and local health departments, who would be responsible for contacting the travelers within 72 hours to advise them to isolate themselves for two weeks and to monitor whether they developed symptoms.
 The system was flawed to begin with. States could opt out of receiving passenger information from the CDC, and six did so: Georgia, New Jersey, Oregon, North Carolina, Arizona and Illinois. For the opt-out states, CDC simply disabled notifications. Any passengers from mainland China coming to their state would do so without being flagged or tracked.
 At the time, a robust testing and contact tracing effort might have been able to curb the spread of any virus arriving with travelers from mainland China, 
 But the effort immediately ran into problems. 
 “Hearing word of people already leaking through screening system and ending up in states without the funneling airports,” a CDC employee wrote to several local health officials on Feb. 6, soon after the program began, according to an obtained by the AP through a public records request. “Knew it would not be perfect but it has begun.”
 “One flight did not receive any screening,” said another between New Hampshire officials stated on Feb. 7. 
 The CDC said it had no record of any complete flights not being screened. But it said if the Department of Homeland Security failed to send the CDC that information, it would not know whether whole flights were missed.
 New Hampshire state officials soon began getting calls from people who had recently returned, but that they hadn’t been notified about, according to a Feb. 10 . 
 New Hampshire officials said the individuals who called were proactively reaching out to self-report their travel based on their understanding that local health departments would monitor them. They noted “it took a period of time” to establish the process of passing along traveler information to states.
 CDC spokesman Scott Pauley said the agency didn’t get enough information from customs officials with Homeland Security, who were responsible for gathering passenger data at airports. 
 “The records were poor quality, and the data wasn’t complete enough for anyone to be able to do anything with,” Pauley told the AP. 
 The CDC said some 26,000 travelers from China were screened in all of February. The agency acknowledged that data problems contributed to thousands of notifications not being sent to state health departments. Because of these problems, the CDC has since issued a rule requiring airlines to report passenger data directly to the agency during public health crises.
 Despite the breakdown in notifying states, the CDC pointed out that at the time, travel screening was just one of a number of infection control measures in effect. There was a mandatory 14-day quarantine for all travelers from Wuhan city, and for those with known exposure to the virus.
 But even when notifications were sent to states, the information wasn’t reliable, frustrating local officials worried about getting in touch with them quickly enough to prevent any spread.
 “There was lots and lots of bad information,” said Fran Phillips, Maryland’s deputy secretary for public health services. 
 The data was plagued by bad telephone numbers, erroneous itineraries, and people claiming they had never even been to China. Because the CDC wasn’t able to verify the information, the agency told local officials that they were trusting that people were telling the truth, according to internal shared among California state health officials. 
 In New Mexico, officials were left scrambling after a woman who had just returned from China appeared on the television news. The state got no warning from the CDC and couldn’t reach her. They were left to judge her condition based on the TV segment.
 “Fortunately, she appears healthy, without cough,” wrote the state’s chief of epidemiology to others in the health department in an .
 Public health experts and state officials have criticized the administration for failing to quickly follow up the travel restrictions with social distancing, ample testing and other anti-viral measures. Researchers have shown that virus-borne travelers flying in from European nations also stoked infections in New York and other cities during February and March before the administration suspended travel from Europe.
 ___
 Dearen reported from Gainesville, Florida. Associated Press writers Candice Choi and Michael Rezendes in New York, Colleen Long and Deb Riechmann in Washington and Ken Moritsugu in Hong Kong contributed to this report.

Trump's `strong wall' to block COVID-19 from China had holes