The U.S. government-led missions, which included an operation to evacuate Americans from a virus-stricken cruise ship off the coast of Japan in February 2020, were plagued by “serious fundamental coordination challenges,” the Government Accountability Office concluded in a report requested by Congress and released Monday.
The episodes have already been the focus of a whistleblower complaint that sparked a pair of investigations, including a review conducted by lawyers at the Department of Health and Human Services. Those prior reports documented safety lapses, including health officials being told to remove protective gear when meeting with the Wuhan evacuees to avoid “bad optics.”
In their 13-month probe, GAO auditors faulted the health department for an array of broader management failures, including a lack of preparation that led to agencies within HHS feuding over which division was in charge of the rescue operations, sometimes because of the terminology used in government plans.
The disorganized federal response also meant officials delayed issuing a mandatory quarantine for Americans who had returned from Wuhan in January 2020 and were being housed at March Air Reserve Base in California, the GAO concluded. As a result, one American ignored a voluntary quarantine request and nearly left the base, prompting the surrounding county to issue an order to quarantine the person. The Centers for Disease Control and Prevention ultimately issued a federal quarantine order, but the two-day delay boosted the risk that covid-19, the illness caused by the virus, would spread in the nearby community, GAO auditors said.
Citing last year’s failures, the GAO recommended officials devise plans that focus on hypothetical rescue missions during a pandemic, and then test them in government-wide exercises to strengthen ties among agencies and identify areas of improvement.
“Until HHS revises or develops new plans that clarify agency roles and responsibilities during a repatriation in response to a pandemic, it will be unable to prevent the coordination and health and safety issues it experienced during the COVID-19 repatriation response in future pandemic emergencies,” the GAO concluded.
HHS said it agreed with the watchdog’s recommendations. The department declined further comment.
Former Trump administration officials involved in the missions declined to comment on the report, which did not cite any officials by name.
Rep. Rick Larsen (D-Wash.), who chairs the House Transportation subcommittee on aviation, said the GAO’s depictions of last year’s chaos — including what he called a “horrendous” fight between agencies over which had jurisdiction based on the terminology — showed the need to be better prepared for the next public health crisis.
“We have been calling for a broad, coordinated approach in the event of something like this happening again, and this report is another data point in why we need it,” Larsen said, referencing his legislation for a national aviation preparedness plan.
The GAO report focuses on rescue operations that unfolded during several weeks and on multiple continents, with a recurring theme: Government officials butted heads as they were pressed into scenarios they had not rehearsed.
Auditors detailed repeated clashes between three HHS agencies — the CDC, the Administration for Children and Families and the Office of the Assistant Secretary for Preparedness and Response — that contributed to disorderly efforts to receive the Wuhan evacuees in California, ensure there was sufficient protective equipment for government workers and even decide who would lead the entire operation in January 2020.
The health agencies “operated independently of each other without coordinating their efforts at March Air Reserve Base,” the GAO concluded.
In one flash point, officials disputed whether the mission was an “evacuation and quarantine,” which would have fallen under CDC’s authority, or a “repatriation,” which was the responsibility of the health department’s children and families division, better known as ACF.
The resulting confusion meant health officials were still scrambling to make key decisions when hundreds of Wuhan returnees began arriving at March Air Reserve Base, GAO auditors determined.
Among the most significant decisions: which officials would oversee infection control and prevention, a particularly salient concern given that health experts had limited understanding of how the new virus spread in the pandemic’s earliest days. According to ACF and officials in the emergency-preparedness office, better known as ASPR, they had concluded CDC would take the lead on fighting infection risks during the mission, citing the agency’s expertise and an existing emergency plan devised to handle Ebola.
But CDC officials said their agency’s Ebola expertise was not applicable when responding to another infectious disease such as the coronavirus — and it was up to each health division to conduct infection-control prevention and ensure its workers had protective equipment.
The confusion led to safety failures at the base, the GAO said, with the watchdog faulting health officials for “inconsistent use” of protective equipment when working with the Wuhan evacuees.
Defense Department officials at the base also experienced “confusion and frustration” in trying to coordinate with health officials, the GAO said.
The GAO detailed a subsequent clash in February 2020 between health and diplomatic officials over whether coronavirus-positive Americans evacuated from the virus-laden Diamond Princess cruise ship in Japan should have been flown back to the United States. While CDC officials did not approve of including infected Americans on the return flights, citing their risk of spreading the virus to uninfected passengers, ASPR officials ignored the disease agency’s recommendation and insisted the virus-positive evacuees should be brought back on the same planes, the watchdog said.
Many of the details in the GAO report were previously documented in a review conducted by HHS lawyers and an investigation overseen by the Office of Special Counsel, which were obtained by The Washington Post this year. The Post last year detailed the whistleblower’s allegations, which prompted the HHS review.
The watchdog said it had ongoing questions about whether the health department was well structured to handle emergency situations.
“We have serious concerns about HHS’s leadership during a public health emergency, and we’re keeping an eye on it,” said Mary Denigan-Macauley, the GAO investigator who oversaw the report. She cited the health department’s response to the coronavirus and also other public health crises, such as when Puerto Rico was devastated by a hurricane in 2017.
“The one common denominator is that ASPR is in charge of leadership and coordination,” Denigan-Macauley said.
A former health official said the GAO report was further evidence of the fumbled response to the early coronavirus outbreak.
“It certainly underscores what we knew last year. It certainly underscored the failure of leadership and coordination,” said Nicole Lurie, who led ASPR during the Obama administration and faulted senior Trump administration officials for not making clear which agencies were in charge of the operations.
Lurie also said she was familiar with Trump administration planning that involved repatriating Americans from overseas. “The idea that they hadn’t worked out how to do this is a little bit mind-boggling,” she said.