On Monday, as the Grand Princess cruise ship prepared to offload more sick and exposed passengers in Oakland, Calif., San Antonio Mayor Ron Nirenberg was bracing for a third set of evacuees — and losing patience with a chaotic federal evacuation and quarantine process that he fears is endangering residents.
“It’s disconcerting,” said Nirenberg (D). “Throughout the course of this, what I’ve seen is that the lack of coordination at the highest levels of this president’s administration is simply stunning.”
Texas is one of three states that so far have accepted hundreds of evacuees flown out of dire conditions in Wuhan, China, and aboard the stricken Diamond Princess. In nearly every location, local officials say they have been blindsided by the sudden requests, alarmed by the lack of information and exasperated by haphazard protocols.
Though most evacuees are confined to military bases for a 14-day quarantine, people who test positive for covid-19, the disease caused by the new strain of coronavirus, must be transported by local emergency crews to local hospitals. In San Antonio, bungled testing by the Centers for Disease Control and Prevention led to the Feb. 29 release of a still-infected woman, who checked into a busy airport hotel and roamed the local North Star Mall.
“Everyone is mad and scared,” said perfume vendor Setareh Eb, who was wearing a mask and gloves at the mall last week upon its reopening after a “deep cleaning” prompted by the woman’s visit. “Who can you trust?”
In interviews, Texas and San Antonio officials say communication with the federal government has improved in recent days. In a March 2 letter to state health officials, CDC Director Robert Redfield said the agency had made adjustments to the testing regime to prevent the release of infected individuals. He added that the CDC’s protocols are “consistent with globally accepted standards.”
The CDC and the Department of Health and Human Services did not respond to multiple requests for comment.
Still, distrust remains high here and in some other host communities.
After receiving scores of evacuees from China and the Diamond Princess at Travis Air Force Base, Solano County, Calif., recorded the first U.S. case of community transmission of the virus. Leaders there say they are still frustrated with federal officials for failing to release information about when and how the case was detected. Federal officials said Travis would receive more evacuees from the Grand Princess.
In Costa Mesa, Calif., where the federal government dropped plans to house infected patients in a local mental-health facility after the city sued, officials said they could not get answers to critical questions about the operation.
And in Georgia, Cobb County leaders are preparing to receive several dozen Grand Princess evacuees — their first — at nearby Dobbins Air Reserve Base. County Commission Chairman Mike Boyce said he hopes their experience working with Ebola patients in 2014 will spare them any issues. But Boyce said there is a lot he still doesn’t know about the operation.
No place has had a more disturbing experience than San Antonio. Lackland Air Force Base, which so far has received 235 evacuees, is located 10 miles west of the center of town. Federal health officials alerted the city’s office of military and veteran affairs when the first flight was en route. But not to worry, they said: The evacuees would be confined to the base under a tight quarantine and would pose no danger to residents.
It never occurred to the city to fight the plan.
“We took them at their word” that it would be safe, Assistant City Manager Colleen Bridger said.
But city officials quickly discovered that federal officials had neglected to share a crucial piece of information: Lackland was refusing to house any evacuee who tested positive for the virus. When the plane from Wuhan landed just past noon on Feb. 7, city officials learned that one person was sick — and that the federal government expected local officials to care for her.
The city health department quickly located a specially equipped ambulance with dedicated staff to avoid exposing regular emergency responders. And regional health officials scrambled to find a bed at a hospital equipped to treat the patient. They settled on Methodist Hospital, one of the city’s largest, about 25 minutes north of downtown.
Things calmed down until Feb. 17, when the Diamond Princess passengers arrived. This was a more medically fragile group, with a median age of 70 and higher rates of infection. Several had tested positive.
Lackland didn’t want any of the infected evacuees on the base. At first, federal officials considered diverting some of them to a facility in Anniston, Ala., but residents there revolted.
So it was back to San Antonio. City health officials said they were told to have seven ambulances waiting on the tarmac and to prepare at least seven isolation rooms.
“Don’t we get to say no? What happens if we say no?” Bridger remembers asking. “They told us, ‘This is happening, so figure it out.’ ”
There were a million critical details to consider. Every person who came into contact with the evacuees would need proper protection. James Lawler, an infectious disease specialist from the University of Nebraska Medical Center, who accompanied the evacuees on the flight, said he wore a full Tyvek coverall suit and a special helmet.
Then there was the matter of the isolation rooms, special chambers that use negative pressure to prevent airborne particles, such as virus cells, from escaping. State officials offered the Texas Center for Infectious Disease, a tuberculosis hospital with 22 negative-pressure rooms, located in southeastern San Antonio.
Ten cruise-ship evacuees, all of them positive but asymptomatic, were transferred to the center, as was the woman at Methodist Hospital, who by then had mostly recovered.
Local officials were not happy about using the specialized facility to hold people who were not seriously ill. Nirenberg and Bexar County executive Nelson Wolff wrote a letter to Defense Secretary Mark T. Esper complaining that the beds “should be reserved for the sickest of our patients.”
Rep. Chip Roy (R-Tex.) sent a letter to Esper and Health and Human Services Secretary Alex Azar asking whether “the extra transportation and movement of sick patients put San Antonio and Bexar County residents further at risk?” Roy said that he has since been in touch with HHS but that the Pentagon has not responded — “and I’m pretty ticked about it.”
Pentagon officials did not respond to a request for comment.
Getting CDC officials to talk also “was like getting a diamond out of coal,” Nirenberg said. “Everyone continued to point up. They weren’t being empowered to make decisions locally.”
As more than 100 cruise-ship evacuees settled in at Lackland, another concern arose: Independent epidemiologists and city health officials wanted the evacuees to clear three virus tests before being released from quarantine, a standard Lawler said is used for evacuees at the Nebraska medical center. But the CDC required the evacuees in San Antonio to test negative only twice.
In late February, the CDC cleared most of the evacuees from Wuhan, including the woman at the tuberculosis hospital. At that point, she had been tested three times: The first was negative, and the second was inconclusive. So the CDC collected a third specimen, which also was negative, and cleared her for release just before 3 p.m. on Feb. 29.
According to a detailed timeline assembled by the city’s Metropolitan Health District, the woman checked in to the Holiday Inn Express hotel near the San Antonio International Airport. Then she boarded a hotel shuttle and traveled to the North Star Mall a few minutes away.
The woman spent two hours visiting a Dillard’s department store, a Talbots clothing store and a Swarovski crystal shop. She also went to the food court, where she dined alone.
The next day came the bombshell: Without the CDC’s knowledge, according to the March 2 letter, the woman had been tested a fourth time by hospital staff. That test, which was still pending when she was released, had come back positive for the virus.
Bridger was floored. “That is exactly what we assured the community would not happen . . . that the federal government would do everything in their power so no one would be exposed,” she said. “We freaked out. That’s when it got ugly.”
In Austin, Texas Gov. Greg Abbott (R) issued a rare rebuke of the Trump administration in a Monday news conference, calling the CDC’s actions “unacceptable” and “a case of negligence.”
By then, the woman had been returned to isolation. But the CDC was preparing to release more than 120 Diamond Princess evacuees, 11 of whom had declined to be tested.
City officials said they did not trust the CDC to manage the release safely. So they filed an emergency lawsuit asking a federal judge to stop it and to require the CDC to obtain three — not two — negative tests before releasing any evacuee.
U.S. District Judge Xavier Rodriguez, a George W. Bush appointee, quickly denied the request.
“This Court has no authority to second-guess [the CDC’s] determinations,” Rodriguez wrote, “even though the Court also shares the concerns expressed by the Plaintiffs.”
The city declared a public health emergency to try to regain some control.
“It concerns me that depending on where you are in the country, it seems as if there are different standards,” Nirenberg said. “The standard we ought to be going with is that of the medical professionals, not the federal bureaucracy.”
Last week, Texas health department spokesman Chris Van Deusen said the CDC had relented on one point: If any evacuee has an inconclusive test, the agency now will require two sequential negative tests before ending the quarantine.
“We are satisfied with that,” Van Deusen said.
With the Grand Princess evacuees on the way, San Antonio officials are worried the virus will start spreading. But as of Monday, that hadn’t happened, state health officials said. So for now, San Antonio is planning to proceed with one of its biggest annual festivals, the Fiesta parade and celebration that honors the heroes of the Alamo and the Battle of San Jacinto.
The 10-day party is due to kick off April 16. Unlike Austin’s canceled South by Southwest festival, which attracts an international and therefore potentially riskier crowd, “Fiesta is more of a Texas event. People drive in,” Wolff said hopefully. “But I’m not sure what’s going to happen.”
Faiz Siddiqui in San Francisco and Todd C. Frankel and Julie Tate in Washington contributed to this report.