TOKYO—The best advice on novel coronavirus crisis management may come from an ancient Chinese philosophical treatise, The Tao Te Ching: “A tree as great as a man's embrace springs from a small acorn,” it tells us. That would certainly be an apt description of the spreading plague of COVID-19 over the last 10 weeks. And the Tao advises that trouble is most easily overcome before it starts: “Set things in order before there is confusion.”

What we have seen here in Japan and even moreso in the United States is the utter failure to apply that axiom. And at the U.S. embassy in Tokyo we have a microcosm of confusion that reflects those much bigger, and potentially fatal problems.

“Without leaving your hut, you can know the whole world,” says the Tao, and in this case the hut is the big, forbidding block of glass and concrete that flies the American flag in the Akasaka neighborhood of Tokyo.

The Daily Beast has learned that the embassy exposed at least five employees to fully virulent coronavirus sufferers from the cruise ship Diamond Princess last month, and when they all asked to be tested, the U.S Embassy Tokyo Deputy Consul General Timothy G. Smith not only refused to do so unless they exhibited symptoms, he strongly discouraged them from getting outside testing.

Given mounting evidence that the disease can be transmitted by people with few or no symptoms, that would seem to be the height of folly. But in the mire of bureaucratic and political stubbornness, great plagues can grow.

Our questions about this issue, when put to the embassy, were kicked to the State Department in Washington, which gave this response on Monday:

“Throughout this crisis, we have continuously worked hard to ensure the safety of our staff, including through training and the provision of appropriate personal protective equipment by U.S. Government medical professionals. All health and safety protocols have been strictly followed.”

Okay. But what about getting tested on their own?

“All health and safety protocols have been strictly followed in accordance with U.S. and local requirements and standards. If required, any testing would be done in coordination and consultation with health authorities.”

“ On Tuesday this week, the World Health Organization upped the estimated COVID-19 mortality rate to 3.4 percent. Seasonal flu is 0.1 percent. ”

From such vague responses to specific questions it‘s clear that, as our reporting shows, actual testing for infection is not part of the program–unless there are symptoms.

The United States would not be the first country to make this mistake. The Ministry of Health, Labor and Welfare in Japan also refused initially to test the 90 officials and health-care workers who had been on the Diamond Princess, asserting that all safety protocols had been followed . Now 10 or more of them have been diagnosed with the coronavirus, after first returning to work.

Is it a coverup, a fuckup, a compromise or just the way things are? Hard to say, but the Tokyo embassy scandal raises questions the entire United States and its public servants will be facing soon:

Do we test first-responders for the virus? When do we test them? Do we test them only when they’re ill, thus ensuring the virus will spread, or do we test them routinely if they are in contact with the infected?

You‘d think the answers would be obvious, but the embassy example shows they are not.

Furthermore, how do we quarantine these workers if they are positive? Do we treat U.S. State Department staff or military who get ill in their host countries while they are there? Or do we take them home and treat them in the USA?

THE CDC/TRUMP CONTEXT

Here is what happened in Japan, according to sources in Japan’s Ministry of Foreign Affairs; the Ministry of Health, Labor and Welfare; a temporary staffing agency; embassy officials; and the public affairs office of the U.S. State Department.

You may recall that the Diamond Princess cruise ship docked at Japan’s Yokohama port on Feb. 3 and was quarantined. Ten people on board tested positive for the virus on Feb. 5. Now over 700 people have been infected with the coronavirus from the on-ship epidemic. Early on in the quarantine more than 30 Americans were hospitalized in Japan after developing the disease.

On Feb. 10, embassy employees were sent to hospitals to visit infected American citizens as part of their “welfare and whereabouts” duties. The embassy representatives included local Japanese hires. At some of the hospitals, the U.S. embassy staff came within an arm’s length of the infected. Safety precautions such as a plate of glass, or a plastic curtain between the visitor and visited, were not taken.

After witnessing the extreme illness of those infected, several staffers went to the medical unit at the embassy to ask to be tested for the virus but were turned away. They were told they can only get tested if they have full blown symptoms including a high fever.

The U.S. Embassy in Tokyo is located on three acres close to the Prime Minister of Japan’s residence and many other embassies. The functional but old embassy building was constructed in 1976 and the ambassador's residence is also on the grounds. Most of the employees live in a nearby compound, which is an eight-minute walk from the embassy buildings.

“ After witnessing the extreme illness of those infected, several staffers went to the medical unit at the embassy to ask to be tested for the virus but were turned away. ”

Within the embassy itself cubicles are in short supply and it’s sometimes likened to a crowded Toyio high school. Conditions for spreading the disease are similar to what you would find in any densely populated building, which is to say, good for the virus, not for the humans.

The medical unit and consular management assured those exposed that the normal seasonal flu was a greater danger and that only old people die from the coronavirus and therefore they were in no danger.

Of course, that isn’t true–young people also die from the virus, as we now know, and the overall death rate has been reported consistently as about 2 percent, or 20 times higher than 0.1 percent for the flu. On Tuesday this week, the World Health Organization upped the estimated mortality rate to 3.4 percent.

But the smug conclusion of the embassy hierarchy was essentially, “You all are healthy, so you’ll be fine.” At that point in mid-February, there were still questions about how virulent COVID-19 really was and the embassy and Centers for Disease Control lacked understanding of the still somewhat mysterious routes of infection. But in such cases, it would seem obvious one should err on the side of caution.

This should also be seen in the context of messages coming out of the Trump White House. The president constantly sought to downplay the threat of the virus. As late as Feb. 26 he claimed the number of cases in the U.S. was declining when the opposite was true. He actually claimed the death rate was lower than for seasonal flu, which is patently false, and he insisted a vaccine was coming soon, when it likely won’t be available until next year, at the earliest. Trump saw publicity about the virus as a ploy, if not a plot, by his critics.

After Donald Trump Jr. went so far as to claim Democrats wanted to see millions of Americans die in order to hurt his father, and as some Americans did start to die, the president began to take a more sober approach. Even so, testing in the United States has lagged far behind some other affected countries, and testing kits have been flawed.

‘YOU SHOULD BE OKAY’

In the meantime the staff at “The Tokyo State Department High School” were told everything was fine. Many were not convinced. And the consular briefing by the Centers for Disease Control on Feb. 13, didn’t help matters.

Barbara Knust, an epidemiologist in the Viral Special Pathogens branch at the CDC, informed the consular staff that under no circumstances should embassy personnel be in the same room as COVID-19 positive patients. Almost immediately there was a question from one of the embassy staff. “We have been in the same room with the patients. Close enough to them to touch them. Are we okay?”

Knust then paused and said, “You should be okay if you were wearing full protective gear.” It’s not clear that the protective gear was adequate; necks and arms were exposed. Some walked through possibly contaminated areas of the hospital before and after they donned the gear. As on the Diamond Princess itself, quarantine conditions seemed less than adequate.

After this meeting, the embassy’s management decided to discontinue the “welfare and whereabouts” visits for those in medical care and to conduct the follow-up checks over the phone.

However, the names of the individuals who had been exposed to infected patients had already become known in the embassy and colleagues began to avoid them. One embassy employee said, on condition of anonymity, “It makes people nervous to know there may be infected co-workers walking around the embassy. We don’t want to ostracize them but we keep hearing of people who tested negative, later turning out to be infected. These people haven’t even been tested, ever.”

“ It makes people nervous to know there may be infected co-workers walking around the embassy. ” — Concerned U.S. embassy staffer who spoke on condition of anonymity.

The evacuation of American citizens from the Diamond Princess began on Feb. 16. The Japanese government had promised that all of those ready to evacuate were virus free but as the planes got ready to take off, it became apparent that Japan’s quarantines had failed. Many of the Diamond Princess cruise passengers who had been evacuated under the assumption that they were not infected were in fact carriers of the illness. That created more uneasiness within the embassy.

The history of precautions taken overseas–or not–should give you an idea of how stubbornly infectious the virus can be.

Carl Goldman, one passenger evacuated from the ship who contracted the virus, has been in an Omaha, Nebraska, hospital since Feb. 17. He is in a room that has been made virtually airtight to prevent doctors from contracting the virus; the windows are double-pane thick glass.

Around the time Goldman was sealed into his room, embassy staff contacted senior management asking for follow-up testing.

“ The staff was told several times that no one would be tested unless they displayed symptoms within a 14 day incubation period. ”

According to a former employee of the embassy who left for the private sector last year but remains in close contact with his embassy colleagues, on the afternoon of Feb. 18, Deputy Consul General Smith held a meeting with staff who had visited the hospital and apologized for putting them in a precarious situation. Smith explained that when management had decided to send officers and staff to the hospitals, that they were following the guidance of the CDC.

“Unfortunately,” he reportedly told them, “two or three days later CDC changed their guidance. That was not foreseen.”

While addressing the officers and local staff requests for testing, Smith assured them that he had consulted with the CDC and there was little or no danger. He asserted that their recent exposure with the gear they had on renders concern “negligible,” concluding, “Since you have no symptoms, no tests are needed.”

The staff was told several times that no one would be tested unless they displayed symptoms within a 14 day incubation period.

When staff asked to have themselves tested on their own, they were strongly discouraged from doing so. During meetings, embassy officials told them verbally that if they independently sought tests at a hospital, it might bring unwanted attention to the recent embassy practice of exposing officers and staff to the virus.

FEVER DREAMS

On the evening of Feb. 18, Consul General Karin M. Lang would tell officers that actually no testing was available but the medical unit was giving out self-exam kits.

The self-exam kits include a thermometer, a daily log, the recommended temperature for testing, and a medical mask that, in fact, is not designed to prevent the spread of coronavirus.

A day or two later, there was an embassy wide town hall and Deputy Chief of Mission Joseph M. Young thanked the staff for their hard work.

At this town hall, Knust explained to them, “We are still learning a lot about the virus,” but could not provide the nervous embassy personnel with any more conclusive information.

“ On Feb. 23, a new study suggested that the incubation period for coronavirus could be up to 27 days. ”

On Feb. 20, the media began reporting that the U.S. State Department flew coronavirus infected Americans from the ship back to the United States on a plane full of healthy people. The CDC had opposed this decision. The 14 infected passengers were put in seats behind 10-foot-high plastic walls on four sides.

On Feb. 23, a new study suggested that the incubation period for coronavirus could be up to 27 days for some individuals. This means that without being tested, there is still a chance that the embassy employees could silently be dispersing the virus within the embassy walls and the compound where they live.

Epidemiologist Kentaro Iwata said at a press conference on Feb. 20 that not testing those who have been exposed to those who have been infected raises the possibility of increasing the spread of the disease significantly. He emphasized that while early testing does produce false negatives, testing criteria shouldn’t be so stringent as to only test after someone is visibly ill. Pre-emptive examinations were critical in preventing an outbreak, he said.

THE DOUBLE BIND

The Daily Beast reached out to several parties at the embassy. A list of questions were submitted to the embassy public affairs office in Tokyo. As noted, the questions were then kicked up to Washington D.C., where the Department of State spokesperson responded with anodyne assurances that, “All health and safety protocols have been strictly followed.” They would not discuss whether or not staff had been discouraged from seeking tests outside the embassy, nor explain why tests were not conducted.

However, one senior State Department officer told The Daily Beast on conditions of anonymity there were two main reasons testing had not been done.

“The CDC information kept changing. We were told they didn’t have enough testing kits and that effectively they were already conducting triage. Thus: no symptoms, no test, no problems. We reached out to the Japanese Ministry of Health and were more or less rebuffed. We were told that it would be awkward if we tested our employees while the Ministry of Health was refusing to test staff that had been involved in the quarantine.”

So far, none of the five who visited the sick patients from the Diamond Princess have shown symptoms, but without the tests, which still have not been carried out, it is impossible to say whether they might have carried the disease to others. And even then, results are not reliable—only better than nothing.

“ The CDC information kept changing. ”

A source at the ministry did confirm that there had been talks, but no formal request that the embassy suppress testing.

Indeed, 90 Japan health ministry employees who had been working around the ship during the first two-week quarantine initially returned to their normal work duties without being tested for the virus. The ministry, too, refused to do testing, insisting that all proper health protocols had been followed.

After several fell ill, the ministry reversed its decision and agreed to test 41 of them; then eventually decided to test all 90. Eleven of them were infected.

The dilemma faced by those at the U.S. embassy will very soon face everyone working in the public service in the U.S.

Do we test those at risk and treat them accordingly, or do we work not to know and let things go as they may?

Knowing as early as possible would seem to be the best way to treat illness before it gets severe and stop infection before it spreads.

So far, the Trump administration and the CDC have not followed the wise advice of Lao Tzu, the alleged author of the Tao Te Ching. The greatest problem could have been solved when it was small.

What to do?

Lao Tzu, was no prophet but he may have some post-crisis advice that we all should heed, now that the growing number of deaths in the United States appears to have focused the administration’s attention: People usually fail when they are on the verge of success. So give as much care to the end as to the beginning; then there will be no failure.

Unfortunately, we weren’t careful in the beginning.

The acorn has become a tree and it will soon become a forest. The question is how we will conduct ourselves at the end to try to salvage success from failure.

The full State Department statement on the situation at the U.S. embassy in Tokyo:

The welfare and safety of U.S. citizens and our employees is the Department of State’s highest priority.

We work around the clock to provide U.S. travelers with timely, accurate information regarding risks abroad, as well as to assist Americans in need.

In the case of the Diamond Princess, our Embassy in Tokyo, with the full support of the State Department, the Centers for Disease Control, and the Department of Health and Human Services, has made strenuous efforts on behalf of the U.S. citizens involved.

Our team has assisted these citizens every step of the way, including working to ensure: that those on board had access to prescription medication and appropriate medical attention; that those who tested positive received appropriate medical care in Japan; and, that all were kept informed through daily updates. Of course, we also arranged charter flights to take U.S. citizens from the ship to the United States.

We have and will continue to provide all appropriate consular assistance to the U.S. citizens involved, including those who remain in Japan.

This assistance continues to include working closely with the cruise line, Japanese health authorities, the Centers for Disease Control, and the Department of Health and Human Services to monitor treatment and quarantine of those still in Japan, and work to lift the Do Not Board restrictions as appropriate.

Throughout this crisis, we have continuously worked hard to ensured the safety of our staff, including through training and the provision of appropriate personal protective equipment by U.S. Government medical professionals. All health and safety protocols have been strictly followed.

We extend our thanks to the Government of Japan for its invaluable collaboration with us and for its commitment to protecting the welfare of our U.S. citizen community in Japan. We remain committed to working alongside Japan and all of our international partners to combat the outbreak.

Are embassy staff free to get tested on their own, now that the Japanese government is offering such tests?

All health and safety protocols have been strictly followed in accordance with U.S. and local requirements and standards. If required, any testing would be done in coordination and consultation with health authorities.