Health officials at the US Centers for Disease Control and Prevention did not want 14 people who had tested positive for the new coronavirus to be flown back to the US, among hundreds of other uninfected people—but the CDC experts were overruled by officials at the US State Department, according to a report by The Washington Post.

On Sunday, February 16, the 14 positive people flew from Japan to the US on State Department-chartered planes. They were among over 300 others, all evacuees from the luxury cruise ship, the Diamond Princess, which had an explosive outbreak of COVID-19 cases.

The cruise ship, initially carrying 3,711 passengers and crew, had been quarantined in Yokohama, Japan since February 3, after a former passenger tested positive on February 1. But the quarantine efforts failed to curb the spread of the virus on board, and case counts steadily climbed during the 14-day confinement. Even in the last days, health officials in Japan were still reporting dozens of new cases.

On Friday, February 21, after the initial quarantine lifted on the 19th and hundreds of passengers and crew were allowed to disembark, the outbreak on the ship reached 634 cases. It is by far the largest cluster of cases outside of China, accounting for around half of all cases outside of the hard-hit country.

But the failure of the quarantine was clear well before now. On Saturday, February 15, US officials announced that they would evacuate Americans. “To fulfill our responsibilities to US citizens, as well as to reduce the burden on the Japanese healthcare system, the US government recommends that US citizens disembark and return to the United States for further monitoring,” the CDC said in a statement.

The agency made clear that only the uninfected would be allowed to fly back. “All travelers from Japan will be screened before boarding the State Department-chartered aircraft to prevent symptomatic travelers from departing Japan,” the CDC said.

But in a last-minute twist, that all changed. As American evacuees sat crammed into buses idling on an airport tarmac in Japan, officials received the results of coronavirus testing done a few days before: 14 of the people on the buses were positive. A fierce debate broke out in Washington, DC, according to the Post, who spoke with unnamed senior US officials involved with the decision.

Risk management

CDC’s principal deputy director, Anne Schuchat, reportedly argued against letting them board the planes. She expressed concern about infection control and noted that the agency had already assured the weary cruise ship passengers that they would not be evacuated with anyone who had tested positive for the virus or showed symptoms of COVID-19.

Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, reportedly backed up the stance, noting the concerns were valid and should be considered.

But Robert Kadlec, assistant secretary for preparedness and response for the Department of Health and Human Services, argued for letting them fly. He noted that the evacuation aircraft, two Boeing 747s, were already equipped with infectious disease doctors and areas enclosed by 3-meter-high plastic walls to keep infected passengers.

The US State Department ultimately made the decision to let the infected passengers return to the US on the aircraft.

Afterward, CDC officials insisted on having references to the agency wiped from any statements about the decision. According to the Post:

"CDC did weigh in on this and explicitly recommended against it,” Schuchat wrote on behalf of the officials, according to an HHS official who saw the email and shared the language. “We should not be mentioned as having been consulted as it begs the question of what was our advice.” She wrote that the infected passengers could pose “an increased risk to the other passengers."

According to the Post’s report, some of the evacuated passengers were not aware that there were infected people on board the aircraft until their arrival in the US.

“We were upset that people were knowingly put on the plane who were positive,” one passenger told the Post from a military base where she and her husband are under a federal quarantine. “I think those people should not have been allowed on the plane,” she went on. “They should have been transferred to medical facilities in Japan. We feel we were re-exposed. We were very upset about that.”

In a press conference Friday, Nancy Messonnier, Director of CDC's National Center for Immunization and Respiratory Diseases, said that there are now 21 confirmed COVID-19 cases in the US among repatriated people, 18 of which were from the Diamond Princess. Dr. Messonnier said it is unclear if any of the evacuees from the Diamond Princess were infected in flight.

Those 21 cases are in addition to 13 other confirmed cases in the US, which involve people who were not repatriated.

At the time of publication, there are 76,785 COVID-19 cases worldwide, with 2,249 deaths, according to the World Health Organization. The vast majority of cases and deaths are in China. About 1,200 cases outside of China are scattered among 27 countries and the Diamond Princess.