Watchdog report faults chaotic and unsafe response to early pandemic overseas evacuations

A lack of specific planning and infighting between federal agencies in the earliest days of the coronavirus pandemic led to a chaotic effort to bring home hundreds of Americans from overseas that put repatriates, federal personnel and nearby communities at risk, according to a government watchdog report.

The Government Accountability Office (GAO) report found the agencies within the Department of Health and Human Services (HHS) “experienced serious fundamental coordination challenges, including disagreement over whether to designate the effort as an evacuation or repatriation.”

The report centers around efforts between January and March 2020 to bring back to America approximately 1,100 individuals from Wuhan, China, and the Diamond Princess cruise ship in Yokohama, Japan.

According to the report, HHS agencies did not follow repatriation plans or guidance and had not previously exercised emergency repatriation plans in the context of a pandemic, which would have helped clarify roles and responsibilities and identify any response efforts needing improvement.

The GAO probe found agencies were fighting over who was in charge, and disagreements over the terminology led to confusion and safety lapses. 

“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 report concluded. 

The report centered around three HHS agencies — the Centers for Disease Control and Prevention (CDC), the Administration for Children and Families (ACF), and the Office of the Assistant Secretary for Preparedness and Response (ASPR).  

In one notable example, the report detailed a disagreement over whether the mission was an “evacuation and quarantine,” which would have fallen under CDC’s authority, or a “repatriation,” which was the responsibility of ACF.

This led to fundamental problems for HHS agencies and their federal partners, including at the March Air Reserve Base quarantine facility in California where the first repatriated citizens were quarantined prior to widespread transmission of COVID-19 in the U.S. 

The lack of coordination left agencies scrambling, and they were unprepared when the initial flight from Wuhan landed in California. The disorganization led to a delay in issuing a mandatory quarantine order for the base. 

The CDC initially requested that repatriates voluntarily quarantine themselves. The agency did not issue the federal quarantine order until two days after repatriated Americans first arrived, during which time an American with the potential to spread COVID-19 ignored the request and attempted to leave the base. As a result, the surrounding county issued an order to quarantine the individual.

The GAO also highlighted a disagreement over which agency was responsible for infection prevention and control, and managing the use of personal protective equipment (PPE).

Personnel from ACF and ASPR believed that the CDC would be the lead for quarantine efforts, based on the CDC’s areas of authority and expertise and an emergency plan for dealing with Ebola. However, CDC officials said that the Ebola section was not applicable to other infectious diseases.

That confusion also led to inconsistent PPE use on the base, and differing use of PPE for personnel performing the same tasks. At one point, health officials directed HHS personnel to remove PPE at a meeting with Wuhan evacuees to avoid “bad optics.”

As a result of the failures, the GAO recommended that officials devise plans that focus on hypothetical rescue missions during a pandemic, clarifying the different roles and responsibilities of separate agencies, and then practice and test them with federal, state, local and territorial governments.

HHS agreed with the recommendations.