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CDC scientists overruled in White House push to restart airport fever screenings for COVID-19

Brett Murphy and Letitia Stein
USA TODAY
The News Herald

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The White House is pushing a return to its failed experiment in relying on temperature screening of air travelers to detect coronavirus despite vehement objections from the nation's top public health agency, internal documents obtained by USA TODAY show.

The discord underscores the administration’s disregard for science and the diminished standing of the Centers for Disease Control and Prevention at a moment when local governments, businesses and community leaders are seeking direction on how to reopen safely.

Recent emails show CDC scientists, who have begun owning up to initial missteps in the federal response, trying to persuade the administration to reconsider.

The White House directive to check travelers in 20 U.S. airports for fever comes after earlier efforts by the CDC to screen travelers returning from China failed to stop the global pandemic from reaching the United States.

“Thermal scanning as proposed is a poorly designed control and detection strategy as we have learned very clearly,”  Dr. Martin  Cetron, the CDC’s director of global mitigation and quarantine, wrote in an email to Department of Homeland Security officials on Thursday. “We should be concentrating our CDC resources where there is impact and a probability of mission success.”

Cetron questioned his agency’s legal authority to execute the airport plan, ending the email: “Please kindly strike out CDC from this role.”

White House Chief of Staff Mark Meadows pressed ahead anyway, directing the DHS to announce the airport screenings, which would be visible and instill confidence in travelers, according to meeting notes.

Passengers with fever, Meadows said, would be referred to the CDC for clearance. The full plan has not yet been finalized.

The exchange follows two weeks of internal skirmishes between the CDC and the Office of Management and Budget over how to safely reopen the nation’s schools, restaurants and churches.

Separate emails show the public health agency’s recommendations that bars install sneeze shields and teachers space student desks six feet apart were dismissed as overly prescriptive.

As a result, detailed plans – which CDC Director Dr. Robert Redfield personally approved – have idled in administration officials’ email inboxes since late April. The Associated Press has reported on the draft guidelines since last Tuesday, but an official plan has not been released.

At the height of restrictions in late March and early April, more than 310 million Americans were under directives ranging from “shelter in place” to “stay at home.” Now governors across the United States are rolling out a patchwork of plans to relax social-distancing restrictions.

“The number one public health agency is completely ineffective in the most important of moments,” said Dr. Ashish Jha, director of the Harvard Global Health Institute. “It’s so absurd.”

CDC spokesman Benjamin Haynes said in a statement that Redfield has had a seat at the table throughout the crisis.

The agency’s public health expertise is “helping shape our nation’s response, as well as the response by our state and local health department partners who continue to be on the front line fighting this war,” Haynes said.

He said the CDC is revising its reopening guidance, based on White House feedback, but did not address the records that show the agency sparring with administration officials over the airport screenings, referring questions to the White House.

White House spokesman Judd Deere downplayed any discord, noting the administration has been “encouraging all Americans to follow the CDC guidelines from the very beginning of this pandemic.”

He said the CDC never cleared the reopening instructions it wanted to issue, and that standardized guidance would be inappropriate across all states. Deere did not answer questions about the airport screening proposal.

In an Oval Office meeting last week, Trump signaled support for some form of increased health screenings, which airlines hope will convince travelers it's safe to fly again.

This week, the chief executive officer of Southwest Airlines said the Transportation Security Administration should add temperature scans to airport security checkpoints, and discount carrier Frontier announced plans to begin screening passengers before they board with touchless thermometers, beginning June 1.

The White House coronavirus task force also has requested evidence of results from the screenings after the President’s China travel ban early in the U.S. outbreak, in late January, emails show.

Scientists, including those at the CDC, have repeatedly insisted that those measures miss the large percentage of people infected with COVID-19 who display no symptoms or can infect others before or without spiking a fever. And fever can be a sign of a wide range of illnesses.

In Nevada, public health officials struggled to get basic details from the CDC about contact information for the early travelers it was supposed to track, according to records obtained by USA TODAY under a public records request.

The head of the state’s Department of Health and Human Services sent an alarmed letter to Redfield on Feb. 11.

“I am concerned about the breakdown between the communication the states have received from the CDC,” Nevada public health director Richard Whitley wrote. “The lack of communication in this circumstance created frustration and confusion for all those involved."

CDC spokesman Haynes said issues were addressed "as quickly and efficiently as possible," calling the airport screenings starting in January unprecedented.

Recently, the CDC has begun both a public and private reckoning of its early mistakes, putting it at odds with a White House that has steadfastly defended the federal response.

An internal CDC memo, commissioned at the request of Health and Human Services Secretary Alex Azar and obtained by USA TODAY,  reviews how the federal government missed early warning signs as the virus spread undetected around Washington state and California as early as late-January.

The agency also published a report last week highlighting the role of travel and large gatherings like Mardi Gras, a professional conference in Boston and a small-town funeral in contributing to the early spread. The analysis was intended to help public health better prepare for the next outbreak, and not repeat mistakes.

The federal government’s coronavirus failures may have started with the first case documented in the United States, the CDC acknowledges in the internal memo documenting the disease’s spread.

Viral genetic sequencing now suggests a link from the first case detected in late January in Washington state, involving a man who had traveled to China, to a chain of some 300 infections, although numbers vary widely.

The same viral line also circulated on a Grand Princess cruise ship that departed several weeks later out of California, the first in a set of voyages that ended with with evacuation and quarantine of passengers.

That explosion of infections occurred despite the CDC’s leadership of a vigorous public health response. The Washington state resident’s close contacts were carefully tracked and monitored.

In the internal memo, the agency speculates that its efforts nonetheless could have missed people who were infectious but only later, or never, showed symptoms. Large numbers of those infected with the virus now are known to be such asymptomatic cases, although at the time that had not yet been fully recognized.

“The virus could have spread from this case, despite the thorough investigation and response,” the CDC memo notes, adding a concerning conclusion for a country facing a likely second wave of the virus: The origin of the Washington cluster “will probably always be unknown.”

The agency’s internal accounting of how the virus spread recognizes another shortcoming in the lack of adequate testing in the early stages of the outbreak. Critical weeks elapsed in February with minimal testing capacity after the CDC botched the development of what was then the nation’s only coronavirus test.

In the memo, the CDC says early transmission occurred during a period of “limited availability of testing.” But instead of highlighting its own delays in developing a reliable test, the agency described a Food and Drug Administration policy that blocked the scaling up of testing through commercial laboratories until late February.

Public health officials in Santa Clara County, California, recently learned from autopsies that two people who died in their homes in early and mid-February were infected with the new coronavirus – suggesting the virus was spreading locally much earlier than previously recognized.

These deaths occurred “during a time when very limited testing was available only through the CDC,” the California health officials said in a news release, noting that the agency’s guidance on testing then excluded people without a travel history or specific symptoms.

Santa Clara County Public Health Director Dr. Sara Cody discloses that two people with coronavirus died at home as much as three weeks before the U.S. reported its first death from the disease.

The CDC’s internal memo, however, minimizes the agency’s authority in those situations.

“CDC guidelines emphasized that they were just that – ‘guidelines’ – and that decisions about testing needed to be made on a case-by-case basis,” the document stated, adding that the discoveries in Santa Clara County, which the agency confirmed in late April, were still “preliminary and could easily change.”

Haynes, the CDC spokesman, confirmed the government made decisions in January and February based on available data of likely exposures by those who had traveled to Wuhan, China. In addition, he said, "CDC guidance has always allowed for clinical discretion on who should be tested.”

Dr. Alison Roxby, a University of Washington epidemiologist who has been testing nursing home patients in the Seattle area, said she has been consistently let down by the federal response. She compared her recent experiences — vying for testing supplies daily with little clear direction from the federal government — with her time working in developing African countries.

“The leadership vacuum is tremendous,” said Roxby, noting that inconsistent public health messages have contributed to people mistakenly believing the crisis has passed.

“It’s not over,” Roxby said. “It’s the eye of the hurricane.”

Reporter Kenny Jacoby contributed to this report.