An epidemiologist specializing in outbreak detection and response told members of Congress this week that quarantines of passengers coming from China or banning travelers from the country will do little good to stop the spread of the coronavirus because “this virus is spreading too quickly and too silently, and our surveillance is too limited for us to truly know which countries have active transmission and which don’t.”
“The virus could enter the U.S. from other parts of the world not on our restricted list, and it may already be circulating here,” Associate Professor & Senior Scholar Jennifer Nuzzo, Ph.D., from the Center for Health Security, Johns Hopkins University, told the House Foreign Affairs Subcommittee on Asia, the Pacific, and Nonproliferation at a Wednesday hearing on the deadly outbreak.
According to today’s situation report from the World Health Organization, there are 31,481 confirmed cases of the novel coronavirus, including 3,205 new cases in the past 24 hours, across the globe. The 24 countries outside of China where the virus has appeared, including the United States, account for 270 of the confirmed cases and 54 of the past day’s new cases. There have been 637 deaths in China and one outside China — a 44-year-old man in the Philippines.
The WHO assessed risk from the outbreak as “very high” in China and “high” across the rest of the world. Seventy-two countries have placed in effect some sort of travel restrictions, 10 of those within the past day.
“The U.S. was a target of travel bans and quarantines during the 2009 flu pandemic. It didn’t work to stop the spread, and it hurt our country. I am concerned that by our singling out China for travel bans, we are effectively penalizing it for reporting cases. This may diminish its willingness to further share data and chill other countries’ willingness to be transparent about their own outbreaks,” Nuzzo said. “Travel bans and quarantines will make us less safe if they divert attention and resources from higher priority disease mitigation approaches that we know are needed to respond to cases within the United States.”
“Caring for and monitoring even a small number of quarantined individuals would be highly challenging for health departments and may siphon attention from other, more important response work,” she added. “And we’re already hearing stories about chaos in the states as they’re trying to implement these recent policies.”
Nuzzo said that trying to lock down borders to prevent the spread of illness is “a completely understandable instinct,” but “I have never seen instances in which that has worked when we are talking about a virus at this scale.”
“Respiratory viruses like this one, unlike others — they just move quickly. They are hard to spot because they look like many other diseases. It’s very difficult to interrupt them at borders. You would need to have complete surveillance in order to do that,” she added. “And we simply don’t have that. In China, we’re looking for largely sick people. In the other countries, we are only looking for people from China. So, we are going to miss transmission elsewhere.”
Nuzzo said she talked with one health department that has 31 staff working around the clock supporting two quarantined people. “And I just think, as this epidemic grows, that’s not likely to scale,” she said. “So, I’m worried about that.”
Jennifer Bouey, Ph.D., senior policy researcher & Tang Chair in China Policy Studies at RAND Corporation, said China, determined to project stability, downplayed the severity of the outbreak. “From January 3rd to the 20th, the expert investigation team assured the public that there was limited person-to-person transmission and, after closing the animal markets that associated with the first group of cases, the epidemic was under control,” she said. “It was not until cases outside China appeared that the second team was sent and it confirmed the communal transmission. Then, the government announced a public health emergency and triggered the national case reporting system.”
Ron Klain, who served as the White House Ebola czar to coordinate response to the outbreak that began in 2014, stressed that “while scientists are working at unprecedented speed to learn more about this virus, we still know less about the coronavirus today than we did about Ebola in 2014 — there are many important gaps to be filled in.”
The whole-of-government Ebola response, he noted, included the first-ever deployment of U.S. troops to combat an epidemic along with measures such as travel screening.
“The epidemic was tragic, a loss of 11,000 lives or more. But, experts had forecast a death toll of more than one million. Thus, as part of a global response, with Africans playing the largest part, America helped save hundreds of thousands of lives,” Klain said. “Here at home, after some initial missteps in Dallas, no one contracted Ebola on U.S. soil, and the evacuation of Americans from Africa with Ebola saved lives and resulted in no spread of the disease here.”
That epidemic and the lessons learned also helped build out the country’s response infrastructure, and Klain said that, while the coronavirus and Ebola are different beasts, lessons can be applied to today’s challenge, such as the designation of a single high-level official inside the National Security Council overseeing the response, helping other nations where the virus has spread, deferring to the country’s top scientists on key decisions, an administration request for and congressional passage of an emergency funding package, and congressional renewal of funding set to expire in May for special pathogen hospitals created during the Ebola epidemic. Klain also cautioned against discrimination aimed toward Chinese-Americans, as “the coronavirus strikes humans, not people of any particular race or ethnicity.”
“There should be a wakeup call to finish the work we need to pandemic preparedness. Recently, we marked the hundredth anniversary of the single largest mortality event in American history, the Spanish flu epidemic,” he said. “At present, it seems very unlikely that the coronavirus poses a similar threat. But, even if this epidemic is not the big one… it’s a reminder that the danger lurks, and it will come.”
On travel restrictions, Klain declared that right now the U.S. has “a travel Band-Aid” instead of a ban.
“Before it was imposed, 300,000 people came here from China in the previous month. So, the horse is out of the barn,” he said. “…What we should be focused on is monitoring the people who are here who have been in China in the past 14 days. That is complicated. That is hard. We built a pathbreaking system to do that in the Ebola response. This is much larger, more complicated.”