Ask KFF: Josh Michaud Answers 3 Questions on the Coronavirus and U.S. Response

This weekend, the Centers for Disease Control and Prevention confirmed that five people in the U.S. have been diagnosed with the latest international outbreak – coronavirus – which started in Wuhan, China, and has since spread to more than 10 other countries. Five major U.S. airports with direct flights from Wuhan have started screening arrivals for symptoms of the contagious respiratory illness, while the Chinese government has shut down transportation to and from Wuhan and 16 other cities in central China. Josh Michaud, an Associate Director for Global Health Policy at KFF, took time between interviews and providing insight on Twitter to offer perspective on the U.S. role and how response to this outbreak compares to others, such as SARS in 2003 and the West African Ebola epidemic that ended in 2016. The following has been edited from a longer conversation.

Josh Michaud Headshot1. How has the U.S. role in global response efforts to outbreaks like this changed over time?

The U.S. has played an important role in basically every major international disease outbreak over the last few decades. More specifically, public health experts at CDC provide technical assistance and support for efforts to contain the diseases overseas. The National Institutes of Health and other U.S. institutes have been vital to the scientific research needed to understand these pathogens and to develop the diagnostic tests, medicines, vaccines and other tools needed to control them. Even diplomats at the State Department and elsewhere work to coordinate U.S. efforts with country partners and with international organizations like the World Health Organization (WHO). Through foreign assistance agencies like USAID, the U.S. often provides funding and other technical assistance.

These main roles haven’t changed much, although the extent of U.S. involvement and types of assistance have varied greatly. It depends on the severity, the risk, and also where geographically these outbreaks are occurring. The U.S. was heavily involved in responding to Ebola in West Africa, 2014-2015. During that outbreak, the U.S. provided $3.7 billion in international assistance, hundreds of CDC experts worked on the response, and almost 3,000 U.S. troops were deployed. Going back a little further, the U.S. had a smaller international footprint when it came to the SARS epidemic of 2003, when U.S. engagement came in the form of technical support, guidance and scientific research contributing to the efforts to contain that outbreak. The U.S. was heavily focused on preventing and containing SARS within our own borders as well.

At this point, there’s little indication that the U.S. is planning to provide funding to other countries facing this new coronavirus. For the most part, China is seen as capable of addressing the outbreak on its own and is highly capable, scientifically and from a public health standpoint. The WHO is leading the international collaboration effort and just announced that the outbreak does not constitute an international emergency, but it does constitute an emergency in China.

When an outbreak occurs in a very poor country, which may lack China’s capacity, for example, and where the population may be especially vulnerable, that’s often where the U.S. will step up and play a larger role. And that’s what we saw in the Ebola case. Things could change with the current outbreak in the future.

2. China is implementing travel restrictions in the city of Wuhan and other affected areas, and some U.S. airports are screening travelers arriving from Wuhan for signs of the virus. How does the U.S. decide when and where to enact policies like this? What are the strengths or limitations?

China’s decision to essentially quarantine tens of millions of people in and around Wuhan is really unprecedented.Needless to say, this is a major imposition on people and requires an incredible amount of effort and resources to implement. And it remains to be seen whether the benefits to interrupting the outbreak will outweigh the economic and social costs. So it’s highly unlikely the U.S. would institute a similar policy, given what we know about the virus and its risks.In fact, the last time the U.S. implemented the mass quarantine at all was over a hundred years ago during the 1918 influenza pandemic.

As you noted, the U.S. has taken some steps with the CDC screening travelers arriving from Wuhan at five international airports. The decision was likely made as a proactive step to demonstrate resolve to both identify and to try to prevent importation of cases. At this point, the risk to Americans is still very low. There’s a debate about whether the benefits of this type of screening are worth the cost. The CDC has dispatched hundreds of workers to support the efforts at the airports — an expensive proposition. From prior outbreaks, studies have shown that screening of this type wasn’t very effective at identifying cases. Not a single case of SARS was identified when millions of arriving passengers were screened across multiple countries. The first U.S. case infected with the new virus came into the country before the enhanced screening began, and they landed in Seattle (not one of the 5 airport screening sites), so they wouldn’t have been found through this screening anyway.

There is also a regular, so-called “passive” surveillance system, which is how the first U.S. case of coronavirus was identified. This person saw the news, went to their health care provider, told them about recent travel in mainland China, and reported symptoms of an influenza-like disease. That person was tested, reported to the state authorities and the CDC. So making sure providers have the information and the diagnostic criteria they need to identify cases that way is very important.

3. How might recent U.S. policies or politics affect this outbreak?

There’s little indication right now that the U.S. will be heavily involved in any of the international responses to this outbreak, other than the kinds of technical assistance and expertise that the CDC and NIH can provide. But given it’s an election year, if the outbreak continues to expand and more cases come into the country from elsewhere, we could certainly see more heightened politics surrounding the issue. We saw that during the Ebola epidemic, where there was a push to ban all travel from the affected countries, even though it went against the CDC’s recommendations and was seen as overly restrictive. Unfortunately, those affected by outbreaks are often stigmatized and attacked, something that is not limited to the U.S.

President Trump has stated that he believes the U.S. government is handling the current situation well, and that China is capable of addressing the outbreak in their country. So we’ll see how policy may change, but it would be surprising to see a major push for U.S. assistance outside the U.S. in this case, unless the virus itself becomes more dangerous or spread more widely.

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