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بهترین سایت شرط بندی ایرانی
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بهترین سایت شرط بندی ایرانی

Global Statistics

All countries
695,781,740
Confirmed
Updated on September 26, 2023 9:04 pm
All countries
627,110,498
Recovered
Updated on September 26, 2023 9:04 pm
All countries
6,919,573
Deaths
Updated on September 26, 2023 9:04 pm

Global Statistics

All countries
695,781,740
Confirmed
Updated on September 26, 2023 9:04 pm
All countries
627,110,498
Recovered
Updated on September 26, 2023 9:04 pm
All countries
6,919,573
Deaths
Updated on September 26, 2023 9:04 pm

California’s Plan to Trace Travelers for Virus Faltered When Overwhelmed, Study Finds

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David Waldstein

In the early days of the coronavirus outbreak, the United States, like many countries, had a very brief chance to limit the spread of the disease at its borders. Identifying travelers from high-risk countries and tracing their contacts with others would have been critical measures, if put in place early enough.

In California, the largest state and a point of entry for thousands of travelers from Asia, a program was established to do just that. But its tracing system was quickly overwhelmed by a flood of passengers, many with inaccurate contact information, and was understaffed in some cases, rendering the program ineffective, according to a study released on Monday by the Centers for Disease Control and Prevention, which looked exclusively at California.

“Despite intensive effort, the traveler screening system did not effectively prevent introduction of Covid-19 into California,” the report said.

In early February, over 11,000 travelers from China — and later Iran — who landed in California were identified for contact tracing. The hope was to keep track of people traveling from high-risk countries, enabling public health officials to identify possible cases of the coronavirus, quarantine them and contact people who were exposed to them to limit the spread of the contagion.

But when the program was begun on Feb. 5, several weeks had already passed since the disease was first identified in Wuhan, China. On March 17, the program was abandoned so that health care officials could shift their focus to mitigating the spread of the disease within the state. By mid-March, the coronavirus had already established a foothold in California; preventing further introduction from overseas was seen as less important than fighting it on the ground.

“This report is a good example of the challenge of trying to use travel screening to contain and prevent pandemic transmission,” said Dr. Timothy Brewer, a professor of medicine and epidemiology at the University of California, Los Angeles.

The report was prepared by the California Department of Public Health for the C.D.C., which also provided similar passenger information to other states.

A spokesman for California’s health department said the report spoke for itself. When asked if traveler monitoring is a useful tool in fighting a pandemic, the spokesman referred to a passage in the report noting that it can be effective if begun early enough, but that it is particularly difficult with a respiratory disease like the coronavirus, with which transmission can occur before symptoms arise.

The report also said that traveler monitoring is most effective when there is accurate information about passengers and when the number of passengers does not overwhelm the system. None of those conditions existed in this case.

Strict measures in smaller countries like New Zealand and Taiwan are believed to have helped contain outbreaks there, Dr. Brewer said. New Zealand instructed everyone coming into the country after the outbreak to spend two weeks in quarantine, and Taiwan instituted similar measures.

But those are island nations with much smaller populations, and Dr. Brewer noted that Taiwan began installing its restrictions “within one or two days after becoming aware that Covid-19 existed.”

When passengers arrived in California on flights from China during the study period, their information was recorded by customs and border patrol officers and then forwarded to the C.D.C., which in turn sent the contact information to California health officials. Those names were then given to health departments in local jurisdictions throughout the state for contact tracing and follow-ups.

Travelers from Iran were included in the program, called Return Traveler Monitoring, beginning on March 5. The study found that three of the passengers, including two from Iran, were later reported to California’s health department as Covid-19 patients.

In theory, after their arrival, the travelers would be contacted to see if they developed symptoms and find out whom they had seen in person. If any of the passengers developed symptoms or tested positive for the coronavirus, they could be isolated to prevent further transmission, and anyone they came into contact with could be isolated as well.

The C.D.C. report said that, in California, incomplete information made it hard to fully institute the plan. Sometimes names, addresses or phone numbers were inaccurate, and passengers could not be found for follow-ups.

Also, the number of people to keep track of was overwhelming. During the seven weeks of the program, a median of 1,431 people from Asia entered California per week, the study said. By comparison, passenger identification during the Ebola outbreak of 2014-15 was effective in California, in part, because only 21 people per week came from affected countries in Africa.

The study also cited the issue of asymptomatic patients, who can spread the disease before showing signs of illness.

Still, the C.D.C. report endorsed traveler-monitoring programs, although they are “likely more effective during the initial containment phase” of the outbreak.

Once California’s current outbreak is under control, the study said, public health officials should still try to put in place the tracing program, if another wave of disease emerges. But it recommended that it be done in a more efficient and comprehensive way, particularly in collecting accurate information about the passengers.

The C.D.C. called on airlines to provide flight passenger lists to federal officials and for health departments to use text messaging to communicate with passengers after they leave the airport. It said all of that might be useful to “maintain low disease incidence.”

“The critical words there are ‘low disease incidence,’” Dr. Brewer said. “What they are saying is, this could work if you got on top of it early before your system gets overwhelmed. That’s what Taiwan did.”

He added, “In order to do it correctly, you will have to have significantly more resources than are typically available in public health departments.”

  • Updated April 11, 2020

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

    • When will this end?

      This is a difficult question, because a lot depends on how well the virus is contained. A better question might be: “How will we know when to reopen the country?” In an American Enterprise Institute report, Scott Gottlieb, Caitlin Rivers, Mark B. McClellan, Lauren Silvis and Crystal Watson staked out four goal posts for recovery: Hospitals in the state must be able to safely treat all patients requiring hospitalization, without resorting to crisis standards of care; the state needs to be able to at least test everyone who has symptoms; the state is able to conduct monitoring of confirmed cases and contacts; and there must be a sustained reduction in cases for at least 14 days.

    • How can I help?

      The Times Neediest Cases Fund has started a special campaign to help those who have been affected, which accepts donations here. Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities. More than 30,000 coronavirus-related GoFundMe fund-raisers have started in the past few weeks. (The sheer number of fund-raisers means more of them are likely to fail to meet their goal, though.)

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • How do I get tested?

      If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.

    • How does coronavirus spread?

      It seems to spread very easily from person to person, especially in homes, hospitals and other confined spaces. The pathogen can be carried on tiny respiratory droplets that fall as they are coughed or sneezed out. It may also be transmitted when we touch a contaminated surface and then touch our face.

    • Is there a vaccine yet?

      No. Clinical trials are underway in the United States, China and Europe. But American officials and pharmaceutical executives have said that a vaccine remains at least 12 to 18 months away.

    • What makes this outbreak so different?

      Unlike the flu, there is no known treatment or vaccine, and little is known about this particular virus so far. It seems to be more lethal than the flu, but the numbers are still uncertain. And it hits the elderly and those with underlying conditions — not just those with respiratory diseases — particularly hard.

    • What if somebody in my family gets sick?

      If the family member doesn’t need hospitalization and can be cared for at home, you should help him or her with basic needs and monitor the symptoms, while also keeping as much distance as possible, according to guidelines issued by the C.D.C. If there’s space, the sick family member should stay in a separate room and use a separate bathroom. If masks are available, both the sick person and the caregiver should wear them when the caregiver enters the room. Make sure not to share any dishes or other household items and to regularly clean surfaces like counters, doorknobs, toilets and tables. Don’t forget to wash your hands frequently.

    • Should I stock up on groceries?

      Plan two weeks of meals if possible. But people should not hoard food or supplies. Despite the empty shelves, the supply chain remains strong. And remember to wipe the handle of the grocery cart with a disinfecting wipe and wash your hands as soon as you get home.

    • Can I go to the park?

      Yes, but make sure you keep six feet of distance between you and people who don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.

    • Should I pull my money from the markets?

      That’s not a good idea. Even if you’re retired, having a balanced portfolio of stocks and bonds so that your money keeps up with inflation, or even grows, makes sense. But retirees may want to think about having enough cash set aside for a year’s worth of living expenses and big payments needed over the next five years.

    • What should I do with my 401(k)?

      Watching your balance go up and down can be scary. You may be wondering if you should decrease your contributions — don’t! If your employer matches any part of your contributions, make sure you’re at least saving as much as you can to get that “free money.”


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