During the Initial COVID-19 Response, HHS Personnel Who Interacted With Potentially Infected Passengers Had Limited Protections

WHY WE DID THIS STUDY

In early 2020, various sources-including personnel from the Department of Health and Human Services (HHS), Members of Congress, and the media-expressed concerns with how HHS personnel were protected from risk of COVID 19 exposure at quarantine stations and sites during the initial COVID-19 response. CDC, within HHS, issues recommendations for protection against infectious disease exposure, which includes travel-related containment measures. At quarantine stations, CDC personnel screened passengers who were entering the United States as private citizens via commercial flights. At quarantine sites (six Federal worksites), HHS personnel screened and quarantined passengers entering the United States as evacuees. In total, HHS screened hundreds of thousands of passengers and quarantined thousands of them in an effort to prevent the spread of COVID 19 in the United States.

HOW WE DID THIS STUDY

Our review covers the initial COVID-19 response (i.e., January through March 2020). We interviewed officials and program staff within HHS, including CDC. We surveyed nearly 700 HHS personnel who worked at quarantine stations and sites, and we reviewed written responses and documentation. We also analyzed several thousand HHS documents.

WHAT WE FOUND

During the initial 3 months of the COVID-19 response—January through March 2020—CDC initially recommended limited personal protective equipment (PPE) for some HHS personnel at quarantine stations and sites. As a result, some personnel wore only limited PPE while interacting with potentially infected passengers. In addition, CDC's PPE trainings appear to have failed to meet two standards set by the Occupational Safety and Health Administration (OSHA). CDC was also initially limited in the extent to which it recommended other protections, such as social distancing, symptom monitoring, and self-quarantining. As data and knowledge about COVID-19 increased over time, CDC improved its recommendations for PPE and other protections, although some vulnerabilities remained.

CDC said that its approach to recommending protections for personnel was guided primarily by evolving COVID-19 data and previous pandemic-planning documents. However, we note that CDC's approach did not align with assumptions outlined in these documents. Finally, CDC did not have a comprehensive plan for recommending travel-related containment measures that weighed the risks—such as the risks to HHS personnel conducting screening—relative to the public health benefits.

WHAT WE RECOMMEND AND HOW THE AGENCY RESPONDED

OIG recommends that CDC: (1) update its guidance recommending protections for personnel who interact with potentially infected passengers, (2) ensure that its PPE trainings meet OSHA standards, and (3) develop a comprehensive plan for recommending travel-related containment measures that weighs the risks relative to the public health benefits. CDC concurred with all three recommendations.