Wisconsin Documents Offer Window into Early Uncertainty over Covid-19

As American Oversight investigates the government’s response to the coronavirus pandemic, we have come across a number of records from the first months of the crisis that, in the light of what is now known about the virus’s rapid spread, cast a troubling shadow over the government’s deficient early efforts to prevent tragedy.

The latest records obtained by American Oversight include a number of emails from Wisconsin public health officials that reveal confusion and serious misgivings about recommendations from the Centers for Disease Control and Prevention (CDC). The emails were released in response to a public records request to the Wisconsin Department of Health Services (WDHS) for the coronavirus-related communications of high-ranking officials. Among numerous press releases and other communications touting the Trump administration’s “aggressive” response to the coronavirus are comments and concerns shared between WDHS officials that now prove prescient and testing recommendations that now prove to be dangerously inadequate.

The evolution in the understanding of the risks of asymptomatic transmission and our current recognition of the levels of U.S. community spread that occurred as soon as early February are grim counterpoints to the assurances contained in a Feb. 28 update from the CDC. “To date,” read the update, “there has been limited spread of COVID-19 in the United States.” The update also provided criteria for evaluating patients that focused on people who were exhibiting symptoms in conjunction with readily identifiable points of exposure.

A month before that guidance was sent, a CDC fellow assigned to the WDHS circulated a link to a New England Journal of Medicine article documenting asymptomatic transmission, including a graphic detailing how the virus was passed from one patient to others prior to the first person (P1) exhibiting symptoms. “This makes me less hopeful that [the virus] is going to be contained easily, if [patients 3 and 4] had only casual contact with P1 2-3 days before he/she had symptoms,” Dr. Ryan Westergaard, the health department’s chief medical officer, wrote in response. “This is concerning news.”

In response to a question from a WDHS official a couple of days later, Westergaard confirmed that there was “no recommendation for testing anyone without symptoms for [Covid-19], even close contacts, at this time. Testing is only for [patients under investigation], which must have exposure history and symptoms.”

The documents also contained a number of emails indicating significant uncertainty about quarantine recommendations for recent travelers. After the CDC updated its criteria for evaluating patients under investigation (PUIs) to include anyone who had traveled to mainland China and who was experiencing fever and symptoms requiring hospitalization, Westergaard emailed colleagues with his reservations about the policy’s efficacy with regard to containment. “This does not make sense strictly from a public health perspective, since many confirmed cases have not had severe symptoms requiring hospitalization,” he wrote. “I hope as the lab capacity increases they will revisit this.”

A call with the White House that day did not answer all officials’ questions about whether the quarantine order for people returning from China’s Wuhan or Hubei provinces would also apply to people who had already returned. “At this point it is not clear if … there is an expectation that states and locals will attempt to trace back people who have arrived in the past 14 days,” wrote WDHS official Julie Willems Van Dijk. “Still many unanswered questions about the expectation on state and local health departments regarding people who are already here,” wrote WDHS official Stephanie Smiley the next day.

An email from a physician in Madison, Wisc., later that month also expressed concerns about the potential inadequacy of the U.S. quarantine orders for travelers. “Given the new evidence of community spread of Covid-19 in Japan, surely the US should impose actual quarantine on travelers arriving to [the] US from Japan, but at the very least, self-quarantine [for] 14 days of said travelers?” she wrote. “On a personal note, my asymptomatic brother … is arriving Wednesday to Chicago O’Hare from a 2 week trip to Yokohama, Japan, with no restriction on his activities when he returns. Does that make sense?”

Multiple emails from that time also revealed a growing anxiety about shortages of personal protective equipment (PPE) for health-care workers. “Are you hearing concerns from member organizations regarding availability of level 3 and 4 sterile surgical gowns?” wrote the CEO of Western Wisconsin Health on Feb. 24, in an email that was eventually passed on to WDHS officials. “We are at a crisis here. Surgical gowns are backordered until June. … We anticipate many other products being [affected] — masks, duraprep, etc.”

Another email from an infection preventionist at the Wisc. Division of Quality Assurance notified WDHS of concerns about the PPE situation. “[T]he news is not good,” she said, writing that several vendors had “started rationing their PPE. Apparently their large shipments of PPE which were literally on ships from China were diverted from coming to the US due to the Coronavirus. In January 2020, some large companies started stockpiling their PPE which has exacerbated the PPE supply problem.”

A response from a CDC official on Feb. 26 said that “our public health response colleagues at local/state and federal levels are aware of and working on solutions to this issue.” Of course, the shortage of PPE for essential workers continues to be a serious threat to individuals’ safety and public health.

American Oversight has previously obtained records that paint a similar picture of the federal government’s poor coordination with state officials, with those records coming from requests filed in Nevada and Washington state. As we continue our investigation, you will be able to view all the documents we obtained at americanoversight.org.