Special Briefing On the Repatriation of U.S. Citizens from the Princess Diamond Cruise Ship| site |

Special Briefing

Dr. Robert Kadlec, Assistant Secretary for Preparedness and Response at the U.S. Department of Health and Human Services

Dr. William Walters, Executive Director and Managing Director for Operational Medicine for the Bureau of Medical Services at the U.S. Department of State

Carl Risch, Assistant Secretary for the Bureau of Consular Affairs at the Department of State

(February 17, 2020) - - Today (February 17, 2020), the U.S. Department of State provided the following transcript of a Special Briefing (held via Teleconference) On the Repatriation of U.S. Citizens from the Princess Diamond Cruise Ship:

MR BROWN: Good afternoon, everyone, and thank you for joining today’s call with senior administration officials on the repatriation of U.S. citizens from the Diamond Princess cruise ship. I am deputy spokesperson for the United States Department of State, Cale Brown, and I will be moderating this call.

We are joined today by Dr. Robert Kadlec, Assistant Secretary for Preparedness and Response at the U.S. Department of Health and Human Services; Dr. William Walters, Executive Director and Managing Director for Operational Medicine for the Bureau of Medical Services at the U.S. Department of State; and Carl Risch, Assistant Secretary for the Bureau of Consular Affairs at the Department of State.

Today’s briefing will be on the record. The briefing will be embargoed until the conclusion of the call.

We are able to take a limited number of questions. So, for purposes of efficiency, we ask that you press one, and then zero now, rather than at the end of the opening statement, to queue up for questions.

I will now turn it over to our speakers, who will begin our call with opening remarks. And after a brief pause, we will move to your questions.

Dr. Kadlec.

ASSISTANT SECRETARY KADLEC: Thank you very much, everyone. And I’m Dr. Bob Kadlec, the Assistant Secretary for Preparedness and Response at HHS. I want to just give you a brief overview of the joint ASPR-State operational medicine operation that was conducted to bring those individuals back from the Diamond Princess.

I also want to thank the Japanese Government and the Ministry of Health for their extraordinary help in facilitating the deployment of my disaster medical assistance teams and infectious disease experts to work along with their national disaster medical teams at the Diamond Princess, and facilitated our ability to provide care to the Americans on the boat and also assist them, as required, once the decision for repatriation was made.

This culminates about 18 months of work we have done with the Ministry of Health in Japan. We were scheduled to do an exercise in March on this very kind of scenario: How do you repatriate Americans from Japan in the event of a disaster or an emergency? And much of that work paid off in spades with our ability to safely and effectively recover those Americans off of that ship.

I will turn now to Dr. Walters to explain some of the particulars as it relates to the air operations and State’s vital contributions to this activity.

DR WALTERS: Thank you, Dr. Kadlec.

Dr. Walters from the State Department.

So the Directorate of Operational Medicine within the Bureau of Medical Services is responsible for the aviation missions to repatriate these individuals.

We work very closely with ASPR. This is our sixth flight over the past several days. We managed the flights out of Wuhan, China, and, obviously, this one.

The planning was ongoing for several days. And once the National Security Council had made the decision to move forward, we certainly executed with our partners.

I would like to echo Dr. Kadlec’s compliments to the Government of Japan. They were facing significant uncertainties with this virus, and we do appreciate their cooperation.

The aircraft departed – the aircraft are on contract through Kalitta Air group. This is a standing contract that we have through Phoenix Air group out of Cartersville, Georgia, and we have exercised that contract over the past several years for the management of patients infected with highly contagious pathogens.

The aircraft departed out of Atlanta Hartsfield, routed direct to Haneda Airport in Tokyo, and then there was a hand-off of patients and process between ASPR and their personnel on the ground and the State Department personnel from the embassy, and then, of course, State Department personnel on the aircraft.

The aircraft departed Haneda. Aircraft one went direct to Travis Air Force Base, with close coordination amongst NORTHCOM from DOD, obviously, HHS-ASPR, HHS-CDC, and State Department all playing a critical role.

Aircraft two went direct from Haneda to Lackland Air Force Base in Texas. Passengers were deplaned in those two locations, and then a select number of high-risk patients were transported onward from both locations, using those same aircraft to Omaha, Nebraska, for care at the University of Nebraska.

The aircraft are currently on their way back to Atlanta for decontamination, and the aircraft will be placed back in service for the vendor.

Back to Dr. Kadlec for a sort of what happens next for those passengers, once they are on the ground.

ASSISTANT SECRETARY KADLEC: Thank you, Dr. Walters. And very briefly, the individuals received multiple screenings while they were transitioned from the ship to the bus to the plane. And then, once they arrived at the two destinations, Travis and Lackland, they went – more extensive medical assessment, as well as a questionnaire concerning their baseline health and their current symptoms.

These individuals were processed and put into quarantine at those bases. Three individuals that arrived at Travis experienced an elevation of temperature, and were taken to the hospital and being evaluated, and evaluated for what may be the causation or (inaudible) of that event.

These individuals will spend the next 14 days under the joint supervision and oversight of CDC and ASPR to monitor their health, and at which point in time, after 14 days, they’ll be cleared to return to their home of record.

With that I’ll stop and pause and just comment that, additionally, several patients – 10 [1] passengers, excuse me – and their spouses were transported to University of Nebraska in Omaha for isolation, as well.

MR BROWN: Okay. Now we’ll take a few minutes to answer questions. First let’s go to the line of Jennifer Hansler from CNN.

QUESTION: (Inaudible) were kept away from the other passengers? And then, do you have any sense of how many Americans still remain both on the Diamond Princess and then, more largely, the ones who are sort of isolated around the world?

MR BROWN: Jennifer, can you reiterate your question? It seems like it cut off a large portion of it up front.

QUESTION: Oh, sure. Sorry. Could you get into a little more detail about how the passengers who were infected with coronavirus were kept isolated from their fellow passengers on these flights back? And then, more broadly, how many Americans still remain on the Diamond Princess? How many remain from the Westerdam in Cambodia, and, I guess, just any message to them?

DR WALTERS: Yeah, this is Dr. Walters. So the way – the use of the aircraft, and the movement of patients exposed to, in this case, coronavirus is very specific, very deliberate, and is sort of the culmination of a lot of interagency work over the years.

The 747 is large, obviously, and is broken up into sections. The airflow within the aircraft is nose to tail, and so our crew aboard kind of owns the nose area of the aircraft, and we call that a safe area. Then there’s passenger seating. And then, at the tail of the aircraft we take 18 seats, and that will become an isolation area. Because it’s a cargo aircraft we’ve got tremendous latitude in the way that we set up both the seats and the ability to drop plastic on all four sides of that block of seats. That plastic is, like, 10 feet tall and has one entrance, one exit at the back of that isolation area. And so that – that both protects the rest of the passengers and the rest of the crew from any spread. Every interaction with passengers that are inside the isolation area is very deliberate, it’s very – it’s planned, and it’s done very carefully.

When – the way this unfolded, we had – every one of the evacuees had been evaluated by a medical officer, or a nurse, or nurse practitioner from the U.S. Government prior to disembarking from the ship. There were no known coronavirus-positive personnel mixed into that evacuee population. So we had a group of people, in this case 338 [2], that had – that were – there was no reason to believe they had a positive lab test, and they had been evaluated, and they did not have any symptoms of disease.

We disembarked them from the ship. When they left that ship into the evacuation process that was being managed by the government, they were an evacuee. They were in the process. They were loaded onto buses, and those – roughly 15 buses, and those buses were moved as a package, escorted by Japanese security and police. And it was only once they were loaded onto the buses, and the buses were in motion that we were made aware that these positive results had come back from the Government of Japan.

Now, understand the Government of Japan is doing amazing work, right, in trying to manage this unprecedented event with not a lot of information regarding the virus, because they’re just – we just are learning new things every day. But we were faced with a situation where these are people who are already in the evacuation pipeline, they’re already on buses, they’re already on their way to the aircraft.

When the bus – and it was a direct line. When the buses arrived at the aircraft, those people that were identified during that process as being coronavirus-positive but asymptomatic with no symptoms of disease were taken off the bus, were moved onto the aircraft into that dedicated isolation area, which was the safest place for them to get them away from the rest of the passengers and give us time to make some decisions.

I contacted Assistant Secretary Kadlec. We had a conversation, and the conversation was this: We have a protocol that we have used on all preceding flights for passengers that develop symptoms – or, in this case, new information – that put them at a higher risk. And that protocol is to move them to the isolation area for the remainder of the evacuation.

Then the question was simply this: Are these evacuees? And do we follow our protocol? And the answer to that was yes on both accounts. Yes, these are evacuees. We have taken – we have put them into the evacuation pipeline, we have a plan. Should we execute the plan? And the answer was yes.

And so they were put into the isolation area to give room for decision-making, and then they were kept in the isolation area because they fit the profile of the people that go into that isolation area, and in the isolation area they pose no additional risk to passengers or crew.

Dr. Kadlec, I don’t know if you have anything to add.

ASSISTANT SECRETARY KADLEC: Yeah, I just want to add one thing. Because of the extraordinary nature and the uncertainty associated with both the virus and this particular group, or cohort, particularly for their age and pre-existing medical diseases, ASPR supplemented the State medical team with two infectious disease doctors, one from the University of Nebraska, one from Mass General Hospital in Boston, who were very experienced in managing not only SARS virus cases during the 2003 outbreak, but also the Ebola cases that – there have been several since.

So we had additional expertise and experienced eyes on these people and monitoring through the flight, not only during the flight, but evaluated them on the boat, and then basically monitored them through the flight. So we felt like we had very experienced hands in evaluating and caring for these patients.

DR WALTERS: With regard to the rest of your question, we’re currently tracking roughly 60 American citizens, U.S. persons that are still in Japan [3]. And we are tracking a little over 200 American citizens that remain in Cambodia pending onward travel, with 92 remaining on board the ship there in Cambodia, the Westerdam.

MR BROWN: Okay, let’s move on to the next question. If you could open the line of Shawn Donnan from Bloomberg News.

OPERATOR: Shawn Donnan, your line has been opened. Please, go ahead.

QUESTION: Hi, thank you so much for doing this call. If I could just drill down a little bit more on the situation on the Westerdam in Cambodia, when you say you are tracking a little over 200 American citizens that remain in Cambodia, are they in one location? Are they spreading about?

We had the reports coming out of Asia overnight of a woman who was diagnosed with the virus when she arrived in Malaysia by plane. Are you worried at all that some of these cases may have left Cambodia? We are just trying to understand the situation a bit more there in Cambodia.

DR WALTERS: Right. So we’re tracking, again, 92 American citizens that remain on board the Westerdam, another 260 that remain in hotels in Phnom Penh. Roughly 300 American citizens have departed Cambodia, but only after testing by the Government of Cambodia’s Ministry of Health.

The one couple that remains in the hospital in Kuala Lumpur is the only – really, the only individual that has tested positive coming off the Westerdam.

Obviously, everyone is very concerned about the safety of all of the American citizens and all of the other passengers on the Westerdam, and every step is being taken on an international basis to collaborate on contact tracing and in staying in very close contact with the passengers of that ship.

MR BROWN: Okay. Let’s open the line of Ed Wong from New York Times.

OPERATOR: The line of Ed Wong has been open.

QUESTION: Thank you all for doing this call. I just have one follow-up question that – on Dr. Walters’s reconstruction of sort of, like, the procedure that happened.

So there were U.S. medical practitioners who examined the passengers. I assume, from the way you laid it out, that they didn’t do a test, but it was Japanese medical professionals who did do some sort of test for the coronavirus.

And then, had results already come back from that test, and they were negative, but then there was a change of mind on that? Or had results not come back, but the passengers were already being moved? And if that was the case, why were they being moved before the results of the test?

ASSISTANT SECRETARY KADLEC: Dr. Walters, can I just start, and you can finish on this, please?

DR WALTERS: That’s fine.

ASSISTANT SECRETARY KADLEC: Great question. When our teams arrived there, as we have confronted, as well, in our own country, the capacity to do testing rapidly is very limited. And if you think about the 3,000 individuals that are on the boat, the Japanese Ministry of Health was doing serial testing on these people, as capacity would permit. And so the individuals who were identified on the bus on the way to the airport were tested two to three days before the actual – their actual movement. And so there was a latency of about two to three days for those individuals.

Our – my medical teams that went on the boat to evaluate these people were able to identify – and again, when we were evaluating some people, test results came while they were still on the ship, and those people were excluded from movement because they were – they were identified and, per protocol, were basically sent to hospital.

So the testing was done, the Japanese tests. We didn’t have the means to do testing in place for ourselves. And I’ll turn to Dr. Walters for any other additional comments.

DR WALTERS: Yeah, I think what I would point out is that the Japanese have been sort of fastidious about the way that they’ve been testing. They’ve implemented some really good protocols, or certainly to the best of their ability, but were left a little bit short as an international community in the knowledge and – which leads to the testing and rapid testing based on the – some of the delay in information coming out of China regarding this disease.

So, as we all sort of pressed to do the right thing, and we pressed to get the testing done, we anticipate that the testing will take two or three days. And it’s unpredictable, based on the number of tests that the Japanese are forced to do, given this unprecedented event, when those results come back. If those results had come back four hours earlier, before we’d started to disembark the ship, and before these people were evacuees within an evacuation system, it would have been a different discussion.

But at the end of the day, when we received the results, these people were already on a bus, and they were already in the pipeline, and the next step was to move them to an isolation area. And frankly, once they were in the isolation area, it was safest to keep them in the isolation area and complete the evacuation.

ASSISTANT SECRETARY KADLEC: By the way, we would suffer the same constraints given numbers, in terms of testing that large of a group.

MR BROWN: Okay, for our next question can we open the line of Alex Horton from Washington Post?

OPERATOR: The line of Alex Horton from Washington Post has been opened. Please, go ahead.

QUESTION: Yeah, thanks, everyone, for jumping on this call on a holiday. So I was curious about when discussion with the CDC was executed to make this call. Based on their press release a few days ago, they said there would be screening to prevent symptomatic travelers from departing Japan. The press release you guys issued is very carefully worded when you said, “After consulting HHS, the State Department made the decision to allow those individuals to go on,” those 14.

So is there daylight with CDC and HHS in this decision by you guys to send them forward, and what were some of their objections that you – that you seem to have overturned?

DR WALTERS: This is Dr. Walters. What I’d say is that the chief of mission, right, through the U.S. embassy, is ultimately the head of all executive branch activities. So when we are very careful about taking responsibility for the decision, the State Department is – that is the embassy. The State Department was running the aviation mission, and the decision to put the people into that isolation area initially to provide some time for discussion and for onward, afterwards, is a State Department decision.

There is a – I think where you might see the appearance of a discrepancy is in the definition of symptomatic. Symptomatic – when we use the word “symptomatic,” we’re talking about coughing and sneezing and fever and body aches. Those are symptoms, all right? And as Dr. Kadlec laid out and I reinforced, each one of these 338 [4] people was evaluated by an experienced medical provider, and none of them had symptoms.

Once they were on the bus, we received information about a lab test that had been done two or three days earlier. But it is, in fact – it is a fact that no symptomatic patients – no one with a fever or a cough or lower respiratory tract infection or body aches, or anything that would lead one to believe this person is infected with the virus was – none of that was in place before – at the time a decision was made to evacuate these folks.

MR BROWN: Okay, thanks. For the next question, can we go to the line of Conor Finnegan from ABC?

OPERATOR: And Conor Finnegan from – Conor Finnegan from ABC News, your line is open.

QUESTION: Hi, two quick questions here. One, just to be clear, are there any Americans left still on the Diamond Princess cruise ship, and are any hospitalized in Japan?

And then secondly, there was a statement from the State Department yesterday saying that the U.S. Government will continue to consider different options overseas, including the repatriation of U.S. citizens where appropriate. Are there other individual cases, perhaps the hundreds of Americans in Cambodia, where you are considering doing more evacuation flights?

DR WALTERS: This is Dr. Walters. We are following very closely both the American citizens that are currently hospitalized in Japan, as well as those that chose to remain on the Diamond Princess, as well as a number of Americans all over the world, whether it’s Phnom Penh or anywhere else that may find themselves either exposed to the virus, infected with the virus, or having difficulty in returning to the United States because of the disruptions in the international airline industry, and flights, and so forth.

This is the meat and potatoes of Consular Affairs. This is the meat and potatoes of the State Department of – this is the State Department’s primary responsibility is for the well-being of American citizens overseas, and we take that very seriously.

MR BROWN: Okay, thanks. For the next question, can we go to the line of Lauren Caruba from San Antonio.

OPERATOR: The line of Lauren Caruba from San Antonio Express-News is now open. Please, go ahead.

QUESTION: Hi, thanks so much for taking my question. Could you provide a numbers breakdown of how many of the 338 passengers, like, went to Lackland, went on to Omaha, went to Travis? Can you give us kind of a – the granular specifics of where the passengers went?

And also, related to that question is were any of the passengers who were found to be infected with coronavirus, did any of them end up at Lackland?

DR WALTERS: This is Dr. Walters. Three hundred and thirty-eight [5] persons were evacuated. On aircraft one, which went to Travis, there were 177 people. Of the 177 people, 7 had isolated coronavirus-positives. An additional three during the flight were isolated for fever, but these were not the people who were virus-positive by test. A hundred and sixty-seven were not isolated. A hundred and seventy-one stayed in Travis. Sixty-four moved on to Omaha, and these were three spouse pairs, which means four folks that were coronavirus-positive but asymptomatic were taken to health care facilities in the vicinity of Travis Air Force Base.

Aircraft two went to Lackland. There were 151 persons on board. There were seven isolated with a positive lab test but no symptoms. Two additional personnel were placed in isolation during the flight for fever, as in accordance with the protocol we have discussed. A hundred and forty-three were not isolated. A hundred and forty-four persons stayed in Lackland, seven went on to Omaha. All of the personnel that were – that seven includes a spouse. All of the personnel that – or all of the passengers that had a positive lab test for coronavirus were moved onward to Omaha, Nebraska.

MR BROWN: All right. So I think we have time for one more question, if you could open up the line of Michelle Hackman from Wall Street Journal.

QUESTION: Hi, there, folks. One —

OPERATOR: Your line is open.

QUESTION: Hi there, can you hear me? Thanks.

One clarifying question and a follow-up. So, first of all, you mentioned that some folks were brought to hospitals nearby Travis Air Force Base. How did you make the decision to bring some people to local hospitals, as opposed to Omaha?

And then also, for the bus rides, could you tell us how long the people who were positive with coronavirus were on the bus with other passengers?

And has this experience made you guys consider whether the coronavirus has a longer sort of incubation period than you initially thought?

DR WALTERS: So I’ll address the first part – or the last part of your question first, and then I’ll hand it off to Dr. Kadlec as far as hospital selection and those decisions.

With regard to the bus, the ride from the ship to the airport was roughly 40 minutes. And we removed them from the ship – I’m sorry, from the buses as soon as those buses sort of came to a stop on the tarmac and it was safe to do so.

As far as the science behind the vessel – behind the virus, it continues to evolve. And as we get more information certainly out of Wuhan, out of China, from the WHO, and from the CDC, I think that’s going to shape all of our understandings of this virus, its incubation period, and how it behaves in the human host.

I will hand off to Dr. Kadlec for the hospital selection question.

ASSISTANT SECRETARY KADLEC: Sure, I’m just going to comment on the incubation period. It looks like the median is somewhat around 5 to 6 days, with a range of 2 to 14. That’s kind of like where maybe the coalescence of data – and again, that’s not firm, but it gives you some range of what you should think about in terms of incubation period.

And I’m sorry, could you just repeat your question on the hospital selection over? Hello?

MR BROWN: Her line might be closed. I believe the question was how was the decision arrived to send some patients to local hospitals in the vicinity of Travis versus going onward to Omaha.

ASSISTANT SECRETARY KADLEC: Okay, yes. I mean, so the issue there is prearranged with state and local public health authorities that basically arranged to – again, not all fevers, not all illness, is coronavirus. So the intent here is basically to evaluate them in the appropriate setting, in an isolation – respiratory isolation room at a local hospital that has been designated by the state and local authorities and then evaluated for their overall health as well as specifically to rule out coronavirus as well as potential influenza – it is influenza season – or any other malady.

So that’s the protocol that is being followed both at Lackland and Travis, or anywhere where we have individuals who are undergoing quarantine.

Thank you.

MR BROWN: Okay, thank you, everyone, for joining the call today, and thank you to our briefers for joining in, as well.

Since this is the end of the call, the contents – the embargo on the contents is lifted.

Everybody, please, have a great day.