New York Gov. Andrew Cuomo made the over-the-top claim that if the Trump administration “had done its job, the virus wouldn’t come” to New York. Cuomo pointed to a study that suggested government officials could have better mitigated the spread of the coronavirus in New York City, but it didn’t say they could have stopped it.
Cuomo made his comments in a July 16 CNN interview after anchor Kate Bolduan asked him about criticism from CNN’s Jake Tapper of a poster Cuomo released depicting New York’s fight against the coronavirus as a successful climb up and down a mountain. The poster, which Cuomo sketched and can be purchased for $11.50, is a whimsical homage of sorts to early 1900s poster art.
Tapper, in a July 14 Twitter thread, mentioned the poster in criticizing the “crowing” from Cuomo’s administration over the state’s handling of the pandemic. “NY state has lost more than 32,000 lives to COVID-19,” Tapper wrote. “So while it’s great that the numbers have gone down, it’s perplexing to see crowing. … No other state has lost as many lives, not even close.”
The poster doesn’t mention that. Bolduan asked Cuomo: “Do you think the poster was a mistake in the midst of all this?”
The governor responded by referring to a study by the Centers for Disease Control and Prevention that he and Bolduan had discussed. The study found that genome sequencing of positive coronavirus cases in New York City mostly resembled sequences in Europe, but the U.S. government’s travel restrictions on Europe were implemented too late to mitigate the introduction of the virus. Those restrictions were implemented on March 13; by March 15, the CDC report says, “community transmission was widespread in New York City.”
Cuomo, July 16: No, Tapper’s point — as you just heard from the CDC report, Tapper should say that Trump is to blame for the virus coming to New York, because that’s the fact. That’s what the CDC just said.
If Trump’s government had done its job, the virus wouldn’t come here. We don’t do — governors don’t do global pandemics. I was trying to explain that to Mr. Tapper. State governments don’t do global public health. …
The federal government does that. The virus didn’t come here because of anything New Yorkers did. The virus came here because the federal government missed it. That’s what the CDC, the federal government, says today.
The governor got it right when he said earlier in the interview that the CDC “says the virus came from Europe and the travel ban was too late.” That’s the main takeaway from the report. But the CDC didn’t say that “Trump is to blame for the virus coming to New York” or that the federal government could have stopped the virus from coming to New York, as Cuomo suggests.
As we’ve written before — in looking at Trump’s unsupported claims that his restrictions on travel from China have saved “hundreds of thousands” of lives — the research on international travel limitations shows they can delay the path of the spread of diseases but do little to contain them.
We asked the governor’s press office for clarification on his remarks and what he believed the Trump administration could have done to stop the virus from coming to New York. We haven’t received a response.
What the CDC Said
The CDC report, released on July 16, used specimens collected by the New York City Department of Health and Mental Hygiene from March 1 through 20 at six hospital emergency rooms from patients with influenza-like symptoms who had tested negative for influenza. Of the 544 specimens, the CDC found 36 tested positive for SARS-CoV-2, the virus that causes COVID-19. The CDC then used genetic sequencing and found the positive specimens in New York City mostly resembled the genetic sequences of the virus circulating in Europe.
“Using genetic sequencing, CDC determined that the sequences of most SARS-CoV-2–positive specimens resembled those circulating in Europe, suggesting probable introductions of SARS-CoV-2 from Europe, from other U.S. locations, and local introductions from within New York,” the report said. “These findings demonstrate that partnering with health care facilities and developing the systems needed for rapid implementation of sentinel surveillance, coupled with capacity for genetic sequencing before an outbreak, can help inform timely containment and mitigation strategies.”
The study also found that the earliest specimens, from March 2, weren’t connected to genome sequences from Wuhan, China, where the coronavirus outbreak began in late 2019. This was “unanticipated,” the report said, because most of the emergency departments that collected the specimens were in ZIP codes with a high percentage of Chinese speakers.
The study suggests the virus spreading in New York City in March largely wasn’t affected by the federal government’s restrictions on travel to and from China, which were implemented on Feb. 2. Those restrictions said that non-U.S. citizens were prohibited from entering the U.S. if they had traveled to China within the previous two weeks, but there were exceptions for citizens, permanent residents and the immediate family members of both.
While such travel policies “are an important mitigation strategy,” the CDC said, the subsequent restrictions on travel from Europe — imposed on March 13, with the same exceptions — came too late. “[B]y the time the European restrictions were implemented, importation and community transmission of SARS-CoV-2 had already occurred in NYC.”
Five days earlier, on March 8, the city’s Department of Health and Mental Hygiene had announced sustained community transmission of the virus. That week, there were 1,917 confirmed cases in the city, and the CDC’s report estimated there were another 1,170 undetected cases.
And by March 15, just two days after the travel restrictions on Europe went into effect, “community transmission was widespread in New York City,” the report said.
Limited testing availability and strict criteria harmed the ability to detect cases and slow the spread, the report further said.
“Expanding the testing criteria at the beginning of the outbreak to include persons with any travel exposure and with [influenza-like symptoms] without an alternative diagnosis would have increased the number of cases detected through passive surveillance,” the CDC said. “Limited testing capability and strict testing criteria led to many COVID-19 cases going undetected, slowed DOHMH’s capacity to use surveillance to make timely public health decisions, and ultimately contributed to sustained community transmission.”
The report does have at least six limitations, it said — most notably, the small number of patients, which “led to large uncertainty in estimated SARS-CoV-2 prevalence and the number of undetected COVID-19 cases in the target population.”
But the findings show the travel policies don’t appear to have made much of an impact — if any — on the virus’ arrival in New York City. And testing limitations further contributed to the spread of the virus. The CDC, however, doesn’t say, as Cuomo claimed, that “Trump is to blame for the virus coming to New York,” or that a different strategy could have stopped the virus from coming.
The Impact of Travel Restrictions
“While it is true that banning travelers from China did not keep the virus out of the US, it is unrealistic to think that it would have been possible to implement expanded travel bans to try and stop the virus,” Jennifer Nuzzo, a senior scholar at the Johns Hopkins Center for Health Security, told us in an email. “It is very difficult to know in real time where in the world the virus is and this makes it near impossible to create a list of countries from which to ban travel. So far, all evidence suggests that no country has been successful in using travel bans to prevent the virus from entering its borders.”
Similarly, we found previously that studies of this pandemic as well as past research have shown travel restrictions can slow a virus’ spread but not stop it.
Saad B. Omer, director of the Yale Institute for Global Health, told us in April when we looked into this issue that previous studies of viruses with a reproduction number of 1.9 or higher, meaning the average number of other people one person infects, have shown the policies have to be very strict to have an effect. Travel restrictions “can have an impact if you shut down 90% of all travel,” Omer said. But, “even then, it delays it a little bit but it doesn’t stop it.”
The U.S. travel restrictions were limited, of course, and so was testing for the virus generally.
Initially, the CDC testing criteria focused on those with symptoms who also had been to Wuhan or in contact with someone suspected or confirmed to have COVID-19. By late February, those criteria included anyone with a fever who was hospitalized with a severe acute lower respiratory illness. On March 3, Vice President Mike Pence announced doctors could order tests if they thought one was needed.
Nuzzo told us previously that in February, other countries, including Japan, Singapore and Korea, had a significant number of coronavirus cases, but they weren’t subject to travel restrictions. The U.S. “would likely not have picked it up” if travelers coming to the U.S. from those countries were infected with the virus “because we weren’t using these other countries as criteria for testing,” she said.
And the U.S. wasn’t using travel from European countries as criteria for testing, either. But it’s worth noting, there weren’t many confirmed cases in Europe in late February.
A report by European researchers said that on Feb. 21 there were just 47 confirmed cases in nine European countries (not including another nine cases in the United Kingdom). Nearly two weeks later, on March 5, the number had grown significantly, to 4,250 cases, and 113 deaths, among 38 countries in the World Health Organization’s European region.
The CDC’s July report indicates that expanded testing — “to include persons with any travel exposure” and flu-like symptoms — could have aided public health officials in their decision-making and potentially reduced the community transmission.
We asked Columbia University epidemiologist Stephen Morse whether the Trump administration could have done anything to stop the virus from coming to New York. He agreed that it’s unlikely any policy could have stopped the introduction of the virus entirely.
“I’m not surprised that New York, a crossroads of the world, would be at high risk, and we don’t know which of the several introductions took root and which fizzled out,” Morse said in an email. “With the type of genomic work described in the paper, it becomes more possible to make these distinctions now. Since we’re not yet very good at foretelling the future, I think the data are very informative to us scientists, but the main goal should still be to stop spread and establishment of an infection as soon as we possibly can. Period.”
Morse said Cuomo and New York Health Commissioner Dr. Howard A. Zucker “deserve the great credit they’ve gotten for taking this seriously and usually acting accordingly, and communicating appropriately.” But he also said he has been “stunned and disheartened by the total lack of seriousness and urgency with which most western countries have treated this outbreak.”
“There were numerous missed opportunities for the pandemic to be slowed or possibly even stopped,” he said. Travel restrictions targeting Wuhan “might have had some value if carried out well” and “[v]ery early on.” But once people infected with the virus had traveled to other places around the world, “such focused measures were no longer feasible.”
A testing and tracing policy is “more effective the earlier you can do it,” he said. “With more infections, and additional dispersion, the complexity of the work increases astronomically, and it’s not really sustainable. … I would suggest, based on the current situation, we wouldn’t be any better off now if the virus (even with all we know about it and all our tools) arrived today, instead of early 2020, and doubt we’d be any more effective at stopping it.”
All that said, it’s clear from the CDC report that the U.S. travel restrictions did little to mitigate infections traced to Europe from spreading in New York City, and the report notes that limitations in testing ability “contributed to sustained community transmission.” But Cuomo goes too far in claiming that the CDC said “Trump is to blame for the virus coming to New York.” The report did not say the virus could have been stopped from coming to New York entirely.
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