WASHINGTON (NYTIMES) - US President Donald Trump was infuriated that 14 US citizens who had tested positive for coronavirus were permitted to return this week to the United States, said two senior administration officials.
The decision took the President, a self-declared "germophobe", by surprise.
Officials at the State Department decided to bring back the citizens, who had been quarantined on the Diamond Princess cruise ship in Japan, after consulting with a senior official at the Department of Health and Human Services.
But officials at the Centres for Disease Control and Prevention objected, concerned that the passengers, among hundreds of Americans being evacuated from the ship, could spread the virus.
News organisations reported on the decision on Monday (Feb 17), and the passengers arrived in the United States that day.
Mr Trump, furious at not having been briefed on the Americans who had tested positive, relayed his anger to Mr Alex Azar, the Health and Human Services Secretary, and other top officials.
They then alerted the White House inter-agency task force on the coronavirus, which Mr Azar oversees.
One official said Mr Trump views shutting the borders to infected people as critical to keeping the country safe and wants to be seen as managing a proper response.
The top State Department official on the task force is Mr Stephen Biegun, the Deputy Secretary of State.
During the early legs of a four-day trip to the West Coast meant to bolster his re-election effort, Mr Trump paid close attention to Fox News' coverage of the Diamond Princess that played aboard Air Force One.
Word of Mr Trump's anger had already begun circulating among officials on Tuesday morning. The Washington Post first reported on it on Friday.
In 2014, during an Ebola crisis in Africa, Mr Trump, who was then a private citizen, angrily demanded that the Obama administration cancel flights and bar anyone infected with the virus from entering the country - including American medical workers who had gone to Africa to help.
"KEEP THEM OUT OF HERE!" he wrote in a July 31 tweet after learning that one American medical worker would be evacuated to Atlanta from Liberia.
"The US cannot allow EBOLA infected people back," Mr Trump wrote on Twitter the next day, adding: "People that go to far away places to help out are great - but must suffer the consequences!"
There have been at least 634 infections and two deaths from the Diamond Princess, which Japanese officials kept in isolation for two weeks at a port in Yokohama.
That effort at a quarantine contributed to the virus' rapid spread among passengers.
The cluster from the ship is the largest concentration of coronavirus cases outside China, warranting its own category in data compiled by the World Health Organisation.
US officials began a complex evacuation procedure for 328 passengers aboard the Diamond Princess on Sunday night (Feb 16).
All had been examined by American medical experts and showed no symptoms of the coronavirus, Dr William Walters, managing director of operational medicine at the State Department, and Dr Robert Kadlec, assistant secretary for preparedness and response at the Department of Health and Human Services, said on Monday during a conference call with reporters.
But as those passengers were bused to Haneda Airport in Tokyo early on Monday morning, Japanese officials told American counterparts that laboratory tests for 14 passengers had come back positive, Dr Walters said.
The tests had been conducted two to three days earlier, but US officials, believing the timing of the results would be "unpredictable" because of the volume of testing being done in Japan, began the evacuation without having all results in hand.
American passengers who had already tested positive or who had displayed symptoms had been sent to hospitals in Japan, Dr Walters said.
After they learnt that 14 passengers had tested positive, US officials decided that the entire group set to leave Japan should be treated according to protocols the officials had developed for evacuees, Dr Walters said.
That meant continuing to transport those who had tested positive but putting them in isolation - behind sheets of plastic about 3m tall - at the rear of the two planes flying them back to the United States.
Dr Walters said on Monday that he and Dr Kadlec reviewed the possible options after learning of the test results.
"Then the question was simply this: Are these evacuees?" Dr Walters said. "And do we follow our protocol? And the answer to that was yes on both accounts."
Dr Kadlec added: "We had additional expertise and experienced eyes on these people and monitoring through the flight."
The planes landed at Travis Air Force Base in California and Lackland Air Force Base in Texas.
Most of the 14 passengers who had tested positive were then flown to Omaha, Nebraska, for treatment and monitoring by experts at the University of Nebraska.
Since then, Japanese officials have informed US officials that several other passengers among the 328 brought back had also tested positive for coronavirus.
On Friday (Feb 21), US officials said at least 34 people inside the United States have the virus - 18 of them from the Diamond Princess. All of the 34 cases have been linked to overseas travel.
There has been no sign yet of the virus spreading among communities in the United States.
The State Department is closely monitoring US citizens on board another cruise ship in Cambodia, the Westerdam, as well as Americans who have disembarked and are in hotels in Phnom Penh, the capital of Cambodia.
Those Americans are expected to travel onward at some point. One 83-year-old American woman from the ship travelled to Malaysia and tested positive for coronavirus.
Dr Walters said on Monday that 92 US citizens were still on board the Westerdam, while another 260 were in hotels in the Cambodian capital.
About 300 US citizens had left the country, but "only after testing by the government of Cambodia's Ministry of Health", he said.
When asked whether the United States was thinking about arranging evacuation flights for the hundreds of Americans in Cambodia or elsewhere, Dr Walters did not offer a direct answer.
He said the State Department was "following very closely" the situation of US citizens in places where coronavirus is prevalent and of citizens who are "having difficulty in returning to the United States because of the disruptions in the international airline industry, and flights, and so forth".
Separately, State Department officials say that thousands of Russia-linked social media accounts are spreading disinformation about the coronavirus, including a conspiracy theory that the United States is behind the outbreak.
American monitors first identified the campaign in mid-January. Agence France-Presse reported the assessment on Saturday.
"Russia's intent is to sow discord and undermine US institutions and alliances from within, including through covert and coercive malign influence campaigns," said Mr Philip Reeker, the acting assistant secretary of state for Europe and Eurasia.
"By spreading disinformation about coronavirus, Russian malign actors are once again choosing to threaten public safety by distracting from the global health response."