Safer Abroad

BEIRUT—When the U.S. Embassy in Beirut made a follow-up call to 64-year-old Cecilia Blewer and urged her to board a repatriation flight from Lebanon to the United States, she said her decision was already made. “I told them, ‘No way,’” Blewer said. 

While some desperate Americans are trying to get home, many others abroad are saying there are safer places as the United States becomes one of the worst-hit countries by COVID-19. 

“I’m from New York City, and the health system was already overloaded as the politicians had closed so many hospitals,” said Blewer, who arrived in Lebanon in January to study Arabic and volunteer with a church group. “I think it’s unhealthy to be in the U.S. right now.” New York City has become an epicenter of the coronavirus outbreak in the United States. 

The U.S. State Department issued an advisory on March 19 to “avoid all international travel due to the global impact of COVID-19.” On March 31, it upgraded that advisory to a level-four warning—the highest issued by the department—“Do not travel.” The U.S. government has organized repatriation flights from far-flung destinations where Americans have found themselves without standard commercial options. 

[Mapping the Coronavirus Outbreak: Get daily updates on the pandemic.]

But some are snubbing those flights, pointing to the soaring numbers of cases and deaths in the United States and stories of refrigeration trucks holding bodies parked on residential blocks and makeshift morgues in public spaces. Others say they would arrive home to a pandemic without health insurance in one of the world’s most expensive health care systems. All the Americans staying abroad who were interviewed for this story criticized the Trump administration’s response to COVID-19.

Madelynn Azar-Cavanagh happened to be in Lebanon visiting her brother when borders and airports started shutting in March. Azar-Cavanagh had a flight back to Boston on March 15 but decided to stay in Lebanon instead. She’s an occupational consultant who has previously worked with New York’s Mount Sinai hospital network—and other organizations—to prepare them to protect staff in situations much like this one.

Azar-Cavanagh, who had been living near Boston, had a similar reaction to Blewer at the offer of a repatriation flight, which was allowed to just a few American cities via Qatar—“You are going to take me from Beirut and put me in Miami?” 

Lebanon has recorded just 21 deaths and 668 cases of the virus so far.

Azar-Cavanagh also wasn’t keen to board what she called “a petri dish in the sky.” She said that while the number of cases in the United States were doubling every two days, in Lebanon the curve was much flatter, doubling every seven to 10 days. And a trip to the grocery store makes it obvious why, she said.

“When I go to the supermarket here, they take my temperature. Everyone is wearing masks and gloves. They are spraying everything down,” Azar-Cavanagh said. “In the U.S., they weren’t doing anything like that.” 

Lebanon has been in a state of medical emergency for a month. The airport and borders have been closed, as well as bars and restaurants, with the exception of delivery. People were told to stay home unless absolutely necessary, and security forces are on the streets to enforce it, though not tightly. 

While other countries went into lockdown, the United States was slow to react, Azar-Cavanagh said, pointing to the disbanding of the Global Health Security and Biodefense unit in 2018, which was responsible for pandemic preparedness. She also said it’s one of the reasons she personally chose to stay in Beirut.

Two Americans—one six months pregnant—in Mozambique said they believed it was hands down safer than returning to the United States. Mozambique has recorded only 34 cases and no deaths from the virus. Still, the low numbers may be deceptive: Both Lebanon and Mozambique have much lower testing rates than the United States; the latter has carried out only 898 tests for a population of around 30 million. 

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Experts have also cautioned that countries with low numbers now may be hit hard by an outbreak later. And health systems, particularly those in developing nations, could crumble under the sorts of numbers the United States is now seeing. 

Other Americans point to the high cost of repatriation flights—some over $4,000—and the fact that they would not have health insurance in the United States.

“In the United States, I was conditioned to only go to the doctor ‘if the bleeding doesn’t stop,’” said Niall Bailey, 38, an Illinois native now living in Seoul. Bailey pays about $150 per month for national health care in South Korea, which he said is as good as, or better than, in the United States.

Despite a pledge this month by U.S. President Donald Trump that the uninsured would have treatment costs for COVID-19 covered through payments to hospitals, there has been skepticism from groups within the United States, and uninsured Americans abroad say they aren’t willing to risk it.

“If anyone wants to risk a $30,000 hospital bill on the word of a press release from this administration, good luck to them,” said Patrick McGrann, an American who works as a researcher at the University of London. “I have zero faith that the feds will pick up the tab on COVID treatments.”

McGrann actually caught COVID-19 in March and said he was happy to be in United Kingdom, where he has access to the country’s public National Health Service. He said his symptoms were moderate, so he isolated at home and didn’t require treatment, but he “wasn’t stressed as there was a hospital just down the street.”

Jessica Olney was in the United States for a conference and was supposed to return to Bangladesh, where she works, on April 1. Instead, she said, she got “stuck” in the United States. She is waiting it out in rural California, which has some of the country’s lowest numbers. She feels safe but said: “I don’t have health insurance here, which makes me quite nervous as I’ve seen articles about COVID patients receiving $35,000+ hospital bills.”

Several Americans who are choosing to ride out the pandemic abroad told Foreign Policy that they didn’t trust that the government would cover medical costs in the end, despite Trump’s pledges. 

In late February, cases of the novel coronavirus spiked in South Korea, making it then the second-worst affected country after China, but even then Bailey said he never considered going home. “I trust South Korea to get stuff done,” Bailey said, “but not America to do it.” 

He said none of the Americans he knew decided to leave South Korea, despite pressure from their families to return and a warning from the State Department in February. Bailey said his mother, however, who is a nurse in the United States and had visited him in Seoul, didn’t even try to get him to come home. “My parents have been here. They kind of know I’m safer here than there,” said Bailey, who added that Illinois is handling the outbreak better than other states. 

The South Korean government said it would cover all medical costs associated with COVID-19 for both Koreans and foreigners in the country. People who did get the virus were given paid leave, and even unemployed nationals were given stipends to cover basic living costs. “This created a sense of financial certainty and an environment where no one had a reason to hide if they became infected,” according to a report from the Brookings Institution titled “Combating COVID-19: Lessons From South Korea.”

In South Korea, hospitals were prepared to avoid in-facility contagion, and medical staff had the proper protective gear. Bailey said people have been wearing masks for months as the government ramped up production. The Brookings report pointed to strong contact tracing and tracking of the movements of infected nationals—something that could be considered unacceptable by many Americans. Brookings also emphasized the role of strong leadership in South Korea flattening its curve.

“The trust is broken in the U.S.,” Bailey said. “The U.S. presidency is considered kind of a joke.” He said the English-language teaching center where he works never closed; it just took strict precautions from the beginning. 

“I wear a mask all day at work. It’s annoying, but I do it,” Bailey said. “Americans are unwilling to do what they’re told to do. They seem unwilling to do their bit.”

But that may be what Azar-Cavanagh called the “mixed messaging” around COVID-19 from the Trump administration whereby the president repeatedly contradicts the advice of both the World Health Organization (WHO) and Anthony Fauci, the top infectious disease official in the United States. Trump has halted funding to WHO, he said over its handling of the pandemic, and even retweeted a call to fire Fauci.

To many Americans watching the news from abroad, it looks like a political, economic, and medical disaster. Another American, living in Erbil, Iraq, who asked not to use her name as she is not allowed to speak to the media without approval from her employer, said that while her insurance does cover her in the United States, Iraq seems safer than her native Utah. Northern Iraq was on military-imposed lockdown, while Utah had not implemented statewide stay-home measures at that point.

“To return home would be to return to a place less safe than where I am,” she said. “It seems like a wise decision to wait it out here.”