Trump has Covid-19. What did the White House do wrong?

There appears to be a Covid-19 cluster mushrooming inside the White House and beyond. President Donald Trump has tested positive for the coronavirus, as have first lady Melania Trump and White House adviser Hope Hicks. In the days ahead, White House Chief of Staff Mark Meadows told reporters Friday, he expects more administration staff to test positive. Sen. Mike Lee of Utah, who attended a White House function on Saturday, also announced a positive test, as did several other attendees.

An obvious question: How did this happen? Didn’t the White House have protocols in place to protect the president, his family, and his closest advisers (not to mention the supporters and political allies he was around during campaign events)?

An easy answer: By most accounts, with the exception of testing, Covid-19 control inside the White House, at Mar-A-Lago, and on the campaign trail has been lax.

Mask-wearing at the White House is “up to the individuals,” a White House official told Vox. On Friday, when Meadows briefed reporters (outdoors), he wasn’t wearing a mask, despite his close proximity to the president and other advisers. Even after the diagnoses, White House officials told reporters that mask-wearing would continue to be optional (that guidance was later revised to require staffers wear masks in common areas).

White House staff and the president have also shown carelessness about isolating after being exposed to one another after someone tests positive: Meadows confirmed that Trump knew of Hicks’s test result before he left for a campaign event Thursday. Per public health guidance, he should have quarantined after this potential exposure; instead, he attended an indoor fundraiser event where he came into contact with 100 people, the New York Times reports.

At best, this is sloppy Covid-19 prevention. At worst, it’s negligence that endangers others.

Scientists have repeatedly outlined what needs to be done to prevent new cases and cut off transmission chains before they grow out of control. It’s now clearer than ever that Team Trump wasn’t listening to most of it.

What works when it comes to preventing Covid-19 outbreaks

The greatest Covid-19 risk is being around breathing, laughing, coughing, sneezing, talking, or singing people.

So the best Covid-19 prevention strategy is to keep humans far apart from one another, and conduct business and interactions remotely when possible. But in the cases where distancing is harder (as in a workplace like the White House), there are ways to reduce the risk of viral spread.

President Trump and Judge Amy Coney Barrett walk toward the Rose Garden on September 26. Behind them are Barrett’s children and the first lady.
Olivier Douliery/AFP via Getty Images

The main one is mask-wearing. It’s not foolproof, and you still need to wash your hands (especially if you touch your mask). But universal mask-wearing will help reduce the spread of Covid-19 by putting the brakes on many of the viral-laden bits of spit coming out of our mouths. It’s not a replacement for distancing. Even when wearing masks, people should stand around 6 feet apart from one another to prevent the spread of the virus.

The other big way to reduce spread in an indoor setting like the White House is by improving ventilation. Superspreading events — where many people are infected by the virus in one setting — tend to occur in poorly ventilated indoor spaces.

When possible, outdoor venues are safer than indoor venues. And if indoor venues must be used, experts recommend changing the air in the space six times per hour through opening windows, bringing in more outdoor air through HVAC systems, or directly purifying the air with a capable air filter. Again, good ventilation is no replacement for either distancing or mask-wearing. If people are in close contact in a well-ventilated space, there’s still a chance for the virus to fly through the air from one body to another.

Precautions like temperature checks and recurrent Covid-19 testing can also be part of a mitigation strategy, but they each come with caveats.

Temperature checks may help identify a person who, well, has a fever, and is therefore infectious. Isolating this person can help prevent an outbreak. But it’s possible for a person to start spreading SARS-CoV-2 two days or so before they start feeling symptoms. It’s also possible to be contagious without any symptoms and not everyone who experiences symptoms gets a fever.

Recurrent testing can also protect a workplace from a Covid-19 outbreak. But here’s the thing: A negative Covid-19 test doesn’t necessarily mean a person is virus-free. Someone could test negative one day and positive the next, as it takes some time — on average, around five days — for the virus to establish itself in the body (before a person becomes infectious or feels ill). Also, the rapid PCR test the White House has usedAbbott’s ID Now test — is designated for people showing symptoms, and might not be sensitive enough to detect a presymptomatic case.

But even with the more sensitive (and slower) tests that have to be sent to a laboratory, there’s the chance that a person tests negative while they’re infectious and feeling sick.

The “best” time to test — in terms of avoiding false negatives — is the third day after symptom onset, according to Muge Cevik, a physician and virology expert at the University of St. Andrews. “Testing negative — especially if one is not taking precautions such as masking, hand-washing, and social distancing — could give a false sense of security.”

Testing, along with contact tracing, can help stop a burgeoning outbreak. But, again, it’s imperfect. And it’s no absolute replacement for the primary prevention measures: distancing, mask-wearing, and good ventilation.

What the White House did instead

That’s the ideal rundown of how to prevent Covid-19 outbreaks. So what did the White House do? The Secret Service and White House Operations (the team in charge of things like travel logistics), among others, are nominally in charge of the Covid-19 protections around the president. But, ultimately, how much the protections are enforced or adhered to is up to the president.

For months, there have been reports of lax Covid-19 procedures at the White House, as well as reports of cases popping up. (Most recently — before today’s revelations — at least 11 members of the Secret Service and Trump’s national security adviser, Robert C. O’Brien, had tested positive, according to the New York Times.)

While Trump, as well as anyone who comes into regular close contact with him, is tested for the virus, the same isn’t true for many of the people who go in and out of the West Wing.

At times, they’ve had to submit to random testing. But that’s about as good as it gets. “It’s not like everyone’s getting tested every single day,” a White House official tells Vox. The approach left the Atlantic’s Peter Nicholas with the impression that the White House was a “coronavirus breeding ground.”

Mask-wearing has also been hit or miss. After two White House staffers tested positive for the virus in May, the White House made mask-wearing mandatory — but dropped the requirement by July, leaving mask-wearing up to individuals. That’s no surprise, since the president has made mask-wearing a political flashpoint and as recently as Tuesday mocked former Vice President Joe Biden for regularly donning one. (O’Brien on Friday reinstated the mask requirement in common areas.)

In June, the White House also dropped the temperature screening requirement for visitors. So it seems regular testing for the virus was the strongest protection Trump’s inner circle had. But, again, testing isn’t foolproof.

As for ventilation: Trump has chosen to hold some campaign rallies indoors despite all the evidence suggesting outdoors is safer. The White House has a relatively new HVAC system, installed in 2017, Fast Company reports, which is better than the install date of HVAC systems in many of the country’s schools. But we don’t know how seriously they’re taking ventilation in the pandemic, and experts tell us you can’t ventilate the way out of the need to maintain distance and wear masks.

When it comes to quarantining and isolation, the big questions now are: How many people in Trump’s circle are positive? And how long did the White House know about these cases while they were still attending public events? According to the latest reports, Trump went to a campaign event on Thursday after learning Hicks was positive.

That move could mean Trump knowingly exposed others to the virus — and the cases we know about now are only the beginning of something much larger. Trump is now “working in isolation,” as Reuters reports. If he remains that way for 10 days, per CDC guidance, that should keep him from infecting others. But this is a sneaky virus: It may be already incubating in many more people connected to the White House. If the cluster is large enough, it could become a superspreader, seeding many, many more infections.

Alex Ward contributed reporting to this story.

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