POST 49. October 4, 2020. CORONAVIRUS. RAPID RESPONSE. “The possibility that the president and his White House entourage were traveling superspreaders is a nightmare scenario for officials in Minnesota, Ohio, New Jersey and Pennsylvania…”

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“Contact tracing was put into place at the White House immediately after Trump aide Hope Hicks tested positive for coronavirus, White House press secretary Kayleigh McEnany said on Friday…

In separate remarks to reporters, McEnany said it was considered safe for Trump to travel to his resort in Bedminster, New Jersey, for a private fundraiser on Thursday.

“It was deemed safe for the president to go. He socially distanced, it was an outdoor event and it was deemed safe by White House operations for him to attend that event,” she said.” (A)

President Donald Trump’s big-dollar fundraiser at his New Jersey golf club went on as planned Thursday night despite the President and staff knowing he had been exposed to coronavirus.

Trump attended three events at the fundraiser: an indoor roundtable, an indoor VIP reception — donors had a socially distant photo opportunity with him — and an outdoor reception, according to an event invitation obtained by CNN.

Donors that gave $250,000 were able to participate in a roundtable, photo opportunity and reception with the President, according to the event invite. The roundtable included 18 donors, according to a source, and was held indoors at socially-distanced tables.

Another source says that the attendees at the roundtable were tested for coronavirus when they arrived and that no one wore masks.

Three attendees told CNN that most people at the events were not wearing masks; all three say they have not been contacted by any contact tracers….

An hour and a half before the fundraiser, some senior staff and the President were informed Hope Hicks had tested positive for coronavirus, White House chief of staff Mark Meadows told reporters on Friday.

The decision was made to still hold the fundraiser despite Trump’s exposure; attendees say they were not notified the President had been exposed to Covid-19…

On Friday at noon, the Trump campaign emailed attendees officially notifying them the President tested positive for coronavirus.

“We unfortunately write today to notify you that, as you have probably seen, President Trump confirmed late last night that he and the First Lady were tested for COVID-19 and produced positive test results,” the email, obtained by CNN, reads. “Out of an abundance of caution, we want to call this to your attention.”

The email went on to encourage attendees to contact their medical provider if they, or their loved ones, develop Covid-19 symptoms. It did not make any mention of quarantining or self-isolation but did recommend attendees visit the CDC’s website.” (B)

“With President Donald Trump’s positive coronavirus test, the White House is now ground zero for the most closely watched contact tracing exercise of the Covid-19 pandemic in the US….

How big could the cluster of infections around Trump grow? The only way to figure it out is contact tracing: identifying who has been in close contact with the president since he became contagious, and asking them to quarantine to prevent Covid-19 from spreading to others, and to get tested themselves. We also aren’t sure what kinds of tests the Trump administration is using, and that makes a difference in figuring out who else might be exposed.

Testing for Covid-19, tracing people who may have been exposed, and getting them to isolate is the backbone of an effective coronavirus response. It’s also a program that the US has largely failed to execute effectively but which is now of utmost importance to the continued health of our nation’s leaders and those around them.

Ashish K. Jha, dean of the Brown University School of Public Health, laid out in a brief Twitter thread what should happen now, and the challenges that will make contact tracing difficult even at the White House.

This is the first difficulty: People who have contracted the coronavirus and are contagious still might not show symptoms for several days. As Muge Cevik, a virologist at the University of St. Andrews, laid out on Twitter recently, people with Covid-19 generally start to become more infectious in the two days before their symptoms start and then for a week afterward.

So Jha recommended: “Everyone who has been near the President at least from Saturday on needs to be identified.” But that is, as he acknowledged, easier said than done.

Contact tracing, in non-pandemic times, is typically concentrated on sexually transmitted diseases. Generally speaking, people know whom they’ve had sexual contact with; so while these can be sensitive discussions, there is not much confusion about who may have been exposed to HIV or syphilis.

But an airborne virus like Covid-19 is much more difficult to trace. The general rule of thumb, public health workers have told me previously, is you want to identify anybody who has been within 6 feet of an infected person for a period of 15 minutes or more….

So this work of testing, tracing, and isolating is already underway, because the president and senior government leaders being exposed to a deadly pathogen is rightfully seen as a national emergency. This is the right response after learning a person who is in contact with a lot of people has contracted the coronavirus.

But the US has also struggled to implement a test-trace-isolate program more broadly, despite strong expert consensus that it’s the best way to get the pandemic under control.” (C)

….”As you read this, Trump’s immediate contacts are being identified and contacted. Those who got close to Trump after he was infected will need to go into quarantine, defined as a 14-day period of having no contact with anyone, regardless of whether they develop symptoms.

It sounds straightforward in theory—but in practice, it’s a lot harder. When we talk about contact tracing for Trump’s potential Covid-19 exposure, what we really mean is identifying the people who’ve been exposed to Trump in a handful of specific ways, between the time that he encountered the virus and the time that he tested positive. And that’s where things get a little messy.

When did infection happen?

It’s hard to pin down when someone was initially infected with Covid-19 because of the nature of how SARS-CoV-2 enters the body: slowly, one cellular ACE2 receptor at a time, which can trick individuals into thinking they’re healthy even after they’ve been infected.

On average, “you have two days of incubation, in which a PCR test wouldn’t test the virus,” says Brooke Nichols, a health economist at Boston University who uses mathematical models to map infectious spread. During these two days, a person likely wouldn’t have enough of a viral load to infect others.

Then, however, most people enter a pre-symptomatic phase. This is the danger zone: A person is sick, still not showing symptoms, but has enough of a viral load to potentially infect others. This when people are most likely to give the virus to others. Once a person does have symptoms, they’re (usually) wise enough to get tested, tell others, and isolate.

Based on what we know about the appearance of Trump’s symptoms and the test he took on Oct. 1 that came back positive, he could have been exposed, infected, and contagious to others as early as the beginning of the week…

At the moment, no one knows—though hours before Trump announced he had Covid-19 on Twitter, Bloomberg reported that one of his senior aides, Hope Hicks, tested positive. On Sept. 29 Hicks had been aboard Air Force one with Trump and others as he traveled to the debate in Cleveland, and then to Minnesota for a campaign rally. She reportedly felt sick in Minnesota, so isolated herself on the plane ride home.

That means Hicks could have given Trump Covid-19. But given that they tested positive around the same time, it’s possible that one person exposed both of them, says Gurley. And that possibility introduces the need for a totally different approach to contact tracing—not just in the White House, but in general.

Identifying, quarantining, and potentially testing every one of Trump’s contacts in the last week, when it was likely he was exposed—the traditional contact tracing approach—would successfully squash any outbreaks that stem from him, alone. But it wouldn’t stop any outbreaks that started with the person who infected Trump.

A different approach would attempt to identify the missing link between a growing number of positive cases connected to the White House. If we could trace all of their contacts backwards in time, we could potentially identify an infected person who exposed them all… (D)

“The White House has yet to deploy a specialist Centers for Disease Control and Prevention (CDC) team to track and test those whom President Donald Trump came into contact with after being infected with the coronavirus.

Two sources told The Washington Post Saturday that the CDC specialists’ team was on standby but had not yet begun to work tracing all of those the president came into contact with while infected.” (E)

In the days immediately preceding President Donald Trump’s COVID-19 diagnosis, he and his aides travelled to five states, holding several rallies and crowded indoor events with large groups of people. But there’s no clear indication that the White House is playing its stated role as the coordinator of a critical contact tracing effort that could help stem the spread of the virus, according to local and state health officials.

At a press conference on Oct. 3, Trump’s personal physician said the White House was at the center of the contact tracing effort. “The White House medical unit, in collaboration with CDC and local state and health departments, are conducting all contact tracing per CDC guidelines,” said White House physician Dr. Sean Conley.

But in response to questions from TIME, local and state health officials in many of the locations that Trump recently visited indicated the Trump Administration has taken few evident steps on contact tracing to date. Officials in four states—Minnesota, Pennsylvania, New Jersey and Virginia—stated or suggested they had not been contacted by the Trump campaign. Officials with the city of Cleveland, where the presidential debate was held Sept. 29, did not respond to an inquiry, and the Cleveland Clinic declined to comment on that topic.

In response to a TIME inquiry about contact tracing, the Trump campaign pointed to Conley’s comment saying the White House Medical Unit was doing the tracing. The Centers for Disease Control and Prevention (CDC) referred TIME to the White House, which said the White House Medical Unit was doing contact tracing in coordination with CDC personnel.” (F)

“Public health officials in the cities and states that President Trump visited in recent days are working to contact those who were in close proximity to him, first lady Melania Trump and others who traveled with him.

Since he has tested positive for the coronavirus, health officials worry those who attended events with the president could be at risk for the virus, too.

Over the past two weeks, Trump attended events in Florida, Georgia, Pennsylvania and Minnesota as well as a fundraiser in New Jersey and, of course, the presidential debate in Cleveland. He also went to his golf club in Potomac Falls, Va., and hosted an event announcing his Supreme Court nominee Amy Coney Barrett at the White House…

The president’s rally was held on the tarmac of Duluth International Airport, where according to Minnesota Public Radio, thousands of people attended, including many who didn’t distance themselves from each other or wear face masks, with the notable exception of those behind the stage and in camera view.

The Minnesota Department of Health is offering guidance to those who attended the rally, too, warning that community transmission of COVID-19 in the Duluth area was already high before the campaign event, “and people attending the rally may have been infectious without realizing it.”

Before Wednesday’s campaign rally, Trump attended an afternoon GOP fundraiser at a private home in Shorewood, Minn., a suburb of Minneapolis-St. Paul.

Minnesota Republican Party Chair Jennifer Carnahan said in a statement that about 40 people attended that fundraiser but that she did not meet with Trump.

“I have not been in contact with any of the donors who had been at that event,” she said. “My understanding as well, they were all required to take a negative COVID test with results within 24 hours of the president’s visit to donors, and it is also my understanding that people were not allowed to shake hands or come into that close of contact with the president while he was there.”..

In an interview with Minnesota Public Radio, Dr. Michael Osterholm, an epidemiologist and director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said he was alarmed by reports that some who attended the president’s events think they can be tested once and be in the clear.

“I’m a little disturbed by the fact that I heard some of the individuals who are exposed in the last 48 hours saying, ‘Well, I’m going to be tested today and then if I’m negative, I’m going to go ahead and do what I do.’ And in fact, they won’t even show up positive for at least three up to five days after the exposure.”..

White House chief of staff Mark Meadows told reporters that positive test results for senior aide Hicks came to light “right as the Marine One [helicopter] was taking off” Thursday to take the president to Joint Base Andrews for the flight to New Jersey.

“We actually pulled some of the people that had been traveling and in close contact,” Meadows told reporters Friday at the White House, explaining contact tracing had just begun. Other senior staff, including Dan Scavino and Jared Kushner, have since tested negative, he said.

Public health officials in Somerset County, N.J., are asking Trump’s country club, the Trump National Golf Course, for a list of facility staff, event participants and other people who may have come in contact with the president and first lady, according to a statement from the county’s Department of Health.

“As the public health department for Bedminster, and in conjunction with the New Jersey Department of Health, Somerset County has begun the contact tracing investigation to determine the potential risk of exposure to attendees and staff at the facility to COVID-19,” the statement said.

New Jersey Gov. Phil Murphy, a Democrat, said the golf club, White House and Republican National Committee are all cooperating with state and local health officials, according to NPR member station WNYC.

“The process for gathering information for case investigation and contact tracing has begun, and as far as we know folks are cooperating and we need them to,” Murphy said at news conference Friday.

Amid reports that some people who attended the fundraiser are calling doctors’ offices and health departments in a panic, Murphy urged everyone who was there to take precautions.

“Self-quarantine everybody. Take yourself off the field,” Murphy said. “Wait five to seven days probably and get tested. Even if you test negative, you really have to stay off the field for the full 14 days.” (G)

“The possibility that the president and his White House entourage were traveling superspreaders is a nightmare scenario for officials in Minnesota, Ohio, New Jersey and Pennsylvania — four states where Trump rallied, debated or fundraised in the past week.

The White House itself may have become a nexus of infection in the Washington, D.C., area and beyond, hosting events like last Saturday’s celebration of Supreme Court nominee Amy Coney Barrett. At many Trump events, masks were a rarity, social distancing minimal. Video of the Barrett event, for instance, shows people shaking hands, hugging and standing close together.

“They’re way behind the curve in trying to catch all the folks that the president has been around,” said Georges Benjamin, executive director of the American Public Health Association. “The fact that he’s been around so many people and that he doesn’t wear a mask, he could be a superspreader, we just don’t know yet.”

Trump on Friday evening was taken to Walter Reed National Military Medical Center, where he will spend the “next few days,” the White House said.

The White House is complying with CDC guidelines and has started contact tracing, with notifications and recommendations for people who may have had exposure to an infected person, spokesperson Judd Deere said.

The Secret Service, while staying mum on how many of its employees have tested positive for Covid-19 or are quarantining, said it’s following CDC protocols on testing and tracing. Anyone who tests positive is immediately isolated, a spokesperson said.” (H)

“To really be out of the out of the woods, we want to continue seeing” negative results for 14 days after exposure to the virus, said Michael Mina, a Harvard University physician and epidemiologist. He said the vast majority of individuals will have a positive test results within five to seven days.

It may be impossible to determine exactly how many people Hicks and Trump exposed before they received their positive test results this week. It’s not even clear right now if Hicks infected Trump – or vice versa. It’s also possible they were infected by a third person. 

Welty said it may have been “inevitable” that Trump and others in his inner circle became infected “because they were relying solely on testing to keep them safe” and shunning other tools – such as masks and distancing – that can prevent infection.

“It’s too late once you test positive,” she said. By that time, “you’ve already been around too many people and spread it to too many people.”” (I)

“On Thursday (Oct. 1), the two states each launched their own contact tracing apps called “COVID Alert NY” and “COVID Alert NJ,” respectively. These apps, which keep users’ identities anonymous, are based on a new technology developed by Google and Apple. They use bluetooth to connect to nearby phones and alert users if they’ve been in close contact with someone who has been infected with the coronavirus.

From the very start of the pandemic, contact tracing has been an important part of helping to stop the spread of the virus. Contact tracing involves identifying people with COVID-19, figuring out who they came in close contact with, and notifying all of those people so that they can self-quarantine or get tested before spreading the virus to others. Most of those efforts have been conducted by people conducting phone calls.

“We have about 15,000 people statewide who do contact tracing. They call them disease detectives,” New York Gov. Andrew Cuomo said in a briefing on Thursday. “But we’ve been looking for a technology-based solution.”

The contact tracing app “knows where your cellphone is, the app will know where a person who tested positive was through their cellphone and the app can tell you if you were within 6 feet of that person,” Cuomo said. “It doesn’t give names, it doesn’t give any privacy information [and] it’s voluntary.”

This is how it works: When you’ve spent more than 10 minutes within 6 feet of another person with the app, which is “long enough and close enough for you to catch the virus,” your phone exchanges a “secure” and “random” code with the other person’s phone, according to the COVID Alert NY app. The phones will store these random codes in a list.

If you end up testing positive for COVID-19, a public health representative will call and ask if you’d be willing to share the app’s list of random codes to help protect other people. “Sharing your list is secure and private,” according to the app descriptions. “The app never reveals who you are to anyone.” Also, the app will constantly compare its own list to the list of infected codes, and if there’s a match it will send a notification to the person’s phone, alerting you that you may have been in close contact with an infected person. You also have the option to keep track of your own symptoms on the apps.” (J)

“With the president and first lady’s stunning diagnoses of COVID-19, the couple will receive exemplary care. They will have all the support they need to—we hope—emerge fully recovered from this potentially lethal virus.

That’s as it should be. But the tens of millions of Americans who could receive similar diagnoses will continue to be sent into spirals of uncertainty—and, for a tragically large number, death itself. Too many of those who fall ill will not have the means or wherewithal to follow even the most basic Centers for Disease Control and Prevention guidelines for those who have been exposed.

The news that the coronavirus has infected one of the most powerful people on the planet should serve as a sobering reminder that this pandemic knows no politics and respects no borders. It’s a reminder, too, that the U.S. government, at the federal, state and local level, needs to provide support through the duration of this pandemic so that every American has what’s needed in the event that they, too, are struck by this virus…

During this pandemic, our societal and structural failures have been laid out for the world to see. At least 28 million Americans don’t have health insurance, and millions of others are underinsured. Too many parents, often those in low-wage jobs, don’t have paid sick leave. About 60 percent of the workforce is paid hourly, and the strains on these workers during the waves of closures and economic shutdowns have proved devastating…

The first family’s diagnosis is just the latest indication that we are nowhere near the end of this pandemic. More than nine of every 10 people in this country have yet to be infected by the coronavirus. With more than 200,000 deaths already and a projection of 371,000 deaths by the year’s end, we need to continue to embrace the guidance laid out by public health experts that we know works: again, we must wear masks, practice social distancing, test and trace, and make prudent decisions for individuals and for their communities…

The president and first lady’s diagnoses should serve as a wake-up call to us all. COVID-19 will thrive if we are divided and dismissive of its dangers. And it can only be bowed if we follow the public health road map to a better day.” (K)

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