Contact-tracing efforts scrutinized after COVID-19 outbreak spreads

‘It’s clear there’s not a comprehensive outbreak investigation going on at the White House and it is very concerning,’ public health expert says

 President Donald Trump removes his mask Monday evening after returning to the White House from Walter Reed National Military Medical Center, where he was treated for the coronavirus.  (Win McNamee/Getty Images)
President Donald Trump removes his mask Monday evening after returning to the White House from Walter Reed National Military Medical Center, where he was treated for the coronavirus. (Win McNamee/Getty Images)
Posted October 7, 2020 at 5:00am, Updated at 1:23pm

Efforts to trace the contacts of officials in Washington should be more intensive, say public health experts who note that practices vary across different government branches.

A number of top officials, including President Donald Trump and three senators, announced their COVID-19 diagnoses in the past week.

The White House and Capitol Hill don’t appear to have the type of contact-tracing plan that would be recommended for such an outbreak, said David Harvey, the executive director of National Coalition of STD Directors, which has experience in tracing the contacts of people infected with diseases.

He estimated that 100 contact tracers may be needed to quickly determine who was exposed at various White House, Trump campaign or Capitol Hill events last week and conduct any additional follow-up from those cases.

“It’s clear there’s not a comprehensive outbreak investigation going on at the White House, and it is very concerning,” Harvey said in an interview.

Harvey said a thorough contact-tracing program would entail a “massive cluster outbreak analysis” to determine the initial source of infections and how it spread to others.

The White House has regularly tested some staff and visitors, while some lawmakers have called for more widespread testing on Capitol Hill. The White House and the Office of the Attending Physician at the Capitol are taking different approaches to contact tracing.

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Harvey said it is notable if officials are making their own determinations about their risks. In general, experts say people risk contracting the virus that causes COVID-19 if they spend more than 15 minutes within 6 feet of someone with the disease.

“We have everybody doing different things,” he said. “This is not how you combat an infectious disease outbreak.”

Republican Sens. Mike Lee of Utah, Thom Tillis of North Carolina and Ron Johnson of Wisconsin are quarantining after testing positive. Both Lee and Tillis, along with many other Judiciary Committee members, attended a Sept. 26 Rose Garden ceremony for Supreme Court nominee Amy Coney Barrett. The Senate is essentially in a two-week recess, although several senators plan to be back in the Capitol next week when the Judiciary Committee’s confirmation hearings for Barrett begin.

The Office of the Attending Physician did not speak with Lee’s contacts but told the senator to reach out to everyone he’d been within 6 feet of for more than 15 minutes beginning Sept. 29 through his self-quarantine, his spokesman Conn Carroll said in an email. No staffers in Lee’s office have since tested positive for the virus, he added.

“In conjunction with local Public Health authorities, this office performs contact tracing of all positive results at the time the result is available,” the attending physician’s office said in a Friday statement, “and concludes this in a rapid timeframe.” The office did not respond to a request to discuss the contact-tracing efforts in greater depth.

At least three senators — Republicans Ted Cruz of Texas, James Lankford of Oklahoma and Ben Sasse of Nebraska — said they would quarantine after being exposed to colleagues or others who tested positive for the coronavirus. Several other senators reported negative test results after their colleagues tested positive.

The White House is following a narrow definition of “close contact” in conducting contact tracing by going back 48 hours from the first positive test or onset of symptoms.

That means it is unlikely there would have been any contact tracing from the White House in relation to Trump or any of the senators who attended the Sept. 26 ceremony, since none reported a positive test until days later.

Since the White House has declined to make clear when Trump became infected, it is difficult to gauge who should quarantine, said Crystal Watson, a senior scholar and assistant professor at the Johns Hopkins Bloomberg School of Public Health Center for Health Security. Officials who were exposed but aren’t entering quarantine are contradicting best public health practices that experts and federal agencies have urged for months.

“It sends a message that members of this administration feel like they are above those rules and guidelines and they’re not willing to follow public health advice,” Watson said.

Vice President Mike Pence was at the Rose Garden celebration and met with Trump several other times through Sept. 29 but is not quarantining.

Pence’s office on Tuesday released a memo from Centers for Disease Control and Prevention Director Robert Redfield explaining that Pence is not considered a close contact of Trump since he tested positive for the virus, and therefore he doesn’t need to quarantine. The memo said it would be safe for Pence to participate in Wednesday’s vice presidential debate.

The White House has been citing the CDC guidelines not only for Pence but also for others who are not quarantining.

“For COVID-19, a close contact is defined as any individual who was within 6 feet of an infected person for at least 15 minutes starting from 48 hours before the person began feeling sick until the time the patient is isolated,” the CDC guidelines state.

Calls for more clarity

Senate Minority Leader Charles E. Schumer joined Health, Education, Labor and Pensions ranking member Patty Murray of Washington in a Tuesday letter to White House Chief of Staff Mark Meadows to say the information provided to the public about the president’s condition was wholly insufficient.

“As the President thankfully recovers and returns to the White House after his hospitalization, we call on you to immediately provide a thorough and complete description of what, if any, contact tracing regimen has been instituted to prevent further spread of the virus, and detailed information about the progress of that effort, if it exists,” Schumer and Murray wrote. “We also call on you to provide complete transparency regarding the timeline of the outbreak and guidance to any and all individuals working within the White House complex, including additional information on testing, quarantine and isolation, and the use of masks on White House grounds.”

Separately, Schumer and Sen. Amy Klobuchar of Minnesota, the ranking Democrat on the Rules and Administration Committee, filed a resolution Monday seeking to mandate a contact-tracing protocol for the Senate office buildings and the Senate wing of the Capitol.

“This resolution will require mandatory masks and a reliable testing protocol in the Senate. These are common sense measures our government must have in place to protect the Senate community, including our staff, and to fully function during this pandemic,” Klobuchar said in a statement Wednesday. “This is critical for continuity of government and our work on behalf of the American people.”

Contact tracing of other individuals potentially exposed by the president or the senators appeared to be a fragmented effort. New Jersey authorities were working through a list of attendees at a fundraiser that Trump attended at his club in Bedminster on the day of the publicly reported positive test result. But it remains unclear when the president last tested negative.

Lawmakers would most likely be handled by state health authorities back home. For instance, Utah Department of Health Communications Director Tom Hudachko said the statewide statistics include cases among Utah residents “regardless of where they tested positive.”

House members representing the National Capital Region are calling for more clarity on the number of cases and seeking more federal cooperation with state and local health officials.

“We are alarmed and dismayed by the casual disregard for the health of our community,” nine Democratic House members representing the District of Columbia, Maryland and Northern Virginia said in a joint statement that mentioned risks to White House staff, the U.S. Secret Service, journalists and the general public.

“When a D.C. resident tests positive in D.C. from their health care provider or at a community testing center, that information is shared with D.C. Health, and the District can conduct contact-tracing. However, when a White House staffer tests positive from one of your tests, this information is not shared with D.C.,” Democratic D.C. Del. Eleanor Holmes Norton wrote in a separate letter to Physician to the President Sean Conley.

“Indeed, since the recent outbreak at the White House, testing in D.C. has increased in the last several days as has the overall number of new infections,” Norton said.

The District’s 105 new cases in Tuesday’s daily update is the highest single-day jump in months.