While Trump’s speedy return to large public events was alarming, it’s unlikely he exposed many of his supporters at his first rallies after his diagnosis this month to the virus. The distance the Secret Service tends to require between presidents and big crowds alone should have protected most of his voters. What’s more disturbing to epidemiologists like me is that Trump continues to act in ways — and model behavior — that run directly counter to best practices for controlling infections. Even after becoming the world’s most famous covid-19 patient, Trump demonstrates an utter lack of seriousness or willingness to manage the virus.
The president’s diagnosis last month was not a surprise to infectious-disease experts, as the White House approach to prevention had been focused on testing, which is a secondary form of prevention. Use of testing as the only strategy is highly imperfect, especially with rapid tests, as what we gain in speed often costs us accuracy. Data on accuracy is based on samples from sick or exposed people, not necessarily on a healthy population using this frequently as a mechanism to avoid masking and distancing. The administration’s lackluster adherence to masking, distancing and overall risk reduction measures meant an outbreak centered on the White House was not particularly shocking, but it was nonetheless disappointing.
Trump held his first post-hospital rally in Sanford, Fla., last Monday. The White House still hadn’t been particularly transparent about his illness or the timeline for infection and contagiousness, but Sean P. Conley, Trump’s physician, released a memo stating vaguely that multiple tests had shown the president was negative for the disease. That memo, emphasizing the use of rapid testing, raised concerns for several reasons. The Abbott rapid tests being used by the White House have been shown to have higher rates of false negatives. But the public still didn’t know if the president experienced severe disease, which would require a longer isolation period. From an epidemiological and infection prevention perspective, this knowledge is critical: Understanding when his symptoms began and when he tested negative and then positive helps us gauge when he was probably infectious (guidance from the Centers for Disease Control and Prevention recommends we start contact tracing on the two days before symptom onset or a positive test). These pieces not only allow us to identify potential cases moving forward, but they would also shed light on whether Trump was infectious during the presidential debate with former vice president Joe Biden last month and at events just before his diagnosis. As the White House has opted not to engage in contact tracing, this has left much to crowdsourcing in an attempt to get a handle on what many are calling a superspreader event stemming from the Sept. 26 Supreme Court nomination event for Amy Coney Barrett in the Rose Garden.
Now recovered, Trump has continued to tout his newfound immunity to the virus. With knowledge of immunity and things like re-infection evolving as our knowledge of SARS-CoV-2 and covid-19 develops, two