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 findings stand out: Re-infection is possible, though it’s rare, and we’re still learning about how long protective immunity lasts. But listening to Trump, it sounds as if he thinks he can now do whatever he wants without regard for the pandemic. As he told Maria Bartiromo on Fox News, “It seems like I’m immune, so I can go way out of the basement,” noting a “protective glow.” Even if you do have temporary immunity because of a recent case, public health experts still want people to be safe and engage in distancing, masking, etc. If nothing else, remember that covid-19 isn’t the only infectious-disease that exists, and we’re heading into respiratory virus season.
Despite Trump’s current immunity to the virus that causes covid-19 — an immunity we know to be temporary anyway — his willingness to hold large events still puts others at risk. Continued large campaign rallies, for an administration that has pushed back against the most basic prevention strategies such as masks, are dangerous. Images have routinely shown limited mask usage at Trump’s events and virtually no social distancing. Crowded indoor environments for hours at a time are ripe for transmission and superspreader events. Even events in airport hangars pose a risk, as there is an assumption of adequate ventilation and little effort to ensure other prevention measures, such as distancing and masking. His campaign event in Des Moines on Wednesday is another example: In a state struggling with the pandemic, events have been limited to no more than 25 attendants, but Trump went ahead with a crowd of thousands. The rally was outdoors, but it still brought together large numbers of people in close contact for a prolonged period. Without masks, that becomes riskier. He also attended a large, indoor church service in Las Vegas on Sunday where few attendees wore masks — which is even risker.
And despite his firsthand experience with the virus — or perhaps because of the skewed view that his aggressive and unusual treatment gave him — Trump is determined to host events that put thousands at risk. This attitude isn’t particularly new for Trump, of course. But the fact that he touts his own immunity while holding unsafe events makes him look indifferent and lax about the health of his own supporters. Trump’s grandiose rallies appear more important to him than the safety of those around him, just as the health of the Secret Service officers who accompanied him on his joyride outside Walter Reed National Military Medical Center during his treatment came second to the public spectacle.
But covid-19 is getting out of control in the United States again, and that requires putting the public’s well-being first. Holding large events with thousands of attendees at which speakers mock those wearing masks runs counter to our efforts to control the spread of this virus. And that’s how these campaign events reveal Trump’s underlying attitude toward management of the pandemic. The theme seems to be hear no evil, see no evil, speak no evil, and the president is still, 10 months in, directly attacking those scientists and public health officials who are working to control the spread. The White House keeps acting as if preventing the spread of the virus comes down to one trick, like rapid testing or an outdoor rally. But no single approach is a panacea to stop transmission. Risk reduction requires multiple efforts at the same time — so outdoor events, with small crowds, wearing masks would be significantly safer.
The contrast this week with the Biden campaign could hardly have been starker. As Trump continued to jet around from large event to large event in the midst of the third wave of an outbreak, Biden’s running mate Sen. Kamala D. Harris (D-Calif.), canceled campaign events because of positive test results for a staffer and an airline attendant who had been on her plane. The Biden campaign shared information about the timeline for exposures, measures it had already taken and its enhanced efforts moving forward — efforts that were not required but taken out of an abundance of caution. Harris wasn’t even considered exposed to the virus under CDC guidelines, but she stepped off the trail regardless. The president, meanwhile, rushed back to it after hosting a superspreader event. In the process, both camps revealed how they value public health and the sacrifice it takes to protect it.