When he called the White House about a coronavirus outbreak, the Indiana doctor expected to get some help, not a “head in the sand approach.”
It was Oct. 1, and Mark Fox, a county public health officer in South Bend, had just learned that the University of Notre Dame’s president, the Rev. John I. Jenkins, had tested positive for the novel coronavirus after attending a Rose Garden ceremony days earlier in honor of Supreme Court nominee Amy Coney Barrett. It seemed likely that either Jenkins had taken the virus to the White House, potentially infecting others there, or he had become infected in Washington and brought the virus home to South Bend.
There are long-standing protocols for investigating the spread of a virus: contact tracing, or interviewing infected people about their recent interactions and advising those exposed that they should get tested. There’s also a more cutting-edge technology that can map the spread of a virus by tracking tiny changes in its genetic code. The Trump administration did not effectively deploy either technique in response to what Anthony S. Fauci, the nation’s top infectious-disease specialist, has called a “superspreader event” at the White House, leaving not just the president and his staff at risk, but also the hundreds of people who were potentially exposed.
Officials say the White House called off early efforts to get to the bottom of the outbreak, including sequencing the genomes of virus samples from infected individuals. This genetic analysis could have revealed shared mutations that linked cases in Washington and other affected communities.
Had the administration done such an investigation, it would know whether infections among aides to Vice President Pence that were reported this past weekend bore the same genetic signature as earlier cases at the White House. That could indicate whether the virus was circulating among administration officials for weeks or had slipped through infection-control measures a second time.
But the administration has shown little interest in investigating its outbreak, Fox said. He was initially told that the White House would send contact tracers from the Centers for Disease Control and Prevention as part of a multistate investigation — and later learned they were asked to stand down. To this day, Fox, the local official tasked with contact tracing for the outbreak, has not seen a full list of people from his county who attended the Rose Garden ceremony.
“I have seen so many opportunities not just missed but cavalierly dismissed by this White House,” said Fox, citing the president’s travel even after learning he’d been in close contact with staff members who tested positive. “He failed to follow what in our county would have been really basic public health guidance.”
Fox’s frustration with the White House response isn’t unique. In Minnesota, after a Sept. 30 Trump visit, health officials sought the names of attendees at a private presidential fundraiser to see who might have been exposed to the president and staff members. The White House did not provide the requested information.
The day after the Rose Garden ceremony, Trump hosted some 25 families of U.S. military personnel killed in action. While at least one veterans organization supporting the event said it was contacted by the White House, several families were left on their own to prevent further spread, even after the president suggested that they may have given him the virus, according to veterans organizations.
It’s not clear how the president and several dozen others in his orbit contracted the coronavirus in early October. Was it at the celebration for Barrett, the event with Gold Star families or one of the other events Trump attended before announcing he had tested positive in the early hours of Oct. 2? Did the administration officials all become infected at the same time, or were they sickened by multiple strains of the virus on different occasions? Experts say vigorous contact tracing and a genetic investigation could answer these questions. But without these standard public health practices, it may never be known how widely the outbreak spread — or who was avoidably harmed.
The White House insisted the administration has followed all CDC guidelines, which advise contact tracers to reach out to anyone who interacted with an infected person up to 48 hours before that person was diagnosed. The Rose Garden event was five days before the president tested positive.
“This is nothing more than the continuation of a disgusting fishing expedition to try to tie a White House event from more than four weeks ago to a ‘so-called’ outbreak with no scientific or even common sense connection,” White House spokesman Judd Deere said in an email to The Post Monday.
A second spokesman, Brian Morgenstern, earlier characterized the source of the president’s infection as “unknowable.”
“Of course it’s knowable,” said Tom Frieden, who directed the CDC under President Barack Obama and now runs the nonprofit Resolve to Save Lives. “It’s only unknowable if you don’t want to know.”
The CDC declined to comment.
When Fox called the White House Oct. 1, he only got as far as the switchboard. It was after 5 p.m., and he was told to call back in the morning, he said.
The next day, an epidemiologist from the CDC detailed to the White House got in touch. The official, Tyler Sharp, told him that the CDC was considering launching a multistate contact tracing effort and sending a team to South Bend. Separately, another official from the CDC, Peggy Honein, called to say that the agency was interested in collecting genomic samples from the Notre Dame infections to genetically analyze them and map the spread of the outbreak.
Later, Fox learned that the CDC investigation had been called off. “I believe they said that the White House medical unit would handle any contact tracing, and that was kind of the end of the story,” he said.
Fox said he directed the lab that tested Jenkins to preserve the virus sample for genetic sequencing by the CDC, but as far as he knows, that key clue to the virus’s march has not been examined. The White House declined to say whether samples from other people infected in the outbreak, including the president, had been genetically analyzed.
Fox said that if the White House had launched a rigorous contact tracing effort, early steps would include notifying local authorities of who was exposed. Fox was able to get a list of faculty members who attended the White House event from Notre Dame, where Barrett graduated and taught at the law school, but he does not know who else from the county was there. While he did not request help from the CDC with local contact tracing, he said, he initially assumed that the agency was making the effort.
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One CDC official told a D.C.-based official familiar with the matter that the White House had told the agency to “stand down, that this is a matter of national security, on the White House grounds, and they don’t need to get involved,” the Washington official recalled, speaking on the condition of anonymity to share internal discussions.
State health officials would have welcomed a more robust investigation.
“The usual process of CDC support when there is a large multistate outbreak was not used in this case, and that has probably led to transmission in the states that could have been avoided if CDC had engaged more prominently and state health departments had been informed,” said Michael Fraser, chief executive of the Association of State and Territorial Health Officials.
The reverberations are still roiling Notre Dame and South Bend, where coronavirus cases spiked significantly after more than a dozen South Bend residents attended the Rose Garden ceremony. Jenkins has issued an apology to Notre Dame students, faculty and staff members for his “error of judgment” at the event. The faculty senate is considering a resolution of “no confidence” against the school president.
Although there is no known link between the White House ceremony and the outbreak in South Bend, students, parents and faculty say they’re still concerned.
“The ties between Notre Dame and the White House super-spreader event, and the subsequent spike in COVID-19 back in the South Bend region, illustrates neatly how politics affects public health,” said Ellen Hunt Botting, political science professor at Notre Dame.
From celebration to contagion
The White House also does not appear to have traced contacts or taken other basic public health precautions with all the veterans’ families who were at the White House on Sept. 27. Most attendees did not wear masks or maintain social distance as they talked with the president and had photographs taken.
The White House informed one of the organizations supporting the ceremony when the president was diagnosed five days after the event, but not all the veterans’ families were notified. Morgenstern, the White House spokesman, said CDC guidelines didn’t call for it.
There were no reports of illness from the families, who have generally given the White House event high marks.
Yet the CDC estimates that up to 40 percent of people infected with the coronavirus never show symptoms of disease. These asymptomatic cases are often hard to identify because people don’t know they are sick. One of the goals of contact tracing is to reach these individuals and encourage them to get tested so they don’t inadvertently spread the disease to others.
Officials in Minnesota say they, too, got limited help from the Trump administration following the president’s visit on Sept. 30. The rationale was similar. After the trip and Trump’s announcement that he had tested positive early on Oct. 2, officials sent a letter to the White House asking for names and contact information for those who came in contact with the president and staff members who later tested positive, including aides Hope Hicks and Stephen Miller. But the White House told Minnesota officials that contact tracing had been “completed” and did not provide further information.
The back-and-forth came after days of internal debate among state officials over whether they should be more aggressive in seeking the names of those who came into close contact with Trump and his staff, according to a state official who spoke on the condition of anonymity because the official was not authorized to speak publicly about the conversations.
Trump’s interactions with Minnesotans had begun on the tarmac at the Minneapolis-St. Paul airport, where some 200 supporters — most of them maskless — gathered behind a barricade to greet the president. He then traveled to Shorewood, Minn., a tony suburb of Minneapolis, to attend an indoor fundraiser at the lakefront home of quartz-countertop mogul Marty Davis. Finally, in Duluth, he presided over an outdoor rally of roughly 3,000 people.
No known infections have been traced to the Shorewood fundraiser, and the White House insists that full contact tracing, consistent with CDC guidelines, was completed for the Minnesota trip. The White House has said the president did not have interactions that would be considered “close,” meaning lasting 15 minutes and within six feet.
But Minnesota Department of Health infectious-disease Director Kris Ehresmann told reporters that four people who attended the Duluth rally had tested positive for the coronavirus. Ehresmann’s department also hopes to use genomic sequencing to track cases tied to Trump’s movements in Minnesota.
‘A place where you don’t want to be’
The CDC has long employed genomic epidemiology to track tuberculosis outbreaks, and under Frieden’s leadership, the agency started using the tool to investigate food-borne illnesses. Though genetic sequencing is not yet a standard part of epidemiological field investigations, Frieden said, “it’s something that maybe should be standard.”
And for a “VIP investigation” — such as one involving the president of the United States — “you would certainly do it,” Frieden said.
But genomic testing could have been politically sensitive in the final weeks of the presidential campaign because it could have mapped who had infected whom — and what actions led to a major outbreak among the upper echelons of American government.
According to Dave O’Connor and Tom Friedrich, virologists at the University of Wisconsin at Madison, a genomic investigation could have determined whether the virus was introduced to the White House one time or multiple times and how a major security breach happened.
“If you’re not using it as an exemplar when you have all the resources in the world,” O’Connor said, “you have to think that it is a conscious decision that applying those resources might lead you to a place where you don’t want to be.”
More important than determining culpability, Friedrich added, such an investigation could uncover flaws in the testing apparatus the White House relied on to protect the president and other top officials.
“In terms of keeping upper levels of leadership safe in the future,” he said, “that’s something you want to know.”
The CDC does not automatically deploy epidemiologists to any place with a disease outbreak; state or local health departments must issue a formal request for assistance from the agency.
If an outbreak involving dozens of members of the federal government and patients in multiple states had happened while he was CDC director, Frieden said: “Absolutely the CDC would be invited in and do it in close collaboration with Secret Service and the White House physician.
“The results might be confidential,” he added, “but the investigation would be done.”
Chris Mooney and Holly Bailey contributed to this report.