Letters to the Editor • Opinion
The coronavirus pandemic is not over
Letters to the Editor • Opinion
We already know how to prevent pandemics
The Washington PostDemocracy Dies in Darkness

A week into a White House outbreak, CDC still playing only a limited role

President Trump and at least 34 White House staff members and other contacts have tested positive for the virus

Former New Jersey governor Chris Christie was among the guests at a White House Rose Garden ceremony Sept. 26 marking the Supreme Court nomination of Judge Amy Coney Barrett. Christie later was diagnosed with covid-19. (Jabin Botsford/The Washington Post)

A week after a cluster of coronavirus cases emerged following a White House event, the Trump administration is now working on a limited basis with the federal government’s elite cadre of disease detectives to control further spread.

Two epidemiologists from the Centers for Disease Control and Prevention are assisting the White House in tracking down people who may have been exposed to the coronavirus, CDC spokesman Jason McDonald said Thursday. One epidemiologist has been detailed to the White House since March and the second arrived recently.

President Trump and at least 34 White House staff members and other contacts have tested positive for the virus, according to Wednesday’s senior leadership brief on the covid-19 response prepared by the Federal Emergency Management Agency. Some of those people are suspected of having become infected at White House and Republican National Committee events.

The White House by Tuesday completed contact tracing related to the president’s infection and cases involving several other people, a senior White House official said, raising concerns among infectious-disease experts about whether a thorough investigation could be completed so quickly. The official, who spoke on the condition of anonymity to discuss internal matters, said anyone meeting the CDC’s definition of “close contact” with someone who tested positive had been notified and given health recommendations.

A week after President Trump tapped Amy Coney Barrett as Supreme Court nominee, he and several attendees at the event have tested positive for coronavirus. (Video: The Washington Post, Photo: Jabin Botsford/The Washington Post)

It remains unclear when the White House began contact tracing. If the effort did not begin right away, or go far back enough, infections may have been missed, experts said.

If the White House had started immediately, “then early control could have held back numbers of infections and further need for ongoing tracking,” said Jeanne Marrazzo, an infectious-diseases expert at the University of Alabama at Birmingham.

Several White House staffers and administration officials expressed anger and bewilderment that the White House had not undertaken a more robust contact-tracing effort sooner. They said many people — including White House residence staff who do not have the stature of a lawmaker or a top political aide — had not been contacted despite possible exposures, putting them and others at risk in a still-growing outbreak. The officials spoke on the condition of anonymity to discuss sensitive matters.

The CDC began offering help last Friday, after President Trump announced he had tested positive, only to be repeatedly spurned, according to a CDC official who spoke on the condition of anonymity to discuss internal matters. On Wednesday, an arrangement was made for “some limited CDC involvement,” the official said.

White House officials rejected the assertion they have turned down help, pointing to the CDC epidemiologist already detailed to the White House Medical Unit. That epidemiologist is leading the White House investigation and has been in communication with agency officials, according to a senior White House official who spoke on the condition of anonymity to discuss internal deliberations.

White House officials said they have completed their investigation of the Rose Garden event celebrating the Supreme Court nomination of Amy Coney Barrett that was attended by nearly 200 people, based on photos.

The White House Medical Unit, with a staff of more than 50, has been in touch with the D.C. Department of Health and mayor’s office to report confirmed cases, the official added.

“Any positive case is taken very seriously, which is why the White House Medical Unit leads a robust contact-tracing program with CDC personnel and guidance to stop ongoing transmission,” White House spokesman Judd Deere said.

White House officials said their investigation is unlikely to find the outbreak’s source.

“There were a number of guests who have been at the White House who maybe tested negative, but then later tested positive,” White House spokesman Brian Morgenstern told reporters Wednesday. “So, it’s sort of an unknowable question as to where it entered the environment. But where do we go from here is trying to mitigate further transmission.”

Public health experts said the White House’s characterization of an “unknowable” outbreak source shows a flawed understanding of disease detection.

“Saying it’s unknowable is like saying about a murder, we won’t investigate because we might not crack the case,” said Tom Frieden, CDC director during the Obama administration. “Of course, it’s possible to figure out where and how virus spreads, especially with genetic analyses.”

Proper contact tracing is labor-intensive. Detectives must track down anyone who interacted with a confirmed case and ensure they are rapidly tested, and that anyone who is infected or exposed can safely isolate or quarantine.

Investigators would draw up a list of all known positive cases and determine when they were infectious, generally 48 hours before their first symptoms. Then they track their movements, including where they went for lunch and any hallway encounters.

“If you’re person A working in the White House, and now a dozen people who walked into the White House have become infected, did you come into contact with any of them?” the CDC official said.

Then everyone who works there has to be interviewed. If they were within six feet and had contact for more than 15 minutes with someone who tested positive, CDC recommends quarantining for 14 days.

“This is a gigantic contact investigation,” the official said. “We are talking about dozens and dozens of people, given all the events, and all the places.”

Without significant CDC involvement, public health experts said it is unlikely all those who may have become infected will be identified, putting more people at risk and making it more difficult to stem transmission.

“What’s complicated here is there was flagrant flouting of basic public health and medical guidance,” Marrazzo said, referring to the lack of mask-wearing and social distancing at the Sept. 26 Rose Garden event.

“This involves the highest levels of government,” Marrazzo said. “If you were in charge, wouldn’t you want to go back and figure out what really happened?”

The investigation of the White House outbreak could offer important lessons, said Richard Besser, president of the Robert Wood Johnson Foundation and acting CDC director during the 2009 H1N1 swine flu pandemic.

“This could be the moment that turns the pandemic around,” Besser said.

The CDC intervenes only if requested by a federal agency or state.

“The idea that we would tell the White House ‘we’re investigating you’ is just not in the cards,” Frieden, the former CDC chief, said.

The agency offered assistance to eight health departments conducting contact tracing in connection with White House or Republican National Committee events. Some still do not have all the information they need. New Jersey requested help, and the CDC has completed technical assistance. Florida, Indiana, Minnesota, Ohio, Pennsylvania, the District and New York City declined help.

On Thursday, the D.C. Department of Health released a letter — signed by nine other local health departments — urging testing for anyone who worked in the White House in the past two weeks, attended the Rose Garden event or had contact with those people.

“Given the growing numbers of positive COVID cases reported from staff working in and near the White House, people who attended the event hosted by the White House on Saturday, September 26, 2020, and our preliminary understanding that there has been limited contact tracing performed to date, there may be other staff and residents at risk for exposure to COVID positive individuals,” the letter states.

The RNC gave New Jersey officials a list of 206 people who attended a Trump fundraiser at the president’s Bedminster golf club last week but included only email addresses, worrying officials who feared that might not be sufficient to undertake a proper contact-tracing effort.

The state health department has done initial outreach to those who attended the fundraiser, New Jersey Department of Health spokeswoman Donna Leusner said. The Somerset County Health Department is focusing on the club’s staff, Leusner said.

In Minnesota, state health officials have not received a list of people who attended a private Trump fundraiser. But health department spokesman Doug Schultz said people who attended and came into contact with someone testing positive are aware of that because of media reports.

The administration’s hesitance to accept CDC’s offer comes partially from Chief of Staff Mark Meadows, who does not trust the agency, according to a senior administration official who spoke on the condition of anonymity to speak frankly.

“They think the leadership of the agency is a failure and that they’ll try to embarrass the president and his aides,” the official said Wednesday.

White House officials have not determined when — or how — the virus entered the building. They believe it could have come through a Trump International Hotel fundraiser, the Rose Garden event or a party inside the White House after the outdoor ceremony. There have been several meetings of White House staffers with differing opinions and inconclusive results, officials say.

Some who became infected, including former New Jersey governor Chris Christie (R) and former senior adviser to the president Kellyanne Conway, helped Trump prepare for last week’s debate and attended the Rose Garden event and a reception inside the White House, according to people close to them.

Some of those who had been at the White House and tested positive said they were not contacted by outbreak investigators.

Several White House staffers and other administration officials involved in the response have been furious that the White House contact-tracing effort is not more robust as the number of infections has grown, according to several current and former senior administration officials speaking on the condition of anonymity to discuss internal matters.

“How can they let the virus so easily get into the West Wing? This was avoidable,” one former senior administration official said.

On Monday, the White House Management Office emailed senior staff who regularly interact with Trump. The memo, obtained by The Washington Post, encourages staffers to “limit foot traffic on the First Floor of the West Wing as well as in the Residence,” adding that “staff should only go to the Oval Office or the Second Floor Residence when they are requested and expected.”

Alice Crites contributed to this report.

Coronavirus: What you need to know

Where do things stand? See the latest covid numbers in the U.S. and across the world. In the U.S., pandemic trends have shifted and now White people are more likely to die from covid than Black people.

The state of public health: Conservative and libertarian forces have defanged much of the nation’s public health system through legislation and litigation as the world staggers into the fourth year of covid.

Grief and the pandemic: A Washington Post reporter covered the coronavirus — and then endured the death of her mother from covid-19. She offers a window into grief and resilience.

Would we shut down again? What will the United States do the next time a deadly virus comes knocking on the door?

Vaccines: The CDC recommends that everyone age 5 and older get an updated covid booster shot. New federal data shows adults who received the updated shots cut their risk of being hospitalized with covid-19 by 50 percent. Here’s guidance on when you should get the omicron booster and how vaccine efficacy could be affected by your prior infections.

For the latest news, sign up for our free newsletter.