The Trump administration’s resistance to contact tracing since the president tested positive for Covid-19 reflects a calculation that there’s little political upside in highlighting this close to the election the number of people at the pinnacle of US power potentially exposed to the virus by him, say health experts and political analysts.
Masks and contact tracing – used effectively in China, Taiwan, South Korea, Singapore and elsewhere – are proven tools in breaking the chain of infection in lieu of a vaccine, medical experts say. But their success can depend on many other factors.
Public health experts have traditionally focused on the profile of the virus and therapies to combat it.
Get the latest insights and analysis from our Global Impact newsletter on the big stories originating in China.
“But it turns out the most important thing in fighting it seems to be effective political leadership, and in the US we don’t have that,” said Ronald Waldman, a global health professor at George Washington University and former investigator at the US Centres for Disease Control and Prevention (CDC). “If your primary priority is getting elected, that’s great for the virus.”
Analysts say President Donald Trump and aides appears to have concluded that robust tracing of hundreds, even thousands, placed at risk by his inner circle would only spotlight the virulence of a disease he has repeatedly downplayed, claimed would disappear or decried as a hoax.
It also could highlight his controversial policies and behaviour, and the particular vulnerability of top Republicans central to his legacy and re-election effort, they add, hardly a good look for a president losing support in the polls.
“From the White House point of view, it probably doesn’t make sense to pursue contact tracing,” said Charles Franklin, director of the Marquette Law School Poll. “A stricter testing regime risks showing second- and third-order infections. That’s not something you want to expose.”
But the president’s doctors’ and spin doctors’ apparent disregard for the basics of crisis management – disclose bad news fast and fully – has have been badly undercut by a drumbeat of daily headlines detailing new infections and quarantines hitting the White House, Congress, the Pentagon, presidential press corps and Secret Service.
Among the latest, the US Marine Corps’ No 2 general, Gary Thomas, said on Thursday that he had tested positive after huddling with top military leaders a week earlier.
This drip drip of news not only ensures that public attention remains intently focused on Trump’s management of the disease until the November 3 election. It also hampers the ability of top advisers to carry out policy or craft damage control as they increasingly worry about their own health.
“Everyone is going to make the comparison between, can he deal with the crisis in his own house, or the White House, and his ability to control things outside,” said Bethany Albertson, a political psychologist with the University of Texas at Austin.
“If I’m giving them advice, I would tell them to get on top of the crisis, that it’s better to have it come from them. But the continued trickle of cases, it’s not even a trickle but a tsunami, makes it much harder for voters to trust him.”
Underscoring the point, some 26 recent cases of Covid-19 at the top reaches of the US government exceeds Taiwan’s eight new cases within the past week and New Zealand’s three, combined.
Any hope for checking the embarrassing spread of elite infections comes as doctors and administration officials repeatedly sidestep questions about contact tracing, how often Trump was tested and when he last tested negative.
“I’m not going to go into that,” Trump’s lead doctor, Sean Conley, said on Saturday. “I don’t want to go backwards,” he added on Sunday, explaining that he wasn’t directly involved in contact tracing.
But as Juliette Kayyem, a senior lecturer in international security at Harvard’s Kennedy School, pointed out: “Backwards is literally the point. Is there another kind of tracing?”
The White House said it has traced those who remained within six feet of Trump for at least 15 minutes during the 48 hours before Trump’s announced infection, without providing details.
The New York Times, citing sources, said this was done by email rather than by phone, considered more effective, while CNN said on Tuesday that White House employees received emails that “all contact tracing” was completed.
“At this point, we should assume anything they tell us on Covid-19 protocols is a lie, with the burden of proof on them to prove it’s true,” said Kayyem, who served in the Department of Homeland Security during the H1N1 pandemic in 2009.
“The entire structure meant to defend us has been at the whim of an individual who has not wanted to admit this was going to affect his presidency, even though it’s led to over 200,000 deaths.”
Trump supporters, including Tamara Fryziuk, a cardiac nurse in front of the Walter Reed military hospital on Sunday hoping to bolster the president’s spirits, said the pandemic would have killed 3 million people without his leadership. “He did everything he could for us,” she said.
Another reason the administration may shun aggressive contact tracing is the risk it could identify Trump as the superspreader who infected others rather than as a victim, said Kayyem. Trump initially suggested he caught the virus from aide Hope Hicks, then intimated on Thursday it might have been from Gold Star families.
“They all came in,” he said on Fox Business, adding that in meetings with family members of US war dead, they “come within an inch of my face, sometimes”.
The White House has expressed little interest in mapping infection pathways. “The purpose is to mitigate further transmission of the virus, it’s not to go back and identify patient zero,” spokesman Brian Morgenstern said on Wednesday. “It's sort of an unknowable question.”
Biden said on Tuesday that masks, social distancing and contact tracing shouldn’t be politicised. “It isn't a political statement. It is a science-based decision,” he said.
In sharp contrast to the White House response, the Pentagon said on Tuesday that it was “conducting additional contact tracing and taking appropriate precautions to protect the force and the mission”.
Asian nations have used Covid-19 tracing effectively, led by Taiwan, which is helped by having a vice-president who is also an epidemiologist, Chen Chien-jen. But even the best examples underscore how small blind spots can backfire, experts said.
Singapore contained infections until an outbreak among migrant workers it had largely ignored. And South Korea did well until outbreaks among a religious group and at nightclubs during a May holiday.
Contact tracing works and has been used for centuries, health experts said. In the early 1800s, officials tracked smallpox patients after a vaccine was discovered.
A century later, investigators quarantined asymptomatic cook “Typhoid Mary” Malone by tracking the employers she had infected. And starting in the 1920s, it was used to check venereal disease, with “upstanding patients” identified by code while poor patients or prostitutes were identified by name.
Even as phone apps replace shoe leather, the basic principle remains the same, experts said. Tracing has even been employed to stem tit-for-tat gun violence by Gary Slutkin, a doctor who spent decades battling disease in Africa.
“You figure out who the people are and try to intervene,” said Waldman, who once swam across a Bangladesh river to trace smallpox victims. “You want to break the chain.”
Under repeated questioning, doctors and administration officials said the White House medical unit, in collaboration with the CDC and local and state health departments, conducted contact tracing as needed under CDC guidelines.
But Trump and top administration officials have frequently ignored, played down or appeared to undercut their own CDC guidelines.
The mayor of Washington, Muriel Bowser, said this week that the administration has not been particularly cooperative since the White House reception on September 26 that is considered a likely superspreader event. Washington this week saw its largest one-day spike since June, and the White House is now the city’s biggest hotspot.
“We have reached out to the White House on a couple of different levels, a political level and a public health level,” Bowser said, adding that a city health department representative “had a very cursory conversation that we don’t consider a substantial contact.”
But the city’s leverage may be limited since it lacks jurisdiction over federal property. For months, the administration has defied local restrictions on wearing masks and hosting large gatherings. Many of those recently infected in Trump’s circle, including debate adviser Kellyanne Conway, live in Washington.
Beyond Trump’s evident personal dislike of masks, social distancing, testing and contact tracing – steps that ironically could accelerate an economy recovery and bolster his political fortunes – is the example he sets, health experts said.
Last week, Senator Chuck Grassley, a Republican from Iowa, pointedly refused to get tested despite coming in contact with another senator who subsequently tested positive.
“Words matter,” said Waldman. “I cannot emphasise enough the importance of having trust in authorities, and he’s done everything he can to undermine trust.”
While Trump’s delayed response, mixed messaging, deflections and denials have fuelled disjointed policy, structural factors also play a part, analysts said, especially the relative independence of US states under federalism. “You’ve seen more of a cacophony across states,” said Franklin.
Ultimately, any effort by Trump advisers to control the damage politically, let alone medically, even as early voting has already seen more than 5 million people cast their ballots, depends on cooperation from the candidate.
“Anything they do, with tracing or not doing tracing, is likely to be overshadowed by the next presidential tweet, or video, or how he suddenly decides to go to Oval Office” while infected, said Franklin.
“As with most of the Trump administration, so much ultimately rests in the hands of the president and what he says and what he does.”
More from South China Morning Post:
- A wave of polls paints a dire picture for Donald Trump
- Donald Trump returns to a West Wing ghost town
- Coronavirus in the White House: who in Donald Trump’s orbit tested positive
This article White House, a coronavirus hotspot, is cold on contact tracing despite Donald Trump’s Covid-19 diagnosis first appeared on South China Morning Post