The Morning Jolt

White House

Trump’s Return to the White House

President Donald Trump walks out the front doors of Walter Reed National Military Medical Center after a fourth day of treatment for the coronavirus in Bethesda, Md., October 5, 2020. (Jonathan Ernst/Reuters)

On the menu today: The president returns to the White House and boasts that he led despite the risks; contract-tracing efforts within the White House appear to be minimal or nonexistent; and the president assures the nation, “don’t be afraid of it. You’re going to beat it. We have the best medical equipment. We have the best medicines, all developed recently.”

‘Maybe I’m Immune’

The president, in a video recorded at the White House last night: “I knew there’s danger to it, but I had to do it. I stood out front. I led. Nobody that’s a leader would not do what I did. And I know there’s a risk. There’s a danger, but that’s okay. And now I’m better. And maybe I’m immune, I don’t know.”

The generous interpretation is that Trump is saying that now that he has the virus, he will be immune to reinfection in the future — at least for a while. The less generous interpretation is that when he says, “maybe I’m immune,” he has convinced himself that he was never in much real danger.

At some point in the past week, the president of the United States was infected with SARS-CoV-2. We don’t know when, in part because White House officials and the president’s doctor steadfastly refuse to disclose the date of the president’s last negative test. This is ominous, because back in July, White House press secretary Kayleigh McEnany told us the president is “tested more than anyone, multiple times a day.” If he really is being tested multiple times a day — or even once a day — we should be able to narrow down the window of his infection to a 24-hour period or less. If he’s not being tested once a day, then the president is being reckless, and his staff is lying to the public about this basic matter of the president’s protection from a contagious and deadly virus.

The other possibility is that they don’t want to disclose the date of the president’s last negative test because they are indeed testing every day and the last negative test was not Thursday.

The president’s infection was disclosed at 1 a.m. Friday. Last week, the president attended the presidential debate Tuesday, an indoor private fundraiser and an outdoor rally in Minnesota on Wednesday, and a private fundraiser at his resort in Westminster, N.J., on Thursday. At some point in that week, a test of the president came back positive, and it’s possible this development didn’t send everyone around the president to red alert.

The cluster of cases among attendees of the Rose Garden ceremony for the nomination of Judge Amy Coney Barrett to the Supreme Court on Saturday, September 26, suggests that the president may well have caught the virus at that event — even though all guests were supposed to be screened for the virus beforehand.

As the NR editors observe, “The White House believed that it could dispense with masks because it has a regime of daily testing. We now know the virus can slip through even frequently administered tests (and it turns out the tests used by the White House were prone to false negatives).”

As noted, false positives are pretty rare and usually involve lab errors and cross-contamination. But false negatives aren’t so rare, and this weekend, FDA commissioner doctor Scott Gottlieb pointed out that a system designed to protect the president that is reliant on one instant test, is going to fall apart after a false negative:

The Abbott test is a very good test when used appropriately. You have to fit the right test to the right purpose. The White House was relying almost solely on testing as a way to protect the President. They needed a zero-fail testing protocol because they weren’t taking any precautions beyond testing people who are going to be in contact with the President. And that requires multiple layers of testing. If you want a — something close to a zero-fail testing protocol, and you’re never going to be able to achieve a hundred percent, you would probably be needing to use a PCR-based test at the point of entry at the White House. So the Cepheid GeneXpert probably would be more fit to purpose. But, frankly, you’d need double layers of testing. You’d probably want to test people before they depart for the White House and then test them again when they arrive. And even that wouldn’t be a hundred percent, but it would get you closer. Using these kinds of tests — and they’re now using the Binax as well as — the antigen-based tests  and– and the Abbott ID NOW, using that to screen an asymptomatic population to try to detect virus, you might only have fifty percent sensitivity –, perhaps, a little bit better than that.

The possibility that the president (and others) caught the virus at the Barrett ceremony is particularly ominous because those infected with coronavirus can become contagious “two to three days before symptoms start and are most contagious one to two days before they feel sick.” Symptoms usually show up five days after infection, but they can appear anywhere from two to 14 days after infection.

Yet the White House is not doing contact tracing for the Rose Garden ceremony . . .

The White House has decided not to trace the contacts of guests and staff members at the Rose Garden celebration 10 days ago for Judge Amy Coney Barrett, where at least eight people, including the president, may have become infected, according to a White House official familiar with the plans.

And it’s not clear that the White House is doing much contact tracing at all:

Dr. Sean Conley, the White House physician, told reporters on Saturday that his team was working with the agency to trace contacts. But according to the federal official, while the C.D.C. had a team of experts on standby to help the White House, it has not been approached to do so.

In an interview Sunday on the CBS program “Face the Nation,” Dr. Scott Gottlieb, a former commissioner of the Food and Drug Administration, also offered evidence suggesting that no robust contact tracing effort was underway. Dr. Gottlieb said he had spoken to several officials who attended the Rose Garden event and who had not been spoken to by any contact tracers.

“I think they have an obligation to understand how the infection was introduced into that environment,” he said of the White House. “There doesn’t seem to be a very concerted effort underway.”

It’s easy to imagine other administrations launching a contact-tracing effort and getting poorly executed, delayed, or muddled and incomplete results. This administration does not appear to be even trying.

As far as excuses go, “the president is poorly served by his staff” is a good one because it often has the advantage of being accurate. It is not reasonable to expect Trump to direct the contact-tracing effort from Walter Reed or his private residence. But he did hire all of these people.

“Maybe I’m immune.”

According to White House physician Dr. Sean Conley, by Friday afternoon, “the President had a high fever and his oxygen saturation was transiently dipping below 94 percent.” The president was given oxygen. On Friday afternoon, Conley said in a White House letter that Trump received “a monoclonal antibody cocktail — an investigational immune system treatment from the biotechnology company Regeneron — and had taken zinc, vitamin D, the heartburn drug famotidine, melatonin and a daily aspirin.”

The situation was serious enough to spur the decision to move him to Walter Reed National Military Medical Center.

On Saturday, “there was another episode where [the president’s oxygen saturation] dropped down to about 93 percent,” and Trump’s physicians decided to give him the corticosteroid drug dexamethasone, which has been shown to help coronavirus patients and is typically given to patients on supplemental oxygen or ventilation.

Monday, shortly before the president returned to the White House, Conley declared the president “may not be entirely out of the woods yet.”

“Maybe I’m immune.”

In last night’s video, Trump declared, “I could have left two days ago. Two days ago, I felt great, like better than I have in a long time. I said just recently, better than 20 years ago.”

Ah, Donald Trump. It’s not enough for him to tell us he’s feeling better or recovering well; he needs to go that extra mile and insist that after three days of hospitalization, a high fever, and low oxygenation, he feels better than he did at age 54. I’m not going to engage in Zapruder-film-level analysis of the footage of President Trump on the White House balcony last night, but it wouldn’t surprise me if he was experiencing shortness of breath or pain. He’s still fighting off a serious virus!

“Maybe I’m immune.”

The president also told the nation, “don’t be afraid of it. You’re going to beat it. We have the best medical equipment. We have the best medicines, all developed recently. And you’re going to beat it.”

He has access to the best doctors, the best medical equipment, and the best medicines, including experimental treatments. Not everyone else in America or the world has the same.

ADDENDUM: In case you missed it yesterday, Pennsylvania Republican senator Pat Toomey says that this term in the Senate will be his last, and that he won’t run for governor or any other office. I’m starting to miss him already.

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