On Wednesday, October 7, leading infectious disease experts addressed some of the policy implications of the current outbreak of COVID-19 inside the White House and among those close to President Donald Trump, in the wake of President Trump’s own infection, announced publicly very late on Thursday night, October 1, and which has dominated national news headlines for several days in a row.
The press briefing was sponsored by the Arlington, Virginia-based Infectious Diseases Society of America (IDSA), which describes himself on its website as “a community of over 12,000 physicians, scientists and public health experts who specialize in infectious diseases. Our mission is to improve the health of individuals, communities, and society by promoting excellence in patient care, education, research, public health, and prevention relating to infectious diseases.”
On Wednesday morning, Chris Busky, the IDSA’s CEO, introduced the two speakers at the press briefing: Rochelle Walensky, M.D., M.P.H., and Rajesh Gandhi, M.D. Dr. Walensky is chief of the Infectious Diseases Division at Massachusetts General Hospital, a practicing infectious diseases specialist at both Massachusetts General and Brigham & Women’s Hospital, and a professor of medicine at Harvard Medical School, all in Boston/Cambridge. And she is vice chair of IDSA’s HIV Medicine Association. Dr. Gandhi is director of HIV Clinical Services and Education at Massachusetts General Hospital, and is a member of IDSA’s COVID-19 Treatment and Management Guidelines Expert Panel.
Walensky began by stating that “There have been a lot of comments made about contact tracing and about the CDC [Centers for Disease Control and Prevention] guidelines for how we handle COVID-19 exposures. I want to be very clear: there are certain definitions we use across the nation. One is quarantine; and the duration of quarantine is 14 days, per CDC [Centers for Disease Control and Prevention] guidelines. And there’s generally no leaving quarantine based on a negative test. Another is isolation; isolation is generally for 10 days, and could be longer, based on the potential for infection. Finally,” she said, “there is contact tracing: how do you identify contacts, ask them to quarantine, and make sure they’re not infecting others? The guideline is that an exposure has taken place if a contact lasts longer than 15 minutes or occurs at a distance of less than 6 feet; and it doesn’t have to be continuous 15 minutes.”
With regard to the outbreak inside the White House, Walensky said that “Some of those policies that we live by in infection control have not been followed by the White House or by the federal government. And without transparency, it’s impossible for us to be able to understand what’s going on—whether people are being properly quarantined, isolated, or contact-traced, or not. I do want to make a comment about contact-tracing,” she added. “There’s been a lot of discussion about contact tracing involving all those who participated in the Rose Garden event,” she said, referencing the September 26 event in the Rose Garden at the White House, in which President Trump formally announced his nomination of federal Judge Amy Coney Barrett to the U.S. Supreme Court—an event that is being brought under suspicion as a potential super-spreader event. “There are a lot of people who likely merit contact tracing who might not have been seen on TV in the Rose Garden,” she said. “They’re White House personnel. They might live in multi-generational households. If we’re not fully contact-tracing people who were at events like the Rose Garden event—we have to make sure all communities have access to contact-tracing,” she urged.
“COVID-19 is really a spectrum of diseases, ranging from people who never develop symptoms, to those who develop critical illnesses,” Dr. Gandhi said. “The majority, about 80 percent, never end up in the hospital or need oxygen. About 15 percent need to go to the hospital an need oxygen. About 5 percent need a ventilator. For mild to moderate disease not yet in the hospital, a promising treatment is a single antibody or a cocktail of antibodies,” he went on. “Several companies have developed promising treatments. They’re still investigational, experimental, but they do have some promise. We know the President received a cocktail early on. Remdesivir: our panel recommends Remdesivir for people in the hospital with severe disease, meaning needing oxygen. Dexamethasone: reduces inflammation—D tamps down the inflammation in COVID, which can be severe. We at IDSA recommend that it only be given to people with severe disease. We’ve learned that the President needed dexamethasone because he needed oxygen. We know that the first week or so after a person gets symptoms is when they can get worse. And ongoing evaluation is necessary.”
Meanwhile, Gandhi added that, “COVID-19, we know, has had a disparate impact on minorities and the poor, ad we believe they and all should have access to valuable medications.” And, he said, “We think that trials must go on during the pandemic; it’s the only way to make progress. We know that from HIV. And to control a pandemic, prevention trumps treatment. We know that for all diseases, it’s better to prevent the disease than to have to prevent it.”
Journalists ask questions
Following those opening statements by Drs. Walensky and Gandhi, Chris Busky opened the virtual floor to questions from the press.
The first question: should cities and states ramp up contact-tracing measures or plan ahead for that in cities and states where there will be presidential campaign stops; and what does that look like? “I’m hopeful that by the time the President gets back on the campaign trail, he will be out of that period of needed isolation,” Walensky said. “However, with increasing disease throughout the country, there should be robust contact-tracing throughout the country, once individuals have been identified as having the disease. I think that not necessarily because President Trump or his campaign would be coming, but because there’s more disease out there. And based on the news we’re hearing that there have been exposures, such as in New Jersey; there should be contact tracing there.”
Another member of the press asked about the vice presidential debate, scheduled to take place Wednesday evening. Some have stated that President Mike Pence doesn’t yet meet the CDC’s guideline in terms of the timeframe for clearing quarantine. The journalist asked whether the Vice President should participate in the debate; and if so, what safety measures should be put in place.
“Here’s where transparency would be really helpful; all I know is what I’ve seen in the news,” Walensky said. “From the footage I’ve seen in the Rose Garden, and it suggests he was sitting within six feet [of individuals who have been infected and have tested positive for COVID-19], and longer than 15 minutes, at the event. By that standard, he would meet the definition of CDC guidance to quarantine, which means 14 days after that event, which would go beyond tonight’s event. And there’s no guidance for how you should behave if you’re not quarantined, because you should be quarantined. For Vice President Pence to actually get to the event tonight, he’ll be in contact with many people he’ll be in contact with people who will drive his cars, work his planes, and so on, and all of those people will be exposed. That’s where I find it very important to follow CDC guidelines.”
Another member of the press asked about the fact that “The President has seemed to downplay the seriousness of the disease, and flu season is coming up. How does COVID compare to the flu, ad has the death rate changed because of treatment?”
“I would say it’s really critical to understand that COVID has a vast spectrum” in terms of its presentation in patients, Gandhi said. “But it is more deadly than the flu. COVID has killed more than 200,000 people in a short period of time. Influenza kills on average 20,000-40,000 people per season, but it pales in comparison. In terms of prevention,” he continued, “there is a way to prevent influenza, which is to take the vaccine, and I would say, all of us should be running, not walking, to get that vaccine. Lastly, treatment has advanced for COVID-19, particularly with the use of Remdesivir and dexamethasone. And the antibody therapies are looking more promising for people in preventing disease from getting worse.”
What about quarantine or isolation protocols that could be taken inside the White House, now that so many infections have occurred among White House staffers, and that the White House has not agreed to do contact tracing? “There are maybe up to 18 who have been infected,” Walensky said. “They should not be there in person, share meals or quarters. They should be wearing masks, eyewear, gowns, gloves. If anyone in isolation… they should be in a mask if with someone. Anyone exposed should be in a 14-day quarantine, regardless of tests.”
Another member of the press asked what diagnostic technologies are available for assessing whether a known COVID patient remains infectious. “One is testing to see whether the virus has cleared” in a patient, Gandhi said. “The problem with the PCR test,” from the Laboratory Corporation of America, he said, “is that we know it can stay positive for weeks or even months. So that’s why the CDC has moved towards the guideline that if you have mild to moderate disease, 10 days from the onset of symptoms and improvement of symptoms, and no fever for 24 hours without use of fever-reducing medicine; because the tests just haven’t held up.”
What about the issue of the White House’s having broken the public trust through the refusal to provide clear, truthful information about President Trump’s condition in the past week, and the refusal to disclose what actions are being taken inside the White House right now in terms of infection control? Another journalist asked.
“I think this is the greatest uncertainty we’ve faced, beyond living memory,” Gandhi stated, referring to the COVID-19 pandemic in general. “That’s where a clear and consistent message is needed: transparency, clear information, coordinated responses. I would say in the time of uncertainty we’re in, we need transparency, and a consistent, coordinated message.”
“I completely agree; public trust is going to be key,” Walensky added. “Even over the last several months, there have been challenges in the White House, and even more with the FDA [Food and Drug Administration] and CDC, and that could do damage, because we need for the science to lead the way. So I would echo about the public trust issue.”
“Dr. Walensky and I cut our professional teeth on the HIV epidemic,” Gandhi added. “And once we had a coordinated response, trials, comparative studies, we made progress, and we’ve made immense progress with HIV. We can get there with COVID-19, but we’ve got to do it the same way: trust the scientists, trust those who have been there before, the FDA, the CDC and the NIH”—National Institutes of Health.
“There’s a famous saying in the infectious diseases world: vaccines don’t save lives, vaccinations do, and vaccinations require trust,” Walensky added.