White House COVID outbreak grows as Midwest hospital cases surge

As the COVID-19 outbreak in the White House continues to grow, infectious disease experts expressed concern about the limited information coming from the Trump administration concerning contact tracing efforts, as well comments made by the president downplaying the dangers of the coronavirus.

Stephen Miller, a senior adviser and speechwriter for President Donald Trump, yesterday became the latest member of the administration to test positive for the coronavirus.

According to a website that's tracking all recent COVID-19 cases linked to the White House, Miller is the 35th person to be infected over the past week. He's also among seven people who participated in President Trump's Sep 27 debate preparation session who've tested positive.

The White House's efforts to inform staff members about infections and trace the contacts of those infected have been criticized. Earlier in the week, the White House declined offers from the Centers for Disease Control and Prevention (CDC) to help investigate the outbreak.

"Some of those policies that we all live by in infection control as we're trying to contain this pandemic have not, at least by appearance, been followed in the White House and in the federal government," Rochelle Walensky, MD, MPH, chief of the infectious diseases division at Massachusetts General Hospital and a professor of medicine at Harvard Medical School, said today at an Infectious Diseases Society of America media briefing.

"Given the intermittent information that we're getting, it's very hard to understand whether people are being properly quarantined, whether people are being properly isolated, and whether people are being properly contact traced," she added.

Concerns about White House personnel

Walensky also mentioned the Sep 26 Rose Garden ceremony where President Trump announced the nomination of Judge Amy Coney Barrett to the Supreme Court. While 1 people who attended that event have tested positive, Walensky said she's concerned about the people behind the scenes.

"There are over 300 people who work in the White House who might be considered White House essential personnel who might go home to places where it might be harder to find a test, harder to find quarantine, and who might live in multigenerational households," she said. "I know there's a lot of discussion about a lot of tests for people who are front and center in the White House, but many of us are really interested in what's happening in the other personnel of the White House."

In addition, Walensky noted that contact-tracing efforts should be undertaken in places the president visited in the days before his COVID-19 diagnosis, including Bedminster, New Jersey, where the Trump campaign held a fundraiser on Oct 1. "There should most definitely be contact tracing going on there," she said.

Rajesh Gandhi, MD, also a professor at Harvard Medical School and director of HIV Clinical Services and Education at Massachusetts General Hospital, addressed comments made in recent days by President Trump in which he urged Americans not to let COVID-19 dominate their lives and suggested the flu is just as dangerous.

"COVID-19 is more deadly than the flu," Gandhi said. "COVID-19 has killed more than 200,000 people in the United States in a very short period of time. Influenza…on average kills 20,000 to 40,000 people, which is way too many, but it pales compared to COVID-19."

Discussing President Trump's prognosis, Gandhi said the next few days will be critical.

"We know that after someone gets COVID-19, the first week or so after they get symptoms is the critical period of time when they can get shortness of breath and worsening oxygen levels, and so it's critical to be very vigilant during this period of time, throughout the rest of this week and early into next week," he said.

That timeline suggests the next presidential debate, scheduled for Oct 15, could be in question. The president tweeted yesterday that he's looking forward to the debate, but Democratic presidential candidate Joe Biden said that if the president is still infectious next week, the debate should not go forward.

The guidelines from the CDC say people who've been infected with COVID-19 and have symptoms should isolate for 10 days after their symptoms begin, and can go out after 10 days only if they've been fever-free for 24 hours, and other symptoms are improving. President Trump tested positive for COVID-19 on Oct 1.

In a letter posted on Twitter today by White House Press Secretary Kayleigh McEnany, the president's physician, Sean Conley, DO, said Trump has been fever-free for 4 days, symptom-free for over 24 hours, and has not needed any supplemental oxygen since his initial hospitalization.

Meanwhile, the vice presidential debate between Vice President Mike Pence and California Sen Kamala Harris will go on as scheduled tonight, though some, including Walensky, question whether Pence should be in quarantine given his close proximity to people at the Sep 26 Rose Garden ceremony who've subsequently tested positive. The candidates will be separated from each other, and the moderator, by plexiglass.

"In my mind, I believe he meets the CDC definition for quarantine," Walensky said.

Hospitalizations rising in Midwest

While the president's illness and the White House outbreak continue to dominate headlines, the surge in COVID-19 cases observed in Midwestern states in recent weeks is now being accompanied by rising hospitalization rates.

In Wisconsin today, state officials announced that they've opened a field hospital at the state fairgrounds near Milwaukee to handle the surge in COVID-19 patients needing hospitalization, the Associated Press reported.

"We hoped this day wouldn't come, but unfortunately, Wisconsin is in a much different, more dire place today and our healthcare systems are beginning to become overwhelmed by the surge of COVID-19 cases," Gov Tony Evers said.

Wisconsin currently has 853 hospitalized COVID-19 patients, its most since the pandemic began.

The coronavirus is also starting to overwhelm healthcare capacity in North Dakota. As the New York Times reports, the state has reported more COVID-19 cases per capita in the past week than any other state, and hospitals in the sparsely populated state are filling up. Across the entire state, only 39 intensive care unit beds are available.

Data analyzed by the Washington Post show that new COVID-19 cases in South Dakota rose by 27% in the last week, while hospitalizations in the state rose by 29%.

Wisconsin, North Dakota, and South Dakota are among 22 states, many of them in the Midwest, experiencing uncontrolled spread of the coronavirus, according to covidexitstrategy.org, a website that tracks each state's progress on controlling the virus. An additional 19 states are trending poorly.

The United States currently has 7,535,794 confirmed COVID-19 cases, and 211,513 deaths, according to the Johns Hopkins COVID-19 online dashboard.

NIH official steps down

In other US developments:

  • USA Today obtained a private letter from former CDC director William Foege, MD, MPH, urging current director Robert Redfield, MD, to expose the federal government's failed response to the coronavirus epidemic and the White House's rejection of science, and to orchestrate his own firing as a protest. "Don't shy away from the fact this has been an unacceptable toll on our country," Foege said in the letter. "It is a slaughter and not just a political dispute. You don't want to be seen, in the future, as forsaking your role as servant to the public in order to become a servant to a corrupt president."

  • Former Biomedical Advanced Research and Development Authority (BARDA) chief Rick Bright, PhD, stepped down from his position with the National Institutes of Health, citing continued efforts by the Trump administration to thwart his work on the nation's pandemic response, NPR reported. Bright was ousted from BARDA after raising concerns that the government was mishandling the outbreak.

  • Drug maker Eli Lilly announced today that is has submitted a request to the Food and Drug Administration for an emergency use authorization for LY-CoV555, a monoclonal antibody therapy for people diagnosed as having mild-to-moderate COVID-19.

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