Why the White House’s testing-only strategy to shield Trump from Covid-19 fell short

WASHINGTON — “I’m all for masks,” President Trump has said. “Masks are good.”

But the president, notoriously, has long refused to wear one on all but a few occasions. Throughout the Covid-19 pandemic, Trump has been photographed barefaced during Cabinet meetings, press briefings, flights on Air Force One, and campaign events attended by thousands of largely unmasked supporters.

Trump’s justification: Nearly everyone he comes into contact with receives a coronavirus test beforehand. “Everyone gets tested before they see me,” he said in July.

The strategy, however, fell short on Friday: Trump reported that he and his wife, Melania, had tested positive for Covid-19. The positive tests follow a week that included numerous flights to campaign rallies around the country — and to a presidential debate in Ohio at which the president’s family refused to wear masks, according to attendees, even when asked to do so by event staff.

To some public health experts, the news came as little surprise. Many have long warned that testing is inadequate as a preventive measure without other baseline mitigation strategies.

“If you told me that somebody who was only testing, not wearing their mask, not distancing, and not taking every other precautionary measure tested positive,” said Saskia Popescu, a University of Arizona epidemiology professor and biodefense expert, “I would say: No shit, Sherlock.”

For months, however, the Trump administration has done exactly that, proceeding amid a pandemic with an aggressive campaign schedule, including large events at which the president has appeared indoors, maskless, and in close proximity to other attendees. Trump has also openly mocked two basic behaviors known to stop the spread of coronavirus: mask use and social distancing.

By and large, the administration’s only precaution has been the frequent use of Abbott’s ID Now diagnostic test: West Wing staffers, guests, and reporters have been required to take rapid Covid-19 tests upon entering White House grounds, but little else. Aides have frequently appeared maskless, even in cramped indoor spaces.

Though epidemiology experts had cast doubt on the White House’s testing-only strategy since long before Trump’s positive test, health secretary Alex Azar doubled down on the Trump family’s testing-only strategy during a congressional hearing on Friday.

“Now, the first family and the protective aspect around the president is a different situation than the rest of us because of the protocols around the first family,” said Azar, the administration’s top health official. Other Americans, he added, should wear masks, practice social distancing, and wear face coverings.

The remark was the latest in a string of comments from Trump and his top advisers defending his refusal to wear a mask in public settings.

Mark Meadows, Trump’s chief of staff, was photographed this week seated indoors at a restaurant with his family without a mask. He told reporters on Friday morning that even in light of the president’s positive test, he wasn’t wearing a mask on White House grounds because he’d recently been tested.

And during Tuesday’s debate, Trump mocked his Democratic opponent in the Nov. 3 election, former Vice President Joe Biden, for his insistence on mask use during public appearances.

“I don’t wear masks like him,” Trump said. “Every time you see him, he’s got a mask. He could be speaking 200 feet away from [others] and he shows up with the biggest mask I’ve ever seen.”

Trump’s positive test is just the latest in a string of infections throughout his administration and the federal workforce dedicated to serving the president. Katie Miller, an aide to Vice President Mike Pence, tested positive for the virus in May. Numerous agents on Trump’s and Pence’s Secret Service details have also tested positive for Covid-19, in addition to an 11-agent outbreak reported this week at a training facility in Maryland.

Beyond highlighting the limitations of testing as a sole preventive strategy, Trump’s positive test also calls attention to the unreliability of the diagnostic tests themselves. For months, the White House has relied on Abbott’s ID Now Covid-19 tests, which return results within five to 15 minutes of sample collection.

Those tests have been criticized for their high detection limit — in other words, they only return positive results if individuals tested submit samples with large amounts of viral material. As a result, it’s possible that early in the course of an infection, or as an infection is waning, the test could return a “false negative” result even if its subject is still contagious.

The tests, in fact, are not authorized for use as a surveillance tool. The Food and Drug Administration even reissued the emergency authorization for the test last month to clarify its limited sensitivity. The test, the agency said, is meant for people displaying Covid-19 symptoms; it is not indicated for use by individuals who aren’t suspected to be sick but receiving tests as a precaution.

In a statement Friday, Abbott defended the sensitivity of the ID Now test, criticizing an New York University study that found the test returned high rates of false negatives.

A White House spokesman did not respond to questions about whether the administration’s testing protocol still relies on the ID Now test, which it has used for months, or a newer antigen test branded Binax Now.

Aggressive testing strategies do help to reduce the risk of Covid-19 exposure, said Ashish Jha, the dean of the Brown University School of Public Health. But he called the White House’s prevention strategy, which effectively relied on testing as its sole element, “wholly inadequate.”

“The single biggest issue is that you can be infectious and not have a positive test,” he said. “People can get tested in the morning and become infectious by the afternoon or evening, even if the test functioned effectively.”

Jha and other experts, however, stressed that Trump’s positive test is a sign that the White House’s testing protocol succeeded, not that it failed. In this case, he said, administering frequent tests with rapid results may have detected cases early and prevented additional spread.

“Trump’s just another person, and by isolating him, and by detecting early in his infection, this program is working,” said Michael Mina, an epidemiologist at Harvard’s T.H. Chan School of Public Health. “It’s stopping him from further propagating the virus in the White House.”

But given the stakes, he and Jha each expressed befuddlement at the White House’s reliance on solely testing.

“For someone as important as the president, you always need a layered protection,” Jha said. “People around him should be wearing masks. I think testing is great, and I’ve obviously been a huge advocate of it. But we should really limit the number of contacts he has, and limit the number of contacts that people who contact [Trump] have.”

The White House has clearly chosen otherwise: In the last week alone, Trump flew to Ohio for the debate, flew to North Carolina for a health care event and subsequent campaign rally, then from Florida to Georgia to Virginia (all on Sept. 25), and later to Pennsylvania, Minnesota, and New Jersey for a combination of fundraisers and campaign stops.

Trump also invited hundreds of attendees to the White House on Saturday to witness the introduction of Amy Coney Barrett, the federal judge who he has nominated to serve on the Supreme Court. Nearly every attendee was maskless for much of the event, including Sen. Mike Lee (R-Utah) and University of Notre Dame president John Jenkins, both of whom announced positive Covid-19 tests on Friday.

“It just feels like the White House hasn’t been doing that,” Jha said. “They have not taken this seriously, and that’s why we find ourselves, unfortunately, in a situation where the president is infected.”

Andrew Joseph contributed reporting.