Coronavirus flourishes where Donald Trump spends much of his time: indoors

On Saturday, President Donald Trump met with Justice Amy Coney Barrett, the Supreme Court nominee, and others in the Oval Office. On Tuesday he debated with former Vice President Joe Biden in an indoor room, without a mask, speaking at high volume and often without pause.

On Wednesday, Trump flew to and from Minnesota on Air Force One along with dozens of others. On Thursday, the president appeared inside before hundreds of supporters at a golf club in Bedminster, New Jersey.

On none of these occasions did the president wear a mask. Often there were not many in the room or on the plane with him either. Still, conditions like these are a recipe for so-called super-spread events, in which a single infected person transmits the virus to dozens of others, research has shown.

“The White House has been breaking basic public health rules for a long time,” said Dr. Ashish Jha, dean of the Brown University School of Public Health in Providence, Rhode Island. Regarding the president’s diagnosis that he was infected with the coronavirus, he added: “There are no surprises here.”

The problem is one that scientists have been warning about for months: airborne transmission. In addition to the heavy droplets that infected people sneeze or cough, research has shown that the coronavirus can float in the air indoors, held in the air in tiny particles called aerosols.

Now, the White House is trying to determine exactly who had contact with Trump in recent days, and to whom these people, in turn, may have transmitted the virus. Potential contacts can number in the hundreds.

All of these people will need to be identified, tested and quarantined. “Instead of looking for a needle in a haystack, it’s like Trump is the needle, and you’re trying to figure out if she touched every piece of hay,” said Angela Rasmussen, a virologist at Columbia University in New York.

Experts may never know how the president got infected or who he may have infected. The Rev. John Jenkins, president of the University of Notre Dame, tested positive for the coronavirus after attending a ceremony at the White House on Saturday for Barrett. So did Senator Mike Lee, R-Utah.

The timing raises the possibility that the president was infected over the weekend, the scientists said. Most people develop symptoms about five days after being infected with the virus, so exposure over the weekend would fit with reports that the president was showing early symptoms on Wednesday and Thursday.

People are believed to be most contagious to others a day or two before symptoms appear.

“We know that presymptomatic transmission drives a significant amount of spread of this virus,” Rasmussen said. “The bottom line is that you can catch it before you know you’re sick.”

The presidential debate, in particular, resembles other indoor events in which widespread transmission has been documented: a gathering in a contained environment in which an infected person is talking, coughing, or even singing near other people.

Biden tested negative for the virus on Friday. Still, given that Biden was recently exposed, “he should quarantine himself and get tested again,” Rasmussen said. (Biden said he would go ahead with a campaign event in Michigan planned for Friday.)

Others in the debating hall may have been at risk as well.

The aerosols are expelled when people speak, shout, sing or breathe. The longer an infected person is indoors, the greater the risk. Trump was in the debating room for at least 90 minutes.

“He talked a lot, he yelled a lot,” said Linsey Marr, an airborne disease transmission expert at Virginia Tech in Blacksburg, Virginia.

The president and Biden were on lecterns more than six feet apart in the debate. At that distance, Biden could have had protection against the largest respiratory droplets released by the president, but not against the aerosols that linger in the air.

Indoors, aerosols can travel more than 6 feet. In August, for example, scientists reported that they had successfully isolated live virus from aerosols collected eight feet away from an infected patient in a hospital.

Marr compared the aerosols released by talking or yelling to cigarette smoke. People closest to the smoker, such as Biden and the moderator, Chris Wallace (who planned to run a test Monday), would have been exposed first.

But over time, the smoke in a poorly ventilated room will travel throughout the space, reaching even those far away.

Anyone who covered their face would be at least partially protected from the virus. But most of Trump’s family members and associates did not wear a mask during the debate, despite requests from the venue’s hosts, the Cleveland Clinic, to do so.

“Now the question is, what is ventilation?” Marr said.

Representatives for the Cleveland Clinic did not immediately respond to requests for information about ventilation in the discussion room, the location of the lecterns and other details that may influence whether the president may have infected others.

In a prepared statement, Halle Bishop Weston, a spokeswoman for the Cleveland Clinic, said Trump, Biden and the people traveling with them had been tested for the virus in their campaigns and said to be negative. Everyone who entered the debating room tested negative for the virus, he added.

Safety measures in the debate aligned with the Centers for Disease Control and Prevention guidelines and included “social distancing, hand sanitizing, temperature controls and masking,” the statement said.

The discussion took place in a large space with high ceilings, “so there is a lot of air in which the infectious aerosol could be dispersed and diluted,” said William Bahnfleth, an architectural engineering expert at Penn State University in University Park, Pennsylvania.

“I imagine that the increased risk in this event was due to some of the participants not masking or distancing themselves,” he added. “The First Lady would have been in the place most likely to pose a risk to others in the audience.” (Melania Trump also tested positive for the coronavirus, according to an announcement early Friday.)

Several members of the Trump family did not wear masks for much of the debate. And experts pointed out that inadequate ventilation could have encouraged the spread of the virus.

“This is something to keep in mind in every indoor setting, whether it’s schools, offices, or no doubt at a high-profile event like this,” said Joseph Allen, a building security expert at the School of Health. Public TH Chan of Harvard. .

Ventilation becomes especially important when many people are together with an infected person for a long period of time.

“That’s exactly what we had in the debate,” Allen said. “The president was speaking often and loudly for the entire hour and a half.”

In addition to the debate, the president likely spent time with his inner circle in other rooms, Allen added.

The CDC has not fully recognized the risk of indoor airborne transmission of the virus, beyond indirect nods to the importance of ventilation in schools and businesses.

On September 18, the CDC released a new version of its guide on how the virus spreads that recognized the importance of aerosols and said that inhaling the virus was the primary way the virus was transmitted.

Before that, the agency had emphasized hand hygiene, wearing face coverings, and keeping 6 feet of clearance as the main ways people protect themselves.

The version released on September 18 also said that indoors, “there is increasing evidence that airborne droplets and particles can remain suspended in the air and be inhaled by others, and travel distances greater than six feet ( for example, during choir practice, in restaurants, or in fitness classes) “.

But that guide was removed from the agency’s site three days later and replaced with a document that no longer mentioned aerosols or airborne transmission. At the time, CDC officials said the revised document had been published in error and had not yet been approved by rigorous scientific review.

But given the many recent reports of meddling by the White House and the administration in CDC science, some public health experts feared the agency had been ordered to reverse recognition of the aerosols and airborne transmission of the coronavirus.

Apoorva Mandavilli c.2020 The New York Times Company