Dr. Mark Kortepeter, who’s fought epidemics on multiple continents, explains what the government needs to do right now to combat the Covid-19 outbreak that’s struck the White House.
The recent news of the infection of the President, First Lady and increasing numbers of others in the White House circle is made all the more tragic knowing that it was completely predictable and preventable. But let’s move beyond that. This is a national crisis and one that is important for the nation to get past expeditiously and with as minimal fallout as is feasible.
Given my work in public health and exotic infectious diseases, I am accustomed to being on the receiving end of crisis calls from high places, including the White House. One thing one of my public health professors taught me was that when you find yourself in such a crisis, you need to throw everything you can at it as fast as possible. Drawing upon my experience managing crises, I have some thoughts on some things that need to happen right now.
First, addressing the medical care of the President and others is obviously critical, but it is important not to lose sight of what else needs to be done. This is an outbreak embedded within a pandemic, and managing an outbreak investigation is different than managing individual patient care. There are other important public health aspects that need to be addressed, and rapidly, in order to make a difference.
This is where it is critical to have trained epidemiologists to run this to ground – not the kind who sits behind a computer and crunches numbers, but the “shoe leather” epidemiologists who have experience hunting down outbreaks the way predators stalk prey, or a counterintelligence agent seeks out spies. The U.S. has some really good ones. You can find them in county, city, or state health departments, the military, or among those with field investigation experience with the CDC’s Epidemic Intelligence Service. They have stalked measles, meningitis, Ebola, and Covid-19. If they are not already on the case, I hope they are brought in soon and they are put in charge of the outbreak response.
The sooner we get a handle on who was potentially infected and who else is at risk, the sooner we can get ahead of it.
What do they need to do? It comes down to basic outbreak investigation:
1. Establish an outbreak curve by identifying and counting cases of Covid-19 among people who interacted with the people around the President. This will pinpoint the dates and times of who has thus far been infected, when they might have been contagious and when they may have exposed others.
2. Establish the progress of the outbreak. Where has the President been, what did he do, who was at the activities and events he attended, who interacted with him directly, when and where?
3. Quarantine and isolate. These two public health terms are frequently used incorrectly. Quarantine is for those who have been exposed, are not yet ill, and are being distanced from others to monitor them for signs of illness, ultimately to limit spread. Isolation is for those who are already ill or known to be infected and are brought in for care or kept out of circulation for similar reasons of limiting spread.
Until we have a handle on which critical staff have had contact with others in the White House who were potentially infected, the staff should be quarantined. The clock for keeping people under quarantine starts from the time of their last known contact with someone known or suspected to be infected and continues for 14 days.
4. Communicate. Tell people who are potentially at risk of their risk so that they can quarantine themselves and seek testing.
5. Coordinate with other public health authorities on tracking and notifying people.
6. Expect the unexpected. Given the potential for an incubation period lasting up to 14 days, this is far from over. There are more shoes to drop.
The sooner we get a handle on who was potentially infected and who else is at risk, the sooner we can get ahead of it. But it all starts with basic outbreak investigation and response.