This story was updated Oct. 4 at 6:03 p.m.
Oct. 2, 2020 -- Tracing the contacts of President Donald Trump and First Lady Melania Trump after both tested positive for COVID-19 last week is now becoming a much larger effort than originally believed.
Contact tracing "could easily approach 1,000 at least," Georges Benjamin, MD, executive director of the American Public Health Association, says. He based that estimate Sunday on the number of people in close contact who attended the White House Rose Garden announcement of Supreme Court nominee Amy Coney Barrett, the presidential debate in Cleveland, the golf club fundraiser in New Jersey and now the families and staff of the known members of Congress who have tested positive.
Late last week, Benjamin and other experts had estimated that 100 or possibly hundreds would need to be tracked down to inform them of exposures of the president, first lady and others. But as more people tested positive, that number rapidly grew.
Former White House counselor Kellyanne Conway and three U.S. senators who attended the Rose Garden event are now positive, and at least 11 people connected with the debate on Tuesday in Cleveland have also tested positive.
So have three unnamed White House reporters, a personal assistant to the president, an unnamed White House staffer and the President of Notre Dame, Fr. John Jenkins.
Former New Jersey Gov. Chris Christie, who also tested positive, checked into a hospital Saturday afternoon as a precaution, CNN reported.
Ohio Gov. Mike DeWine is waiting for information about contact tracing, he told CNN’s Jake Tapper on his Sunday morning State of the Union show. Tapper tweeted: "MikeDeWine tells me that even though Trump (and others on his team) were likely infected when in Ohio Tuesday, the White House didn't call to let him know they tested positive. Nor have they reached out to him to contact trace to find Ohioans possibly exposed by POTUS.
The Cleveland Clinic issued a statement on Twitter saying none of those people accessed the debate hall. All were either members of the media or worked setting up the debate hall days in advance. Nobody was allowed into the debate hall until they had a negative test, the Cleveland Clinic said.
Calculating how many people will need to be traced will depend on when the Trumps became infected. At a White House news conference Friday, chief of staff Mark Meadows said Hicks’s positive diagnosis was known before Marine One, the president’s helicopter, departed Thursday as Trump headed to New Jersey for a fundraiser.
On Thursday, some staffers were pulled from the flight, which raised more questions about why the trip to the fundraiser proceeded. As many as 300 people attended the fundraiser at Trump’s golf club.
"I would have expected him to stand down and find some excuse to not go or to do it virtually," Benjamin said last week. Because the president had remained negative for COVID up to that point, despite close contact with many people who had tested positive, "he may have had a false sense of security," Benjamin says. The better option, he says, would have been to quarantine.
Kayleigh McEnany, the White House press secretary, told reporters Friday afternoon that it was "deemed safe" for Trump to travel to the Bedminster event on Thursday.
“White House operations made the assessment it was safe for the president, in consultation with others,” she said and then walked away without giving other details.
Before the New Jersey event, Trump's schedule was also busy. Among other events, he had been in Cleveland for the debate and an outdoor rally in Minnesota attended by about 3,000 people. He also had ongoing meetings with Barrett after the announcement of her nomination last Saturday.
"The contact-tracing process is under way,” said New Jersey Gov. Phil Murphy. “We urge everyone who attended yesterday's event in Bedminster to take full precautions, including self-quarantining and getting tested."
On Sunday, CBS News reported that the White House sent the names of more than 200 people who attended events in Bedminster to Somerset County authorities. The New Jersey Department of Health is reaching out to these indviduals and the federal government is also involved, the agency told CBS.
In Washington, testing was underway Friday of Cabinet members, family, and others who had been in close contact with Trump. Among those who tested negative include Vice President Mike Pence; Treasury Secretary Steven Mnuchin; and the president’s daughter Ivanka Trump and her husband, Jared Kushner.
In Ohio, the city of Cleveland is working with the Ohio Department of Health, the CDC and the Cleveland Clinic on contract tracing after the debate.
Ashish K. Jha, MD, dean of the Brown University School of Public Health, says people who attended a rally and were more than 100 yards away, or people on a plane but not nearby, likely don’t need to worry.
"But anybody who was in close contact with him for any extended period of time needs to be identified and quarantined and probably tested.” Jha told NPR.
When Did Infection Occur?
Public health experts can only speculate as to when the president became infected, which would affect the number of people who should be contacted.
In a Friday Twitter thread, Jha said it is "reasonable" to assume that Trump was infected between Saturday and Monday, although it could have been earlier.
According to Benjamin, "3 to 5 days after exposure is usually when a test turns positive, although it can be earlier." It depends on how much virus the person carries, as well as how accurate the test is. He speculated that "he got infected sometime between Saturday and Thursday."
They would also need to know when he had his last negative test and when exactly his symptoms started, says Amesh Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security.
Deciding how many people will need to be contact traced "depends on significant exposures," says Adalja. That is generally defined as being within 6 feet of someone infected for 15 minutes or longer with no mask. The contact tracing after Trump's diagnosis "will probably go broader" than that, he says.
As for how many people need to be contacted, "It could be over 100," Adalja says
Benjamin says "it's going to be hundreds."
Jha says anyone who was near Hicks starting Monday or Trump beginning Tuesday should quarantine, and anyone near the president from Saturday on should be tested.
In a statement, the Department of Health in Somerset County, NJ, says it has reached out to Trump National Golf Course with a request for lists of event participants and facility staff at the Thursday event to identify those who may have come in close contact with people who tested positive.
Anyone who attended the rally in New Jersey on Thursday should be tested, according to Valerie Fitzhugh, MD, interim chair of pathology at Rutgers New Jersey Medical School and Rutgers Robert Wood Johnson Medical School. "Some of them could test positive as early as today or tomorrow, particularly if they are symptomatic."
That may be overkill, Benjamin says. "If someone was in the back, the likelihood of infection is low," he says. Better, he says, to advise anyone to monitor themselves for symptoms and talk to their health care provider if symptoms appear or if they have concerns.
Ralph Ellis contributed to this report.