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Inside the flawed White House testing scheme that failed to protect Trump

U.S. President Donald Trump and Vice President Mike Pence
U.S. President Donald Trump and Vice President Mike Pence

U.S. President Donald Trump and Vice President Mike Pence Drew Angerer/Getty Images

President Donald Trump’s COVID-19 diagnosis is raising fresh questions about the White House’s strategy for testing and containing the virus for a president whose cavalier attitude about the coronavirus has persisted since it landed on American shores.

The president has said others are tested before getting close to him, appearing to hold it as an iron shield of safety. He has largely eschewed mask-wearing and social distancing in meetings, travel and public events, while holding rallies for thousands of often maskless supporters. 

The Trump administration has increasingly pinned its coronavirus testing strategy for the nation on antigen tests, which do not need a traditional lab for processing and quickly return results to patients. But the results are less accurate than those of the slower PCR tests. 

An early Abbott test used by the White House was plagued with problems, with multiple researchers finding that it was less accurate than rival companies’ tests in picking up positive cases. But the new antigen test the White House is using has not been independently evaluated for accuracy and reliability. Moreover, the Trump administration recently shipped antigen tests from Abbott and other manufacturers to thousands of nursing homes to test residents and staff.

Testing “isn’t a ‘get out of jail free card,'” said Dr. Alan Wells, medical director of clinical labs at the University of Pittsburgh Medical Center and creator of its test for the novel coronavirus. In general, antigen tests can miss up to half the cases that are detected by polymerase chain reaction tests, depending on the population of patients tested, he said.

The White House said the president’s diagnosis was confirmed with a PCR test but declined to say which test delivered his initial result. The White House has been using a new antigen test from Abbott Laboratories to screen its staff for COVID-19, according to two administration officials. 

The test, known as BinaxNOW, received an emergency use authorization from the Food and Drug Administration in August. It produces results in 15 minutes. Yet little is independently known about how effective it is. According to the company, the test is 97% accurate in detecting positives and 98.5% accurate in identifying those without disease. Abbott’s stated performance of its antigen test was based on examining people within seven days of COVID symptoms appearing.

The president and first lady have both had symptoms, according to White House chief of staff Mark Meadows and the first lady’s Twitter account. The president was admitted to Walter Reed National Military Medical Center on Friday evening “out of an abundance of caution,” White House press secretary Kayleigh McEnany said in a statement.

Vice President Mike Pence is also tested daily for the virus and tested negative, spokesperson Devin O’Malley said Friday, but he did not respond to a follow-up question about which test was used.

Trump heavily promoted another Abbott rapid testing device, the

Why Trump’s testing strategy failed him

“They had this false belief that testing would suffice — and it was clearly just wrong,” said New York University bioethicist Arthur Caplan.

Just this Monday, Trump in a Rose Garden announcement touted his administration’s plans to distribute 100 million rapid coronavirus tests to states by the end of the year, claiming they would help schools and economies open “immediately and as fast as they can” as he took a swipe at state restrictions.

“Lockdowns can be very harmful, and we have too many states that are locked down right now,” Trump said at the time. “The governors are — nobody knows what the governors are doing, actually.”

Trump has often bragged about the scope of the country’s testing regime. More than 900,000 coronavirus tests are now administered nationwide each day, which is more than this summer but still short of where experts say the country needs to safely reopen. Daily new cases are hovering around 40,000, and a rapidly approaching flu season could vastly complicate the health crisis in the months ahead, infectious disease experts have warned.

The president has also sent mixed signals on testing, at times blaming them, inaccurately, for an alarming spike in cases. He infamously told a rally in Tulsa, Okla., this summer that he ordered his administration to slow down testing, although health officials later said they never received those instructions.

Testing only provides a snapshot of a person’s infection status, and it may not even detect cases in which patients aren’t showing symptoms. That’s why public health experts preach social distancing, mask wearing, hand washing and disinfecting as effective tools to curb the virus spread.

“There are a few problems with relying on testing as an exclusive strategy,” said Holly Fernandez-Lynch, a medical ethics professor at the Perelman School of Medicine at the University of Pennsylvania. There is a gap between testing and receiving results, leaving a window to infect others if a person does not isolate. It’s also possible for an infected person to not have enough viral material to trigger a positive result while still having the ability to spread the disease to others.

“These delays are why people are encouraged to quarantine if they think they may have been exposed, rather than waiting for confirmation of infection,” Fernandez-Lynch said. “It’s also why social distancing and mask wearing are so important.”

On these measures, Trump’s record is spotty. Trump himself has rarely worn a mask, often questioned their utility and mocked his opponent, Democratic presidential nominee Joe Biden, for his regular mask wearing.

Trump has also flouted social distancing guidelines in campaign rallies, a jam-packed Rose Garden address to the Republican National Convention this summer, and most recently, last Saturday’s announcement of his nominee to the Supreme Court, Amy Coney Barrett, which is seen as a potential source for an outbreak among Republican officials. Masks have been scarce at these events, and White House aides aren’t required to wear face coverings.

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New Jersey Veterans Homes Likely Failed to Acknowledge Covid-19 as Cause in Dozens of Deaths, Officials Say

A state-run nursing home for veterans in New Jersey failed to attribute nearly 40% of its likely Covid-19 deaths to the virus, according to the state’s own Department of Health.

The Menlo Park Veterans Memorial Home, in Edison, N.J., attributed 62 deaths to the new coronavirus on the website of the state’s veterans’ affairs agency. But a Department of Health spokeswoman, Nancy Kearney, said late Wednesday that an additional 39 people probably died from the virus at the facility during a wave of infections there.

Another state-run veterans home, in Paramus, N.J., also likely had more Covid-19 deaths than the total it attributed to the virus, Ms. Kearney said. The likely undercount at the two facilities, among the deadliest in the state for the virus, was first reported by The Wall Street Journal.

The findings show how publicly reported nursing home mortality figures can fail to reflect the true toll the pandemic has taken on the facilities, which are home to some of the most virus-vulnerable people in the country.

A spokesman for the New Jersey Department of Military and Veterans Affairs, Kryn Westhoven, in a statement released Wednesday, said his agency “mourns each and every veteran that passes away in our Memorial homes…. Much like other long-term care facilities across the state and country, Covid-19 created unprecedented circumstances and demands within our veterans memorial homes. During this time, all deaths were reported to the Department of Health.”

The New Jersey Veterans Home at Paramus, another state-run home for former members of the U.S. military, originally reported 81 Covid-19 deaths.



Photo:

timothy a. clary/Agence France-Presse/Getty Images

The two state-run nursing homes have faced a barrage of criticism from families of deceased residents. The Paramus facility, which initially reported more deaths, has in particular come under fire.

In the early days of the pandemic, testing wasn’t widely available to residents at many facilities. A large number of deaths at Menlo in April, the peak of that facility’s outbreak, were attributed to other causes, such as pneumonia, even as the death toll soared above usual levels.

The Paramus facility reported 81 deaths linked to Covid-19. The health department’s Ms. Kearney said an additional eight patients at that facility probably died from the virus.

The state counted as probable deaths those that weren’t clearly explained by another cause where patients had Covid-19 symptoms, or autopsies found signs of Covid-19, Ms. Kearney said in an email, as well as some other types of deaths.

Veterans agency records viewed by the Journal show nearly 100 people died at the Menlo facility in April alone. That’s about as many as the facility typically loses in a year, historical records show.

Mr. Westhoven also said in an earlier interview that the department only counted deaths when a death certificate expressly listed Covid-19 as the cause. That accounting missed some cases where residents tested positive but still didn’t have Covid-19 listed on their death certificates.

William Hefele, a Navy veteran and Menlo resident, was hospitalized in early April