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Health Care Renewal: President Trump and Surrogates Continue to Hold Campaign Events Enabling Spread of the Coronavirus: Had Enough Yet?

While the US continues to suffer from one of the worst outbreaks of the
novel coronavirus pandemic to beset any developed nation (look here), national, state and local political leaders in the US who support President Trump have continued to hold events and otherwise behave in ways that seem designed to increase the spread of coronavirus. Multiple instances included leaders purposefully avoiding wearing face masks and social
distancing in instance in which disease transmission was likely, eg,
government meeting and political session, and engineering crowded events
in which social distancing and wearing of face masks were rare (look here and here).

Three weeks since we last discussed this topic, as the US presidential race heats up, we have noted multiple instances in which President Trump and his campaign surrogates have again promoted multiple crowded, socially not distant events at which few attendees wore masks. At some of these events, the practices promoted by the organizers went against state or local laws or regulations.  And these practices are continuing to be associated with disease spread.

Listed in chronological order according to the date of the reporting:

Trump Campaign Events in Three States

As reported by the AP (via PBS) on August 19, 2020:

Iowa

During Pence’s Des Moines event, chairs arranged in small clusters six feet apart were quickly abandoned as many in the audience of about 200, few in masks, moved within a few inches of each other. Dozens crowded together afterward to get an autograph or nod from Pence.

Wisconsin

in Wisconsin on Monday, Trump absolved his audience of health precautions, along the way mocking the racial justice protests he has railed against for weeks.

In an aircraft hangar in Oshkosh, Trump flaunted violations of the state’s distancing and masking guidelines — recommendations also promoted by the federal Centers for Disease Control and Prevention — as he spoke to hundreds of supporters, most not wearing face coverings.

‘This was supposed to be just a quick, little small gathering,’ Trump said, joking that ‘We’re supposed to have 50 people, right?’

‘We’ll call it a peaceful protest, that way we can do whatever we want,’ Trump added.

‘This is like a rally,’ Trump added, before telling supporters: ‘I hereby grant you a pardon.’

Later in Wisconsin,

On Wednesday, Pence addressed a crowd at a metal fabricating pant in Darien, Wisconsin, where the crowd stood and sat close together, many people not wearing masks despite a statewide order requiring them indoors.

Arizona

At Tuesday’s similarly raucous rally in Yuma, Arizona, supporters sat on closely packed-in chairs and bleachers, and stood on a balcony as they chanted ‘four more years!’ While the hangar was open on one side overlooking Air Force One on the tarmac, it nonetheless felt stuffy inside in the stifling heat. Most in the crowd did wear official ‘TRUMP’ and ‘MAGA’ masks, though many did not.

To summarize, Trump campaign events were crowded and attended by people with face masks, and thus appeared designed to violate local rules about public health.  Trump himself mocked such rules and public health practices.

Republican National Convention Site, Charlotte, North Carolina

As reported by the Charlotte Observer on August 24, 2020:

Face masks were supposed to be worn at the Republican National Convention in Charlotte. In addition to North Carolina’s COVID-19 statewide mask mandate, RNC staff agreed to enforce the rule inside the convention center.

But on the floor of the RNC, strict coronavirus protocols quickly fell by the wayside Monday.

Social distancing was expected too — in addition to COVID-19 symptom screening and testing — to prevent a virus flareup as more than 300 delegates gathered at the Charlotte Convention Center Monday, in a dramatically scaled-down RNC to renominate President Donald Trump.

But many inside were seen not wearing masks and some attendees shook hands and huddled in tight-knit circles as the RNC recessed awaiting the arrival of Vice President Mike Pence. Among delegates and convention staff, some people did wear masks. Still others did not or were seen wearing face coverings ineffectively, such as having the mask slung below their chins.

Note that the management of the convention proceedings appeared to go against local public health rules..  Yet after local public health authorities reminded convention management of that, the problems continued.

Mecklenburg Public Health Director Gibbie Harris said Monday she contacted the RNC about the lack of masks and social distancing, observed not only by journalists inside the convention hall but also easily seen on live streams from the event.

‘I have just shared concern about the lack of mask wearing and social distancing in the room at the RNC Roll Call Meeting with the RNC Convention staff,’ Harris said in a statement Monday.

‘I have been assured that they are working hard to address these issues. All attendees agreed to comply with the requirements prior to attending and were informed that these requirements would be enforced.’

Yet just a few hours later, delegates swiftly converged near the stage of the Richardson Ballroom as Trump concluded his remarks, holding up smartphones to snap a picture of their presidential nominee. Attendees, packed close to one another, danced the YMCA — with many still not wearing face coverings.

Further note that the Republican convention organizer’s lax approach occurred at a time when transmission of coronavirus is a major concern in Charlotte.

The Charlotte area continues to grapple with the highest coronavirus case levels in North Carolina, though crucial trends — including hospitalizations and the test positivity rate — continue to improve. There have been 24,260 coronavirus cases and 282 related deaths among Mecklenburg residents as of Monday afternoon, according to state and local health officials said.

Thus it is not surprising that within days several convention attendees proved to be infected.  As reported by the Charlotte Observer on August 28, 2020:

Two attendees and two local support staff at the Republican National Convention in Charlotte tested positive for COVID-19, Mecklenburg County and GOP officials announced Friday.

The disclosures come after county health officials raised concerns about a lack of social distancing and mask wearing during the roll-call vote to renominate President Donald Trump for a second term on Monday — despite strict health protocols that were supposed to be followed. The GOP is defending the safety procedures it had in place.

Local health officials said the county instructed those who were infected to isolate immediately, and people who came in close contact with them should also quarantine themselves. A county spokeswoman did not respond to questions on whether the orders were followed.

To summarize, despite assurances that the event would promote best public health practices, the organizers allowed crowding and unmasked or inadequately masked attendance, even after public health officials had warned them about problems.  Probably due to the lack of public health preventive measures, attendees are already beginning to test positive for infection.

Republican National Convention Site, Washington DC

Melania Trump’s Speech

As reported by CNN on August 26, 2020:

Those who attended first lady Melania Trump’s speech in the White House Rose Garden that capped the second night of the Republican National Convention were not required to get tested for coronavirus, a person who attended the speech told CNN.

Despite that,

The vast majority of those attending did not wear masks, and the chairs provided for attendees did not appear to be placed six feet apart.

Trump’s Nomination Acceptance Speech

According to the New York Times, August 28, 2020:

The chairs were packed in tightly on the White House lawn. Hundreds of people in the crowd had not been tested for the coronavirus upon attending.

The mostly maskless guests were seated cheek by jowl for hours….

Again, no masks, no social distancing, no observance of local public health rules.

Campaign Rally in Manchester, New Hampshire

As reported by NPR on August 28, 2020:

President Trump returned to New Hampshire Friday night, fresh off the Republican National Convention, for a rally at Manchester Airport.

For the hundreds of supporters in attendance, the atmosphere was that of a festival. Many wore Trump-themed clothing. Others wore T-shirts celebrating right-wing figures ranging from Fox News host Tucker Carlson to Brazilian President Jair Bolsonaro.

A minority wore masks, which are now required in New Hampshire at gatherings of more than 100 people. And many in the crowd jeered when an announcer on the PA system suggested they don them.

Again, no masks, no social distancing, and apparent public contempt for public health rules

Disease Spread Among Secret Service Agents Protecting Trump

Finally, the evidence that the Trump campaign is actually promoting the spread of COVID-19 is growing.  As reported by the Washington Post on August 28, 2020:

When President Trump gave a speech to a group of sheriffs in Tampa late last month, his decision to travel forced a large contingent of Secret Service agents to head to a state that was then battling one of the worst coronavirus surges in the nation.

Even before Air Force One touched down on July 31, the fallout was apparent: Five Secret Service agents already on the ground had to be replaced after one tested positive for the coronavirus and the others working in proximity were presumed to be infected, according to people familiar with the situation.

Then,

After the incident in Tampa in July, two agents who were assigned to stand guard at Trump’s private club in Bedminster, N.J., fell sick with coronavirus symptoms this month while the president golfed. It was his third trip there this summer.

In summary,

In the past two months, dozens of Secret Service agents who worked to ensure the security of the president and Vice President Pence at public events have been sickened or sidelined because they were in direct contact with infected people, according to multiple people familiar with the episodes, who spoke on the condition of anonymity to describe the incidents.

Trump’s apparent disregard for the health of those who have sworn to protect him appears to be generating some unprecedented discontent.  A more rigorous program of coronavirus tests for agents was instituted:

after some discontent and anxiety percolated inside the agency earlier this summer, with agents and officers privately complaining that the White House and the Secret Service were not properly addressing the risks they faced on the road, according to people familiar with the concerns. Testing and protective equipment had been offered sparingly and inconsistently, some argued.

Even more pointedly,

this new virus that has killed nearly 180,000 Americans in eight months has prompted some to ask a new question: Should they be required to risk contracting a lethal disease — and infecting a loved one — to secure an event that does not follow health protocols?

Discussion

There is growing evidence that wearing face masks decreases the
likelihood the wearer will transmit or contract the infection, and the
likelihood that any such infection will be severe.  Keeping people
physically separate, particularly by more than six feet, and
particularly when they are indoors, also decreases transmission in
either direction.

Nevertheless, after the Trump administration failed to effectively shield the US from the coronavirus pandemic, while peddling disinformation about the disease and its effects, the president continues to act in ways that actually promote further spread of the virus.  The perversity of his behavior is even being acknowledged by those sworn to protect him.  As reported by the Washington Post,

Never before has the Secret Service run up against a president so intent on putting himself first regardless of the costs, including to those around him,’ said Ned Price, a national security expert and former CIA analyst.

While the Secret Service is having doubts, some Trump supporters deny the risks they are taking on his behalf.  Those who attend his campaign events, especially those who choose not to wear masks, have an elevated risk of becoming infected, and once infected, of transmitting infection to their friends and family.  Those who are already infected when they arrive at an event, even if asymptomatic, are at risk of spreading the disease to his other supporters.  Trump’s careless, if not malevolent approach to public health at his campaign events is likely to hurt his own supporters before it hurts others.

Yet, perhaps rendered  stupid by Trump’s propaganda and disinformation, they remain blissfully ignorant.  For example, as reported by NPR at the New Hampshire rally,

The COVID-19 pandemic was on the mind of many attendees. Timothy Parnell, an engineer who lives in Seabrook, said Democrats’ criticism of Trump’s handling of the coronavirus is ‘absurd.’

‘The only way the president could have done better is if he was psychic,’ Parnell said. ‘He took advice from the scientists; he asked for advice.’

Yet the evidence that Trump repeatedly disregarded, and often contradicted scientists’ advice is clear.

Furthermore, as reported by the AP from a Pence event in Iowa,

Rob Mudd, who drove 120 miles from Cedar Falls to see Pence, was among those not wearing a mask. ‘Is the disease real? Yes,’ said Mudd, 53. ‘So is the fear mongering.’

Likewise, Justin Chance, from suburban Des Moines, shook his head when asked why he, too, wore no mask. ‘I just don’t believe all the hype,’ said Chance, 55. ‘I just don’t worry about it.’

Yet the US death rate for coronavirus this year has already exceeded 180,000.

Maybe his supporters are reassured about what Trump said in Oshkosh, “I hereby grant you a pardon.”   Of course, the coronavirus doesn’t care if Trump gave someone “a pardon.”  It could infect, and even kill such a person regardless.

Maybe the more Trump supporters fall ill, or see their friends and family members fall ill, the more they will doubt Trump’s pretensions at royal pardons.  But that may take a long time, and a lot of deaths.  Meanwhile, Trump will be able to do more and more damage to patients’ and the public’s health.

We may not be able to wait.  Instead, I hope my fellow professionals step up. It is time for us to tell every patient what they need to know to protect themselves as best they can from a deadly pandemic.  It is time for us to use every forum to reach the public with the message.  And it is surely time to call out the president and his supporters for their perverse and malevolent enabling of a deadly disease.

I know many health care professionals are afraid of appearing partisan. 
It is not partisan to speak up for common sense public health measures
to combat a deadly pandemic.  If there was ever a time for us health
care professionals, especially those in the most senior and/or
leadership positions to speak up, it is now.  Who will hear the call?

“If not now, when?”

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