What IPs Can Learn from White House, CDC COVID-19 Bombshells

This week was rocked by two major news alerts – President Trump was hospitalized with coronavirus disease 2019 (COVID-19), unearthing a large cluster in the White House, and the US Centers for Disease Control and Prevention (CDC) released information on airborne transmission. How do these relate to infection prevention? Both events amplify two things—infection prevention efforts are additive and we need to do more communication and education in risk awareness.

Not long after President Trump was diagnosed with COVID-19 and several other White House officials were also found to have the disease, it became apparent that the White House strategy for COVID-19 prevention was heavily focused on testing and not much else. You can track the outbreak here, but over the last few days news reports have shed light on the near daily use of rapid antigen testing in the White House, and little adherence to other infection prevention efforts like masking, distancing, limiting meetings, etc.

What can we take from this? Simply put, infection prevention, like any harm reduction, is additive. A wholistic approach means multiple components, emphasizing the Swiss-cheese approach that is about additive layers as no single approach is perfect. Our emphasis on masks or distancing alone isn’t sufficient. Many of us have seen this in small hospital clusters among healthcare workers who were diligent in their use of personal protective equipment (PPE) but exposed to coworkers in breakrooms over lunch and potlucks. Much of this reinforces the need to educate and communicate on risk awareness – what many see as high risk can be biased. Moreover, what many consider as an acceptable intervention, like just masking or testing, isn’t enough for continued exposures. Simply put, a single approach strategy, like the test-only approach within the White House, is one doomed for failure.

On Monday, the CDC updated their “How COVID is Spread” page to reflect situational airborne transmission. In their Scientific Brief, the CDC describes a bit more what this means, which is an important piece to public awareness and communication surrounding “airborne.” The CDC takes care to describe what airborne transmission is, noting the meaning for public health efforts and how this is uniquely different than for what an aerosol scientist might refer to as “airborne.” The CDC notes that “however, most infectious disease and public health experts reserve the term airborne specifically for use in the context of airborne transmission to describe infections capable of being transmitted through exposure to infectious, pathogen-containing, small droplets and particles suspended in the air over long distances and that persist in the air for long times.”

Moreover, it describes how airborne transmission is not equally efficient for all respiratory microbes and that what the epidemiological data is showing with COVID-19 reveals transmission predominantly as a result of close contact with some airborne transmission occurring in specific situations and under special circumstances. What does this mean for infection prevention efforts? None of the guidance changes, but rather we should work to communicate situational airborne transmission so people can be safe outside the healthcare environment. This is a good reminder of how we communicate transmission outside the healthcare setting and why all of these measures are important.