As President Donald Trump left Walter Reed Medical Center on Monday—still infected with Covid-19—a reporter in the press pool, Hunter Walker of Yahoo News, shouted: “Do you think you might be a superspreader, Mr. President?” The president did not respond.
Is he? Probably sometime during the last week of September—the timeline isn’t clear—the president became ill with Covid-19. His adviser Hope Hicks tested positive before he did. Since then, around two dozen people who are close to the president or who attended events at or sponsored by the White House have tested positive for the disease, including spokesperson Kayleigh McEnany and members of her staff, First Lady Melania Trump, a couple of senators, former New Jersey governor Chris Christie, adviser Stephen Miller, the president’s “body man,” three journalists on the White House beat, Trump campaign manager Bill Stepien, a Coast Guard officer with responsibilities including carrying the “football” containing codes for launching nuclear missiles … whew. And that’s just the public ones—it doesn’t include White House support staff, for example.
Viruses aren’t exactly alive, and they don’t precisely “want” things (on account of not having brains). They’re just optimized flecks of genetic material inside bubbles of fat and protein, honed by billions of years of evolution to take over the cellular machinery of living hosts and make more of themselves. But if the coronavirus did want anything, it would want Donald Trump to be president. Almost everything he has done or allowed to be done since January has given the virus that causes Covid-19 space to spread. Did Donald Trump carry the virus to or from a fundraiser in New Jersey? To or from a Gold Star family reception? To or from preparation for a presidential debate, or events celebrating the nomination of Amy Coney Barrett to the Supreme Court? Is he a superspreader? Doesn’t matter. Because either way, he is the chief executive of a superspreading presidency.
Scientists have a lot of ways to characterize how viruses spread, but one angle is to say that they usually spread deterministically, when a person infected comes into contact with uninfected but susceptible people, kind of at random, like molecules bumping into each other in a gas. Every person who gets a virus that causes influenza, for example, gives it to about two more people. (Epidemiologists call that a reproductive rate, R0.) On average, that’s true for Covid-19, too, roughly. Except for when it isn’t. For a lot of reasons, sometimes one person with Covid-19 gives it to many, many more—dozens. These epidemiological influencers might amount to just 10 to 20 percent of people who get Covid-19, but they spread it 80 percent of all cases.
Here, R0 value might be less important, perhaps, than another number, k (that’s “kappa”), the dispersion factor. Like the coronavirus diseases SARS and MERS before it, Covid-19 is overdispersed—which means more “heterogeneity” in its spread. Sometimes it spreads a little; sometimes it spreads a lot. “It’s that perfect cocktail combination of the right host, someone who for whatever reason has a high viral load,” says Karen Jacobson, an infectious disease physician at the Boston University School of Medicine. “And then there’s just that they happen to be in the right social situation, also.”
In literal terms, maybe no one will ever know if Trump himself spread the virus through the White House. But his policies and his actions certainly allowed the virus to go viral. His obstinate refusal to listen to experts on how viruses transmit from person to person and how pandemics ebb and flow made it possible for the virus to spread to so many people around him, and to spread around the country. “The reason you wouldn’t label somebody as a superspreader is that often there isn’t anything they’re doing that’s necessarily reckless, right? And you don’t want to put a stigma on them,” says Sam Scarpino, a mathematical biologist at Northeastern University who studies Covid-19 transmission dynamics. “But there’s a difference if you have somebody like the president who is advocating for not wearing masks, who may have shown up to a debate potentially knowing he was sick with family members and others in the entourage who may have been exposed or sick, unmasked, unmasked in the White House, who drives in a hermetically-sealed SUV when he knows he’s infectious with Covid. There is a point when we have to say that this person is continuing to engage in reckless behavior that’s going to lead to transmission.”
So does that mean…? “I would say the president is a superspreader,” Scarpino says. “I’m happy to say that.”
Things didn’t have to be this way. Have tight lockdowns, keep everybody from coming into contact with anybody, and R0 goes down. Even the people who are better at transmitting (they’re carrying more virus, they’re at the peak time in their infection, they’re loud talkers, whatever) don’t have anybody to transmit to. No more infections.
Or, you know, do the opposite of that. Foster social conditions in which the virus spreads (cold, dry, noisy, crowded, no ventilation). Don’t wear masks and make fun of people who do. Result: lots of infections. A virus has biology, and so does its host, but it spreads in an environment, in a context. This is where biology meets policy. “You can decompose the transmission of a pathogen into the biological features of the individual pathogens themselves, the biological features of the host, the sociological aspects of the host—and when we’re talking about humans, we think about policies, the sociotechnical systems embedded in the defective behaviors. All of those things have to interact for transmission,” Scarpino says. “What we see in the United States time and again is this confluence of reckless policy, poor guidance from federal public health agencies around what people need to do to keep themselves safe, and then the biology of the pathogen and the humans.”
Scarpino is part of a team of researchers that has been working on a slightly different characterization of how the virus moves through populations. Their construction looks at a particular form of crowdedness, of how closely packed together people are at different spatial scales—in a building, in a neighborhood, in a city. The specific mathematical term they’re interested in is called Lloyd’s “mean crowding,” basically the number of contacts you might expect from random chance transmissions in a given area divided by the population of that area. What they’ve found is that more densely packed places are more “bursty” when it comes to Covid-19. When the virus gets there, it burns through the susceptible population hotter and faster, a sudden, sharp peak of sick people all in one place at one time.
The burstier places might seem isolated at first, and that can make it look like they’re protected. Until they aren’t. That’s what happens in meat-packing plants and elder-care facilities. It happened in Manaus, a city in the heart of the Amazon rainforest where officials didn’t detect any Covid-19 cases until March. Over the next four months, the virus went on to infect up to two-thirds of the population and killed one out of every 500 people. To Scarpino, the White House looks bursty, too. “It’s really tightly connected, nobody’s really wearing masks, lots of social connections. It was really a matter of when. When the virus shows up, it’s going to sweep through. You’re going to have superspreading. It’s just going to take a while,” Scarpino says. “Really it was just inevitable, because it’s really a microcosm of what we see playing out over the US: a combination of risky behavior, crappy policy, low testing, and in the White House’s case the exact right—or wrong, depending on how you think about it—connectivity and social network structure.”
And not to sound like a Twitter reply-guy here, but—that surprises you because why, exactly? This is the same White House that couldn’t institute widespread testing for the disease, or nationwide contact tracing. It’s the same White House that promoted untested treatments, and spread informational smog like saying disinfectants and ultraviolet light might work inside people’s bodies. It’s the White House that mostly failed to establish reliable clinical trials. It’s the same White House that tried to bend the data in the unimpeachable Morbidity and Mortality Weekly Report. It’s the same White House with a president who mocked mask-wearing right up until his own hospitalization, and in fact blocked the distribution of 650 million masks to Americans. It’s the same White House that rushed the reopening of restaurants and other businesses. It’s the same White House that attempted to block more stringent requirements for new vaccines. It’s the same White House that had staff and a president show up to a debate after exposure to a deadly pandemic disease and didn’t tell anyone. It’s the same White House that derided wearing masks as a way to reduce the spread of virus from people without symptoms—both in the world generally and in the White House itself, as a matter of “personal choice,” even with multiple staffers ill. It’s the White House—the president—that told people not to let the virus “dominate” their lives, who went home from the hospital when he was still sick and almost certainly still infectious. These are all, in their way, superspreading behaviors, as sure as doing a bar crawl when you’re sick.
It’s also the same White House that has declined to do contact tracing and case investigation on the outbreak currently engulfing it. Was the Barrett announcement the superspreading event? That’s knowable. Epidemiologists could trace contacts and figure out who brought the disease into the cluster. Virologists and geneticists could unpack the strain of the virus and figure out its specific path through Washington. “The point of the superspreading event is, that’s an epidemiologic term that can only be defined when we know there are enough linked cases that all go back to one location. But it takes work and science,” Jacobson says.
Of course, none of that will happen. Those facts are knowable, but they won’t be known. The White House staff won’t allow it. So in a sense, the answer is unknowable, because people are standing in the way, fostering instead the kind of environmental conditions where Covid-19 will spread. “It was probably inevitable that somebody in the White House was going to get Covid. But it was not inevitable how many people were going to get it,” Scarpino says. “Covid became an epidemic because the world doesn’t understand complex systems. It’s an interaction, in a nonlinear way, between the rules that govern the pathogen, the rules that govern the host, and the system they find themselves in—which is the politics. With the same underlying rules, a different political substrate leads to wildly different outcomes in terms of the emergent behavior.”
That emergent behavior has led to the deaths of more than 210,000 Americans. Millions are potentially facing long-lasting illness. More will get sick. More will die. Maybe a vaccine or a drug could change the rules that govern the pathogen or the hosts. But the system? The virus doesn’t want anything—but right now it’s getting everything it needs.