by Tia Will
Since Trump’s discharge from Walter Reed Medical Center, several people have asked me to opine on whether he left the hospital against medical advice. My opinion is, we simply do not know, but it doesn’t matter. Technically Trump was not discharged to home the same way you or I would be. He was transferred to the equivalent of a geographically separate step down unit. His “home” unlike ours has a fully staffed 24/7 medical unit. True his discharge was conducted in a theatrically staged manner, but it was still the equivalent of a transfer, not a discharge.
As is so often the case with Trump, the larger issue was obscured by the theatrics. Just as social distancing, masks, and hand hygiene are critical to stop spread of the virus, so are case investigation and contact tracing. As has now been reported by both Vox, NPR and I am sure others, there is no coordinated effort to contact trace on the part of the WH medical team. Despite the fact that Trump had attended multiple events with numerous people in close contact with both him, and other known positive members of his team, there was no timely outreach to known, nor potential contacts. Chris Christie himself reported he found out about the exposure on the news prior to testing and learning he had contracted the virus.
As I write, we have 7 known positive members of the administration, and nine other close associates including Ronna McDaniel, Kellyanne Conway and two GOP senators. There is apparently no WH 
coordinated tracing outreach. You might wonder why this matters. Isolation (keeping known positive individuals away from others), tracing (notifying known contacts of a positive individual), quarantine (keeping contacts of known positive individuals away from others) and testing as indicated are the key steps to limiting viral spread and ultimately saving lives.
Within the past 48 hours Trump chose to breach this protocol in three different ways. First, by leaving the hospital for a cruise past his supporters as a photo op. By this action, he did not further endanger his supporters, but he did endanger his driver and every member of his security detail. He knowingly broke isolation for the purposes of a photo op.
Secondly, he made completely irresponsible statements encouraging people not to take the virus seriously stating people should not allow it to dictate their lives. What he chose not to mention is that while he has done well through the first four days of his illness, he is able to be whisked away to one of the world’s finest medical facilities within minutes and upon discharge returns to a sophisticated medical unit rather than just a bedroom. Amenities almost no one else has. A callous display of his constant self-referential view of the world lacking in understanding or empathy for anyone else’s circumstances.
Finally, what in my mind is possibly the most callous failure of all. The failure to notify. By now the window in time to be most effective in contact tracing has already passed. As with all other aspects of the COVID-19 pandemic, Trump has left it to individuals to sink or swim on their own.
While it is true that individuals having attended the Rose Garden event or one of his rallies should by now know to quarantine and/or test, their contacts will have no way of knowing they may have been exposed. These innocent folks, likely to still be asymptomatic, are out living their lives using whatever precautions they have chosen to adopt in the absence of a uniformly mandated standard.
While my hope is that Trump and all his associates who chose voluntarily to put themselves in harm’s way have a speedy and complete recovery, my greater hope is that their wanton recklessness and lack of interest in anyone but themselves will not kill or due irreparable harm to those who are doing their very best to protect themselves and others.
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Well stated, all.
There is actually explanation for the lack of contact tracing: it goes with the philosophy that spreading the virus and getting it now and getting it over with is the best way forward, and get everyone infected and let the strong survive. It may be hard for many of us to believe some people think that way . . .
I wouldn’t be surprised if there are some at the highest level of government who hold to this horrific philosophy of “let the strong survive.” After all, eugenics and even genocide have a long history in the U.S. The non-survivors—those weeded out—would be those most susceptible to the virus: the elderly, people with underlying conditions, racial minorities, people with disabilities, people in nursing homes and other congregate living arrangements, and the homeless.
I wish everything you just said was incorrect . . . 🙁
Alan
You make a good point, and one that is not without some validity. Some jurisdictions have essentially given up on the strategy of contact tracing for the reason you stated and some because tracing is simply less effective when the virus is already widespread in a community than when there is the possibility of containment.
I disagree for several reasons and would welcome the input of Robb Davis if I am incorrect. I believe tracing can still have value in the situation we have here in Yolo County in which we have relatively isolated communities that could be protected. The UCD campus, for example, is or could be a relatively self-contained unit if guidelines were being followed appropriately. However, according to a UCD professor, they aren’t. The games of beer pong and social activities appear to be occurring as though nothing has changed. The university while working hard to get a testing regimen in place, does not appear to have prioritized enforcement of guidelines.
Secondly, we are entering a particularly hazardous time of year given what we now know about this virus. We are entering the regular flu season, the indoor weather season, and the holiday season all at the same time. This is the time in which Americans revel in large gatherings for Halloween, Thanksgiving, Christmas, Hanukkah and New Year’s celebrations. Perfect conditions for the spread of the virus.
And now, instead of modeling the best practices from the WH, Trump has turned an opportunity to change the message to one of prudent ( not fearful) protection of self and others, into a perfect storm of what not to do. From the initial denial of illness followed by the height of irresponsible behavior in putting others at risk with his drive-by, his insistence on return while infectious, and apparently as of today, insistence on a return to the Oval Office. Rather than remaining in isolation in the medical unit which I had basically provided a rationale for when I wrote this article yesterday, he has decided to place everyone who works in the West Wing at increased risk and is encouraging all Americans to do the same.
I forgot where this happened – but at a University back east about a month ago – those putting together the guidelines for the college assumed that students would gather in large groups and party as part of their modeling – but it got out of control anyway. The researchers later stated it that they did not fathom what actually happened – college students who tested positive continued to socialize and party. Remember being young?
You’d need a small army to keep 15,000 college students from socializing.
“You’d need a small army to keep 15,000 college students from socializing.”
Not if you judiciously used the mechanism of suspension for a semester and made it clear to both students and parents prior to the student leaving home that there would be no refund.
There is obviously no perfect solution, but there are clearly more steps that could be employed than are currently being adopted. Or, maybe with the current level of community spread, it was just too soon to open “safely”.
They’ll just use the defense that their brains aren’t fully developed until they’re 25, so it’s not their fault, and they’ll be reinstated.
Life lessons are part of their education. Or have we grown too soft?
A particular problem is that Halloween is on a Saturday this year, meaning that is more likely than usual that young adults will gather in large groups to celebrate. We could see a surge in early to mid November as a result.
Maybe we could make a national pact that everyone dress up as Covid-19
(round with spikes and all)
And if Trump wins young adults will also gather in large groups to protest. “We could see a surge in early to mid November as a result.”
I can’t help but think of Trump as Hamlet wandering around the castle talking to the ghosts of his father or some other Presidents history will identify him with like Andrew Jackson, James Buchanan, Andrew Johnson, Rutherford B. Hayes, Warren G. Harding, or Richard Nixon.
Meanwhile, Joe Biden is out in pastoral Gettysburg, channeling Lincoln, with Little Round Top in the background.
People said Trump looked like Il Duce on the balcony but I said he looked more like Evita. Well I wasn’t alone.
Clink on the link for the greatest political ad of all time.
https://www.youtube.com/watch?v=4tZVnbDq9B4
THAT is hilarious, and well worth the three minutes.
There are number of issues here related to contact tracing and testing. I have a few minutes:
1. Contact tracing: I am not sure there is a point at which you just “throw up your hands” and say it doesn’t matter but I do know that to be effective, case investigation and tracing does not have to be 100%. It is not all or nothing. But it does take resources (human) and to really work requires social supports to enable people to successfully isolate or quarantine when they are instructed to do so. More and more people are considering the Japanese approach which tries to identify clusters and really work hard to contact all people who were part of them to take action. I am not sure exactly how it works but it is more “backward looking” and goes after super-spreader type events.
2. Student behavior. The Office of Student Services and Judicial Affairs has both guidelines and a form that can be used by anyone to report incidents. There are consequences for actions. I am working with the City PD, OSSJA, the County and Health Services on Campus to put into place and approach that will have the campus working with the PD on complaints to assure those involved can be easily traced if a positive shows up from a party. Information will be reported to OSSJA when students are involved. This is a public health intervention and students will receive warnings and, if necessary, harsher sanctions.
On the latter, public health really walks a fine line in matters of non-compliance related to infectious diseases. Harm reduction, which is a concept that has been used in drug treatment but also came to the fore in dealing with HIV, has several principles but one is that purely punitive measures do not work to change behavior—they typically only drive it underground. By using approaches that remind offenders of the rationale for the policy, having an escalating set of steps for repeat offenders and, in the case of COVID-19 collecting information (which it is legal to do) to facilitate contact tracing, we have the opportunity to influence behaviors (word gets around). In addition, harm reduction should look to develop “safer” alternatives to parties and Open Air Davis and outdoor locations that allow for informal gathering are a good idea.
Real question – there could be dozens of parties going on at any one time, many in private locations. How could one possibly hope to get reports, intervene, warn or sanction — even a small fraction of these — even remotely enough to make a difference? We can’t even cite 1 in 10,000 times that a bicycle blows through a stop sign, right out in public and out in the open. We can’t even afford a bike officer anymore.
I am told that the community does a good job reporting behavior but, you are correct, not all can be captured. There is no one thing we can/must do to deal with COVID-19. That is why we need all the tools to be deployed.
I’ve bookmarked the report page. We live next door to an informal satellite sorority house, and they’ve had a few parties with waaay more than 10 people, no masks, no distancing. They’ve been good neighbors otherwise, but the total disregard for safety protocols is disturbing.
Thanks, Robb, both for your comments and your ongoing work on this issue.
One question. Even though I have tried to keep up on the issue, it is unclear to me where to obtain a report and to whom it should be submitted. Can you provide this info?
https://ossja.ucdavis.edu/
Button in upper right. I was told members of the community can use it.
Thanks again, Robb.
You do all realize that the “elephant” couldn’t care less about opinions in Davis (let alone California, as a whole), right?
You’re wasting your time and energy regarding this.
Is this some kind of “virtue signaling”, as another commenter might have put it?
Though for some reason, Trump has a pretty good relationship with Newsom.
Ron
I am well aware that this blog entry will never reach Trump. As with many of my social media entries, my target is not the person whose initial entry I have linked to, but rather those readers who may not have considered the perspective I am presenting. In this case, I do not understand your apparent hostility (virtue signaling) since I stated in my first sentence the reason I wrote. Several friends had asked my opinion on the topic and I thought others might be interested as well. If anything I wrote, or that Robb added provided insight or information to anyone interested enough to read, then I do not perceive it as a waste of time.
Who cares, regarding the “reason” that he left the hospital? As you noted, “you don’t know”, and “it doesn’t matter”.
Regarding “virtue signaling”, that was not intended as a “hostile” comment. But, I believe it is a real thing, to some people. (Not necessarily you.)
Truth be told, my comment is not necessarily in direct response to this article (alone). But, unlike the presidential race, there are ACTUAL, local issues in which those who comment or write articles on this blog might make some difference.
The presidential race isn’t one of them, nor is referring to that guy as an “elephant” (I assume, based upon his weight). For that matter, Covid isn’t one of them, either. (There’s tons of information that isn’t dependent upon “local information” regarding Covid risk factors and behaviors.) Covid knows no local borders.
” But, unlike the presidential race, there are ACTUAL, local issues in which those who comment or write articles on this blog might make some difference.”
Truth be told we have had a ton of local articles to choose from, but right now people are interested in discussing the presidential race – so let them.
As with national (or even local) politics, I don’t have much say in their decisions, regardless.
I guess it ultimately comes down to what one is primarily interested in, regardless of how much “difference” it makes.
So yeah, you’re right. Or “left”. 😉
But that term “virtue signaling” did stand out to me, from maybe a couple years ago (from one of your former commenters). Sort of like “political correctness”.
But ultimately, local decisions are usually the ones that have a greater impact on local lives. Berryessa/Snow mountain might even fall into that category, despite being made at a national level.
Ron
I find your assumption to not only be odious but also ignorant. No one has likened Trump to an elephant. If you had been following along on the articles, you would have noted that David’s first article on the topic was entitled “The Elephant in the Room…” referencing the expression the elephant in the room that no one wants to talk about. I have never and will never resort to personal comments about anyone’s appearance and am not about to start now. I found the suggestion that I was to be highly offensive.
The intention I have had with the exception of only one article was to have a local impact. I thought I was clear about how the national situation was relevant to our local situation.
In addition to the elephant in the room, there is the added double meaning since elephant is the Republican mascot.
Tia:
You’re not the one who came up with the “elephant” title, in this ongoing series of articles. David did, and I immediately suspected that he did so (partly) for the reason I put forth. If that’s incorrect, then I apologize.
As far as these articles being a “waste of time”, I’m referring to the fact that California is pretty much decided, regarding the presidential race. So, I fail to see the purpose of criticizing Trump. In general, these articles are “preaching to the choir”. Maybe that’s satisfying, for some.
There may be a local angle regarding Covid (e.g., in a university town), but the guidelines have pretty much been covered in detail, in other news sources.
But, there are other local issues which are not decided, and will likely have a more direct impact for locals.
When I first saw the headline juxtaposed with a picture of a bloated Trump from an unflattering angle, that was my first thought as well, RO. Odious and ignorant minds think alike 😉
On another note, I can’t imagine anyone even asking this of you, but I think your response is correct. (I could have told your inquisitors that, myself.) 😉
Thanks, Alan.
And frankly, Trump has been called a lot worse things than that, I’m sure. By some of the commenters on this blog, no less! Doesn’t bother me.
I wouldn’t be surprised if (privately), many don’t even “wish Trump well”, to say the least.
And if you do want to talk about Trump (and some of the Republicans), I’ve got plenty of things to say regarding efforts to sell-off public lands, or otherwise abuse them.
Something that’s never covered, on this blog. But again, won’t make much difference locally (with the exception of Berryessa/Snow Mountain, which I believe was saved “again” – unlike Bears Ears or the Arctic National Wildlife Refuge).
And as usual, without any help from this blog or the articles, therein.
I look forward to your article on the selling off of public lands.
If I wrote something like that, I’d probably submit it to the “other” blog, as it seems to be a better fit.
But honestly, one of these blogs ought to reach out to Tuleyome periodically – regardless of what you think of me. Or, maybe they should reach out.
They were involved in the effort to preserve Berryessa/Snow Mountain, and have directly preserved land, themselves. As did Dr. Cahill I understand, separately.
With your photographic skill, you could really help. (I assume you’ve hiked Stebbins Cold Canyon for example, at some point.)
If you (or your student assistant) ever write an article regarding that, I will likely comment at least.
But, it still won’t make any difference, nationally (at this point).
White House sources say that Trump has a dry cough and trouble breathing. They also mention he seems to be having manic episodes. Almost all of the military’s top leaders are now quarantining after the contagion in chief exposed them to Covid 19. I’m worried about that. I would far prefer that a healthy if equally ethically and intellectually challenged VP Pence were in charge.
His entire life is a manic episode.
Where are you reading this? I searched multiple sources and can’t find it. I’m not doubting you, I was literally trying to read up on his condition and don’t see this.
MSDNC no doubt.
For the first time in over 200 years The New England Journal of Medicine has weighed into a Presidential debate as follows:
“Anyone else who recklessly squandered lives and money in this way would be suffering legal consequences. Our leaders have largely claimed immunity for their actions. But this election gives us the power to render judgment. Reasonable people will certainly disagree about the many political positions taken by candidates. But truth is neither liberal nor conservative. When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent. We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs.”