'The likely outcome': Trump's COVID diagnosis followed waning precautions at the White House

As President Donald Trump quarantined in the White House residence Friday morning after testing positive for COVID-19, Chief of Staff Mark Meadows stood outside and said he wasn't wearing a mask himself because his test was negative.

“We’re hopefully more than 6 feet away," he said to the reporters before him, "and if there’s any concern there from a guidance standpoint, we have protocols in place."

From the earliest days of the coronavirus pandemic, there has been a disconnect between the guidance of public health experts and the actions of Trump and some of his deputies.

From holding large gatherings to resisting masks, the president, his administration and his campaign have sent conflicting messages to the American public as they sought to portray an image of strength and normality.

Experts said Trump and his administration could have done more: Require masks at the White House, hold fewer large gatherings and use technology to allow staff to meet remotely.

"This was not inevitable, but this was the likely outcome," said Dr. Michael Mina, an assistant professor of epidemiology at Harvard T. H. Chan School of Public Health.

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Trump, he said, is "as susceptible as anyone else in the world. Many of us are taking precautions that greatly exceed the cautions that he tends to take."

Just three weeks ago, Trump ridiculed Democratic presidential nominee Joe Biden for wearing a mask so often, saying, "If I were a psychiatrist, right, you know I’d say: 'This guy’s got some big issues.'"

At a presidential debate Tuesday night, two days before Trump announced his positive test, he did it again.

Experts: Testing isn't enough to stop the spread of the virus

Though public health experts recommend social distancing, masks and frequent hand-washing to guard against spreading the virus, the administration appears to have relied mostly on testing. Some of the politicians and Trump administration staffers who have announced they had contracted the coronavirus were tested before they were scheduled to appear with Trump at an event or fly with him on Air Force One.

Frequent testing isn't enough, said Michael Ben-Aderet, an infectious disease physician and associate director of hospital epidemiology at Cedars-Sinai Medical Center. The White House should be “setting an example” through “good infectious control policy,” he said.

“A lot of essential workers have been able to protect themselves, and I see the president as another essential worker,” he said.

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The president announced his diagnosis early Friday and said he and first lady Melania Trump, who also has COVID-19, would be quarantining. Friday evening, he was hospitalized at Walter Reed National Military Medical Center.

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"Out of an abundance of caution, and at the recommendation of his physician and medical experts, the president will be working from the presidential offices at Walter Reed for the next few days," Press Secretary Kayleigh McEnany said in a statement. On Monday, McEnany announced that she also had tested positive for the coronavirus.

First cases at White House spurred testing, cleaning

The virus began creeping into the president’s inner circle at least as early as May, when Trump’s personal valet tested positive. In short order, several Secret Service agents were diagnosed, along with Vice President Mike Pence’s press secretary.

That sent several members of the White House coronavirus task force into quarantine, including Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases.

“It is scary to go to work,” Kevin Hassett, then one of Trump’s top economic advisers, said at the time in an interview on CBS’s "Face the Nation."

Within days, the White House announced it would institute strict protocols. Trump and Pence would be tested daily, as would every staff member who came into close proximity.

A small white tent was set up on the grounds to test visitors to the White House. Workspaces would be deep-cleaned regularly. Staff would follow social distancing guidelines, get daily temperature checks and have their symptom histories reviewed.

“The president’s physician and White House operations continue to work closely to ensure every precaution is taken to keep the president, first family and the entire White House complex safe and healthy at all times,” White House spokesman Judd Deere said May 10.

Before attending briefings in the small press room, journalists received a second round of temperature checks and were asked if they had any symptoms. They received a small colored sticker if they were cleared. Signs encouraging social distancing cropped up inside the West Wing. McEnany's aides regularly donned face masks in the briefing room.

Many staff working at the time in the cramped West Wing wore matching black cloth masks with a small American flag, similar to the one Trump sometimes wore, said a former White House official who spoke on the condition of anonymity.

Staff were not required to wear a mask if they were at their desk and were at least 6 feet apart, the former official said.

“I felt safe, and I know my colleagues did as well,” the former official said.

Safeguards disappeared over the summer

The president continued to eschew mask-wearing even as more Secret Service agents tested positive. In June, Kimberly Guilfoyle, a campaign aide and the girlfriend of his son Donald Jr., came down with COVID-19.

The white tent, the routine temperature checks and other safeguards disappeared by late June, when the White House said it would scale back some of the safety measures. It cited Washington, D.C., entering Phase 2 of reopening.

By July, Trump told reporters he was being tested every two to three days. The president made those remarks hours after McEnany asserted Trump was tested "multiple times a day," which the president flatly denied hours later.

On July 1, Trump said he would wear a mask “in a tight situation with people,” but he said he rarely found himself in such situations and noted people are tested before they get close to him.

Even after urging the American public to wear masks – a step he took in late July – Trump was frequently seen without one. At a Red Cross event in Washington, D.C., on July 31, he wore a mask for part of the visit.

After Biden and Democrats held a virtual nominating convention in August, the Trump campaign gathered more than 1,000 people at the White House – sitting arm-by-arm, most of them without masks – to hear Trump’s acceptance speech.

His large, raucous campaign rallies have continued mostly unabated since: North Carolina, Pennsylvania, New Hampshire, Michigan. Most are outside, though people often pack closely together. Defying state rules, Trump held a rally and a “Latinos for Trump” roundtable indoors in Las Vegas last month.

Campaign volunteers frequently take the temperature of audience members and distribute masks, but the vast majority of attendees do not wear them. In interviews with USA TODAY and other media, many have embraced the president’s rhetoric questioning face coverings.

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His campaign has been eager to draw a contrast with Biden and change the subject from the coronavirus, which has killed about 209,000 Americans. But there were questions about safety all along.

Francis Collins, director of the National Institutes of Health, told CNN last month that he was "puzzled and rather disheartened" by the lack of face coverings at the events.

Attending the rallies – even holding them – is "is an act of defiance," said Republican political strategist Doug Heye. "I think there's a very reasonable question of whether lives are being put in jeopardy just to do a political event."

Though White House policy still recommends masks, they've become a rare sight in the West Wing. Not only have the president’s aides declined to wear them during public events, they have rarely donned them when the cameras are off. Aides are frequently seen jammed into the warren of offices outside the Oval Office, without any face coverings in sight.

"Frankly, anyone in the White House who's not using a mask frequently is a fool," Mina said on a Friday call with the media. "To not do everything in their power to keep themselves healthy is just absolutely foolish."

He added, "It really (ticks) me off that we have a president who has failed to do one of the most basic things a president should do, which is to keep himself safe."

Last weekend, about 180 people filled the White House Rose Garden to watch Trump announce his nomination of federal judge Amy Coney Barrett to the Supreme Court. Less than a third wore masks.

That included the Rev. John Jenkins, president of the University of Notre Dame, where Barrett is a law school professor. On Friday, the university announced Jenkins had tested positive for the coronavirus, though it attributed it to contact with a colleague on campus in Indiana.

Ben-Aderet of Cedars-Sinai said based on what we know about the virus, people tend to feel worse in their second week of infection. Trump has several high-risk factors for COVID-19 morbidity, including obesity and his age. “We don’t know what other risk factors he has,” Ben-Aderet said.

"It’s just another reminder that COVID is still here," he said. Despite the direction from the White House, "we’re still seeing transmission."

Contributing: Josh Salman, Karen Weintraub, Kevin McCoy, Courtney Subramanian, David Jackson and Michael Collins.

This article originally appeared on USA TODAY: Trump's COVID-19 diagnosis followed waning precautions at White House