Trump’s evolving case of covid

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— Much remains unclear about President Donald Trump’s bout with coronavirus, three days after he first revealed his diagnosis and less than a month before the election.

— A White House celebration may be the source of many Trump-linked cases, with more Republicans now sickened after they gathered to celebrate Trump’s latest nomination to the Supreme Court.

— A political appointee tried to pressure CDC to change a bulletin on coronavirus and kids, complicating officials’ own efforts to revise the report.

WELCOME BACK TO MONDAY PULSE — Where weeks after Trump appointees tried to alter CDC’s report on a super-spreader event, saying the agency needed to be more optimistic, the CDC may end up investigating the Trump White House for hosting a super-spreader event.

There’s a word for this in an Alanis Morissette song. Send lyrics and other tips to [email protected] and [email protected].

TRUMP‘s EVOLVING CASE OF COVID — His symptoms were “mild.” His symptoms were “very concerning.”

He needed oxygen. He needed to see his supporters.

Trump’s medical condition was a moving target across the weekend, with White House officials and doctors sending mixed messages about the president’s health, sometimes within minutes of one another. But it appears his condition could be worse than the official party line.

Trump himself sought to buck up public confidence with a Sunday drive-by outside Walter Reed Medical Center, in spite of medical experts’ consensus that the still-infectious coronavirus patient should not be in public.

— As Monday dawns, we still lack insight about the world’s most famous case of Covid-19. It’s not clear when the president was exposed to the virus or what safety measures the White House was using, POLITICO’s David Lim, Joanne Kenen and Lauren Morello write in a review of available information.

There are also specific gaps in our understanding of Trump’s condition, like whether the 74-year-old president has lung damage or why physicians have prescribed certain drugs. Trump’s doctors have dodged those questions, and the president himself is an unreliable narrator.

To put it another way: The president who once dictated his own doctor’s note is now asking a worried nation to trust his doctors’ notes, POLITICO’s Dan Diamond and Meridith McGraw write.

— One thing we do know: Trump and the White House have repeatedly flouted CDC guidance and medical best practices on coronavirus safety and failed to inform Americans who may have been put at risk.

The president, for instance, attended a fundraiser at one of his golf clubs on Thursday and interacted with at least 206 people, even after his close aide Hope Hicks had tested positive for the virus.

Multiple Trump associates, including adviser Chris Christie, said they only learned of the president’s diagnosis from press reports. Christie, who was in close proximity to Trump and Hicks for debate prep last week, subsequently tested positive for Covid-19 himself and told reporters on Saturday that he’s now voluntarily hospitalized.

Biden campaign officials similarly weren’t informed of any diagnoses by the White House, despite Joe Biden sharing a stage with the president on Tuesday when Trump was possibly at his most infectious, POLITICO’s Natasha Korecki and David write. Biden has repeatedly tested negative since Friday.

Sunday’s presidential drive epitomized the White House’s lax approach to safety, with medical experts condemning the president’s decision to leave the hospital for a ride in a small vehicle accompanied by protective agents.

“The irresponsibility is astounding,” tweeted James Phillips, a Walter Reed attending physician who’s also chief of disaster medicine in GW’s emergency department. “Every single person in the vehicle during that completely unnecessary Presidential ‘drive-by’ just now has to be quarantined for 14 days.” A White House spokesperson said that Trump’s medical team cleared the trip.

— What we also know: It’s a fast-moving situation. It’s possible that the president may be discharged on Monday, based on comments that Sean Conley, the president’s physician, made to reporters at Sunday’s press conference.

Or given the unpredictable nature of coronavirus, the situation could swiftly worsen and Trump’s stay at Walter Reed could be much longer. Physicians say they’re astounded that a 74-year-old patient who’s already twice needed oxygen would be rushed back to work.

THE OTHER COVID CASES IN TRUMP’s ORBIT — A parade of Trump associates tested positive since the president and First Lady Melania Trump revealed their diagnoses early Friday morning, including longtime adviser Kellyanne Conway and Trump campaign manager Bill Stepien.

The White House is also bracing for additional cases, with chief of staff Mark Meadows warning reporters that more positive diagnoses are expected.

Meanwhile, three GOP senators — Mike Lee, Ron Johnson and Thom Tillis — have tested positive and are in isolation, introducing a new wrinkle into upcoming Supreme Court confirmation hearings for Judge Amy Coney Barrett. Senate Majority Leader Mitch McConnell has said that those hearings will proceed as scheduled on Oct. 12, although the full Senate will not return until Oct. 19, two weeks later than planned.

It appears increasingly likely that the White House celebration of Barrett’s nomination to the Supreme Court 10 days ago was a major vector of coronavirus spread. See POLITICO’s graphic and timeline.

But scientists can’t say for sure; the CDC as of this weekend hadn’t been activated to investigate the outbreak and perform contact tracing, per multiple press reports.

For context: the Trump-connected outbreak could be one of Washington’s worst super-spreading events after months of generally containing the virus, the Washington Post reports.

“A Bowser administration official said that eight potential cases from a single event would represent among the highest community spread incidents the city has experienced in recent months,” WaPo’s David Nakamura and Fenit Nirappil write.

— The White House strategy of relying on rapid tests to curb Covid-19 clearly failed, POLITICO’s Sarah Owermohle reports, with officials often eschewing protections like masks and social distancing in favor of faith in diagnostics.

But the tests, which were supposed to deliver results in 15 minutes, couldn’t protect the most fortified compound in the country at perhaps the most critical moment in Trump’s presidency, leaving him and a growing share of his inner circle stricken and the government in chaos.

HOW A TRUMP OFFICIAL PRESSURED CDC TO CHANGE REPORT ON COVID AND KIDS — As CDC officials worked to finalize a Morbidity and Mortality Weekly Report about the virus’ impact on young people last month, they encountered an unexpected wrinkle: a Sept. 11 email from political appointee Paul Alexander, who complained that the use of terms like “pediatric” was misleading when describing older teenagers, among other criticisms.

Alexander’s requests arrived in the midst of a weekslong White House campaign to re-open schools and play down the risks of coronavirus to children. His request also complicated CDC’s efforts to change the report after career civil servants made similar suggestions, according to an email exchange that CDC shared with POLITICO.

“[I]f we change the title and how the cases are described, there could be an erroneous perception that we are being influenced,” the MMWR editor wrote in an email shared with POLITICO, three days after Alexander’s email arrived — which was also the same day that POLITICO revealed Alexander’s long pressure campaign on MMWRs.

— CDC did change the bulletin’s title and summary to minimize words like ‘pediatric,’ which the agency defended as the result of a scientific review. But the changes also aligned with the demands from Alexander, who exited the health department the day after the MMWR was posted and didn’t respond to a request for comment.

Current and former CDC officials who reviewed the exchange said they were uncomfortable with Alexander directly making pre-publication requests of the MMWR’s editor, arguing that it broke the historic firewall between political appointees and career scientists.

It’s also the latest example of how Trump appointees’ interference has rippled across the health department — and how even when career experts can find common ground with political officials, they have been tainted by the unprecedented efforts to shape their findings.

ICYMI: MEMO DETAILS HHS PUSH TO UPEND FDA’s TESTING OVERSIGHT — Two months before Health and Human Services Secretary Alex Azar overruled FDA officials to revoke the agency’s oversight of lab-developed tests this August, the health department’s top lawyer began building a legal case that would lead to its controversial decision to remove that authority, according to a memo obtained by POLITICO.

The memo offers new insight into how HHS officials revoked the FDA’s ability to regulate the safety and quality of tests developed by labs for their own use, despite fierce protests from FDA Commissioner Stephen Hahn and other FDA officials, some of whom believed it could allow low-quality tests to flood the market and undermine the country’s ability to track the coronavirus, Dan and David write.

The Trump administration is set to settle a lawsuit with Purdue Pharma over the opioid epidemic, but the Sackler family behind the controversial company will retain considerable wealth, Patrick Radden Keefe writes for the New Yorker.

Organ procurement organizations have been approved for millions of dollars in pandemic loans despite large cash reserves, a history of poor performance or even lobbying to stop the administration’s changes to organ procurement, Adam Zagorin reports for the Project on Government Oversight.

Pennsylvania Gov. Tom Wolf is moving forward with state health reforms modeled on Massachusetts, Kris Mamula writes for the Pittsburgh Post-Gazette.

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