Tara C. Smith Does Trump have coronavirus? He didn't know his results when shaking dozens of hands.

The goals of quarantine and isolation are the same: to reduce the spread of the virus. And it's one Trump publicly eschewed with each news conference he held.
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By Tara C. Smith, professor of epidemiology at Kent State University

Reps. Matt Gaetz, Doug Collins, Don Beyer and Mark Meadows. Sens. Ted Cruz and Lindsey Graham and Rick Scott. Canadian Prime Minister Justin Trudeau, Portuguese President Marcelo Rebelo de Sousa, most of the Romanian government and many more: all important political leaders, all self-quarantined after exposure to people who were diagnosed with COVID-19.

Who decided against self-quarantine? President Donald Trump, despite having had close contact in recent days at Mar-a-Lago with Fabio Wajngarten, press secretary for Brazilian President Jair Bolsonaro, who has since been diagnosed with COVID-19. (Bolsonaro himself was reported to have tested positive, but stories quickly came out to say the opposite; Bolsonaro told Twitter followers not to believe the fake news media.)

On Friday, Trump dismissed the need to enter quarantine after suggesting his exposure was limited to posing for pictures that last "for literally seconds." He also said he did not need to enter quarantine because "I don't have any of the symptoms." On Saturday, Trump's physician, Sean P. Conley, said in a statement that the president had indeed tested negative for coronavirus.

While it's good news that the president isn't sick, his decision to get tested without changing his daily routine completely misses the point of quarantine. And it is an abysmal abdication of leadership during a global pandemic.

First, a brief primer on the difference between quarantine and isolation. Quarantine is the act of being separated from others when you have been exposed to someone who is ill but you are not sure whether you are sick yourself. It keeps you away from others in the event that the infection could be spread before you develop symptoms. While we are still learning more about SARS-CoV-2, the virus that causes COVID-19, it does seem that it can be spread before symptoms develop, at least in some cases. This means that if you wait until symptoms develop to stop spending time with others or until you have a positive test result, it may already be too late — you've exposed them to the virus. Yet Trump has been doing exactly this for days.

If you wait until symptoms develop to stop spending time with others or until you have a positive test result, it may already be too late.

The virus can be transmitted person to person by handshakes, which Trump has steadfastly refused to discontinue. An example of transmission before symptoms in China occurred during a dinner party, like those Trump has hosted at Mar-a-Lago. We're still learning all the details of transmission, such as whether taking a photo with a person who develops COVID-19 is enough to constitute "close contact." But these gray areas are exactly why experts suggest quarantine just in case: It's the most prudent and safest course of action to protect everyone in the face of uncertainty.

Isolation, then, is what happens to people who are ill. The logistics are similar: In each case, the person should be kept apart from others as much as possible and remain so while they are contagious (or potentially so). But while quarantine is typically done in a home setting (with some notable exceptions), isolation may be done at home or, if the person is very ill, within a hospital setting.

The goals of quarantine of the exposed and isolation of the ill are the same: to reduce the spread of the virus. For SARS-CoV-2, on average, one infected person spreads it to two or three other people. If even half of the people who knew that they were exposed to someone subsequently diagnosed with COVID-19 (as Trump now knows) voluntarily quarantined themselves, the intervention would break many chains of transmission and could significantly reduce the overall impact of the virus in the population.

This is what public health officials are working to do by encouraging everyone to minimize their contact with others as much as possible to "flatten the curve": slow the spread of the infection enough so it does not overwhelm our health system and cause an increased number of deaths. It's a responsibility that other leaders are demonstrating they keenly understand — and have taken on despite the disruption it may cause — but one that Trump purposely and publicly eschewed with each meeting he attended and news conference he held.

At a time when schools and universities are suspending in-person classes for weeks to months around the country, when people are subject to layoffs and job loss and when those who are at high risk of serious illness because of age or other health conditions are fearful for their very lives, the least our commander-in-chief could do is demonstrate that he truly believes in the seriousness of the situation — for the country, and for himself. The fact that he chose to gamble with his health and the health of those around him suggests he still does not.