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A scramble is underway in Washington to determine how far COVID-19 infection has spread in the top ranks of US leadership after Donald Trump tested positive, in a week that included a presidential debate, political rallies, and White House meetings with Congress.

The White House said its medical unit had begun contact tracing on Thursday. Among those who may have been exposed is the Democratic challenger for the presidency, Joe Biden, who stood a few meters away from Trump for the 90 minutes of Tuesday night’s televised debate. Epidemiologists said that if Trump tested positive on Thursday morning he could have been infectious at that time.

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The two candidates did not shake hands under COVID-19 rules, and their lecterns were about 3 meters apart, but for the majority of the debate, the president was speaking, sometimes at high volume, in Biden’s direction in an indoor venue in Cleveland.

Saskia Popescu, an epidemiologist and assistant professor at George Mason University, said it was “entirely possible” Biden had been exposed, as Trump would have been infectious for 48 hours before testing positive.

Also on the list for possible exposure is the vice-president, Mike Pence, the White House chief of staff, Mark Meadows, Trump’s pick for the Supreme Court, Amy Coney Barrett, and the Senate Republicans they visited this week to prepare for Barrett’s confirmation hearings. Pence tested negative for the virus on Friday morning and remains in good health, his spokesman said.

The list also includes Trump’s children and his son-in-law, Jared Kushner, along with other senior White House staffers who accompanied Trump from Washington to the Cleveland debate and back. Few if any of them are reported to have worn masks on Air Force One.

The extent of the spread of COVID-19 in the top tier of US politics will depend on when the president, Melania Trump, and Trump’s adviser Hope Hicks became infected.

Hicks tested positive on Wednesday after feeling unwell at a Trump rally in Minnesota. According to the New York Times, a small group of White House officials were aware of the result on Wednesday evening. Hicks flew back from Minnesota in a separate cabin on Air Force One and exited from the back of the plane.

Despite the fact that the White House knew about Hicks’s condition, Trump traveled to New Jersey for a fundraising event on Thursday, and his press secretary, Kayleigh McEnany, held a briefing for journalists.

As she had accompanied Trump on trips all week, Hicks should have been tested every day. However, if she was symptomatic from COVID-19 infection on Wednesday, that raises questions about the testing. Normally symptoms do not appear for several days after infection, so it is possible Hicks was given false-negative results from tests earlier in the week. The White House uses the Abbott ID Now test, which has been found to produce a significant percentage of false negatives.

Pence attended a meeting at the White House on Monday but did not travel with Trump to Cleveland for the debate. However, he has been in close proximity to Meadows since then. Meadows has, in turn, been in daily close contact with Hicks and the president.

Pence and Meadows have accompanied Barrett to a series of meetings with Republican senators starting on Tuesday. A photograph from Tuesday morning showed Pence, Meadows, Barrett, and the White House counsel, Pat Cipollone, meeting the Republican Senate leader, Mitch McConnell. In the photograph, none of them are wearing masks.

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