A ‘COVID kiss’ at the White House: Outdated or politicized rules offer little protection

White House press secretary Jen Psaki insisted last week that President Joe Biden had not been in close contact with House Speaker Nancy Pelosi (D-Calif.), who has tested positive for COVID, despite sharing hugs and a kiss on the cheek at two White House events.            

Psaki invoked the well-worn Centers for Disease Control and Prevention (CDC) guideline, instituted in October 2020, that defines close contact as “someone who was less than 6 feet away from an infected person for a cumulative total of 15 minutes or more over a 24-hour period.” The CDC guideline goes on to indicate that for an asymptomatic person, such as Pelosi, the risk of spread begins starting two days before the positive specimen collection date.

In addition to being somewhat arbitrary, and not proven by prospective double-blinded randomized trials, this guideline also is outdated — it doesn’t take into account the current circulating BA-2 Omicron subvariant. BA-2 appears to be 50 percent to 60 percent more transmissible than the original Omicron variant (BA-1), which itself was three to four times more transmissible than Delta, a variant that was twice as contagious as the original COVID-19 strain. It also takes far fewer viral particles to spread Omicron BA-2 than previous variants. 

So the 15-minute rule is clearly obsolete and perhaps falsely reassuring, especially at a crowded, poorly ventilated White House, without a mask in sight. COVID continues to spread through the administration, including several members of the president’s Cabinet, guidelines or no guidelines. All eyes are on the president himself, though there are no reports of a positive test as of yet.

The kiss on the cheek exchanged between the president and the Speaker has received a lot of attention, as a possible mode of transmission of the virus. My view is that it is possible for SARS-COV-2 to be transmitted this way, because saliva carries high concentrations of the virus. (In fact, saliva measurements are one of the ways we test for it.)

The problem with political rules based on out-of-date guidelines is that they are not only based on the dogma of the moment, they too are arbitrary. If I were attending an event at the White House right now, with the Omicron Beta-2 subvariant spreading, I would wear a mask and kiss no one, whether the rules allowed me to do so or not.

When it comes to clinical practice, guidelines are intended to guide, and they are rarely flexible enough to completely cover shifting clinical realities. They also are based on averages or statistics, which is why, historically, I have frequently ignored them. My clinical decision-making is based on the latest facts I have available, along with clinical judgment and intuition. When the U.S. Preventative Services Task Force guidelines no longer recommended routine PSA screening for men over the age of 55, I continued to test it on all men over 45 anyway, because I used the information to guide me rather than to knee-jerk a biopsy the way the USPSTF was warning about. 

During the pandemic, health agency guidelines have been transformed to rigid rules that have led directly to punitive or unyielding mandates. This is not their best use. I think we can learn a lot from the over-politicization of COVID guidelines on federal, state and local levels.

Of course, we all hope that the president and the vice president do not catch COVID due to contact with Speaker Pelosi or other infected officials in the White House this past week. Nevertheless, I was surprised to see such a maskless cheek-to-jowl gathering, which was not medically or politically sound at a time when COVID mandates still abound. After all, I am still required to wear a mask on a plane — which is probably no more of a risk than a crowded White House gathering.

Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent and author of the new book, “COVID; the Politics of Fear and the Power of Science.”