Jeffrey Goldberg, The Atlantic’s editor in chief, joined staff writer Caitlin Dickerson to discuss her cover story, a years-long investigation into the secret history of the Trump administration’s family-separation policy. Dickerson’s story argues that separating children was not an unintended side effect, as previously claimed, but its core intent. How did officials work to keep families apart longer? Did they obscure the truth to both Congress and the public? What will happen if the Trump administration is restored to power in the 2024 election? This dialogue is an edited and condensed version of a conversation Dickerson and Goldberg had on Friday for The Atlantic’s “Big Story” broadcast.

Jeffrey Goldberg: When did you realize that the Trump administration was doing something new?

Caitlin Dickerson: There were two things here that really stood out from the norm in my experience as a reporter. The first, with family separations, is just the mere fact that they took place in relative secrecy. In 2017, hundreds of separations took place starting out in El Paso, Texas, in a program that later expanded. But when reporters would ask about it, the administration would tell us, “No, this isn’t happening. You know, we’re not separating families.” There’s some complicated reasons for that which we can get into, but that’s really not normal. As a reporter, you’re used to hearing “no comment” in response to a story that the government doesn’t want you to report. Or you’re used to hearing a public-affairs officer offer some context that at least helps to soften the blow of a story that they know the public is not going to react kindly to. But in this case, we actually got denials.

And then, of course, having looked back at immigration policy all the way back to the 19th century in the United States, separating children from their parents as an immigration policy hasn’t happened before. It was the harshest application any of us have seen of this basic concept of prevention by deterrence, which is how we approach immigration enforcement generally. And it was so harsh and painful for parents and for children, and continues to be, that I had to stick with it.

Goldberg: So to be clear, no presidential administration going back all the way had ever done anything this dramatic?

Dickerson: No. As you know, there are examples of kids being taken from their parents in American history, though not in a border context. We’ve had some pretty cruel and pretty harsh border-enforcement policies. But the forcible separation of children from their parents is just not something that the Border Patrol has ever engaged in in American history.

Goldberg: One of the great achievements of your story is that you take us all the way into the bureaucratic decision making that allowed this to happen. But somebody had to think of this first. The assumption, on the part of people who think about this, is that it must have been Stephen Miller, Donald Trump’s very hard-line adviser. He worked for Jeff Sessions and brought a lot of his ideas to Donald Trump. But it’s more complicated than that.

Dickerson: It took a lot more than Stephen Miller, Donald Trump, and Jeff Sessions to forcefully separate thousands of kids from their parents. The idea actually came from within the border-enforcement apparatus: a man named Tom Homan, who started out as a Border Patrol agent in his early 20s, spent a career in enforcement, and ultimately became the head of ICE under President Trump.

He first came up with the idea to separate families as an escalation of the concept of prevention by deterrence: this idea of introducing consequences to discourage illegal border crossing, even when it’s for the purposes of seeking asylum. He first proposes separating children from their parents in 2014, during the Obama administration, which is when we saw the first major surge of children and families crossing the border. Border Patrol was totally overwhelmed at the time. Congress didn’t intervene. And so you have, essentially, a police force that’s left to figure this out—this policy, which is really humanitarian policy; it’s economic policy. When you leave this to the Border Patrol, the solution that they come up with time and again is punishment. So Homan proposes it, and Jeh Johnson, who was Homeland Security secretary at the time, rejects the idea. Then the idea resurfaces very soon after Donald Trump takes office.

Goldberg: So there was a bureaucratic impetus from below. Take us through that—Donald Trump wins in 2016, comes into office, and this dormant idea is brought to whom?

Dickerson: Trump comes into office and is visiting Border Patrol headquarters and Customs and Border Protection headquarters and saying, “Hey, we’ve got to shut this border down, and, really, we’ll stop at nothing to do it. Bring me your best ideas.” Tom Homan, who was the head of ICE, and a man named Kevin McAleenan, who was the head of Customs and Border Protection, very quickly reraise this concept that they had already talked about and already favored. They tell Miller about it, who gets really excited and kind of obsessed with it. And Miller continues to push for the next year and a half until it’s officially implemented. Donald Trump also begins to favor it.

I was surprised about this, ultimately, but the story ends up being kind of a case for the bureaucracy. I learned, in reporting this, the way the policies are made. Typically, you have principals, who are the heads of agencies and have great decision-making power but have huge portfolios. Policy ideas should only ever reach the desk of someone like Kirstjen Nielsen—who was the Homeland Security secretary, who ultimately signs off on family separation—if they’ve been thoroughly vetted. Subject-matter experts have determined these policies are logistically feasible, they’re legal, they’re ethical. They make sense politically for the administration in office. All these layers exist to prevent bad policies from ever even reaching somebody who has the authority to sign. And these systems were really either sidelined, disempowered, or just completely cut out of the conversation. Everybody who was raising red flags was really cut out.

Goldberg: I want you to talk about child separation in its details. The idea is preventative. Which is to say, if word gets out into Guatemala, Honduras, wherever, that if you try to cross the border with your kid, the U.S. government will take your kid from you—actually kidnap your child in some kind of bureaucratically legal way—then all the people who are trying to come to America, asylum seekers, workers, etc., will not come. Is that the theory of the case?

Dickerson: That is the theory of the case. And there’s a lot of reason to believe it’s not a good theory.

Goldberg: Why is it not a good theory? It sounds pretty scary if you’re sitting in Guatemala and somebody says you might lose your kid.

Dickerson: It does. That’s what’s difficult about it: that it is somewhat intuitive, this idea of prevention by deterrence. Academics have been studying it for a long time and know what ways it works, and what ways it doesn’t work. In the early 2000s, we started prosecuting individual adults who crossed the border illegally.

To begin with, there’s this program called Operation Streamline. It completely floods courts along the border, and immediately, prosecutors—assistant U.S. attorneys—are unhappy with it because they’re saying it’s taking away resources from these more important cases that we need to deal with. And not only that, but it doesn’t seem to be influencing long-term trends.

If you look at shifts in migration that have taken place over the last 20 years, those can be explained entirely by looking at economic shifts and demographic shifts in the United States and the countries where people are coming from. All of those changes are attributable to the availability of resources here and the availability of jobs here, and then the inverse: what opportunities people have available to them in their home countries, as well as whether people actually feel safe.

Even though prevention by deterrence, first in the form of Streamline, wasn’t making a dent in border crossings in any significant way, this idea becomes more and more popular until ultimately we get to the point of separating children from their parents. Anecdotally, Lee Gelernt—the ACLU lawyer who’s heading up the federal case against family separations, the main case that prompted family reunification—talks about asking every parent that he interviewed for that case, “If you had known about family separation, would you have left your country to begin with? Would you have decided to stay home?” And they’d just kind of shrug their shoulders and say, “Well, what was I going to do? You know, we left because our lives were in danger. I couldn’t stay.” That is something that people like Tom Homan, who came up with the idea to separate families, didn’t really take into account.

Goldberg: The level of desperation at home is the key determinant of whether somebody is going to start the trek.

Dickerson: It’s a very, very high bar to surpass when you’re talking to a parent who not only can’t feed themselves or their child, but on a day-to-day basis fears that their child may be killed.

Goldberg: Stay on that for one second so people understand this population. You’re talking about people who are living in very dangerous Central American countries, mainly.

Dickerson: You’re talking about a lot of times a combination of deep poverty, daily fear of death, and daily encounters with violence. I can tell you about my experiences reporting in parts of Mexico, where people come to the United States from, and in Central America. When The New York Times sent me to Guatemala to write about a family that was trying to get into the United States, I had security with me the entire time. Many people, just within this family, had been murdered. It’s a domino effect where a gang identifies one person in a family and wants that person to join the gang. If that first individual doesn’t do right by the gang, relatives continue to be murdered.

When I would go house to house to visit with people associated with this family, we were hiding. They couldn’t let anybody know where they lived. They couldn’t let anybody know that I was there, because it would have put them in greater danger. The poverty, too, is really something that I don’t know a lot of Americans have really sat down and thought about. Houses that have no roofs, no floors. Families of four that are splitting a tortilla among them. Access to school is almost nonexistent. Kids don’t have shoes. It’s stuff that I think most Americans have a hard time envisioning. Think about how scared you would have to be to decide to go to the United States, knowing that you’re going to have to travel through a hot and dangerous desert and encounter murderous gangs. Nobody signs up to do that unless they feel like they have absolutely no choice.

Goldberg: Let’s come back to the narrative of the adoption of this policy. One of the reasons, when we were talking about doing this story over the past year and a half, was to try to understand the mentality of government officials and bureaucrats. Somehow the idea of taking children from their parents becomes socialized within these government structures. Talk about that. Did anybody along the way say, “Hey, I’m all for deterrence. I have these views on immigration. I’m a hard-liner. But this does not seem to comport with my notions”—and I’m using this term advisedly—“my notions of family values”?

Dickerson: A lot of people said that. And ultimately, by the time the decision to pursue separating families is made, they had been left out of the room. When family separations are first proposed, they’re described in pretty blatant terms. I interviewed Jeh Johnson—again, who was the Homeland Security secretary under President Obama, and did believe in deterrence—but he said, “That’s too far for me. I’m not comfortable with it.” John Kelly, who was President Trump’s first Homeland Security secretary and considered the idea after it was proposed by Tom Homan, Kevin McAleenan, and others, said the same thing. He wasn’t really a big believer in deterrence, but he’d taken the job for the Trump administration. But this felt too far for him.

Goldberg: John Kelly then goes to the White House as chief of staff and is there when all of this is still going on. What role did he play there?

Dickerson: Kelly told me that his approach to opposing family separations was to focus purely on the logistics. When the idea is formally proposed to him, he requests a briefing to find out whether it’s possible. And he learns, rightly, that the federal government did not have the resources to impose such a program without total chaos, which we ultimately saw—without losing track of parents and kids, without really inhumane situations where kids are being physically taken out of their parents’ arms. You need training, theoretically, to do this in a way that isn’t chaotic if you’re going to do it at all.

He told me that he knew that appealing to the president and to Stephen Miller on some sort of moral basis wasn’t going to be effective. They weren’t going to listen. Instead, he said, you focus purely on the logistics. “It’s not possible. We just can’t do it.” He would say, “Mr. President, if you want to pursue this, you need to go ask Congress for the money,” knowing that Donald Trump wouldn’t be willing to do that. The problem is that when you ask these more hawkish members of the administration what their understanding of John Kelly’s view is, they would say to me, “Well, I didn’t know he had any issue with it. All he said was that we needed more money; we needed more training.” You can see that there’s logic behind Kelly’s approach, but there’s also, as a result of it, repeated meetings where this idea is being discussed. He could have jumped up and down and screamed and said, “I oppose this; I don’t want to do it.” But he didn’t. He just said, “Sir, we don’t have the money.”

Goldberg: I mean, to be fair to Kelly, he did have a reasonable understanding that Trump would never respond to the humanitarian argument.

Dickerson: There are so many different approaches that people say they took to try to prevent this, and it ultimately didn’t work. The higher the numbers rose, the more obsessed Donald Trump became with finding some way to minimize them.

Goldberg: I do want to ask about two people whose names are very intimately associated with this. Kirstjen Nielsen, who was the DHS secretary and signed off on this, and Stephen Miller. I want you to talk about her role, which is more complicated, morally, than we initially thought. And Miller, who obviously is still the ideological driver of a whole set of policies.

Dickerson: Kirstjen Nielsen came into the Trump administration a moderate. She was a cybersecurity expert who helped to establish DHS the first time under George W. Bush. No experience in immigration, and no real strong feelings about immigration. She’s one of a lot of people whom I interviewed who joined DHS under Trump and just said, “I didn’t know all that much about immigration. It wasn’t that important to me.” From the very beginning, they seemed a bit misguided in terms of what their expectations for their job might look like, given how much this White House really cared about the issue.

Family separations are proposed to her right after she’s confirmed, in December of 2017, and she says, “Absolutely not. John Kelly has said no to this. I’m not doing it. I oppose it. I don’t believe in it.” Over time, this alternative version of achieving the same end is proposed to her via prosecution, and conveyed to her in these terms that are quite bland. You know, “We’re going to pursue a prosecution initiative. There are people who have been committing misdemeanor crimes; we’ve been letting them go simply because they’re parents.” There was a lot of fearmongering around this idea that a lot of the parents might have been smugglers, that families may not have actually been related at all, that these children might all have been victims of trafficking. There’s no evidence to support that a significant number of those false families existed. She’s also told, “It’s been done before,” and that systems and processes exist to prevent chaos from ensuing. And so, based on that information, she ends up approving the policy.

Another really important thing to know about her is she came into her role at a disadvantage because she was viewed as a moderate. She was one of a lot of people who were viewed very skeptically in the White House.

Goldberg: Are these people who are trying to prove they’re tough so that Donald Trump likes them?

Dickerson: Or keeps them in their job.I heard in my reporting that, in fact, “You’re not tough enough” is a quote that Trump repeated to Nielsen all the time. At one point an adviser suggested, “Maybe you should write a memoir and call it Tough Enough because he’s always telling you you’re not tough enough.” Nielsen was always trying to kind of meet these expectations and show that she wasn’t a closeted liberal. She eventually signs off on this policy that she intellectually, at least prior, seemed to totally oppose, but had convinced herself of a lot of illogical realities and decided, Okay, I agree to zero tolerance. She’s a really smart person, but she worked so hard to please her bosses.

The other person you were asking about was Stephen Miller. What I understand from people close to him and familiar with his thinking is that he continues to believe that President Trump’s harshest immigration policies were Trump’s most popular and successful accomplishments. I think he still believes in separating families and doing anything to seal the border, stopping at nothing. He’s even made clear to close confidants that the groundwork has been laid so that a future Trump administration, or a future Republican administration that looks like Trump’s, can pursue these policies even more quickly and even more dramatically.

He exerted pressure really kind of shamelessly. He would call not only Kirstjen Nielsen, who was Homeland Security secretary, but all of her advisers and even lower people in DHS: people who had no authority to sign off on anything. He was calling people incessantly to press for his policies, trying to get buy-in. I heard about something he would do on a conference call where he would introduce an idea and say, “Hey, I believe X, Y, and Z needs to happen. And this head of this division of DHS agrees with me.” Then that head of the division might say, “Oh, well, I have some questions about that. You know, I’m not exactly sure.” And Stephen would say, “Well, are you saying that this isn’t a priority?” And they would say, “Oh, no, I do agree with you that it’s a priority.” And Stephen would say, “Great; I have your support.” And then he would go into White House meetings and then repeat it and say that he had buy-in from DHS. He was bullying people into accidentally or tacitly or passively agreeing with his ideas. He was not embarrassed to keep people on the phone after midnight, ranting, not even letting the other person speak. It was a singular focus for him.

Goldberg: John Kelly would give him the cold shoulder. But not everybody had John Kelly’s power, right?

Dickerson: Exactly. And John Kelly is a career military official and general. He believed really strongly in the chain of command. He couldn’t believe that Miller would call people below Kelly and make demands and try to pressure Kelly into making decisions. And so Kelly would call the White House and actually try to get Miller in trouble. He’s one of the few people to do it. But other people much higher in the official chain of command, such as cabinet secretaries, really let themselves be bullied by Miller. When I would ask why, they basically just said Miller had this mystique. He was so close to the president and was protected because of this narrative that immigration is the reason why Donald Trump was elected president and was the key to him being able to hold on to power. Because of that, Miller was insulated from any kind of accountability, even as he defied the chain of command over and over again.

Goldberg: Do you think that these same people, if they came back to government, would do it better? Do you think that they have learned lessons about how to try to pull this off in a more efficient, effective way that wouldn’t draw so much attention?

Dickerson: I do think that a lot of them still believe in this idea, and they’ve taken lessons away from the experience in order to be able to “do it better.” They didn’t have a system for keeping track of parents and kids, so children were sent over to the Department of Health and Human Services, which houses any kid who’s in federal custody on their own. That agency doesn’t have computer systems that talk to DHS. Something like that could be updated. I do think that these officials would go into such a policy in the future a little bit more eyes open about what would actually happen once the separation occurs. But they still believe in this idea. And a lot of them, Tom Homan and many others, would sort of whisper out of the side of their mouth to me in interviews like, “Nobody really likes to say this, but it really worked. And zero tolerance was effective.” Again, the data that they’re citing is inaccurate. There isn’t evidence that family separations were effective. In fact, after zero tolerance ended was the year when a million people crossed the border under President Trump. It was a record-breaking year for border crossings.

Goldberg: Are there any heroes in the story, from your perspective?

Dickerson: There are a lot of people within the federal bureaucracy who tried to prevent family separations from taking place. Within the Health and Human Services agency, which cares for children, there was a man named Jonathan White who oversaw, at the beginning of the Trump administration, the program that houses kids in federal custody. He found out about family separation in an early and rare meeting where you actually had HHS invited to meet with the law-enforcement side. Normally those two agencies—which have to work together on immigration—really don’t play well together, because HHS is made up of a lot of people like White, who are social workers and have backgrounds in child welfare, and then are sitting in the room with cops. It’s a fraught relationship that is detrimental for all sides.

White finds out in an early meeting about this proposal to separate families. And he starts writing up reports mentioning that the agency did not have enough space to house children who are separated, who tend to be younger than those who crossed the border on their own. They didn’t have the resources to deal with the emotional fallout that was easily anticipated by any expert familiar with child welfare and the state a child is going to be in when they’ve just been separated from their parent. He also pointed out that children who cross the border with their parents don’t necessarily have anywhere to go. A child who chooses to cross the border on their own is typically coming here because they have an aunt or a relative, somebody who can take them in in the United States. A child who comes to the United States with their parent is expecting to remain with their parent. Whether they get asylum status or are ultimately deported, the expectation is that they’re going to stay together. And so White started to point out, along with several of his colleagues, that not only did they believe this was a bad idea, the resources just didn’t exist.

You have versions of that same fight, that same argument, being made within DHS, the DOJ, and the U.S. Marshal system. I found examples in all of these places of people within the federal bureaucracy who tried to raise concerns with the White House, with people in their agency leadership, about why this was such a bad idea. There are a lot of people who fought back, and ultimately they didn’t win the argument.

Goldberg: What’s your assessment of the success of President Biden’s executive order setting up the task force for family reunification? How many children do we still think are out there floating in the bureaucratic abyss who haven’t been unified with their parents?

Dickerson: Almost all of the children who were separated have been released from federal custody. If they haven’t been reunified with their parents, they’re in the care of a sponsor: an extended relative or a family friend who went through an application process and was approved to take that child in. That’s very different from reuniting them with the parent with whom they crossed the border, with whom they were living and planning to continue living more than four years ago. That number is between 700 and 1,000—those who have not been officially reunited with their parents, according to government records. Some of them may have, and are thought to have found, their parents on their own and just not reported it to the U.S. government, kind of understandably—not wanting to deal with the U.S. government anymore and fearing future consequences.

The Biden administration had a really tall order in front of it when this task force to reunify separated families was established. So much time had passed, and record keeping was so poor that they had very little to work with. Thus far they’ve been able to track down more than 400 families that have been reunified, and there are several hundred more who are in the process of applying. What I hear from the ACLU and advocacy groups is that the Biden administration is working really hard and doing its best to reunify these families, and they’ve had a significant amount of success in the face of this challenge.

But now they’re dealing with really complicated cases. I’ve heard about parents, for example, who were deported without their kids. That happened in over 1,000 cases. They’ve been back at home since then, and they’ve had to perhaps take custody of an extended relative’s child. I heard about one parent whose sister had been killed. And so the sister’s children were now being taken care of by the separated parent. So then the separated parent is applying to come back and rejoin their own child. And are those other children eligible to come to the United States? It’s not totally clear. I mean, this is what happens. It’s very messy logistically when you separate a family for four years and then try to bring them back together. And so the numbers are shrinking, but the challenge is kind of growing in terms of getting these final families reunified.

Goldberg: Something that, in the colloquial sense, is completely unbelievable to me is that when family separation actually started, no one—for weeks—thought to even write down, keep a log, an Excel spreadsheet, of where the children were going, who their parents were. You could define that as negligence, but negligence bleeds over into immorality very quickly. That, to me, of all the incredible reporting that you did, struck me as almost too much. What for you is the aspect of this entire multiyear saga that you still can’t get your mind around? What’s the thing that still stays in your mind as, “I can’t believe that actually happened?”

Dickerson: The one that I still can’t really believe is the number of people I interviewed who held very significant roles in DHS or in the White House overseeing this issue, to whom I had to explain basic tenets of the immigration-enforcement system. They would say to me, “We never expected to lose track of parents and children. Couldn’t have imagined things would go as poorly as they did.” That just doesn’t make any sense. You can call up any prosecutor in the country and ask them, “Hey, tomorrow I want to start prosecuting hundreds of parents at a time who are traveling with young children who are outside of their communities, with nobody nearby to take those children in. And by the way, they don’t speak the language that most government officials talking to them are going to be using. Is that going to work?” They would tell you it obviously won’t. I was shocked that, to this day, many people involved in this decision making still don’t understand how immigration enforcement works.

Watch: Atlantic editor in chief Jeffrey Goldberg in conversation with staff writer Caitlin Dickerson

By this point, the pandemic saga has introduced us to a cast of recurring characters. Among them are the Chill Friend, who is totally over COVID precautions at this point, and the Unlucky Acquaintance, who has had COVID three times and brings it up whenever someone else falls sick. And then there is the Person Whose Roommate Has COVID. You know the type: They’ll describe, in the hushed tones usually reserved for tragic gossip, how and when their live-in friend, partner, child, or whoever came down with the virus—before interjecting, “But I feel fine! … For now.” Nervous laughter ensues. Whether their house is dealing with a blazing-fever situation or a mild-cough one, Person Whose Roommate Has COVID always has the same underlying worry: Am I next?

The answer can feel like a definitive yes. The perfect conditions to catch the coronavirus might look something like a shared home, where families, friends, or near strangers end up spending lots of time together in confined spaces. Even if they’re not sleeping in the same bedroom, roommates in all their various forms are sitting down at the dinner table together or squeezing past one another on the way to the bathroom—potentially misting the virus into the air in the process. And it doesn’t help that the latest variant, BA.5, is the most contagious yet. If Person Whose Roommate Has COVID has been breathing the same air all this time, is there even a point to quarantining? It can be tempting to throw up your hands, assume that a positive test result is coming, and cozy up on the couch for an extended Netflix marathon.

But while the attitude of Person Whose Roommate Has COVID is natural, it’s also misplaced. All members of a household will not inevitably get COVID if someone falls sick—not even close. One recent roundup of 135 studies found that the overall spread of disease within a home—an epidemiological phenomenon that is unfortunately named “household secondary attack rate”—was 42.7 percent for the earliest forms of Omicron. The offshoots we’ve seen since then are more transmissible, so the chance of getting the virus from a roommate is now probably closer to 50 percent, Bob Wachter, the chair of UC San Francisco’s department of medicine, told me. “It’s about a coin flip,” he said. “The key thing is that it’s certainly not a sure thing.” That is especially useful to keep in mind now that the CDC has updated its COVID guidelines, no longer suggesting that Americans who have been exposed to the virus need to quarantine for five days. It was already happening, but now even more People Whose Roommate Has COVID won’t be taking precautions. Still, the new policy doesn’t change what we know about COVID in the home. Separating yourself from the sick person is tedious and sometimes impossible, but if you can, it’s worth the hassle.

The explanation for why people aren’t destined to get COVID from their roommates “is a complex brew,” Wachter said. He and other experts I spoke with agreed on its main components: the infectiousness of the sick person (the “index case”), the immunity of the other people in the household, the virus itself, and the nature of the home.

Unfortunately, there’s no good way of nailing down just how infectious someone is. Infectiousness varies over time, and a positive test isn’t necessarily a sign that an infection is just beginning—especially these days, when people who are symptomatic can still sometimes get a series of negative rapid-test results. If your roommate comes down with symptoms and gets a positive test result soon after, there is little doubt that person is contagious at that moment. But whether they were infectious prior to the test is not a given. “I wouldn’t assume that just because your loved one was sick for a day or two [before testing] that you were exposed to a contagious person during that time. It’s unknown,” Jennifer Nuzzo, an epidemiologist at Brown University’s School of Public Health, told me. COVID symptoms usually but don’t necessarily equal contagiousness, she explained; confusingly, a vaccinated person may develop symptoms before testing positive on a rapid antigen test because their immune system, primed by the vaccine, is merely reacting to the virus. If you live with that person, “it could give you a glimmer of hope that you could still not get infected, were you to take additional precautions,” Nuzzo said.

And like so many other aspects of COVID, an infected person’s ability to spread the virus also greatly depends on their vaccination status. Remember that the coronavirus is not all or nothing; it builds up in the body incrementally until it spills over and out to other people. In other words, contagiousness hinges on viral load, which may vary with the strength of someone’s immune response. Compared with someone who is unvaccinated, an infected person who is up to date on their shots has a better chance at keeping the viral load down, meaning they are poised to shed less virus to other members of the household.

The vaccination status of other people in the home is “perhaps even more important” than that of the index case, Jodie Guest, a professor at Emory University’s Rollins School of Public Health, told me. Even with the newest variants, vaccines still provide some protection against infection (and even better protection against severe illness and death). In the big analysis of studies, the variant with the highest household-secondary-attack rate was Omicron, but the next-highest was not the second-most-transmissible variant, Delta. Instead it was Alpha, the first major coronavirus variant, which emerged at the end of 2020—before vaccines were widely available in the United States. “That’s solid evidence that the vaccines definitely are preventing a skyrocketing [household] secondary-attack rate,” Guest said. Of course, the protection imparted by vaccination fluctuates with numerous factors: the timing of vaccines and boosters, previous infection with old or new variants, and genetic susceptibility, among others. All other factors being equal, a home made up entirely of unvaccinated people would be expected to have a higher household-attack rate than a home of all boosted people.

Then there is the virus itself. It’s frustratingly good at infecting us humans—a major reason this pandemic has dragged on and on—but it’s still not contagious enough to infect everyone in a household in every single case. “There is some inefficiency in transmission,” Amesh Adalja, an infectious-disease physician at Johns Hopkins University, told me. “It’s clearly not in the same league as measles,” an airborne pathogen that has a household-secondary-attack rate of more than 90 percent. And although Omicron may have qualities that contribute to its high transmissibility—such as a potentially shorter incubation period and larger viral load—those alone might not be enough to fully explain its higher attack rate, Nuzzo said. It’s possible, even likely, that the more important factor is waning immunity, she explained; just about a third of Americans have gotten their first booster shot.  

The factor that is perhaps the most challenging to deal with is the nature of the household itself. Unlike getting vaccinated or putting on a mask, most people cannot change their living situation the moment a double bar materializes on a rapid test. If you live in a mansion, well, congrats. It is much easier to stay distanced and avoid getting sick in a big house with several bedrooms and a backyard. Less so for poorer people who might live in a cramped apartment with a single shared bathroom. Research suggests that poor immigrant neighborhoods—the Bronx, in New York, and Pico Union, in Los Angeles—were among the hardest hit in the pandemic because homes in these areas are disproportionately overcrowded. In multigenerational homes with young children or elderly people who need care, fully isolating is almost impossible. “These are all things that are incredibly variable and specific to people’s situations,” Guest said, “and are going to be inequitably distributed.”

This complex brew has an invisible, maddeningly uncontrollable secret ingredient: luck. Sometimes, a person who is fully vaccinated and boosted falls sick, while a less diligent person dodges infection over and over again. “This is the hardest piece,” Wachter said. “It’s very hard to predict.” Despite our best efforts to protect ourselves and others, COVID can still break through, seemingly at random. So many factors influence susceptibility that accounting for all of them at once is nearly impossible.

Taking all the factors into account, that Person Whose Roommate Has COVID faces baseline 50–50 odds of getting sick is nothing to celebrate. Lots of people in this situation end up falling sick themselves. But it is a reminder that nothing about this virus is preordained. A household can tilt its chances in a favorable direction by doing all the usual, proven things: wearing good masks, opening windows to increase ventilation (and buying a HEPA filter if you can afford one), separating from the sick person when possible, and testing often. If you have no choice but to share a bed with someone who is sick, the CDC recommends sleeping head to toe. Vulnerable people, especially those 65 and over, should have a plan for getting Paxlovid, and everyone should stay up to date on vaccinations and boosters, Nuzzo said. “There’s no point in waiting for a different vaccine in the fall if you get it between now and the fall,” she said. These sorts of measures are really worth the trouble: The problem with not trying is that it can lead to more infections at home, “and then you’ve got a whole other mess,” Adalja said. “Why prolong it?”

There is no way around this: Managing COVID in a household is cumbersome, and it will be far easier for people who have more resources. Some will be able to follow every expert recommendation to the letter; others will have to be more selective. Parents of a sick child may choose not to separate—not because they don’t care about getting infected, but because the risk of doing so is outweighed by the need to care for their child. “Those are fair, emotional, familial conversations,” Nuzzo said. “Some people want permission to not try to stay aseptically isolated from their loved one, and I completely understand why they may want to do that.”

Now that the latest CDC guidance puts COVID safety into the hands of Americans—well, even more than it already was—Person Whose Roommate Has COVID has yet another reason not to quarantine. The hope is that they aren’t infectious. However, there’s always a risk that they may be, and the best way for them to keep protecting others is to remain as cautious as possible at home. The coronavirus is known to spread more easily in households than anywhere else, so doing one’s best to separate from a sick person at home can go a long way in preventing the virus from making the leap from your house to the world outside. Especially heading into the fall and winter, when case numbers are expected to jump even higher, trying to tamp down on household transmission is a small thing we can all do to attempt to keep this virus under control. No matter what, we will continue to meet People Whose Roommate Has COVID, but we can help them avoid becoming People Who Have COVID Too.