WASHINGTON (AP) In an extraordinary step, the Washington, D.C., Department of Health has released an open letter appealing to all White House staff and anyone who attended a Sept. 26 event in the Rose Garden to seek medical advice and take a COVID-19 test.

The letter indicates a lack of confidence in the White House medical teams own contact tracing efforts regarding an ongoing virus outbreak that has infected President Donald Trump , multiple senior staff members and two U.S. senators, among others.

Co-signed by nine other local health departments from neighboring jurisdictions in Maryland and Virginia, the letter flatly states a belief that contact tracing on the outbreak has been insufficient.

It says the public appeal is based on, our preliminary understanding that there has been limited contact tracing performed to date, there may be other staff and residents at risk for exposure to COVID positive individuals.

It asks all White House employees, anyone who attended the Sept. 26 event and anyone who may have been in contact with those people to contact your local health department for further guidance/questions regarding your potential need to quarantine.

The letter represents a rising level of concern and a clear shift in strategy by Mayor Muriel Bowsers government, which had previously remained publicly hands-off and said it trusted the White Houses robust medical operation to handle its own contact tracing and follow-up.

Bowser said earlier this week that repeated attempts to contact the White House over the outbreak had received a very cursory response but that she believed the necessary steps were being taken.

There are established public health protocols at the White House that are federal in nature, Bowser said on Monday. We assume that those protocols have been engaged.

A Health Department spokeswoman did not respond to questions on whether the letter had been directly sent to any White House employees or people who attended the Sept. 26 event, or if the D.C. government had been provided with a list of attendees.