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The Washington, D.C., Department of Health on Thursday released an open letter asking that White House staff and anyone who attended a Sept. 26 event in the Rose Garden contact their health department for guidance on the possible need to quarantine after multiple attendees, including the president, tested positive for COVID.

The letter, co-signed by nine other local health departments from neighboring jurisdictions, indicates a lack of confidence in the White House medical team's 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.

In this Sept. 26, 2020, photo President Donald Trump, center, stands with Judge Amy Coney Barrett as they arrive for a news conference to announce Barrett as his nominee to the Supreme Court, in the Rose Garden at the White House in Washington. Former New Jersey Gov. 

In this Sept. 26, 2020, photo President Donald Trump, center, stands with Judge Amy Coney Barrett as they arrive for a news conference to announce Barrett as his nominee to the Supreme Court, in the Rose Garden at the White House in Washington. Former New Jersey Gov.  (AP)

The letter 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 individuals who have worked in the White House in the past two weeks, attendees of 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 marks abrupt shift in strategy by Mayor Muriel Bowser's government, which had previously said it trusted the White House's robust medical operation to handle its own contact tracing and follow-up. The Democratic mayor 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.

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It was not immediately clear 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.

The letter further shines a spotlight on the Sept. 26 Rose Garden ceremony to introduce Trump's Supreme Court nominee, Amy Coney Barrett. Multiple attendees, including Trump and Notre Dame University President Rev. John Jenkins, who flew in from Indiana for the ceremony, have now tested positive.

White House spokesman Judd Deere said Monday that the White House "has established a robust contact tracing program led by the White House Medical Unit with CDC integration to provide appropriate recommendations."

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The District of Columbia has reported 15,765 positive COVID-19 cases, with 634 deaths. Bowser on Wednesday announced she was extending the local state of emergency, which was scheduled to expire Oct. 9, through Dec. 31.

The Associated Press contributed to this report.