Jonathan P. Baird

When the history of the COVID-19 pandemic is ultimately written, it will be seen as a failure of public health. There is broad agreement among scientists that hundreds of thousands of Americans died unnecessarily. The Lancet estimated 40% of U.S. COVID-19 deaths were avoidable.

Explaining why the deaths did happen is a story that has been inadequately told. It goes far beyond inept and negligent leadership by the Trump Administration. The story is fundamentally about how Trump subordinated public health to his presidential campaign for re-election. Protecting the country from the virus was less important than winning re-election.

Optics meant everything to Trump and his administration’s response to COVID-19 was a model for what not to do in the face of a public health emergency. In their book Nightmare Scenario, Washington Post reporters Yasmeen Abutaleb and Damian Paletta chronicle the Trump COVID-19 response through the last year of his administration.

Early on in January 2020, Trump minimized the virus and said “we have it totally under control”. Abutaleb and Paletta say Trump thought he could will the virus away:

“The key to willing it away was to ensure that his public remarks conveyed no concern, no apprehension. His life, in public and private, was built on a stack of fakes and lies, an amoral brazenness that gave him a decided advantage over his adversaries…He would use the same tactic on this virus, this microbe, this tiny thing no one could see.”

Trump refused to believe the virus would come to America. For months, he repeatedly said the virus was just going to magically disappear.

When it did not disappear, he focused on creating the impression that virus numbers were minimal. Abutaleb and Paletta say Trump saw the U.S. case count like a golf score he wanted to keep low. He did not want infected passengers on the cruise ship Diamond Princess to disembark in America because it would double his COVID-19 numbers.

Trump actually suggested sending the ill passengers, most of whom were elderly, to Guantanamo Bay. His aides killed the idea because they realized sending elderly sick people to Gitmo was a birdbrain idea.

Trump saw the virus as a messaging problem and he wanted to control the message. In the early months of 2020 the message was: this is going away. He blamed testing for making him look bad. From his perspective, the more testing, the more cases would show up. He told Health and Human Services Secretary Alex Azar, “Testing is killing me.” He wanted to slow testing down.

There is no question though that Trump privately knew COVID-19 was deadly. He told Bob Woodward:

“This is deadly stuff. You just breathe the air and that’s how it’s passed. And so that’s a very tricky one. That’s a very delicate one. It’s also more deadly than even your strenuous flu.”

That, however, was never the public message. He always played the virus down. Trump’s re-election strategy was to keep people working and shopping no matter how many died. He remained afraid of the stock market crashing and a poor economy costing him re-election. In March 2020 he tweeted that we could not let the cure be worse than the problem. This became the mantra for Republicans and right wing media.

Things went especially haywire when Trump started touting miracle cures like hydoxychloroquine, bleach and shooting powerful lights into the body. Selling quack cures like some elixir degraded his station and made him look like a snake oil salesman. He became too easy fodder for late night comedians.

No president was ever more anti-science than Donald Trump. When public health officials like Dr. Fauci and Dr. Birx tried to inject reality, Trump accused them of negativity. He had contempt for his own COVID-19 Taskforce calling it “that fucking council that Mike (Pence) has”. Trump was fed up with doctors who would not tell him what he wanted to hear. He could never embrace the importance of masks and social distancing.

In the second half of 2020, Trump gave up on any pretense of fighting the virus. Trusting his gut instincts, Trump backbenched Dr. Fauci and Dr. Birx in favor of Dr. Scott Atlas, a telegenic figure who appeared on FOX, who promoted discredited theories of herd immunity. Doctors in the infectious disease community were horrified. Trump returned to rallies with tightly packed crowds of people who were largely maskless.

Abutaleb and Paletta say that when Trump came down with COVID-19 he was far more sick than was ever reported to the public. His fever spiked and his blood oxygen fell below 94 percent, once dipping into the 80’s. His doctors worried he would die. Because of his access to experimental medications others could not get, he recovered but he appeared to learn nothing from the experience.

Beating the virus, he doubled down and played macho man. His message was that people should not be afraid of the virus and they should live normal lives.In effect, they should ignore the virus.

Trump’s post-illness performance, when he removed his mask after walking up the White House stairs reflected his anti-science attitude. He hated masks as a sign of weakness and he asked aides who wore masks in his presence to take them off. Appearances were always more important than science to Trump.

As the pandemic evolved, Trump was oblivious to the massive pain, hardship and suffering. He remained unable to show empathy or compassion to COVID-19 victims or their families.

In October 2020, a Trump Administration official said: “What happens when you mix politics and public health? You get politics.” Winning was everything to Trump but his incompetent handling of the pandemic was probably the biggest single reason he lost re-election.

Instead of leading a coordinated federal effort, Trump took no responsibility and downshifted blame to the states. Initially he and Jared Kushner wanted to blame blue state governors but the spike of infections in red and swing states nixed that.

Trump believed the COVID vaccine could save his electoral prospects and he was obsessed with getting the vaccine out before the November election. When that did not happen, he did not step up to counter vaccine hesitancy. You would have thought he would have championed the vaccine and then taken credit. Instead he did nothing to counter the anti-vaxxers which is tragic because COVID deaths are now almost entirely coming from red states with higher unvaccinated populations.

In a little known moment, Trump and the former First Lady got vaccinated in the White House back in January 2021. He did very little to encourage people to get vaccinated and it could have made a difference. More recently, he has railed against school age children getting the COVID-19 vaccine saying falsely that they are not affected by coronavirus.

I am not expecting any accountability for the Trump Administration’s epic failure. There is no law against doing nothing while hundreds of thousands die.Hopefully though, when the next pandemic hits, we will have learned something from this debacle.