Nine months into the pandemic, it’s a truism to say that America’s response has been politicized. Even so, with an election looming, the virus surging, and President Trump and others in government recently infected, our divisions now stand out with a startling, even brutal, clarity. There have always been two basic ways of looking at the coronavirus crisis. The first sees the minimization of death as a paramount goal; the second holds that significant death is inevitable and acceptable. Those who take the first view, including most medical and public-health professionals, advocate a temporary, science-driven restructuring of society, designed to save lives; those who take the second view, including the President and those in his circle, say that people die all the time, from car crashes, drug addictions, diseases, and the like, and argue that we don’t stop living to prevent them from dying. “Many people every year, sometimes over 100,000, and despite the Vaccine, die from the Flu,” the President tweeted, earlier this month, after he was discharged from the hospital. “Are we going to close down our Country?” (Twitter flagged the tweet as misinformation since, in fact, far fewer than a hundred thousand people die from the flu each year.)
There are different ways of holding the we-all-gotta-go-sometime view. Someone who grasps it lightly might incline a little more toward risk-taking than caution in her personal choices. But over the course of the pandemic, the President and many of his followers have come to cling to it tightly, even triumphantly, brandishing it as a kind of ideology. In the final weeks of the campaign, they’ve taken the outlook to a new, disturbing place. Erin Perrine, the communications director for his campaign, has faulted Joe Biden for not getting infected, arguing that Trump “has experience now fighting the virus as an individual. Those firsthand experiences—Joe Biden, he doesn’t have those.” Shortly before leaving the hospital, the President tweeted that his own infection had left him feeling “better than I did 20 years ago!” Trump has turned against government scientists with a new ferocity, referring to them as “idiots” and calling Anthony Fauci, the nation’s top infectious-disease expert, a “disaster.” The President has always seemed not to take the virus seriously. But, in recent weeks, something has changed.
An especially telling moment occurred on October 13th. According to the Times, two senior White House officials cited, in a background conversation with reporters, the Great Barrington Declaration—a document that argues for the pursuit of herd immunity through widespread infection instead of a vaccine. Although most Americans haven’t heard of the declaration, many in the medical community have; Fauci captured the consensus view when, speaking to George Stephanopoulos, he called its core ideas “ridiculous.” Although its primary authors are three professors at Harvard, Stanford, and the University of Oxford, respectively, the declaration hasn’t received the imprimatur of a medical or scientific institution; instead, it’s been sponsored by the American Institute for Economic Research, a libertarian think tank situated in Great Barrington, Massachusetts. The declaration proposes that society should stay more or less open and that the virus should be allowed to infect the vast majority of the population while public-health officials focus on protecting the elderly and others who are especially vulnerable. (The details of the protective strategy go unspecified.) Francis Collins, the director of the National Institutes of Health, told the Washington Post that, although the declaration is sometimes presented as a “major alternative view that’s held by large numbers of experts,” it is, in fact, “fringe.” Infectious-disease specialists have signed it, but many of its thousands of signatories are either unqualified or fake (“Dr. Johnny Bananas,” “Dr. Person Fakename”).
The declaration has its roots in the early days of the pandemic, when some scientists asked whether herd immunity—which occurs when so many people have been infected or vaccinated that viral spread becomes unlikely—might be achievable more quickly and less painfully than was widely supposed, and without a vaccine. Perhaps the virus had already spread more than tests indicated, in which case it was more asymptomatic than we thought; perhaps certain people, having previously been infected by other, similar viruses, had some level of preëxisting immunity to it.
These were appealing possibilities. But, as time has passed, persuasive evidence for them has failed to materialize. In New York City, the original epicenter of the American pandemic, the vast majority of the population remains susceptible to the virus, even in parts of the city, such as Borough Park, that have experienced high rates of infection. In the U.S. as a whole, as many as nine in ten people still lack immunity to the virus. In this context, the swift reopening proposed by the declaration would result in a sharp spike in cases, with hundreds of thousands dying and tens of millions suffering serious and debilitating illness. This is likely to occur even if officials try to focus on protecting the vulnerable. The problem, ultimately, is that society cannot be easily divided into separate layers of medical risk. Sweden adopted lighter restrictions while seeking to protect its elderly citizens—and yet the coronavirus found ways around the barriers put in front of it. The country’s COVID-19 death rate is an order of magnitude higher than its neighbors’, and it has not achieved anything like herd immunity.
Throughout the pandemic, Trump and his team have often denied that they are pursuing herd immunity as a strategy. And yet their words and actions have belied their disavowal. “Once you get to a certain number—we use the word ‘herd’—once you get to a certain number, it’s going to go away,” the President told Fox News, in August. At a town hall in September, he promised the audience, “You’ll develop herd, like a herd mentality. It’s going to be—it’s going to be herd-developed, and that’s going to happen.” On October 5th, the day after the declaration was released, its primary authors met with Alex Azar, the Secretary of Health and Human Services, who later said, “We heard strong reinforcement of the Trump Administration’s strategy.” Scott Atlas, a top White House coronavirus adviser, has said that “the thrust of the declaration is exactly aligned with the President.” (Atlas and Jay Bhattacharya, one of its authors, are colleagues at Stanford, where Bhattacharya studies health policy, not infectious diseases.) Speaking on the condition of anonymity, an Administration official told the Times that the White House wasn’t so much endorsing the declaration as acknowledging that the declaration “is endorsing what the President’s policy has been for months.” This is an extraordinary admission—appalling for Americans but perhaps freeing for Trump. He is granting himself license to move into an even higher register of incompetence, not just downplaying the threat but actively encouraging Americans to embrace it.
As a physician, of course, I take the medical view of the pandemic; in a sense, I’ve experienced it firsthand. Caring for COVID-19 patients at the height of New York City’s first wave, I watched as the medical profession, so often fragmented by ego and hierarchy, coalesced around the certainty that any loss of life is a tragedy. Nurses and doctors worked for weeks on end with little respite, often separated from their families to avoid infecting them. Clinicians poured in from across the country to help. Health-care leaders held daily briefings, scrambled for P.P.E., and searched for ventilators. Facilities crews reorganized hospitals. Everyone—even those who weren’t seeing patients—started wearing masks. On the coronavirus wards, we went further, donning goggles, gowns, gloves, respirators, and shoe coverings. Contagious patients were placed in negative-pressure rooms and sometimes seen through telemedicine; infected people who didn’t need hospitalization but couldn’t isolate from their loved ones at home were offered hospital-based housing. Husbands, wives, parents, and siblings died alone. Women gave birth without their partners present. All this was done not out of fear but out of concern. We didn’t want even a single person to get the virus unnecessarily. Our commitment was sharpened by the knowledge that we were witnessing many preventable deaths.
As the virus surged around the country, millions of Americans upended their lives and adopted new habits to protect one another. All the while, the President and his team pursued a different path. Declining to wear a mask or follow basic social-distancing guidance, Trump tweeted about “liberating” states and promoted discredited therapies. Overwhelmed by the task of fighting the virus, he pulled from the playbook of tobacco companies and climate-change deniers, casting doubt on the statistics. The rise in cases reflected only increased testing; the number of deaths had been doctored; the virus’s lethality had been overstated—as his dodges piled up, it became clear that he had no interest in grappling with the reality of hundreds of thousands of deaths.
Atlas, a neuroradiologist without training in epidemiology or infectious diseases, came to the White House at the end of the summer, having spent much of the year offering pandemic commentary on Fox News. He gained regular access to Trump and began wielding greater influence over the Administration’s coronavirus strategy. Atlas has repeatedly voiced skepticism of fundamental public-health principles, such as testing, mask-wearing, and social distancing. (“Everything he says is false,” Robert Redfield, the director of the C.D.C., has said.) Fauci and Deborah Birx, the coronavirus-response coördinator, have confronted him about many of his unfounded claims—among them that parts of the country, including New York City, are approaching fifty-per-cent immunity. But they have been largely sidelined. Trump no longer regularly meets with the White House coronavirus task force; Atlas is now the President’s primary health adviser.
Earlier this month, many wondered whether the President’s own infection might pop the bubble. (Boris Johnson’s COVID-19 illness seemed to chasten him.) But Republican leaders, having maintained for months that concern about the virus is a form of cowardice, responded by ascending to new levels of reality distortion. Some tried to spin the President’s infection as a joke: Marsha Blackburn, a senator from Tennessee, tweeted that “President Trump has once again defeated China” along with a video, set to dramatic music, of Trump maskless at the White House. Nearly two dozen people in Trump’s immediate circle had been infected. Still, Mike Pence’s team requested that no plexiglass barrier be placed between him and Kamala Harris at the Vice-Presidential debate. (“If Senator Harris wants to use a fortress around herself, have at it,” Pence’s press secretary, Katie Miller, said; the Commission on Presidential Debates decided that the plexiglass would stay.) Just eleven days after testing positive for the coronavirus, Trump told attendees at a campaign rally in Florida that he was now immune and threatened to descend from the stage to “kiss the guys and the beautiful women and everybody.”
To watch all this, as a physician, is to struggle with my own disbelief. Trump and his team demand that doctors and hospitals perform heroic acrobatics to save lives and that scientists race to develop a coronavirus vaccine at unprecedented speed, while at the same time displaying a wanton disregard for medical science. Their reckless abdication of duty depends on others faithfully performing theirs.
A fine line separates playing down a risk from encouraging the rush toward danger. Republicans have sought to straddle that line and have sometimes strayed over it. “No one reached out to me and said, ‘As a senior citizen, are you willing to take a chance on your survival in exchange for keeping the America that all America loves for your children and grandchildren?’ ” Dan Patrick, the lieutenant governor of Texas, said, in March, on Fox News. “Don’t let it dominate your life,” Trump tells his followers, before bringing thousands of them together in close quarters. According to the Republican leadership, real patriots risk their lives and the lives of others; liberty is walking into a store without a mask; power is touring a hospital without one—as Pence did, at the Mayo Clinic, in April—or refusing to wear one at a Presidential debate, as Trump’s family did, at the Cleveland Clinic, even after a doctor asked them to. Now months of misinformation under the guise of reassurance threaten to bleed into an outright embrace of infection.
Is this bravado a put-on? At times, it has seemed purely cynical—a show of strength from behind a fortified wall. Throughout the pandemic, Trump has argued that we should perform fewer tests—the cases they uncover make us “look bad,” he’s said—even as he’s relied on regular testing for himself and his staff. A recent poll found that half of Republicans believe that hydroxychloroquine is an effective treatment against COVID-19—and yet the President, when hospitalized, chose not to take the drug himself, even though he had touted it as a “miracle” that was possibly among the “biggest game changers in the history of medicine.”
In other ways, though, Trump and those around him seem to have internalized their rhetoric. To contemplate the lack of screenings, distancing, and masks inside the White House, or to see photographs of the handshakes, hugs, and kisses at the superspreading Supreme Court announcement in the Rose Garden, is to conclude that Trump’s rejection of science is not just a façade meant to project a contorted conception of strength and liberty. His team’s mockery of those concerned about the virus may be wrongheaded, but it isn’t entirely empty; they take few measures to avoid it themselves. Believing their own alternative facts, top Administration officials accuse government scientists of “sedition.” Atlas sends out anti-mask tweets—“masks work? NO”—violating Twitter’s rules on misinformation. The White House threatens to withhold COVID-19 relief funds from liberal, “anarchist” cities. Approvingly, the Administration cites a pandemic strategy that will endanger the lives of millions of Americans. “It’s going away,” Trump promises, at the final Presidential debate, during a viral surge. “We have to open our country.”
Will people follow Trump down this path? Polls suggest that they won’t. More than two-thirds of Americans say that they have little or no trust in the information the President shares about COVID-19 and disapprove of his handling of the pandemic. Only nineteen per cent say that they will trust Trump if he tells them that a new coronavirus vaccine is safe; less than half of Republicans trust him on that question. Americans’ faith in the federal government’s approach is as low as it’s ever been. In a recent CNN poll, Biden, whom the President mocks for wearing a mask, has a sixteen-point advantage over the President—the most lopsided poll this close to an election in the twenty-first century. A cartoonish and destructive Presidency could soon come to an end. If it doesn’t, it’s easy to imagine how the Administration could shift further from an unhelpful stance to an actively harmful one—undermining states’ efforts to keep people safe and demanding, as proof of political fealty, the adoption of unproved or disproved strategies and therapies.
The U.S. is now entering what seems to be a new wave of infection; over the past week, the country saw, on average, more than sixty thousand new cases a day. In many states, COVID-19 wards are filling up again, and some places are seeing record-high hospitalizations; the Midwest is experiencing its largest growth in cases since the start of the pandemic. According to some models, the U.S. could experience nearly four hundred thousand COVID-19 deaths before the next President is sworn in. Despite all this, Trump would likely interpret reëlection as a validation of his approach. We could find ourselves living even more deeply in two incompatible worlds: a medical world, in which doctors, hospitals, scientists, and public-health professionals continue doing their best to grapple with the virus, and a political one, in which wishful thinking and pseudoscience rule. Of course, it doesn’t have to be this way. We could move, together, into a single, fact-based world—one in which we confront reality and work to improve it.
