interesting times

With Trump, the Pathology Is the Point

Photo: Getty Images

It’s perfectly clear by now that the United States does not have a functioning president or administration. It also seems clear that this does not matter to a sizable chunk of the population. They just don’t care — even when it could lead them to lose their lives and their livelihoods. A year ago precisely, Trump’s approval rating was, in FiveThirtyEight’s poll of polls, 53.8 percent disapprove, 41.1 percent approve. This week, the spread was 53.1 percent disapprove and 43 percent approve. Almost identical. None of the events of the last year — impeachment, plague, economic collapse — have had anything but a trivial impact on public opinion.

Neither, it seems, does the plain evidence of Trump’s derangement. Yesterday, at a Ford plant in Michigan, the president reiterated that he was once named “Man of the Year” in Michigan, something that never happened and an honor that doesn’t exist. He insisted that Obama had left no pandemic preparation behind — “we took over empty cupboards. The cupboards were bare” — which is untrue. He said he owned a lot of Lincolns but then he said he didn’t. When referring to the anti-Semite and Nazi-supporter Henry Ford, he ad-libbed, “Good bloodlines, if you believe in that stuff. Good blood.” In a factory where mask-wearing is legally mandatory and where every other executive was wearing a mask — and one who spoke with a Perspex visor on as well — Trump refused to wear one in public, though he apparently put one on behind the curtain. When asked why he wasn’t wearing one, he said: “I don’t want to give the press the pleasure of seeing it.” The official taxpayer-funded White House trip was also used to give an overtly partisan campaign speech, breaking the law. Just one completely bonkers day from a president who has effectively refused to do the job.

Count the objective COVID-19 failures in 2020 alone. The president was briefed on the looming viral threat, both internally and externally, multiple times in January. But he does not read his briefings — he doesn’t actually read anything — and is uniquely un-briefable in person, according to a story in the New York Times: “‘How do you know?’ is Mr. Trump’s common refrain during his 30- to 50-minute briefings two or three times a week. He counters with his own statistics on issues where he has strong views, like trade or NATO. Directly challenging him, even when his numbers are wrong, appears to erode Mr. Trump’s trust, according to former officials, and ultimately he stops listening.” In other words, the officials who tell him things he doesn’t want to believe are soon sidelined or fired. This is the behavior of a 2-year-old. In a man in his 70s, it’s a form of pathology.

He grabbed a chance to stop travel and immigration from China at the end of January — he loves to use his untrammeled executive power to keep foreigners out of the country — but then, nada. So he was aware of COVID-19 when it could help him do what he already wanted, but utterly unaware when it presented him with policy options, like a lockdown, that he didn’t like. As I said, like a 2-year-old. He was told by the National Security Council, and even in a memo by his favored protectionist, Peter Navarro, that if action were not taken swiftly, half a million Americans could die. But he never read the memo — he doesn’t seem to read any memos — and demurred from doing anything about it.

He even predicted at the end of February that “you have 15 people, and the 15 within a couple of days is going to be down to close to zero.” (Asked two months later about this prediction, he said — of course! — that he was right: “Well, it will go down to zero, ultimately.”) He said it wasn’t a threat, and would go away, like a miracle. Put simply, these are delusional attempts to describe his own fantasies as an objective reality — like how the Russians did not try to interfere in the 2016 election, his inauguration crowd was way bigger than Obama’s, tariffs are paid by the Chinese government, and that anyone in America could have gotten a COVID-19 test. This is a form of psychological disorder.

When the CDC’s Nancy Messonnier finally warned the public in clear terms on February 25 that they should get ready for a serious ordeal, Trump exploded that her statement had upset the stock market. By that point, he was dug in, and conceding reality was too much for his psyche to bear. He believed that if he said COVID-19 wasn’t a threat, it wouldn’t be. When the deaths started mounting, and the cases soaring, he did accede grudgingly to a lockdown, along with masks and social distancing. But it didn’t last long. Soon enough, he openly subverted his own policy by tweeting that the states needed to be “liberated” from the public-health measures he had himself proposed. At the beginning of this period he praised China for its transparency; by the end he was claiming that the Chinese hid the information from him. He has said both that the virus came out of the blue and no one predicted it, and that he always believed, before anyone else, that it would be a dangerous pandemic.

I know we’re used to it, but there is no rational or coherent explanation for any of this. There is no strategy, or political genius. There is just a delusional pathology in which he says whatever comes into his head at any moment, determined entirely by his mood, which is usually bad. His attention span is so tiny and his memory so occluded that he can say two contradictory things with equal conviction repeatedly, and have no idea there might be any inconsistency at all.

His COVID-19 press conferences were proof of his mental limits. He couldn’t understand basic questions. He had no grip on epidemiology. He believes that tests are bad, because they make America look bad, and then boasts of his record in testing (which is, of course, not good). When a White House staffer, Vice-President Pence’s spokesperson, Katie Miller, tested positive for COVID-19, this is what Trump said: “She tested very good for a long period of time. And then all of a sudden today she tested positive. So, she tested positive out of the blue. This is why the whole concept of tests aren’t necessarily, right, the tests are perfect but something can happen between a test where it’s good and then something happens and then all of a sudden, she was tested very recently and tested negative.” With anyone else, we would assume he was drunk when he said that. His sobriety is indistinguishable from alcoholic stupor.

He grossly misunderstands what his scientific advisers tell him — like the notion of getting UV light into the body somehow, or injections involving bleach. And he has revealed an inhuman and sociopathic inability to feel empathy for the sick or the frightened. Asked in a press conference what he’d say to fearful Americans, Trump, instead of knocking the softball question out of the park, dismissed the reporter as “bad.” Pushed to answer a question posed by two consecutive women reporters, he walked out of another presser. Of the 28 hours he spent talking in these briefings up till April 26, a Washington Post analysis found that four and a half minutes were taken up with his expressing any kind of sympathy for the victims.

Under Trump’s ultimate command, the Centers for Disease Control and Prevention inexplicably fumbled the creation of a test, producing a dud, and the FDA made it extremely hard for private-sector companies to create and distribute one of their own. When asked this week how he accounted for the low rate of testing in the U.S., compared with many other countries, Trump simply said what he wanted to be true, that the U.S. was “way ahead of everybody … testing at a level that nobody has ever dreamt possible.”

When it was pointed out that what mattered was not the number of tests as a whole but tests per capita, Trump responded: “You know, when you say ‘per capita,’ there’s many per capitas. It’s, like, per capita relative to what? But you can look at just about any category, and we’re really at the top, meaning positive on a per capita basis, too.” I have no idea what he is trying to say and neither does he. But it’s a lie. Per capita, the U.S. is not “way ahead of everybody”: We’re behind Russia, Spain, Portugal, Ireland, Germany, Denmark, Australia, Italy, Austria, and New Zealand. And this is only true because, as Alexis Madrigal has reported, the CDC has been counting antibody testing as well as COVID-19 swab testing, so the numbers are inflated. How the CDC has been reduced to this squalid error is beyond me.

The key thing, however, is that none of this seems to matter to the supporters of the president. For them, the pathology seems to be the point. It is precisely Trump’s refusal to acknowledge reality that they thrill to — because it offends and upsets the people they hate (i.e., city dwellers, the educated, and the media). The more Trump brazenly lies, the more Republicans support him. The more incoherent he is, the more insistent they are. Bit by bit, they have been co-opted by Trump into a series of cascading and contradicting lies, and they are not going to give up now — even when they are being treated for COVID-19 in hospital.

Tribalism is now not just one force in American politics, it’s the overwhelming one, and tribalism abhors reality if it impugns the tribe. But you can’t have both tribalism and public health. When you turn wearing a simple face mask into a political and cultural symbol of leftism, when you view social distancing as a concession to your enemies, you deeply undermine the power of millions of small impediments to viral outbreak.

What we are seeing is whether this tribalism can be sustained even when it costs tens of thousands of lives, even when it means exposing yourself to a deadly virus, even when it is literally more important than your own life. We are entering the Jonestown phase of the Trump cult this summer. It is not going to be pretty.

An easy addition to any coronavirus regimen

After nine months of living in New York City, my doctor noted that for the first time, my vitamin D levels were way below where they should’ve been. He recommended a daily pill to raise them. The primary reason was that you are much less likely to experience direct sunlight in New York, especially during the winter, than most other places. Tall buildings block out the sky. The street I live on, which is not surrounded by skyscrapers, had maybe 40 minutes of direct sunlight a day. I stopped taking the supplements when I returned to D.C. Plenty of sun here.

I mention this because I just added vitamin D back to my daily routine of pill-taking, because of COVID-19. It won’t prevent you from getting the extremely contagious pathogen, but there’s growing evidence that it can help calm the immune system response, and so help you avoid the cytokine storm — the immune system’s overreaction in the lungs — that often kills people. A Northwestern University assessment of global COVID-19 data attempted to discern why some countries were so badly hit, and others spared the worst. Vitamin D stood out:

Not only does vitamin D enhance our innate immune systems, it also prevents our immune systems from becoming dangerously overactive. This means that having healthy levels of vitamin D could protect patients against severe complications, including death, from COVID-19. “Our analysis shows that it might be as high as cutting the mortality rate in half,” professor Vadim Backman said. “It will not prevent a patient from contracting the virus, but it may reduce complications and prevent death in those who are infected.”

Backman argued that age distribution, access to quality health care, testing rates, and COVID-19 strains could not account for the massive range in mortality in different countries, but vitamin D levels could. This is preliminary, and more research is needed. But it would add one more factor to explain why COVID-19 seems disproportionately to affect the elderly and African-Americans, the populations with the most prevalent vitamin D deficiencies.

It might help explain why, for example, Florida has done so much better than New York. Or it might be one factor behind the disproportionately black and Latino deaths in nursing homes in the U.S., regardless of the quality of the care. It may be good news for the sunnier, summer months. It may be good news for Africa. It may have implications for lockdown policies. Keeping people inside all the time may actually raise their chances of a cytokine storm if they get infected, because their vitamin D levels are suppressed.

To be clear, this does not mean that other factors aren’t at work in COVID-19 racial disparities: low socioeconomic status, higher likelihood to work in essential jobs, and much more crowded housing for nonwhites are obviously in play. But in Britain, there are wrinkles in this. Whites, for example, are actually slightly more likely to be essential workers than Pakistani and Bangladeshi Brits, and, as Noah Carl notes, “The percentage of whites living in the most deprived 10 percent of neighborhoods at the last census was slightly higher than the corresponding percentage of Indians: 8.7 percent versus 8.3 percent.” And yet the death rates are extremely different: In the U.K. “the age-adjusted risk of death was 4 times higher for Pakistanis, 4 times higher for Bangladeshis, 2.6 times higher for Indians, 5.7 times higher for black Africans and 3.7 times higher for black Caribbeans.” And this is in a socialized medical system which is much fairer than America’s patchwork one.

Even among those most at risk, health-care workers, the disproportionate rate of deaths for racial minorities is striking. And even studies that fully control for preexisting health conditions alongside socioeconomic factors found part of the gap unexplained. A new study goes further and “argues strongly for a role of vitamin D deficiency in COVID-19 risk.” It seems to me a good idea to educate those most at risk — especially racial minorities and the old — and suggest taking a modest vitamin D supplement. It’s cheap, easily available, and might cut the death rate dramatically. What’s the harm?

A Labour leader, rising

It’s a little surreal for me watching Prime Minister’s Question Time these past couple of weeks, as my old high-school sparring partner, Keir Starmer, faced off against my old college debater, Boris Johnson. Their styles could not be more different. Boris is full of bluster, alliteration, bullishness. Keir is forensic, steady, focused. Boris has been trained by journalism, public speaking, and media performances. Keir, a highly accomplished lawyer and former director of public prosecutions (a type of attorney general), has mastered the art of cunning cross-examination. Their clash was postponed because Johnson was in hospital with COVID-19, and then took a brief paternity leave. And it is different than any previous ones, because the Commons is obeying social distancing, with only a handful of members allowed to attend at a time. The usual baying, and booing, and scoffing is absent.

And in this context, Starmer has killed. Last week, he took Boris apart, statistic by statistic. This week, Boris had clearly done extra prep, but Keir still commanded the exchange. He also scored a coup. He asked: “Does the prime minister think it’s right that care workers coming from abroad and working on our front line should have to pay a surcharge of hundreds, sometimes thousands of pounds to use the NHS themselves?” He was referring to a fee of over $750 non-British health-care workers pay on top of taxes to have access to health care. Johnson said there was no alternative source of funding, and so the charge should stay. But 24 hours later, Johnson reversed himself, and agreed to waive the fee. Starmer duly congratulated him on taking his advice. It’s not often that a Commons exchange immediately forces a change in government policy. For Starmer’s second clash with Johnson, it was a triumph.

Maybe when the full House returns next month, the dynamics will change. And there’s still a big gap between the Tories and Labour in the polls — YouGov puts the Tories at 48 percent and Labour at 33. But the gap is clearly narrowing, as the taint of Corbyn fades a little. Starmer is more popular than his party, and Johnson’s personal ratings have dropped seven points in a month. On the belated lockdown, the paucity of testing, and on the lag in tracing, Johnson is very vulnerable. Studies are beginning to show, as they have in the U.S., just how many deaths could have been avoided if the government had acted a week earlier in shutting the country down. As that settles in, the rally around the leader effect will surely dissipate.

Starmer also executed a media coup by writing a piece for the Tory Daily Telegraph, using VE Day to argue for much more protection for the greatest generation, now in care homes, where the carnage has been brutal. A Johnson cabinet member told the Times: “Starmer was impressive. He has gone up a gear since he’s become leader. He’s got off to an undeniably good start and will make the other side of this argument in a way that doesn’t make people think he’s a Corbynite. He is in the Harold Wilson, Tony Blair mould of Labour leaders.” Which means he looks and feels like a potential prime minister. He’s also avoided melodrama and the temptation to berate a government grappling with a very tough plague that arrived suddenly. All his criticisms have been measured and detailed, and point not just to government failures but to how to remedy them.

There’s a long way to go, but I feel a lot more confident in Starmer’s leadership of Labour than Biden’s leadership of the Democrats. Sadly, we have no forum like Prime Minister’s Questions to force Trump to respond to specifics, demonstrate his lies, hold him accountable, and force him into policy U-turns. But I also fear, that if we did, Joe Biden — 20 years older than Starmer — would be wholly incapable of Starmer’s skill.

See you next Friday.

Andrew Sullivan: With Trump, the Pathology Is the Point