A prelude written after reflecting on this this post

 

I doubt that there is any information in this letter that will be news to you. My guess is that everyone who might read this letter is aware of the events and issues that it covers. These days we all have the facts, and most of us realize that facts define what is real and must be managed. Kellyanne Conway, Trump’s first “explainer” who is now positive for the COVID virus, introduced us to Trump’s ability to distort facts when she defended Shawn Spicer’s defense of the president’s assertion that there were more people at his inauguration than were present for the inauguration of Barack Obama by saying that Spicer and the president were presenting us with “alternative facts.” Facts are facts. Our system of justice is based on discovering facts. What can be unique is our attitude about the facts or our interpretation of the significance of the facts.

 

The fact is that the president has contributed to circumstances that have lead to a needless loss of life. I have never wanted the president to be ill or suffer from his COVID infection, but it is appalling that he is now twisting his own incomplete experience with the virus to diminish the experience of others or to dangerously reassure everyone who is uninfected that the virus is no big deal. 

 

Once again, through his actions and his tweets the president is demonstrating that his foremost concern is himself. He does not seem to understand the responsibility that he has to serve and protect the rest of us. His staged theatrical return to the White House was as disgusting as anything he has done since he descended the escalator at Trump Tower four years ago to announce his candidacy, and to warn us of the threat from Mexican rapists. It was another demonstration for all to see that in his world everything is about him. (Please click on the last link if you did not see the event.)

 

The Post

 

The October surprises keep coming. In retrospect, it is surprising that the president did not become infected with coronavirus sooner. He has violated all of the recommendations coming from the CDC and his own Coronavirus Task Force. In numerous rallies, at his probably illegal use of the White House grounds for his gala acceptance speech for the nomination to a second term, and again for the announcement of his norm violating nomination of Judge Amy Coney Barrett (who tested positive for coronavirus this summer) to the Supreme Court to replace the recently deceased Justice Ruth Bader Ginsburg, there have been egregious violations of good practice that he would not have committed if he had put our welfare above his own concerns and had taken the infectious nature of the virus seriously. In the picture below which I lifted from a YouTube video of Judge Barrett’s announcement, you can easily confirm that the large crowd is tightly packed “cheek to jowl,” as if it were 2019 and no one had ever heard of COVID-19. Is it any wonder that there are at least eight attendees of the event who are now infected? The virus is not like a political sycophant who cowers before the president for fear of being fired on Twitter.  It just does what it does when it gets an opportunity. 

 

 

Bret Stephens and Gail Collins, both of whom are opinion writers for the New York Times, frequently write a joint column that is a humorous back and forth conversation about some recent political event. They did that again yesterday in a piece entitled “There Is Too Much Happening: How can we possibly make sense of it all?” In a creative piece of comedy writing they expressed much of what I am feeling.

 

Bret Stephens: Well, Gail, it was another slow news week. Donald Trump and Joe Biden had a televised conversation and then the president caught some sort of cold. We’ll have to stick to boring subjects. The 25th Amendment, anyone?

Gail Collins: We obviously want to begin by expressing heartfelt wishes for the president’s recovery. One of the goals of this election is reminding the world that this is not a country that believes a politician who’s terrible at his job should suffer physically.

Bret: One hundred percent. Get well, Mr. President: We sincerely wish you good health, long life and the full use of your taste buds in order to savor electoral defeat.

Gail: Last night, as I was trying to send positive thoughts toward the presidential sickroom, America’s most famous patient got in a car and rode around waving to supporters. I’m sure it cheered him up. But once again, not a great example to give everybody else. Of course it’s important for us all to wish him good health, but it’s impossible to ignore for one minute the fact that he spent the fall — and the debate a mere week ago — making fun of people who wear masks.

 

It’s a nice piece of writing. Check it out. It is worth your time, and much better reading than the continuing stream of misinformation, and attempts at manipulation coming from the president and his shills at the White House. 

 

There were some important ideas buried in their attempt at humor. The big question for me now that the president has done the equivalent of signing out AMA from Walter Reed is, “How is the president going to further distort this one?” The distortions probably began even before the wee hours of last Friday morning when the president tweeted that he had tested positive for the virus. His personal physician, Dr. Shawn Conley, gave a very evasive press conference on Saturday. There is certainly a possibility that the president was sick when he chose to attend a fundraiser with big donors on Thursday.  Even if he was feeling well, it was known at that time that a close contact, Hope Hicks, was positive, and the usual protocol would have called for him to self quarantine. That is what would be expected of you or me. 

 

The reports of the president’s illness sounded like they have been written by the president himself or his “spin doctors” with the intent of trivializing his experience and providing him a future opportunity which he is already exercising to minimize the significance of coronavirus for himself and a lot of other people. Even before he left the hospital he was downplaying his infection and telling people not to be afraid of the virus. The last line from the link above says it all:

 

Upon Mr. Trump’s return on Monday evening from the Walter Reed medical center, he climbed the steps of the White House, turned to face the TV cameras that were carrying the news live, and removed his mask. 

 

One question that has occurred to me is how many lives might have been saved if everyone in the country who was febrile and had transient hypoxia had been given the treatment that the president received at Walter Reed. We don’t have much to go on, but here is a likely series of events. I am aided by a recent post from Time magazine written by Alice Park that was entitled “President Trump Is Getting an ‘Unprecedented’ Mix of COVID-19 Treatments. That Puts Him On the Cutting Edge of Coronavirus Care.”

 

• Last Thursday Hope Hicks tested positive for coronavirus. The president nevertheless decided to attend his New Jersey fundraiser even before his tests came back positive.

 

• His rapid test is positive, and then confirmed late Thursday evening by the more accurate PCR test which takes longer.

 

• Friday the president becomes symptomatic with fever and at least two episodes of hypoxia for which he receives oxygen, and is transferred to Walter Reed. We don’t know what his chest x ray or other studies of his lungs revealed, but since he was transferred to Walter Reed, an event that could likely have damaging political consequences given his prior stance on the virus, we must assume there was evidence of something that his physicians used with him to get him to agree to the transfer.

 

• On Friday, at the hospital he is treated as if he was at high risk. He gets treated with a “cocktail” of monoclonal antibodies that are not yet FDA approved, but are hopefully going to eventually be proven to be of benefit if given early in the course of an infection.  If everything is going well, why would that happen? Was it given because he is high risk? We know for sure that he is 74, male, and obese. We really don’t know much more about his medical history than we know about his tax returns, but he did have an unexpected visit to Walter Reed last year and the episode of unsteadiness at West Point this spring. 

 

• On Saturday he was started on a five day course of remdesivir. Remdesivir is approved for “compassionate use” because of its potential benefit of reducing viral replication. 

 

• Late on Saturday or early on Sunday the president was started on dexamethasone which has been shown to be of benefit in blocking the later manifestations of the inflammatory response to the virus which has been the cause of many of the wide range of complications. Was this given in response to clinical evidence, or was it just thrown into the mix for extra benefit? Dexamethasone is a powerful anti inflammatory agent, but it does have many downside concerns. Peck writes:

 

…dexamethasone, a steroid approved to reduce inflammation and suppress overactive immune reactions triggered by autoimmune diseases, is also recommended for patients long into their battle with COVID-19 and who are showing more severe symptoms. The steroid seems to reduce the inflammation that can compromise respiratory tissues and ultimately make it difficult for patients to breathe. But both the U.S. National Institutes of Health and the World Health Organization recommend dexamethasone only for hospitalized patients who need supplemental oxygen or are on a ventilator. The NIH guidance specifically advises against dexamethasone “for the treatment of COVID-19 in patients who do not require supplemental oxygen.”

 

What is a most surprising behavior for anyone who is ill enough to be in the hospital is that by Sunday evening the president took a bizarre ride in an SUV to wave at his supporters, and by Monday morning the president is “feeling great” and beginning to minimize his experience with the virus as he makes plans to leave the hospital. Was that the steroids talking?

 

What is undeniable is that despite having every currently known and possibly effective therapy thrown at him the president is still in the early stages of his experience with COVID-19. From a humanitarian perspective we must hope for his recovery, but there are other considerations. First, he continues to trivialize an illness that has touched 7 million Americans and through their connections to family, friends, and innocent bystanders, has endangered millions more, while killing over 200,000. Second, surely some of the 200,000 who did die, died because they did not have access to the care he did get. As he trivializes the infection after getting the benefit of all we know or hope might be effective, I wonder just how many of the more than a thousand healthcare professionals who have died would have lived if they had access to the same drugs. Beyond the healthcare professionals, how many of the thousands of parents, grandparents, sisters, brothers, neighbors and coworkers who have been lost would have survived if they had been given the treatments he has received?  Before saying that the virus is nothing to fear should he not recognize that he is the beneficiary of all the upside benefits of inequity? His lack of self awareness demonstrates either the fact that he has a steroid psychosis, or is just a self interested narcissist. His action and comments on his departure from Walter Reed don’t allow us to know for sure, but I am favoring the explanation that what we see is a blend of steroid euphoria and his baseline personality disorder. His behavior has been an enigma for thoughtful people, as noted by the New York Times:

 

Public health experts had hoped that President Trump, chastened by his own infection with the coronavirus and the cases that have erupted among his staff members, would act decisively to persuade his supporters that wearing masks and social distancing were essential to protecting themselves and their loved ones.

But instead, tweeting on Monday from the military hospital where he had been receiving state-of-the-art treatment for Covid-19, the president yet again downplayed the deadly threat of the virus.

“Don’t be afraid of Covid,” he wrote. “Don’t let it dominate your life.”

The president’s comments drew outrage from scientists, ethicists and doctors, as well as some people whose relatives and friends were among the nearly 210,000 people who have died in the United States.

 

What happens next? Will he do well because of the great care he got? Will the rallies and the debates resume? Will the president defeat the virus and Joe BIden? Will the president suddenly become symptomatic and need a second hospitalization? Will the announcement event for Judge Amy Coney Barrett at the White House turn out to be a “super spreader event” that derails Mitch McConnell’s attempts to leave a legacy of a generation of conservative Supreme Court decisions? The answers to these questions and others that will surely arise over the next month will shape the future of healthcare in America for at least a generation.

 

I am writing to you from the little town of Elko in semi arid northern Nevada. We spent last night in an even smaller, but less dry and dusty town, Etna, Wyoming, on the Idaho-Wyoming border. We have seen many, many Trump signs as we have traveled west through small rural towns, but until we got to Etna we had noticed only a couple of Trump or Biden signs between Cheyenne and Yellowstone. I was surprised as we passed through Jackson Hole to see only political signs for local races. 

 

At the RV park in Etna things changed. Visual displays of political preferences were back. There were several Trump flags to be seen, like the one in today’s header. From some loud conversations that I overheard, I surmised that there were many people staying at the RV park who were there for the deer hunting season. Whatever the cause for our being in the same place at the same time, there is no doubt in my mind that Trump’s base is solid, and enthusiastic.

 

Over the next month, if he remains well, the president will continue to twist facts, ignore science, and disregard the needs of the less fortunate among us.  Why the rural poor are drawn to him is phenomena that is hard to explain and simultaneously an anathema for me, but I have seen it with my own eyes. He will not go quietly, and many of his supporters like the fellows in the RV in the picture may be armed and are disciples of his distorted world view. It will take a large plurality to overcome his probably cries of election fraud that he has virtually promised us, and may use to stir troubling events. Remember his command to the “the proud boys” from the debate, “Stand back and stand by.”

 

In an opinion piece in the New York Times entitled “Why ‘Stand Back and Stand By’ Should Set Off Alarm Bells: America’s failure to deal with the white power movement,” its author  Dr. Kathleen Belew, the author of Bring the War Home: The White Power Movement and Paramilitary America, writes:

 

Not only does “Stand back and stand by” fail to denounce and disavow white supremacist violence, it seems to be a call to arms and preparedness. It suggests that these groups, who are eager to do violence in any case, have the implicit approval of the state.

The day after the debate, Mr. Trump claimed not to know who the Proud Boys were, and told them to “stand down.” But even the most generous interpretation of his comments does not release Mr. Trump from accountability. The Proud Boys — some of whom were involved in the Charlottesville rally — should be well known to the president. And no matter what he says now, he can’t unring the bell.

The groups Mr. Trump declined to disavow will interpret attempts to clarify to be merely strategic denials. He did not, in his initial statement, specify a moment for which the Proud Boys ought to “stand by.” But if Mr. Trump loses, they will surely move from “stand by” to “engage,” prepared to take violent action. If Mr. Trump wins, they will likely believe that they are an unofficial apparatus of state violence.

 

 

Postlude

 

After writing the post last night, I listened to my son’s song for the week. He usually posts his latest production around 11 PM. It was his 514th consecutive week of offering a song every Monday. His song writing in general goes back back more than twenty years to his teenage years, so that over that time he has written musical responses to George W. Bush, MItt Romney, and Donald Trump. This weeks song is entitled “The KIng of Nothing.” 

 

As usual there is a short introductory note which I will share here as the closing comments on this post:

 

I went to college in thick of the Bush (the younger) administration. Back then we were all passion and rage about that guy. He was an evil puppet, a vacuous empty space for smarter manipulators to fill up with their own dastardly schemes. I had a band, and we had a song called “Mr. Oblivion”, a name that referred to the man himself. I imagined him whenever we played it — his stupidity, his hypocrisy, and the unknowable damage he was doing to our country and the world. In a punk kind of way, It felt good to make fun of him behind his back.

Bush made me feel so many things. Trump often makes me feel numb. I’m not saying that Trump isn’t also a vacuum of intellect, because he very much is, but the first thing he sucks out of the room is belief — belief in people, belief in principals, belief in institutions, belief in the future. In 2020, Trump’s nihilism is another contagion we have to battle. It infects both his supporters and opponents. We can lose ourselves to it. We can spread it further, and when we do that, we’re doing his work for him. That’s why he’s “the King of Nothing”. It’s not as satisfying a moniker as Mr. Oblivion, but it fits. Believe in something, folks. It may be the only recourse we have left. And vote.