A Wartime President 

45 dubbed himself a wartime president because he likes the sound of it. Thinking that it will supersize him onto a footing with FDR & Lincoln, he believes that the moniker will cement his legacy, wistfully envisioning shiny gold monuments arising in Washington and across the country. He’s forgotten or never knew about LBJ, another wartime president, who slunk out of office into a Texas sunset. 

The Art-of-the-DealPresident has known a lot of failure in his life, six bankruptcies alone. Perhaps those experiences made him facile at spinning defeat into victory regardless of the ridiculousness of his claims. He’s always hopeful that rewriting his history will alter the realities in the black and white ink in his court filings and financial accounts. Put bluntly, the essential character traits required to become a great wartime leader are missing from his inventory; what they are seems to have escaped him, aside from giving less than inspiring speeches which inevitably degenerate into self pity parties. He’s no match for Lincoln. Of course ignorance has never stopped him before; he is after all, a reality TV producer who can create whatever effects he can dream up.

This new gig is a step beyond reputation rehabilitation. The RealityTVPresident suffers from the delusion that he’s turned in a sterling performance in his war against covid19. In truth, his efforts recall LBJ in Vietnam more than Lincoln except in the land of Trump/FoxNews where he triumphs, buttressed by his sycophant advisers in the executive branch. He believes his own hype, boxed in by the sand in which his head is buried. Fanciful denials and pundit fired partisan drivel replace scientific evidence and statistical analysis so critical to an effective pandemic response. 

The single most important heroic wartime president characteristic missing from Trump is a sense of personal responsibility.  Never in his life has The Donald accepted responsibility for his actions. For him, the buck always stops elsewhere and he begins probing for candidates early on. Since the time it became apparent that covid19 had hit our shores, he’s laid the fault on China, the Obama administration, state governors, Cuomo, Whitmer and Insley particularly, the FDA and the news media. His latest targets are frontline healthcare workers whom he’s lately accused of hoarding PPE or something more sinister. He knows no shame. Our wartime president has stated specifically that he takes no responsibility for any of it. 

While Covid19 was in the US at the same time it was detected in South Korea, the virus and its consequences were never on Trump’s radar at the same time that federal bureaucrats were staging annual pandemic drills in the belly of some federal building. Lately, both he and Moscow Mitch have intimated that impeachment distracted him (so it’s the Democrats fault by inference). Presidents need to have more bandwidth than that. Bill Clinton separated governance from his legal defense, delegated to lawyers and staff.  

The Trump administration could have been prepared if the intelligence had bubbled up to the attention of the Oval Office. But he was too occupied with campaigning, Muslim terrorists, bungling North Korean and Iranian nuclear threats to realize that the national security experts within and outside the administration named a global pandemic as the biggest security threat to the globe. Officials testified to that before Congress. Instead he eliminated the personnel responsible for pandemic planning when he closed the dedicated office in the NSC while he later denied knowing anything about it. A disingenuous claim made the president who claims to control everything.

All this means the administration lost precious planning time; steps that are being considered now should have been foreseen during the early stages of covid19 in China. Instead, Trump tried to wish the epidemic away, selling the narrative that rolling up our borders would keep us safe while the virus already lurked inside. Worried about the press, 45 consistently filtered information that countered his narrative, like the reports of the number of cases and the extent of testing, to make “his numbers” look like he was in control of a situation that was fast overwhelming us. Literally the CDC stopped reporting. 

Emergency responses in the past have supposedly been for all those affected although, as in all things American, they reeked of the racial bias that has generally disadvantaged minorities. Characteristically the BullyPresident, ripped the subtle veneer off discrimination to make it obvious, as in the contrast between stateside Hurricane Maria disaster relief and Puerto Rico, which is facing another season of hurricanes without getting aid from the last one.

45’s America is more and more exclusive, as he makes a white polka dot tapestry of the Americans he will protect, literally house by house and congressional district by district. As of the week of March 27, 77% of covid 19 cases were in counties that voted for Clinton in 2016 and 19% in Trump voting counties, as reported by Chuck Todd on Meet the Press. Trump is basking in the uptick in his poll numbers reflecting approval of his emergency response. Unfortunately the virus is an equal opportunity vector. The pandemic may arrive later in Trumpophant territory but when it does, it may be even more deadly. Leaders in those places, huddling under Agent Orange’s cape, have been lax about social distancing and suspension of normal activities. They have not done the logistical work to respond effectively. These areas are often resource poor at baseline and will be late to the acquisition party. They will need supplemental medical facilities and ventilators; some rural hospitals in Georgia have less than 10. And they will drag us all down.

In my home state with a governor narrowly elected as a cruder southern imitation of Trump, counties in the Georgia mountains are banning residents from the Atlanta area, fast becoming a hotspot. Here too is evidence of racial bias, as residents of the state’s other two hot spots are not banned. Cartersville and Dougherty counties are primarily white communities where the source of infection was evangelical Sunday church services. The ministers have whispered in the governor’s ear enough to prevent him from ordering churchs to stop services. He has discouraged it but not ordered them shut down. He must protect his supporters even at the cost of their lives. These church members are particularly susceptible because the idea of “God’s will” goes a long way toward erasing responsibility from real world decision making that results in tragedies.  

Conservatives who want to strip away federal regulation and bureaucracy have entered into a marriage of convenience with Trump, a would-be autocrat.

Trump’s modus operandus, governance by instinct, is no match for this novel virus, particularly when his instinct is grounded in misconceptions recycled from the 80s, partisan political concerns, narcissistic visions of grandeur, an information stream from Fox News cratered with misinformation and falsehoods and above all maximizing personal aggrandizement. But instinctual governance is a matter of style which distracts, in this everchanging fast paced news era, from the core conservative principles beneath it. El Presidente has no principles beyond concentrating power in his hands, but the conservative Republicans who’ve surrendered their power to him do.

Conservatives see the federal government as the problem, not the solution. They want to dismantle the federal stranglehold on a state’s ability to control business and regulate its residents according to their own principles regardless of what the residents want. Theirs is a marriage of convenience between a would-be autocrat who wants to strip away constraints on his power and conservatives who want to strip away federal regulation and the bureaucracy charged with enforcing it. Congressional conservatives have happily supported the deconstruction of federal agencies.

This is the first conservative experiment in national emergency response crafted to circumvent the federal apparatus. Perhaps they believe it can work, much like the Kansas experiment under Brownback. There, massive tax cuts bankrupted the state but conservatives, continuing to believe massive tax cuts are effective despite evidence to the contrary, incorporated some of those elements in their federal tax cut for the rich. This pandemic response is the perfect stage to work their magic on a national scale. Conservatives have broken the federal government. The emergency response has been outsourced to the individual states and when they didn’t act, local governments under a White House facade hell bent on plundering the treasury in service to corporate elites.

As the Covid19 Task Force emerges for its daily briefing which it’s rumored the president does not regularly attend, 45’s like a kid in a candy store, announcing the latest innovative solutions extracted from brainstorming sessions bereft of an understanding of the dynamics of disease spread and operational procedures of a public health response. No advisor in the room, except Dr Fauci, has any idea how to harness the power of the federal government to solve problems; the others have had no experience with it and they’re not interested in learning. They purposely try to avoid it except when it’s convenient to extend their powers. They know the laws, not the processes. New public private partnerships is the word of every day even as the RealityTVPresident is more often wrong than right announcing the availability of the products.

The federal government has opted out of drug safety monitoring. The FDA has completely abandoned drug, lab and device approval in favor of a fast tracking process that allows pharmaceutical products into general use without adequate testing or surveillance. The FDA has supported 45’s assertions that drugs already on the market can be used for covid 19 treatment without any way to assess their efficacy. In the wake of that announcement, individual doctors have begun using the drugs on their own, without knowing appropriate dosing or duration of treatment. And in doing so, they’ve created a shortage of the medications for current users, among them, sufferers of rheumatoid arthritis. We have entered a therapeutic wild west where doctors are free to experiment on each patient. 

The public private partnership solution also provides another of Trump’s favorite vehicles, dumping tax money into corporate pockets. It promotes future back slapping, corporate campaign/PAC donations and future employment for employees leaving government service. But the case for new manufacturing in a plant that must be retooled rather than use the stockpile and excess military supplies right now is unclear. 

El Presidente involved the Defense Production Act and then declined to use it, because he has never met a power he didn’t want to have. It appeals to him in a more fundamental way; 45 can think of nothing better than to command captains of industry, directing them to heel to his follies. Apparently the administration was negotiating with GM over government payment for the cost to retool a plant to manufacture ventilators until 45 lost patience and ordered them to do so under the Defense Production Act. They’ll bargain over some compromise reimbursement and GM will have income while other businesses have been shut down. What luck.

It turns out that the Trump administration has used the Defense Production Act which grants government orders priority over any others and extends loans to expand a vendor’s capacity thousands of times. Last summer, the DOD used the power to get rare earth metals to manufacture lasers and armored vehicles. FEMA has used it for disaster relief supplies and Homeland placed over 1000 orders in 2018. The Defense Department has used the act 300,000 times a year. The BullyPresident has represented the Defense Production Act as a rare last resort, a subterfuge for actions that seem to be routine for his administration. He has simply chosen not to use it in his emergency response for reasons that appear vindictive against primarily Democratic governors, bearing the current brunt of the pandemic, who have been critical of his response. This wartime president thinks exclusively in partisan political gain. Apparently, he’s steered equipment from the stockpile to states that have not even requested it yet and altered FEMA distribution after calls from his favorite supporters.

Trump has added his signature politics of division to his pandemic response. He’s attacking governors for looking for the federal leadership they deserve as they are literally struggling on the front lines. He’s playing Roman emperor, setting governors, mayors and county executives in the Coliseum ring to battle each other as well as predators, this time a virus, not the traditional maneaters. The winners will be favored with PPE, ventilators and tests, additional weapons to stagger back bloodied into the ring for another round.

Agent Orange has made clear that governors must show the proper praise and contrition to receive federal aid, like every good tyrant. He’s told Pence to ignore phone calls from Cuomo, Insley and Michigan governor Gretchen Whitmer who have been critical, despite the fact that they are the hotspots most in need. It wouldn’t be complete without the BullyPresident’s added hate speech against them. One hates to think that his malice is underpinned by the potential loss of so many Democratic voters in hard hit urban areas, but given his general conduct, it can’t be dismissed offhand.  This short sightedness is characteristic of a president who always thinks politically in the moment, not anticipating that the virus hops county lines in the travelers carrying it.  

His divide and divide again strategy has set locale against locale. Several states are banning New Yorkers from entry; upstate New York is banning travellers from the city. Florida has ordered travelers from the New York area, encouraged by the covid19 task force coordinator, Dr Deborah Birx to self quarantine for 14 days while refusing to shut down beaches and restaurants statewide. 45 floated the idea of quarantining an ill defined New York area (the city or suburbs or upstate or all of the above) and possibly New Jersey. As usual, he had to walk that back to an issuance of a CDC travel advisory. 

In his isolation, the RealityTVPresident has become increasingly unhinged by the restraints of social distancing as it keeps him from the golf course. His need for adulation is particularly acute in the absence of the idolatry of his MAWA rallies, leaving him adrift in a sea of dwindling numbers of reporters who are not friendly, as their job demands that they not be. He’s had to make due with daily press briefings, hijacked from the covid19 Task Force, which provide live national TV coverage for his campaign themes tailored to the current crisis. Inject a little xenophobia, adopt the foreigners bring diseases theme to castigate allies and foes alike; further torment asylum seekers marooned in Mexico by bringing all immigration to a stop. There’s no applause or cheering in Trump’s ears, but at least he gets direct feedback from his Trump/FoxNews gallery afterwards. And since TV watching is now a bigger part of his life, like all of us social distancers, he calls in frequently to Fox & Friends and other pundits. He can soak up their praise without interruption. In desperation, he went unnecessarily to Virginia to send off a Navy hospital ship just to get out of the White House and flip off pandemic precautions. At least there, he found cheers in an audience of Navy men and their families.  

Now that Agent Orange has floated the idea that if everything is done right, fatalities could be kept to 100,000 -200,000, it hasn’t registered with him that that is a truly staggering number. China with a population of 1,408,526,449 reported 37,780 deaths (0.002%) while 100,000 of 328 million US residents is 0.03%, 15X higher. Even if China misreported, as the Trump Posse has recently suggested, by a factor almost 10 to 25,000, the US death rate will still be 1.5X higher than the Chinese 0.02%. Extreme isolation and extensive testing must have been critical to that differential. 

These recent estimates are a far cry from the “15 cases will soon be 0” narrative that started 45’s pandemic nonresponse. Still, he’s setting expectations for his claims of a successful covid19 response come November, if he hasn’t cancelled elections under an ongoing state of emergency. His campaign is leveraging messages that say this wartime president kept the country from some larger number of fatalities and sets a fall guy among people who didn’t follow the task force’s often squishy guidelines and governors on his hit list. 

That point is underscored by reports that their pandemic modeling has spurious sources. Birx has refused to release the identity of the modelers, stating that it an amalgam of several sources. Jeffrey Shaman, the leading epidemiologist cited by Birx has said his work doesn’t go as far into the future as the task force implies. In fact, he’s not sure what period their model is meant to cover.

Modeling is only as good as the assumptions on which its based. Many have speculated that it was only with this most dire model that Birx and Fauci were able to change 45’s frame of mind and jolt him into what would appear to be more active interventions. Appear is the key word here, because most of his actions are more bluster than rescue. This administration reeks of falseness at every turn; the effort to ferret out tangible truth is truly exhausting.

More importantly, modeling is only useful in constructing an overall strategy using estimates of projected needs. Both Trump and Kushner have poopoo-ed estimates from state governors using their own case statistics. And yet, 45 has only used it to coax his political allied governors into finally initiating social isolation. Even so, some like the Alabama Governor remained a holdout until April 3. He has continued to resist a national isolation order and to actively use the Defense Production Act even as the national stockpile is near empty and people will die today without a necessary ventilator. Again he intones governors to get out there on their own in the feeding frenzy. They simply can’t wait. Everything 45 lauds publicly is an illusion of reality TV editing.

What will the number of deaths from heart attacks, strokes, drug overdoses and other emergencies that go untreated as the hospital staff care for covid19 victims be?

One important mortality statistic, the other sick people that no one is talking about. Deaths from heart attacks, strokes, hypoglycemic and diabetic comas, drug overdoses and other emergencies that are occurring as hospital staff have been consumed with covid19 cases and can’t get to others in a timely manner. Luckily, the number of accidents and sports injuries are way down because people are staying indoors. But beyond that number, there are the number of people with long term consequences from non-timely or inadequate treatment of their illnesses.

Trump’s pandemic response is based on a self involved version of states’ rights where each governor jumps into the mad scramble for medical supplies with 150 other countries across the globe who all need the same items. It’s picture perfect to avoid a leader’s responsibility. The despotic touch is that supplies go to those who worship at the throne. Thus Ron Desantis, Florida’s governor, has had all his needs met as a reward for his staunch political support. He initiated that idea with the president to quarantine The Big Apple fearing New York and New Jersey snowbirds coming to their Florida roosts. Remaining in the denyer category, Desantis refused to initiate lockdown orders until April 1, leaving beach goers to seed cases at home and in other states when they returned. It’s ironic that the governor who is expanding the pandemic is first in line to get supplies that are desperately needed in states overwhelmed by the virus whose leaders Trump sees as political enemies. 

The supply chain has been hampered by the fact that much of it is manufactured in China, shut down first by the virus. Italy, the second country to be devastated is also a center of manufacturing for some components. The lack of production is further exacerbated by the closing of borders, creating a logistics nightmare. The Air Force has recently airlifted covid19 testing supplies from Europe. As Governor Cuomo pointed out, FEMA’s entry into the response effort just added another hand to the bidding war. He’s also said that distributors are playing one entity against another, reneging on commitments to one state to fulfill orders for another higher bidding state.

Where then are those testing supplies from Europe destined to go, now that HHS and the CDC have outsourced testing to each locale, insisting that they are free to develop and procure their own tests? Of course, almost every place is still complaining that they can’t increase their testing. Most continue to restrict testing to inpatients and exposed healthcare workers and without information about asymptomatic and mild cases, there will be no way to determine infection rates. Isolation of exposed healthcare workers must be determined quickly to shorten unnecessary isolations and detection of asymptomatic cases is needed to isolate them appropriately. These are the methods being used successfully in Taiwan and South Korea.

Our fearless leader claims he’s heard nothing about problems with testing; he must not have caught any of the thousands of social media posts about individual experiences. While getting the test has been a bottleneck, getting the result has been even more frustrating, often taking more than a week. Maybe the task force is so focused on innovation they’ve not bothered to track how effective it is. But the exact purpose of a task force is to ferret out problems in execution of its plans. Apparently, they don’t think it’s their problem; the governors and mayors are making those decisions.  

Agent Orange has made one grand gesture, sending naval ships to NYC and LA. As for the USNS Comfort sent to NYC to treat non-covid19 patients more safely, it’s majestic but not substantive. Only 20 New Yorkers have been transferred to it; similarly the USNS Mercy in LA has only 15. The ships have obstructed patient transfers through bureautic hurdles and military protocols. These include a list of 49 conditions which are excluded from treatment. Patients must be first transferred to a city hospital for screening, including a covid19 test before they can be transferred to the ship.  This can require up to 5 ambulance rides, since viral test results take a week, while ambulances in the city are in constant use. Perhaps a better solution would be for the navy doctors on board to start helping out in New York hospitals.

What’s needed is a central procurer, ie the federal government which makes strategic decisions about distribution. FEMA has never played this role for the whole country. But the highest bidder approach is exactly the wrong one. Distribution of needed resources should obviously go first to the hardest hit, as infections peak in waves and resources can be shifted to those hit later as more supplies are manufactured. Every state doesn’t need to be preparing at the same moment and a central distributor will own the equipment and can move it judiciously. Is Cuomo going to want to move those 100,000 ventilators he purchased to Chicago? Probably not without a hefty transfer of funds, which neither one of them can afford. Cuomo could easily decide to sell them to the highest bidder, Norway or Sweden perhaps in the current atmosphere. 

In this country where money talks louder than compassion or anything else, a central distribution authority is critical to ascertain that resources go to institutions that lack financial resources. Phoebe Putney Hospital in Albany Georgia has had 30 covid19 deaths in the midst of a Doherty County hotspot. This is a staggering figure for a city of 79,000 traceable to two funerals. The hospital was financially unstable before the pandemic and has now had to create additional ICUs with the help of the national guard.

Georgia’s governor was refusing to issue a statewide shut down, leaving the work to local governments although he finally declared a state of emergency last week allowing the mobilization of the national guard. In this scenario, who will procure the hospital’s needed supplies? The state may be lucky in this regard; Governor Kemp is also a staunch Trumpophant and his wish may become a command from Agent Orange. Claiming that he did not know that the asymptomatically infected spread the virus, he finally declared a shelter in place order on April 2, although self defeatingly exempting churches in this Bible Belt. He does have a pretty savvy Public Health Department director making his excuse simply pathetic. Kemp has become the butt of comedians everywhere. It is this type of patchwork response that endangers the whole nation, leaving specific populations vulnerable. It increases the case and death rates and diminishes the possibility that viral spread can be eliminated in the near future. Our states have different governments but they are bound together in a single land mass. We are clearly not all in this together, just as our chief executive intends.     

 No doubt medical practitioners are so exhausted from their patient loads, aggrieved by the high number of deaths around them, anxious and saddened by illness in their colleagues and overwhelmed by the struggle to find or create the PPE that they can’t see the forest for the trees. It’s near impossible for healthcare workers to be imaginative under these conditions. But Americans are volunteering to individually support them by making hand sanitizers, sewing masks and jerry rigging plastic shields. One enterprising young man is 3D printing face masks at home and this idea seems to have caught on in a number of institutions. UCSF has 13 3D printers pumping out face masks. This type of production could take these institutions out of the mask lottery, leaving more traditional PPE for other places. New York has a ton of universities who might try filling in their gaps as do many other states. 

A recent news story featured an adapted 3D printed diving mask that is being used as an alternative to ventilators in Italy which could also lower the need for ventilators. The president is thrilled to announce corporate innovations and pay them for those, but who is in charge of developing alternative equipment innovations outside corporate giants.  Why has no federal effort in innovation been launched to print 3D face masks or modified diving masks? Could it be that it might compete with GM ventilator and other corporate contracts? 

This is yet another area where 45 has abdicated his wartime command in favor of allowing each battalion to equip itself with weapons and plan its own strategy. Lincoln saw the folly in letting the generals take the lead as the Union was defeated in every major battle for the first two years of the Civil War. But at least he was providing supplies and logistics and weighed in on the generals’ war plans. 

Certainly, everybody is flying by the seat of their pants in the wake of this novel virus. In the UK Mercedes has modified CPAP devices, commonly used for sleep apnea, to lower the need for ventilators. However, there is evidence from the SARS epidemic that CPAP may aerosolize the virus into the room, increasing transmission. Apparently, China and Italy may have used CPAP in the wake of ventilator shortages but not enough time has elapsed for an analysis. Unfortunately, good evidence takes time. 

Britain, recovering from a miscalculation that the virus would burn itself out, has made a complete u-turn after members of the Royal family, Prime Minister Boris Johnson and several Cabinet ministers tested positive. Boris thought he’d emulate his American friend, but probably had second thoughts when he saw the US top the charts in covid19 deaths. The country shut down with good popular compliance and the NHS has ramped up quickly, building multiple large field hospitals in soccer stadiums in preparation for their peak in cases. They plan to use their modified CPAP devices extensively, perhaps believing they’ve addressed the problem of aerosolization. 

But they stand in sharp contrast to the delayed bungling here, the difference between a pretender and a leader. The Brits demonstrate how modelling can change government strategy. Despite a slow start, Boris Johnson took the bull by the horns even though their response is not yet well oiled and they’re having problems with ramping up testing. But at least they’re trying. In contrast, New York City is just now building large temporary hospitals in the Javits Center and Central Park with smaller units in hotels and any space they can stick sick people, the result of 45’s every-state-for-themselves approach. Only time will tell which approach will leave their country less sick and on the road to a viable economic recovery. 

The danger to healthcare and ancillary hospital staff is real. Physicians, nurses, respiratory therapists, EMTs and anesthesiologists are dying from the lack of appropriate protection from viral infection. Others have become ill and must be treated or self quarantine, taking them away from the jobs they are performing. This fiasco will have a far reaching impact on a healthcare system that has physician and nursing shortages at baseline. The current working conditions will result in early retirements and others who will leave hospital positions for offices or leave clinical positions all together. Some will have PTSD as a result of their experience and require mental health services. As a profession, physicians have high rates of substance abuse and suicide under normal conditions; this will certainly increase after this traumatic event. As the nation debates expanding access to medical care, significant losses of caretakers will make that access only theoretical.

As we sit in our homes in social isolation, or perhaps not if you live in much of the South and western states or you’re an essential or healthcare worker, many of us only see covid19 through our TV or social media. Most of us don’t know anyone infected or healthcare workers. But we do know people who are now laid off or unemployed; we can’t go to our favorite restaurants or movies or sports events or even watch many of our favorite TV shows. The bad certainly feels like it outweighs the good. And yet, none of us is safe from infection; even if there aren’t many confirmed cases around you, the virus could be lurking in an asymptomatically infected person, triggering an outbreak around you. That is the most likely scenario particularly in the absence of a massive testing regime. We have evidence that social distancing works in slowing viral spread which then spares healthcare facilities from being overwhelmed. And yet, there are at least a dozen states that have refused to issue stay at home orders. 

45 has as yet refused to issue a nationwide stay at home order. The longer he waits, the longer we will all suffer and the more Americans will die. The problem with the path Trump has chosen is that a national response must be led nationally. It can’t be outsourced to individual states because sometimes everyone must act in tandem. Conservatives don’t believe that, nor does he. Trump believes that the minority of the populace that supports him can keep him in power, his ultimate goal. He’s not invested in states, he counts on bare to overwhelming majorities in congressional districts. His political calculation that his base, unable to see the consequences of the covid19 pandemic in their neighborhoods, will not react to the mounting death tolls on the two coasts.  It’s shortsighted because the virus will get to them soon. Florida is already being ravaged and Michigan is catching up. The virus won’t stay in Detroit alone. Pennsylvania cases are creeping up as well. By that time, the RealityTVPresident is hoping to rewrite his story to appear to have taken decisive command, with the help of Trump/FoxNews allies. He just needs the right scripted media production to make his flock believe; one that doesn’t contain the reality of events as documented by his own words. This masquerading wartime commander is failing bigly.

On April 4, 1968, Dr Martin Luther King was assassinated on a balcony at the Lorraine Motel in Memphis Tennessee.