By Steven Jonas, M.D.

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"Either this nation shall kill racism, or racism shall kill this nation." (S. Jonas, August, 2018)

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Note to the reader: This column is the second of a two-part series that began with longer versions of the two paragraphs just below.  Part 1 of this series was published on RSN/Writing for Godot on May 28, 2020:

Trump's Way of Thinking About the Pandemic --- And its True Clinical Expression To get an idea of how Trump thinks, and doesn't, about the pandemic (which I call the Trumpidemic2020©) let us first refer to his famous statement that: "When you test, you have a case. When you test, you find something is wrong with people. If we didn't do any testing, we would have very few cases." There is no indication, nor to my knowledge has there ever been one, that these three sentences are not an entirely accurate representation of how Trump thinks --- about the pandemic and about many other issues as well.

There are two trains of thought/non-thought in D. J. Trump's brain that drive his responses to the COVID-19 pandemic and in turn drive the policies that his Administration is carrying out in its dealing with it. One is that from statements of his like that on testing, he simply does not understand the simplest science about the disease [see just below]. Of course, many people do know these basic facts about COVID-19. It is tragic that Trump is not one of them.

OK. As to the virus we are dealing with this one comes from a family of viruses known as "coronaviruses," the "crown viruses" (presumably because of what at least one observer saw when looking at one of them under suitable magnification). This particular one is now known as the "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2). The disease it causes is called coronavirus disease 2019 (COVID-19). In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic.

We do know certain characteristics of this virus and the disease-responses it can cause in humans. First, there is a very wide range of responses it can cause, ranging from none clinically (that is detectable-as-an-illness-of-some-sort in a person) to very severe clinically, leading to death. The primary disease the virus causes involves the respiratory system, which can range from a "cold" to severe pulmonary involvement. This range is well-known in viral diseases. For example, in polio-myelitis, which became very well-known because President Franklin Delano Roosevelt had been afflicted with it, the vast majority of infected people got a cold. "Paralytic poliomyelitis" occurred in relatively few infected people.

Second, SARA-CoV-2 is transmitted from person-to-person through the air, in mucous droplets containing the virus. A very small number of virus particles (around a thousand), can cause a person to get sick. An infected person can expel as many as 200,000,000 virus particles in one cough or sneeze. So, this disease is highly (to say the least) contagious. But again, we don't know why one person inhaling the output of another's sneeze can go on to have a fatal illness while another gets a cold, or nothing.

And so, with modern epidemiology (which is the science of the study of the distribution and expression of diseases in populations) it must be possible to figure out all of this stuff (and I just scratch the surface of the "stuff" we need to know to really control the transmission and distribution of the disease), no? Well, yes, in theory. Over the centuries going back to the Black Death epidemiology at various levels of science has been done to bring a wide variety of infectious diseases under control, ranging from malaria (a parasitic disease, dealt with by mosquito control) to cholera (a bacterial disease dealt with by purifying the water supply) to smallpox (a viral disease that has been wiped out through vaccination).

So why, you might ask, are we not further along already with this one, at least in this country. (They are likely further along with it in other countries, and hopefully the published papers will be coming along soon.) Two words: Donald Trump. In order to effectively determine the details of the epidemiology of the COVID-19 disease (as well as of course effective disease-management), effective and very wide-spread viral and anti-body testing, contact-tracing, and isolation of infected persons must be done.

As is well known, covered extensively by myself and many other observers, Donald Trump has stood firmly in the way of developing and implementing a well-planned, well-coordinated, and fully funded national testing program. I and an increasing number of others have attributed that resistance to, on the one hand, Trump's thinking pattern described as "magical" and on the other his being told by the U.S. Chamber of Commerce and others in no uncertain terms that, for a variety of politico-economic reasons he is not to invoke the Defense Production Act, which invocation would be necessary for such a national program to be developed.

So, as recently as May 22, 2020 (and this President does change his mind so often about a whole range of policies, most often he is responding to some political imperative as he sees it) Trump still would not permit the development and implementation of a national testing-and-etc. program. He describes what he has done as a "national-program-done-through-the-states." But that is not a national program, if for no other reason than that the virus does not know from state boundaries. Further, for everything ranging from being able to fully understand the disease as it expresses itself in populations, to having the mobilization of resources and their standardization so the testing-contact-tracing-isolation can be truly effective, it has to be run on a national scale. For proof of this statement, just see what is happening and not happening as (some) states try to do it on their own.

But most important in understanding why Trump is doing what he is doing, as is well-known his primary focus is not on dealing with the disease but on trying to ensure his re-election. Since he has no understanding of the virus and thus sees the disease solely as a number, that is the number of cases, in his very limited way of thinking the only way he can "win" is to keep that number as low as possible. And that then becomes limiting testing and counting, not expanding testing so that the disease can be (much) better understood, and therefore brought under control in terms of its spread, while we are waiting for possible treatment(s) and vaccine(s).

At the present stage of the international understanding of this, it must be repeated, highly infectious and easily transmissible disease, the only way to control it and its spread is by one-or-another version of the "stay-at-home" order. A number of nations, beginning with the well-known example of South Korea, did this early on and have met with significant success both in disease-control and it limiting the damage-to-the-economy. As is well-known (and is repeated now ad nauseum virtually every morning by Joe Scarborough while Mika and Willie do their best not to look pained), Trump was in denial for an extensive period of time after receiving multiple warnings from multiple sources about the oncoming pandemic. In fact there was a Wuhan-specific epidemic warning as early as last November from US intelligence sources (which may or may not have made it to Trump's desk).

Now if he had any knowledge of how air-borne viral infectious disease work, and had any ability or interest (he had neither --- he'd made to the Presidency without such talents, so why start now) in learning (he has never displayed any ability to do that, at least about such subjects as COVID-19) he could have early on instituted a preventive program based on comprehensive testing, which, based on the experience in the other countries that have been successful in doing so, would have led to a limited disease outbreak here, a limited necessity for "stay-at-home" orders, a limited spread of the disease, and etc. If he had done this, as I noted in March, he would have been a national hero and on a "glide path to re-election."

But it was, and still is, totally beyond him. He simply doesn't, and simply cannot by his very nature which is demonstrated to us every time he does one of those campaign-rallies/cum-press-conferences at the White House, understand that simple fact. He is focused solely on keeping his followers close to him, because --- not truly caring about his followers any more than he cares about anyone other than himself --- in his mind that is his only way to re-election. The necessary lock-downs have come very late, but there have been established national guidelines both for them and for what conditions should be met for reopening.

But Trump, as is well-known, has eschewed any national responsibility for them. He has dumped that responsibility onto the governors who among them a) face very different disease-spread situations and b) have very different intellectual/understanding equipment themselves. Thus in certain states, funded in many instances by the same far-right wing moneyed interests that created the "astro-turf" tea party movement, there has developed the very well-known, very white, anti-lockdown movement with its very dangerous, varying (not all of them, to be sure) racist, gunner, anti-Semitic, aspects, which Trump, as is well-known, has actually encouraged to go against his own government's reopening guidelines.

In the Senate Health Committee hearing of May 12, 2020, Dr. Anthony Fauci did not pull any punches in warning that if various states "open-too-early" there will be enormous disease consequences. But even this will not cause Trump and his allies to change course on testing. That is even though opening too early, which is now happening across the nation, will bring a second wave which may well have a worse impact than the first, especially in the rural areas where hospitals have gone out of business because of huge Republican Medicaid cuts and those that are left will be hard-pressed professionally and technically to provide the highly complex and labor-intensive care that COVID-19 patients require.

However, actually what is now just beginning to come into focus, both for Trump and for his Chorus-in-the-Media is that a) the totally-election-focused-by-keeping-the-Followers-following may not work, and thus b) because so many of the Followers have bought into the line, a new strategy will have to be developed. And being developed it is, right out in the open. Very obviously, it is based on what worked for Trump in 2016: racism, xenophobia, and paranoia, designed to mobilize hate and mobilize the (primarily) white voters to again get behind a uniquely unqualified candidate for the Presidency (who while in office has proven over-and-over again just how unqualified he is).

And so. Here come: the "China virus"/"Wuhan flu" (which China has re-butted extensively). "Obamagate" (remember the "Truthers"? It matters not that even Trump's Roy Cohn --- oops I mean Bill Barr --- has decided not to pursue that one, Trump and his boys, related and other, will do it anyway). "Carter Paige [who, you might ask] was victimized." "They want to take away your guns." (Of course, that one has absolutely nothing to do with the Trumpidemic2020©, but it sure to sit well with Trumpists who show up at astro-turf rallies bearing light artillery.) The "illegals" are spreading it. The "pointy-headed" scientists --- what do they know (see Dr. [!!! - where did this guy go to medical school?] Rand Paul). The Democrats are not just political opponents, but are truly evil people conspiring against you. "Always attack; Never defend." And then the standard distractions, like rallying behind a confessed (twice) perjurer (Flynn, just in case you missed the reference), who "Obama [you know, the black guy] was out to get" (even though it was to Trump's Vice-President that Flynn lied and it was Trump who demanded his resignation. But logic simply does not work in Trump-land.) And so on and so forth.

At least when they do this sort of thing --- and the Republicans, particularly the Trumpublicans© and Trump TV/radio/web, do it over-and-over again --- they make no secret of it. Unfortunately for the U.S. people, the virus does not know from politics. Nor does it know from state boundaries. You thought that the first wave and its outcomes were bad? Just wait for the second --- for which, for all of the reasons discussed in this two-part series, Trump will still have no answers, except those designed to save his own skin.

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Parts of this column were previously published at: https://buzzflash.com/articles/some-basic-infectious-disease-epidemiology-on-covid-19-and-dj-trump, and it also appeared at: https://www.opednews.com/articles/Infectious-Disease-Science-by-Steven-Jonas-Disease-Epidemics_Disease-Virus-Epidemics_Epidemiology_Government-200522-181.html