For a president who worships winning, losing the war against COVID-19 is a bitter pill

I turned on ESPN to watch a bit of professional baseball being played in South Korea. Not because I miss baseball that much but because, using one of President Donald Trump’s favorite terms, I wanted to see what “winning” looks like in the battle against the COVID-19 pandemic. The start of the major league baseball season in South Korea symbolizes how far behind we have fallen in that battle. South Korea is winning, and we are not.

COVID-19 arrived in South Korea on January 20th, the same day the first case was diagnosed in the United States in the state of Washington. As of today, 259 people in South Korea had died from the virus and the death toll has slowed to a trickle. In the United States, 83,807 have died and the number of deaths continues to climb.

South Korea has about one-sixth the population of the United States. That means that the 256 deaths in South Korea were equivalent to 1,554 deaths in the United States, and that the death rate in the United States is about 54 times higher than that of South Korea. With recent estimates that the number of deaths in the United States may climb to as many 135,000, the United States is on track to have a death rate 100 times higher than South Korea’s.

It is an astonishing difference and it did not happen by accident. As has been well documented, South Korea did things right that we did very wrong. It is an example of Mr. Trump’s least favorite term – losing – if ever there was one.

Winning is everything to Trump’s fragile ego. You can see in his eyes during his briefings – and read in his tweets – that it is beginning to dawn on him that through his disastrous handling of the pandemic response he has cemented his legacy as the biggest loser in this country’s history.

How to win

On January 27th, South Korean officials met with representatives of 20 medical companies at a train station, urging them to begin work on developing tests for COVID-19. A regulatory process for approving diagnostic tests that usually takes up to a year-and-a-half was shortened to one week. By the end of February, South Korea had drive-through testing centers and was testing thousands of people each day.

South Korea used its testing capacity, aggressive contact tracing, and quarantining to implement a national program for identifying and isolating people infected with COVID-19 to reduce the sources of transmission and slow the spread of the disease. By controlling the pandemic in that manner, South Korean officials not only lowered the death toll, they did so without severe restrictions on businesses and schools, thus softening the impact on the economy.

How to lose –

              Strike one

The United States, on the other hand, made a series of egregious mistakes. The Centers for Disease Control and Prevention (CDC) declined to use the test kit approved by the World Health Organization (WHO) in favor of one of its own, which turned out to be faulty. It was strike one, and the opportunity to contain the pandemic began slipping away.

              Strike two

The Food and Drug Administration (FDA) initially refused to allow hospital and public health laboratories to develop their own tests. By February 24th, still lacking usable tests from the CDC, health officials in the state of Washington and elsewhere had grown desperate. The Association of Public Health Laboratories sent a letter to Dr. Stephen Hahn, the FDA commissioner, asking him to waive approval protocols and allow state and local public health laboratories to create their own tests. He finally relented on February 29th and allowed public and commercial labs to produce tests, but it was too late. Strike two, and the opportunity to contain the epidemic was lost.

              Strike three

The president failed to use the Defense Production Act (DPA) as part of a national testing strategy to maximize production of test kits and the materials needed to use them, control the supply chains, and distribute test kits where most needed. No national strategy ever was adopted, and in the face of a continuing shortage of testing supplies the president declared testing a “state responsibility.” Strike three, and the chance to avoid a catastrophic loss of life had evaporated.

In effect, Mr. Trump took his bat and ball and went home, leaving the states with a terrible dilemma. They are in the position of lifting restrictions to try to restart ailing economies without adequate testing capacity to do so safely. To make matters worse – if that is even possible – he has pressed states to reopen while at the same time personally denigrating not only the need for more testing but also masking and social distancing practices.

Trump’s hand-picked federal reserve chairman warned him today of dire consequences unless Congress moves quickly to approve more aid to offset the economic impact of the pandemic. Trump appears unable or unwilling to control senate majority leader Mitch McConnell, who is as evil as Trump is mentally ill and is determined not to help the citizens of “blue” states, stalling progress on the next aid package.

The United States is what losing looks like in the fight against COVID-19. The loss will be measured not in runs but in preventable deaths and a ruined economy. We are still in the middle innings, and the number of preventable deaths already is over 80,000 and climbing. The United States is suffering a terrible, terrible defeat at the hands of COVID-19 and the blame lies squarely on Donald Trump. He was handed a team of winners – the greatest collection of medical, scientific, and logistical expertise in the world – and he turned us all into losers.

“The Sad Case of Dr. Deborah Birx” – and how it endangers us.

Much has been written about President Trump’s fragile ego in the context of his malignant narcissism; in fact, I have expressed my opinion that the extent of his psychopathology is a topic that the mainstream media is deliberately and inexcusably avoiding. I believe that a word now is in order about the ego of Dr. Deborah Birx, the coordinator and now de facto chief scientific spokesperson for Trump’s pandemic task force.

Pundits have conjectured that Dr. Birx’s awkward excuses for and obsequiousness toward Trump are tactical in nature, that she is heroically sacrificing our own reputation to preserve a relationship to Trump so that she can steer him away from his most destructive impulses. Maybe in part, and maybe it started that way, but she has gone way too far and is now one of Trump’s enablers.

Somewhere inside she must realize that she is now doing more harm than good. There is more to her relationship with Trump than just tactics.

I believe that Dr. Birx’s own ego may not be strong enough to withstand the thought of being summarily dismissed by Trump. There is nothing obvious in her life that would prepare her for that kind of rejection and disapproval; in fact, the contrary is true. Dr. Birx’s life story has been one success after the next, following a steady uphill course.

She carries herself with dignity and pride, clearly conscious of the image that she presents to the public, down to the fashionable scarves. I emphasize that I am not saying that there is anything wrong with that; far be it from me to take issue with someone as genuinely accomplished as Dr. Birx. I am saying, however, that she may be vulnerable to being exploited by a powerful and malignant narcissist like Trump.

Dr. Birx’s military background conditions her to a certain deference to authority. That deference simply makes it more difficult to contemplate being punished unfairly by someone in authority, especially by being publicly kicked to the curb and humiliated.

I want to also stress that this discussion is appropriate only for one, important reason: Dr. Birx is allowing herself to be used by Trump and in my opinion, despite what she may believe, she is helping to endanger lives. She is lending credibility to Trump’s leadership of the pandemic response, and that troubles me for a particular reason right now: Her tacit support of Trump’s self-serving refusal to embrace the idea that an expanded regime of testing must be implemented before society can safely be reopened.

My training and experience as a psychiatric social worker are helpful in understanding human behavior. On the other hand, I have applied my lawyerly training to evaluating expert opinions on the need for a much more expansive program of testing for COVID-19, including testing of potential symptomatic carriers, as a precondition for restarting the economy. What the research reveals is that, although opinions vary as to the scope, all credible experts believe that a comprehensive regime of testing and contact tracing is necessary to identify and isolate carriers, and to protect vulnerable places like hospitals and nursing homes.

Trump repeatedly has pushed back on this idea, for the obvious reasons described in another post. Dr. Birx has been non-committal about such testing, refusing against all prudence to be more specific – or to tell us if or when the CDC will be issuing its own guidance on a testing program, which the CDC should have done by now.

As a consequence, many states are drifting toward restarting their economies without such programs, or even without any ideas what such programs should look like. It is the next big storm cloud/pandemic screw-up on the horizon, and Dr. Birx has not prevented it. She is helping to enable it.

I hope that friends, family members, or respected colleagues will have a heart-to-heart with Dr. Birx, explaining to her what she is doing to herself – and to the country. Tell her that we appreciate her efforts, but that a constructive relationship with a malignant narcissist on the order of Donald Trump is not possible. Ask her to give you an example of one such relationship in Trump’s life. And have her read the recent interview with Dr. John Gartner in Salon.

Plead with her to follow the example set by her older colleague, Dr. Fauci, and maintain an arms-length professional relationship with the president. Implore her to stop the fawning. And if she gets fired for doing and saying the right things, so be it. She will have nothing to be ashamed about and will feel much better about herself in the end. And the rest of us will be safer.

Dr. Redfield: Where is the CDC guidance for widespread testing of potential asymptomatic carriers of COVID-19?

Where is the CDC’s guidance for the expanded program of COVID-19 testing and contact tracing necessary to allow states to safely relax restrictions on public gatherings and “reopen” their economies? If the CDS has issued such guidance, I sure cannot find it – any help would be appreciated.

My theory: Despite its clear obligation to do so, the CDC will not issue such guidance because to do so would expose how inadequate the current supplies of test kits are to do the testing necessary to implement such a program. And the inadequate number of test kits would in turn underscore the greatest single mistake of the Trump administration’s generally inept pandemic response – the failure to adopt a national strategy to produce, acquire, and distribute critical medical supplies, including test kits and PPE.

The CDC is the repository of the nation’s expertise in how to establish a program of surveillance testing, widespread screening, and contact tracing customized to COVID-19 that would allow states to safely reopen their economies. It is nothing less than a gross abnegation of its core mission for the CDC not to get out in front of  this key step in controlling the pandemic.  

I discussed what such an adequate testing regime would look like in a prior post, referring to an article  in The Atlantic.  It involves much more widespread  testing than called for by the CDC in its current guidance.

The goal of surveillance testing, done by sampling, is to determine rate of infection in a given population. The use of tests for screening is done to accomplish a specific goal, such as making sure that only virus-free nursing home employees have close contact with residents. And it involves testing asymptomatic people – a subject that the CDC has avoided.

Controlling COVID-19 is particularly challenging because it can be transmitted by asymptomatic carriers of the disease, the so-called “silent spreaders.” These silent spreaders can be pre-symptomatic, spreading the disease in the days before symptoms appear, or they can be carriers of the virus who never have any signs or symptoms of the disease. Estimates now are that as much as 40% of the transmission of COVID-19 is from asymptomatic carriers.

The authors of the Atlantic article point out that a widespread testing program designed to make it safe to reopen society must focus on potential asymptomatic carriers of the disease, interdicting transmission of the disease at the points at which it is most likely to be spread and at which it is most dangerous. They recommend widespread periodic screening for COVID-19, and they group people into four general categories in order of testing priority.

The first priority for screening is health care workers, including nursing home workers, and medical first responders. The second includes people who also interact with many other people and are vital to keeping the country going, such as grocery and postal workers and police officers. The third group is for anyone who routinely comes into contact with large groups of people either in the course of their employment or family life. The final group includes everyone returning to their workplaces.

The authors suggest that testing of people in these groups would occur about once a week. That is a lot of testing and estimates of the number of tests necessary to carry out an adequate program of testing range from 500,000 into millions per day.  Any plan similar to the one described in the Atlantic would have to be phased in, beginning with the high priority groups.

It is fair to add that many experts believe that the plan proposed in the article is too ambitious and is unrealistic. To my knowledge, however, none have said that a comprehensive testing program that includes testing of asymptomatic people is unnecessary, and that social distancing alone will be sufficient to safely reopen society. The risk simply is too high that the pandemic will come roaring back if the virus is allowed to spread undetected.

California apparently will be the the first state to adopt its own program of more widespread testing that includes asymptomatic people, beginning with screening of health care workers. It is limited (including by shortage of test kits), but it is a start. And it is an absolute sin that states have been left to their own devices on this. That does not mean that there would not be deviations from a CDC-designed program to account for local conditions, but the basic program must be based on scientific and public health best practices – in other words, an undertaking that is in the wheelhouse of the CDC.

Finally, this note to Robert Redfield, head of the CDC: Dr. Redfield, I don’t care if it highlights the failure of the federal government to take charge of making adequate number of test kits available and embarrasses the president, you have a duty here. And that duty is to render your best advice on a program of comprehensive testing and contact tracing that will protect citizens as the economy is reopened. Think of us as your patients, doc. Don’t we deserve your best medical advice?

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A footnote on my earlier post about the failure of the president to use the Defense Production Act (DPA): To reprise, I pointed out that the greatest single dereliction of federal responsibility (among a whole host of screw-ups in the federal pandemic response) was the failure by the Trump administration to design and implement a national strategy to produce, acquire, and distribute critical medical supplies, including test kits and PPE. Claims by the Trump administration that it was not a federal responsibility are wrong, and reprehensible.

Only the federal government has the power, through the Defense Production Act (DPA), to ensure production of sufficient quantities of supplies and equipment, control and stabilize supply chains, eliminate price gouging, and make sure that distribution is made to where it is most needed. If the DPA had been used in a timely manner, the shortages of PPE and test kits would not exist.

There is an excellent article in Politico titled “Inside America’s unending testing snafu.” It is worth reading if a bit overwhelming in its description of a complex problem. Suffice it to say that the “snafu” that test kit availability has become is the best evidence of why federal officials should have taken charge of this task as soon as they knew that the pandemic was headed our way.

A task of this magnitude and complexity can only be managed centrally. And that means the federal government. And I am absolutely certain that people with relevant expertise and experience told that to the president or his staff at the outset of the pandemic. As I said before, only a congressional investigation will find out why this ball was dropped.

The problems described in the story sound complicated, and they are. But they are the type of problems that logisticians spend entire careers training for and working on. There are about 26,000 employees and a lot of expertise in managing supply chains, interoperability of equipment, and ensuring that multiple moving parts work together to produce the desired results in the Defense Logistics Agency (DLA). There is similar expertise in FEMA.

The president decided to let all of that skill and experience sit on the sidelines and to make acquisition of test kits a “state responsibility,” meaning that he made availability of test kits subject to the vagaries of a market in chaos. There is considerable suspicion that his decision was influenced by manufacturers and suppliers who benefit from such dog-eat-dog sellers’ markets, where states and even individual hospitals are bidding against each other. In any case, it was a horrifically stupid, unjustifiable decision that is costing many lives and will force lengthy delays in safely reopening the economy.

The “original sin” of the federal response has evolved into the president’s misconduct in office.

Brian Williams of MSNBC quoted someone whose name I do not recall as referring to the failure of the federal government to adopt and implement an effective national strategy for diagnostic testing of the COVID-19 coronavirus as soon as the pandemic was on the horizon as the “original sin” of the federal response. The term fits perfectly, and it is a sin that continues to haunt us. This post updates and expands upon my post last week captioned “Trump is rushing us headlong toward disaster for his own political benefit.”

As I described in detail in last week’s post, the Trump administration stumbled badly at the starting gate in addressing the need to quickly mass produce test kits. That failure still haunts us. To make matters far worse, President Trump wants to wash his hands of a problem that he created and has refused to solve, and to pressure governors to restart the economy without adequate testing capacity. His insistence that establishment of testing programs necessary to safely reopen society is a state responsibility not only is maddeningly wrong, it is criminal nonfeasance of his own duties in this national emergency, in my opinion.

I was prompted to write this new post by an article published in the Atlantic titled “Without more tests, America can’t reopen – And to make matters worse, we’re testing the wrong people.” The article describes what an ideal testing regime would look like if we are serious about making it safe to return to anything resembling business as usual in this country – and states that we are nowhere near the point of being able to implement such a regime.

The article takes direct aim at current CDC guidance, which gives priority first to hospitalized patients and symptomatic health-care workers, and then to high-risk patients (people over 65 or suffering from serious health conditions) displaying COVID-19 symptoms. Under the CDC guidance, asymptomatic individuals are not tested, even if they had contact with people who tested positive.

In possible defense of the CDC, I will make a point that I have made in the past about CDC guidance and the standards of other federal agencies: They are not “aspirational” in nature. They are based on what reasonably can be required under the circumstances. It is not reasonable to require a broader testing program when tests are not available to implement it.

To my knowledge, the CDC has not stated that its current guidelines are adequate for reopening society. If it has done so, then I stand corrected. If it has not done so, then when is it going to issue updated guidelines for a broader testing program? If the CDC is waiting for more testing capacity to come online before updating its guidance, then maybe Dr. Redfield, head of the CDC, should just say so, no matter how much it annoys Trump.

The authors point out that a testing program designed to make it safe to relax restrictions must focus on potential asymptomatic carriers of the disease, interdicting transmission of the disease at the points at which it is most likely to be spread. They recommend widespread use of testing for screening purposes, and they group people into four general categories in order of testing priority.

The first priority is health care workers and medical first responders. The second includes people who also interact with many other people and are vital to keeping the country going, such as grocery and postal workers and police officers. The third group is for anyone who routinely comes into contact with large groups of people either in the course of their employment or family life. And the final group includes everyone returning to their workplaces.

I offer an oversimplified explanation for people, like our president, who seem to have trouble understanding the importance of the widespread testing described in the Atlantic article. I will use an analogy to a vector-borne disease, the bubonic plague, which is spread from infected rats to humans by flea bites.

If there was an outbreak of bubonic plague in a United States city, one thing that would be done would be to try to eradicate as much of the rat population as possible. The more rats running around infected with the disease, the higher the risk of spreading it to humans – the more infected rats, the more infected people. You would not interview the rats, take their temperatures, or test them to determine which ones were carrying the plague bacteria, and then isolate them from their peers. You would just kill them.

That approach does not work with people, but the problem is the same: The more undiagnosed asymptomatic carriers of COVID-19 there are in the community, the more the disease will spread. You can’t kill the carriers of COVID-19 (despite what Trump or Dr. Oz might think), so what you must do is try to identify those carriers and then prevent them from spreading the disease by isolating them until the disease runs its course.

We currently are testing about 120,000 – 145,000 people per day for COVID-19. According to some experts, that number will have to triple to around 500,000 tests per day for society to safely reopen. Other experts cited in the Atlantic story put the number much higher, into the millions.

Ever since Trump disclaimed federal responsibility for the testing, accurate information has been hard to come by on the status of test production; Vice President Pence talks in generalities, and there is no one at the briefings able to be more specific. I believe that we must assume the worst and that plans are not in place to assure production of sufficient tests.

I described in last week’s post how the Defense Production Act should have been used to assure production by manufacturers of an adequate number of test kits on an expedited basis – only the federal government has the legal power to do that. The news media must press Trump or Pence on how they intend to make sure that we have the capacity to test 500,000 per day or more as necessary to reopen the country for business as they have stated they want to do. If they do not believe that making the necessary number of test kits available is the job of the federal government, then force one of them to put that on the record.

As the Atlantic article also points out, we also must do contact tracing to identify other people to whom carriers may have transmitted the disease. The authors estimate that we will need to hire and train 100,000 to 200,000 additional health care workers to do the contact tracing. Where are we on that task? Has that become another “state responsibility”?

 Misconduct in office

The failure of the federal government to adopt and implement an effective national strategy for diagnostic testing of the COVID-19 coronavirus as soon as the pandemic was on the horizon was the “original sin” of the federal response. It continues to haunt us today and will do so for the foreseeable future. Trump already is on thin ice in terms of his conduct, but in my opinion if he continues to abrogate his responsibility to increase test production and pushes states to reopen before adequate testing capacity exists he has crossed a line to the point where his conduct clearly can be described as common law misconduct in office, an impeachable offense.

Misconduct in office can be committed by misfeasance, malfeasance, or nonfeasance. I am not going to belabor the issue, because there is virtually no chance that Trump will be held accountable by Congress for his misdeeds, no matter how serious. But I believe that it is worth keeping in our minds just how callously indifferent Trump has been to the health and safety of Americans, reckless in both words and actions. If his conduct hasn’t been criminal, then it should be.

Trump has a duty to oversee an appropriate federal response to a national emergency. He cannot just refuse to perform that duty because he finds it politically uncomfortable. In a court of law, Trump would be held to the knowledge that he is not “liberating” the people of Michigan, Minnesota, Virginia, etc. He is sending them to their deaths.

 

Trump is rushing us headlong toward disaster for his own political benefit.

President Donald Trump has made a truly cynical and potentially deadly calculation. Fearing political harm from a continuing economic downtown more than he fears causing unnecessary loss of lives from the COVID-19 pandemic, he is determined to push an early re-opening of businesses, stores, and institutions regardless of the risks.

He repeatedly has been advised by experts that the economy can be safely be re-started only when there are sufficient rapid-result test kits available to do much more widespread testing than is now being done. Such testing is needed so that the extent of the virus in the community is known and that people with COVID-19 can be identified and isolated. He also knows that there still are nowhere near enough test kits to do that.

Instead of accepting the obvious federal responsibility for the shortage of tests, however, he alternatively denies the shortage and seeks to thrust the responsibility for it onto the states. I.e., there is no shortage, but if there is a shortage it is the states’ fault. Two days ago, he tweeted this:

“Governors, get your states testing programs & apparatus perfected. Be ready, big things are happening. No excuses!”

Trump is fully aware that he is pressing for actions that will kill people. He believes, however, that by creating the false narrative that states are responsible for any failure to do sufficient testing he can blame the loss of life attributable to a premature relaxing of restrictions on the governors. Even for Trump zealots, this may prove to be one big lie too many.

 The approval, manufacture, and distribution of a sufficient number of diagnostic test kits to bring the pandemic under control is and always has been a responsibility of the federal government.

Assuming an argument can be made about state and local responsibility for having sufficient numbers of ventilators, masks, and other ordinary medical supplies on hand to meet a national emergency (it can’t, by the way), there is no argument about the approval and production of sufficient diagnostic tests for a newly-discovered disease. It is a process controlled by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) and is unquestionably part of the necessary federal response to a pandemic that has been declared a national emergency.

Trump’s general dithering as the pandemic evolved has been well-documented by the New York Times, Washington Post and other news sources. The lack of urgency in the federal response was especially problematic when it came to the approval and production of test kits. It is worth reviewing how the the test kit problem began, because it illustrates just how outrageous it is for Trump to suggest that he is going to hand over to state governors a problem that his administration created and still has not solved.

 A superb, detailed account of how the federal government fumbled the testing ball, and how we made mistakes that South Korea avoided, was published by Reuters on March 18th. It’s absolutely essential reading for anyone interested in understanding where we went wrong with the testing. I’ve summarized the highlights of the missteps below.

The CDC runs into a problem, and the delays begin.

Chinese authorities first detected an outbreak of a “novel,” or new type of, coronavirus in December 2019 in Wuhan province. On January 11, 2020, Chinese scientists posted the genome of the new virus on an open website.

Within a week, German virologists produced the first diagnostic test. It was approved by the World Health Organization (WHO) and by February 6th the WHO had shipped 250,000 diagnostic tests to 70 laboratories around the world.  By the end of February more than 1.4 million tests had been sent to nearly 60 countries, not including the United States.

The CDC did not authorize the WHO test for use in the United States, following its standard practice of producing its own test for a new virus to ensure accuracy and reliability. Unfortunately, shortly after the CDC began distributing its own test kits on February 5th, local labs reported that the CDC tests were producing inconsistent results. It turned out that the test kits were faulty and had to be replaced. Valuable time was lost.

The FDA compounds the problem, and the delays continue.

The first confirmed case of COVID-19 in the United States was diagnosed in Washington State on January 20th. By February 24th, still lacking usable tests from the CDC, health officials in Washington and elsewhere grew desperate. The Association of Public Health Laboratories sent a letters to Dr. Stephen Hahn, the FDA commissioner, asking him to use his legal discretion to waive standard approval protocols and allow state and local public health laboratories to create their own tests for the virus. He initially declined to do so.

On February 29th, however, the FDA relented and announced a new policy to make it easier for hospital laboratories to develop their own tests. We now know that many public and private laboratories had been chomping at the bit since early January to develop tests.

Olfert Landt, head of the German lab that developed the first diagnostic test for COVID-19, believes that the United States waited too long before using private companies to develop the tests. He stated that the pandemic was too big and moving too fast for the CDC to develop its own test in time. “There are ten companies in the U.S. who could have developed the tests for them,” Landt said. “Commercial companies will run to an opportunity like this.”

South Korea has a regulatory system similar to ours. During the outbreak of another coronavirus in 2015, MERS, it had learned a deadly lesson about the need to get test kits in the hands of clinicians quickly. The lesson, of which American epidemiologists were aware, was that routine approval procedures were too slow to deal with a coronavirus. The South Koreans were determined not to repeat the mistake with COVID-19 that they made with MERS in 2015.

South Korea had its first diagnosed case of COVID-19 on the same day as the United States, January 20th. On January 27th, South Korean officials met with representatives of 20 medical companies at a train station, urging them to begin work on developing tests for COVID-19, promising quick regulatory approval.

A week after the meeting, South Korea’s CDC approved one company’s diagnostic test. An approval process that normally takes up to a year-and-a-half in South Korea took one week. Another company soon followed. By the end of February, South Korea had drive-through screening centers and the ability to test thousands of people daily.

South Korea used its ability to do quick and widespread testing, along with an extensive program of contact tracing, to identify and isolate those in the community infected with the virus. It’s ability to slow the spread of the virus through those measures dramatically decreased the incidence of and death toll from the disease and allowed officials to avoid severe restrictions on businesses and schools, softening the impact of the pandemic on the economy.

Why did we fail where South Korea succeeded?  

South Korea acknowledged that its expedited approval of testing sacrificed accuracy for speed, but correctly believed the need for speed was paramount; using reasonably accurate tests was better than forcing public health officials to fly completely blind. As manufacturers developed more accurate tests, the early test kits were replaced with the more accurate ones.

The FDA eschewed South Korea’s approach, and erred on the side of caution. Alberto Gutierrez, who led the FDA’s office overseeing diagnostic testing from 2009 to 2017, explained that the agency proceeds with caution because it sees itself as the last line of defense against opportunistic companies looking to cash in on threats to public health, claiming that “the FDA had good intentions.”

“There is money to be made in an emergency, and a lot of people try to take advantage of that,” Gutierrez told Reuters. “The problem the FDA faces is, do you let it become the Wild West?”

Good intentions are one thing, the bigger picture in controlling a pandemic caused by a deadly and rapidly spreading virus is quite another, and it’s hard to believe that the Wild West was worse than what is going on now. In defending the FDA’s slow, cautious approach, Dr. Deborah Birx, the State Department official coordinating the White House COVID-19 task force, stated last month that a less reliable test can result in “false negatives,” meaning test results erroneously indicating that people with the disease do not have it.

That is true, but having no test means that far more people with the disease will go undiagnosed. Did the FDA simply let the perfect become the enemy of the good, somehow failing to recognize that time was of the essence and that waiting for the “perfect” test would cripple efforts to contain the pandemic? It seems doubtful; I believe that there is more to it than that.

Dr. Robert Redfield, head of the CDC, made clear that it was the FDA that called the shots on approval of testing by private labs. A lot of the blame for the slow roll out of test kits therefore fell on Dr. Stephen Hahn, Trump’s appointee who took over as commissioner of the FDA on December 17, 2019.

Dr. Joshua Sharfstein is a former principal deputy commissioner of the FDA as well as a former Secretary of the Maryland Department of Health. Although he agreed that the FDA should have moved more quickly to authorize public and private labs to develop and use their own tests, he did not put all of the blame on the FDA. “The FDA can design an approach to support the public health strategy, but someone has to tell FDA the public health goal,” he said.

Scharfstein also referred to the pandemic response team on the National Security Council under the leadership of Admiral Timothy Ziemer that Trump eliminated in 2018 when discussing how a lack of leadership from the White House may have affected the FDA:

“People talk about, like, why does it matter that they closed the White House office on pandemic preparedness? This is one reason.”

It is not clear that the absence of Ziemer and his team, competent and experienced as they were, would have made any difference. Since Scharfstein made his comments we have learned from the New York Times the extent to which Trump’s stubborn refusal to take the pandemic more seriously, despite the pleas of advisers and other experts, delayed the federal response.

Trump was heavily invested in his boast that the partial ban he placed on travel from China on January 31st had succeeded in preventing a serious outbreak of COVID-19 in the United States. On February 24th, the same day that the Association of Public Health Laboratories sent its frantic letter to Hahn urging him to green light approval of test kits because the window was closing on the opportunity to contain the outbreak of the virus in the United States, Trump tweeted the following:

“The Coronavirus is very much under control in the USA. We are in contact with everyone and all relevant countries. CDC & World Health have been working hard and very smart. Stock Market starting to look very good to me!”

The Trump administration received its first formal notification of the outbreak of the coronavirus in China on January 3rd and within days United States intelligence agencies were warning about the threat in the President’s Daily Brief. Seventy days later, on March 13th, Trump declared the pandemic a national emergency. The Washington Post described in detail how the intervening 70 days, which could have been used to ramp up the federal response, largely were squandered.

In summary, I find it hard to believe that it was nothing more than the failure of the FDA to recognize the urgency of the situation that caused it to move so slowly. We may not know until Trump leaves office, or at least until subpoenas are issued and testimony taken under oath, whether Trump had a personal hand in the FDA’s laggardly response to the pandemic, but the agency’s actions seem remarkably consistent with Trump’s own lackadaisical approach to the emergency.

We do know that Trump has never even acknowledged the need for widespread testing, for reasons at which we can only guess. And we also know that the delay in making tests widely available already has caused many deaths, and will cause many more.

Why is the distribution of test kits still lagging behind need?

Given the almost universal agreement among experts that society cannot safely be “re-opened” until testing is much more widely available, you might think that 1) there would be specific production goals for additional tests based on the number of tests needed to lift restrictions, and 2) a concrete plan for meeting those production goals, with a timeline.

 If you think that, then you haven’t been watching Trump’s pandemic briefings. One of my many frustrations with those briefings is that reporters have not been pressing Trump on this issue.   

Trump has consistently denied that there is a test kit shortage. That denial pretty much rules out Vice President Pence and his task force initiating a discussion on the extent of the shortage and how to address it, even though the shortage of test kits remains the biggest impediment to bringing the pandemic under control, short of a vaccine.  

And it also means that there is a conspicuous absence on the stage during the pandemic briefings: Someone with knowledge of the scope of the test kit problem, and the expertise to know how to solve it. Drs. Fauci and Birx are experts on the control of the disease, not on the logistics of manufacturing and distributing test kits. The closest thing to a medical logistics expert that we’ve heard from so far is Jared Kushner. Need I say more.

I believe that one of the reasons that Trump is ducking this issue is that closer scrutiny will reveal another major mistake involving the failure to use the Defense Production Act. As noted above, Olfert Landt, head of the German lab that developed the first diagnostic test for COVID-19, believed that commercial American companies would have jumped at the opportunity to develop and manufacture tests if the FDA had authorized them to do so from the start.

We don’t know if that ultimately occurred, but even if it did, I believe that it would have been prudent for the federal government to step in via the Defense Production Act to do the procurement. That would have assured a specific level of production, stabilized the supply chain, eliminated price gouging, and enabled distribution of the tests where most needed.

Using the Defense Production Act may still prove to be necessary. We have received so little useful information on the test kit shortage that it is hard to know. I believe that we are being kept in the dark by design.

Is Trump serious about exercising powers that he doesn’t have?

Today Trump doubled down on his incorrect claim that he has the power to overrule state governors and lift restrictions on public gatherings, workplace closures, etc., tweeting:

“For the purpose of creating conflict and confusion, some in the Fake News Media are saying that it is the Governors decision to open up the states, not that of the President of the United States & the Federal Government. Let it be fully understood that this is incorrect…It is the decision of the President, and for many good reasons.”

I doubt that even his slimy Attorney General, William Barr, has told him that this is true. The president has no such power under our federalist system.

Trump wants it to appear as if he is the one trying to save the economy, but without accepting responsibility for the consequences of reopening schools, stores, and businesses too early. If governors push back on reopening, he will accuse them of promoting an economic downturn to hurt him at the polls. If they do reopen, and it turns out that they did so too soon, he will blame them for being unprepared with their “testing programs.”

I may be wrong, but I believe this time Trump is being too clever by half. His mistakes and the mistakes of his administration are too well-documented to bullshit his way out the mess he has made of the federal pandemic response. People are dying, and that tends to make us finally sit up and pay attention.

Is President Trump mentally fit to lead the country through this national emergency? Answer: No.

Update, April 19, 2020:  Trump is now engaged in a concerted effort to undermine governors trying to return their states to some semblance of normality while still keeping citizens safe. He is openly advocating movements to “liberate” Michigan, Virginia, Minnesota and other states. His refusal to wear a mask and mocking reference to social distancing as “political correctness” are all part of the effort.

Jonathan Chait had this to say in The Intelligencer:

Trump is fomenting anarchy in his own country, undermining the prospects for the orderly recovery he needs in order to win reelection, and creating the risk of a violent tragedy. (The Confederate-flag-waving protesters blocking the entrance to a hospital in Michigan yesterday is the sort of episode that, if repeated, could go very badly.) He is raging angrily against the system because he is hopelessly out of his depth.

Chait correctly pointed out that rage by Trump is not strategic in nature. Yes, his base eats it up, but his cult-like followers eat up anything he says. And, rather than distracting from the continuing consequences of his failure to adopt and implement a national strategy for making available a sufficient number of COVID-19 test kits, it draws attention to it: States cannot reopen safely because of the lack of federal attention to test kit production, the “original sin” of the federal pandemic response.

What you are seeing is the consequence of the walls falling in on Trump’s ego. Public humiliation is the most severe threat to a narcissist. Here is a useful, plain-language description from a  Suzanne Degges-White, a licensed professional counselor:

A narcissist’s ego is an extremely fragile thing and when she feels she is being laughed at or is losing the respect of others, it can be tremendously upsetting. The narcissist’s ego is the only protection they have from the world and when their ego integrity is breached, narcissists often respond in ways that seem markedly out of proportion to the circumstances for average people. 

I appreciate Dr. White’s use of the pronoun “she.” As it happens, however, most of the experience that psychotherapists have with narcissists lies in trying to help wives deal with narcissistic husbands. Be that as it may, her comment about an ego breach triggering responses that are “markedly out of proportion to the circumstances” is apt, if a bit of an understatement when it comes to Trump.

Again, all of this was predictable, and predicted. Don’t make the mistake of believing that it cannot get any worse. It can. This may be hard to get your head around, but Trump would rather see the country destroyed than be personally humiliated. If he sees his prospects of re-election in November dimming, there is no limit on the havoc that he could wreak, even if it involves political self-immolation.

PS. I’ve added an answer to the question posed by the title of this post. That answer is a by now obvious “no.”

Update, April 13, 2020: Today’s meltdown speaks for itself. He’s now reduced to infantile temper tantrums and grandiose pronouncements: “When somebody’s the president of the United States, the authority is total.” As predicted over and over again, this only gets worse as Trump feels the pressure on him increasing. Vice President Pence and members of the cabinet have a clear duty to act under the 25th Amendment; in other contexts, it would constitute gross negligence (reckless disregard of an obvious risk) to allow this man to make decisions on when stores can reopen and people can safely return to work and gather publicly.

Update, April 10, 2020 – and a red alert: For me, the pathological highlight of today’s news conference was Trump’s obvious enjoyment as he described the immense power that he had to determine the fate of the nation through his decision when to re-open the country for business. He was almost giddy as described “the most important decision” he had to make as president.

A normal president would be sobered and humbled by such a monumental responsibility for the lives of others. Not one with a severe and disabling narcissistic personality disorder. Trump is gleefully intoxicated by the thought of having such dominion over others. It is his dreams of omnipotence coming true. 

When he was asked what “metric” he would use to make his decision, he pointed to his own empty skull. That’s reason for us to very scared. If today’s news conference didn’t cause red flags to go up for everyone who was watching, then nothing will.

Of course, being as uninformed as he is, he was wrong about his authority to override governors who may not agree with him on when businesses should be reopened, etc. But any pronouncement he makes on the subject will be followed by the half-dozen or so GOP governors who seem incapable of defying him, and more lives will be lost, especially in the populous states of Florida and Texas.

As if to underscore his stupidity, he persisted in discussing the lack of efficicacy of antibiotics against COVID-19. I wonder how many people in the country don’t realize by now, if they didn’t know it before, that antibiotics kill bacteria, not viruses.

The president will make the decision when to declare the country “back open for business” based on his own self-interests. And that probably means well before it is safe to do so. He is anxious to put this crisis in the past by declaring “victory” over COVID-19 well ahead of the election. He believes that voters have memories as short as his, and that they will forget about his mishandling of the pandemic if it is over by summer.

If he is allowed to make critical decisions on when and under what circumtances businesses resume operating normally, public gatherings are allowed to resume, etc. he will kill tens of thousands of additional people. And he won’t even care, as long as it is not him – and maybe Ivanka.

Update, April 7, 2020: I initially considered regular updates to this post, written on March 23, 2020, as Trump’s behavior predictably deteriorated, as sort of a running social history on how a person with severe narcissistic personality disorder responds to pressure, especially criticism. I found the concept too depressing, however, and elected not to do it for the sake of my own mental health.

But I decided that it was worth a case note on Trump’s increasing anger and hostility as he lashes out at critics and even potential critics, in an effort to intimidate and suppress critical feedback. He hasn’t been able to answer a question that he regards as “nasty” during his daily briefings without attacking the character of the reporter asking the question for weeks.

And it’s getting worse. A navy captain is relieved of command of an aircraft carrier because of a letter that Trump and his proxies deemed an embarrassment to his administration. Although Trump’s role has not yet been made clear, the Acting Secretary of the Navy who relieved Captain Crozier reportedly stated that Trump wanted him fired.

It is clear that, in quick succession, Trump himself fired Michael Atkinson, the intelligence community IG who told Congress about the whistleblower complaint that led to Trump’s impeachment, and then removed the acting IG of the Defense Department, Glenn Fine, who would have overseen scrutiny of the pandemic relief effort. Fine, in his position since Trump took office, has a reputation for being an independent and aggressive watchdog. It likely won’t be the last of the IG firings in light of the letter signed by many of them protesting Atkinson’s dismissal.

There is only one way that Trump will react to increasing criticism, and it won’t be with self-reflection. It will be by escalating efforts to suppress it. Even normally obeisant members of the GOP expressed concern at the firings of Crozier and the IGs. That won’t matter; Trump’s judgment is declining at the same pace as his impulse control.

Expect Trump’s scorched-earth tactic of replacing any perceived adversary or critic (to Trump those are the same things) to intensify as the pandemic and economic downturn becomes a growing threat to his re-election. Nothing matters more to Trump in any situation than “winning.” Nothing.

As desperate as he is to suppress criticism, Trump is becoming just as desperate (and bizarre) in his efforts to deflect blame from himself onto others. His latest target is the World Health Organization (WHO), which Trump said “blew” the coronavirus crisis. He accused it of being “very China centric,” and threatened to reduce its funding. Maybe he thought he was not gaining enough traction in his efforts to blame his predecessor, Barack Obama.

As an aside, someone suggested to me on Twitter that it was Trump’s intellectual shortcomings that are the biggest problem. I disagree, although I do believe that former Secretary of State Rex Tillerson gave the most accurate description of Trump’s intellectual capacity, using precise clinical language: “He’s a fucking moron.”

History is replete with successful leaders who did not have extraordinary intellects; other qualities are more important, including a healthy level of self-awareness. But put together Trump’s modest intellectual capacity with grandiosity on a delusional scale, and we have a major problem: An uninformed, mentally unbalanced leader who believes that he is “a very stable genius.”

A bit of “good” news: An opinion writer for the New York Times, Jennifer Senior, wrote a column putting Trump’s mismanagement of the pandemic in the context of his personality disorder. I am not obsessed with psychoanalyzing every human activity (I’ve been a lawyer a lot longer than I was a psychiatric social worker), but I don’t see how you can talk knowledgeably about Trump’s actions right now without understanding what you are seeing and hearing.

There is a very real danger in not recognizing Trump for the malignant narcissist that he is – the danger that we don’t remove him from office before his impaired judgment puts even more lives at risk. Maybe Ms. Senior’s column will prompt others, including her own editorial board, to start ringing the alarm bells.

Update, March 28, 2020: The post that appears below was published on March 23rd. Since then it has been viewed many times. In the meantime, things on the “ground” have gotten worse – both in terms of the impact of the pandemic and in terms of President Trump’s behavior. I decided to add an update in the event more people view the post in the future.

Two days after I posted my comments, an article written by Dr. Bandy X. Lee was published in The Independent. Lee is the Yale psychiatrist who edited “The Dangerous Case of Donald Trump” referenced in my original post. Her article updates her own concerns in light of the COVID-19 coronavirus pandemic, urging that Trump be removed for the safety of the American people.

Lee and her co-authors hardly are the only mental health professionals who have described Trump as having narcissistic personality disorder. Despite the so-called Goldwater Rule, many psychiatrists and psychologists have stepped forward to offer their diagnoses, undoubtedly for the same reason that Lee and her colleagues did: Fear of the consequences if Trump is not removed from office.

A noted exception was Dr. Allen Frances, a prominent psychiatrist who in 2017 opined that Trump did not have narcissistic personality disorder, although he did not downplay the threat posed by Trump’s conduct. In any case, I would invite Frances to revisit his findings in light of what we have observed in the past three years.

I wonder why more mental health professionals have not stepped forward recently to sound the alarm. Have they become like many of the rest of us, inured to the fact that we have a severely disordered individual running the country at a time of national emergency? Are they becoming a bit fatalistic? If so, it’s easy to understand why.

Trump is becoming more inappropriate, and his judgment is worsening.

On March 27th, Trump said something especially stunning, even by his standards:

“You can call it a germ, you can call it a flu, you can call it a virus, you know you can call it many different names. I’m not sure anybody even knows what it is.”

This was more than ignorance; this was the megalomaniacal dismissal of scientific and medical expertise going on inside Trump’s troubled head. Translation: “Why should I listen to Dr. Fauci, et al? They don’t really know what they’re doing. I’ll figure this out before they do.”

As an aside, Trump made the above comment shortly after Dr. Deborah Birx said this about him:

“He’s been so attentive to the scientific literature and the details and the data. And I think his — his ability to analyze and integrate data that comes out of his long history in business has really been a real benefit during these discussions about medical issues.”

Bullshit, Dr. Birx. Does that sound like he gives a rat’s ass about the scientific literature? He isn’t listening to a word you say other than to assess how your advice might conflict with what he believes to be in his own narrowly defined interests. That’s what malignant narcissists do.

Because his boasting and lies will ring more and more hollow as the crisis worsens, he will have to resort to more extreme measures to protect his fragile ego. That means his words and actions are likely to become more inappropriate, even bizarre.

For example, his unconscionable threat to withhold medical supplies from Michigan unless Governor Gretchen Whitmer showed more “appreciation” for his largesse illustrated how desperate he is becoming for social validation in the face of growing public criticism over his handling of the pandemic. He fabricated a conflict with General Motors out of whole cloth for the same reason.

Weaponizing the Defense Production Act, Trump claimed that he used it to bring GM to heel over the price GM wanted to charge for ventilators. He criticized GM for not moving quickly enough. As it turns out, GM already was working with Ventec, a major ventilator manufacturer, to produce the ventilators and sell them at cost, retooling GM’s facilities as rapidly as possible to begin production. Trump flat out lied.

Trump lies for many reasons, and this one about GM was for a familiar purpose: To generate a conflict (even a faux one) in which there was a loser and a winner, and he was the winner. Trump craves “winning” like an opioid addict craves opioids. The lengths to which he will go to validate himself as should frighten all of us.

And oh, by the way, do you believe that it was a coincidence that the governor of Michigan and the CEO of GM both are women? As he grows more frantic, he will be less inclined or able to hide his well-documented misogyny.

Today’s threat by Trump to quarantine New York and possibly parts of New Jersey and Connecticut follows another one of his patterns: He sows the seeds of division by inventing enemies or selecting scapegoats. Doing so not only is useful for deflecting blame (“the Chinese virus”), it also enables to him to take on the mantle of savior, asserting that “only he” is willing to do what it takes to save us from the forces that threaten us.

It was a tactic that worked remarkably well for him in the 2016 election, using immigrants as the “threat.” Now he is going to turn the tactic on citizens from “blue” states in the Northeast, even to the extent of blaming them for the spread of the pandemic in the “red” state of Florida.

He hasn’t suggested building a wall, but don’t be surprised by anything that he says or does to turn the pandemic response into a political war between “his” side and everyone else. His political base certainly got the message from his quarantine threat, and I fully expect citizen militia groups shortly will be volunteering to patrol the borders between red states and blue states.

The mainstream media are dithering on this issue.    

Why aren’t editorial boards in major United States newspapers weighing in the president’s precarious mental state, which is becoming obvious even to laypersons? Why are no reporters from the Washington Post or the New York Times seeking out psychiatrists like Dr. Lee or psychologists like Dr. John Gartner, formerly of Johns Hopkins University, who has talked about Trump’s increasing mental instability?

As I stated in my original post, there may a reluctance to broach such an explosive topic as the president’s fitness for office in the middle of an emergency – people are scared and confused enough. When I re-read my post, I recognized my own trepidation. I concluded that invoking the 25th Amendment to remove Trump was too drastic a step; it is a process that would not happen quickly.

The thought of the country mired in a political crisis at the same time that it is mired in a public health emergency is almost unfathomable. Nevertheless, the president’s judgment seems to be increasingly impaired, and the use of the 25th Amendment should not be ruled out.

We can hope and pray that Trump’s mental state does not continue to deteriorate. I am just not sure that hoping and praying will be enough.

Original post follows:

***********************************************************************************

You don’t have to be Dr. Anthony Fauci to realize that the United States is in the middle of a public health emergency. And I don’t believe that you need to be a board-certified psychiatrist to recognize that we may have a psychiatric crisis on our hands as well. One involving President Donald Trump.

My training in psychopathology and experience as a psychiatric social worker are far in the past. But even I recognize that the president’s megalomania is getting worse. As his megalomania gets worse his judgment becomes more impaired.

A president with impaired judgment is absolutely the last thing that we need during a pandemic when his decisions can make the difference between life and death for many thousands of people. Some type of intervention is needed before Trump’s impaired judgment makes the death toll of the COVID-19 pandemic higher than it otherwise would be.

In 2017, 27 psychiatrists and psychologists co-authored a book in which they concluded that Trump suffered from narcissistic personality disorder. (“The Dangerous Case of Donald Trump,” edited by Bandy Lee, MD.) They warned “that anyone as mentally unstable as Mr. Trump simply should not be entrusted with the life-and-death powers of the presidency.” The book was revised in 2019, adding ten co-authors and the observation that Trump had become more erratic and dangerous during the intervening years as pressures on him mounted.

Megalomania as a feature of narcissistic personality disorder refers to an exaggerated sense of knowledge, importance, and power. It is pathological when it causes significant problems in personal or professional judgment. With Trump it now appears to have reached delusional magnitude.

His defense of his “confidence” that a cocktail of the drugs hydroxychloroquine and azithromycin would prove to be a successful treatment for the COVID-19 coronavirus set alarm bells ringing.  Reacting to push back from Fauci and others because of the unproven efficacy of the drugs, Trump predicted at a March 20th news conference that “People may be surprised by the way [the drugs] would be a game-changer.” He added that “I feel good about it. That’s all it is — just a feeling. [I’m a] smart guy.”

That was the tell. He feels good about it, and the hell with what world-renowned experts say about basing conclusions on a limited, preliminary study: He’s a smart guy and knows things that they do not.  His willingness to make such a reckless statement is a sign of just how impaired his judgment has become, posing a real threat to substantive decisions.

Make no mistake about it, he believes what he said. It was not ordinary arrogance or simple ignorance, nor even intentional misrepresentation. Trump is convinced that he is intellectually superior, and that his thoughts and ideas have special status.

It would be one thing if it was just an ill-advised attempt to create a ray of hope, but it was not. Trump no longer can tell the difference between wishful thinking that goes on inside his head and reality.

Part of megalomania is an insatiable need for social validation. As described in a recent Washingon Post article, Trump “craves a constant diet of flattery,” which officials serve up during his televised news conferences on the pandemic.

As the crisis deepens and hospitals are overwhelmed, people will become scared and angry, and many of Trump’s allies will turn on him. There is no predicting how erratic Trump could become if praise gives way to general condemnation and the defenses that protect his fragile ego begin to collapse.

Almost as an aside, I note that Trump’s grandiosity is not the only facet of his narcissistic personality disorder impairing his judgment. His complete lack of empathy and his extreme egocentricity – his inability to see beyond his own narrow interests when evaluating any situation – are dramatically affecting his decision-making.

Invoking the 25th Amendment to remove the president during a quickly evolving national emergency would be a bad idea even if Vice President Mike Pence and members of the president’s cabinet had the fortitude to use it. But some intervention short of that may be possible by using his narcissism against him, if you will.

Perhaps he can be persuaded that he will be politically and personally destroyed if he continues to be the public face of the federal response, and that he should step back. Once out of the limelight, he will have less inclination or opportunity to demonstrate his own omnipotence by flouting expert advice.

Such intervention includes confronting the president with the fact that his statements and actions are doing harm. The task faced by Barry Goldwater, Hugh Scott, and John Rhodes in convincing Richard Nixon to resign pales in comparison.

Am I optimistic that such an intervention will be attempted and, if attempted, that it would succeed? No, because I’m not the one who is delusional.

_____________________

This commentary originally was submitted to the Washington Post as an op-ed, but not accepted for publication. Conceding that this topic might better be addressed by someone with more relevant and current credentials – as well as the fact that the Post always has many op-eds from which to select, and this one simply may not have made the cut – I nevertheless wonder if there was a reticence to broach an unnerving subject like this at the height of a national emergency. I believe that would be a mistake.

Although I would respect that point of view, I believe that many lives depend on our recognition that Donald Trump is unfit to lead us through this crisis. Rachel Maddow of MSNBC is leading the charge to stop live coverage of Trump’s news conferences as a way of minimizing his ability to do harm by propagating lies and other misinformation. She’s absolutely correct. A majority of the nation’s governors seem to recognize that it is going to up to them to save the people of their states because the federal government is being paralyzed by Trump’s psychopathology and impaired decision-making.

In my opinion, ignoring the truth may make matters even worse. The public needs to be made aware that they need to look to someone other than the president for guidance and support, scary as that may be.

March 23, 2020

Get ready for the performance of your life, Bernie.

After taking his most recent drubbing in the Democratic primaries this week, presidential candidate Bernie Sanders announced that he will be “reassessing” his campaign in the days and weeks ahead. I’d like to offer my assistance with that reassessment.  The executive summary: Get ready to deliver the performance of your life, Bernie.

A lot rides on the performance, including Sanders’ legacy. It will determine whether history remembers him as a Don Quixote – or as an unforgivable villain.

First of all, full disclosure. I don’t like Senator Sanders. As far as I am concerned, he is and always has been a rather unpleasant, self-centered, and self-righteous jerk. A loner by nature, his status as a registered independent in Congress is the perfect cover for him as he snipes at both Democrats and Republicans. He seldom is at the center of debates over important issues, and even less frequently accomplishes anything worthwhile.

He describes himself as a democratic socialist and has worked tirelessly to build a movement of people at the left end of the political spectrum, including those who occupy the “progressive” wing of the Democratic Party. The problem is that he has used a considerable level of demagoguery, based mainly on class-warfare rhetoric, to appeal to the passions of his supporters.

The result of that demagoguery over the years has been to attract a zealous core of followers, mainly young, white males – the Bernie Bros. It is no surprise that a man who seems perpetually angry and aggrieved, and is always yelling and pointing his finger, cultivated a group of angry, nasty loyalists who see themselves as aggrieved by society – and by anyone who does not agree with them. Many of them are threatening to refuse to vote for the Democratic nominee if it is not Bernie. It is a threat that has to be taken seriously.

Bernie, here is the task ahead of you in a nutshell: To withdraw from the race in a manner that does not end up making you the second most despised man in the United States behind Donald Trump. Because if you screw this up and somehow help get Trump re-elected, that is what you will be.

This is what you must do: Announce that you are ending your campaign because the voters have decided that Joe Biden is the best person to unseat Donald Trump, that you accept their judgment, and that from now on working and voting to unseat Donald Trump is the most important thing that progressives can do not only for themselves, but for their country.

Tell your supporters that electing Joe Biden keeps progressive dreams alive, and that Donald Trump wants to kill those dreams; that Joe Biden will work with progressives to reduce the wealth and income inequality in this country, but that Donald Trump couldn’t care less about wealth and income inequality and will ignore progressives.  In fact, point out to them that Trump likes the wealth and income disparity just like as it is.

The primary policy goal of your movement is universal health care. That goal is toast under Trump, as he has made clear by trying to dismantle the Affordable Care Act. But it is a goal shared by Biden and most Democrats. President Clinton tried and failed to implement universal health care, President Obama had to accept an imperfect compromise, but we’ll get there if we can oust Trump from office and gain control of Congress.

As an unrepentant know-it-all, you believe that Medicare for All is the only viable option. Tell your supporters that, while that remains the ultimate goal, compromises will have to be accepted along the way, and that’s fine, because that is how politics work in the real world – i.e., in the world outside your head.

And your delivery is as important as your message. There can be no hint of rancor. No mention of “the Democratic establishment” or other code words to inflame your base. Be gracious to Biden. Try to sound optimistic, and enthusiastic about returning the White House to Democratic control. And then work like hell over the next eight months to deprogram your supporters from the Bernie or bust mentality that you helped instill by your maddening my-way-or-the-highway attitude.

In other words, make clear by both your words and deeds that sitting out the election in November rather than voting for Biden is disloyal and destructive to the progressive movement that you helped to inspire. 

Can you do any of the above? I have my doubts. But here are the stakes: If Trump wins in November and his victory can be tied to the failure of your supporters to turn out and vote for Biden, you will be the second most despised man in America, after Donald Trump. You will live the rest of your life as a pariah. Your followers will move on to someone else, remembering you as little more than a false prophet. People will stand in line to piss on your grave.

Your situation reminds of a Western I remember seeing decades ago. It may have been an episode of “The Rifleman” or “Gunsmoke.”

A hardened criminal was about to be hung for his crimes. He lacked remorse, laughed in the face of death, and was prepared to die with the defiance and bravado with which he had lived.

He had a young son who, despite the man’s crimes, idolized him. Lucas or Matt (or whoever it was) told the man that if he died a hero to his son, his son well may follow in his footsteps and live a life of crime. As the condemned man stood on the gallows, he glanced toward Lucas and then began whimpering and begging for his life, dying like a coward for the sake of his son.

Putting aside the schmaltz (and the dubious child psychology), that condemned man did what you must do, Bernie. You need to give the greatest performance of your life for the sake of your supporters, the rest of us, and your own legacy. This is your Last Hurrah, Bernie. You want to be remembered for your nobility at the end, not for the pique and pettiness that you too often exhibit.

I honestly wish you the best of luck, Bernie. Trust me, the internet is waiting to review your performance. It better be damn good.

We need another work horse, not a show pony, to replace Elijah Cummings

The Democratic primary for the special election to fill the vacancy in Maryland’s 7th Congressional District created by the death of Elijah Cummings will be held on February 4th. I want to explain why I will be voting for former congressman Kweisi Mfume, who held the seat from 1987 to 1996, when he resigned to become the president of the NAACP.

First of all, I believe that Mr. Mfume is by far the most qualified candidate, with a solid record of accomplishment both in and out of Congress. Secondly, he is a work horse, not a show pony. And I am very tired of political show ponies.

Show ponies do whatever it takes to make themselves the center of attention. The customary modus operandi is to generate as much controversy and melodrama as possible through provocative statements and personal attacks. They are more interested in television airtime and Twitter followers than legislative progress; as far as their audiences are concerned, the more provocative the better. They like to portray themselves as “fighters,” although what they are fighting for is the limelight, not concrete results.

Show ponies focus on burnishing their public images, not on establishing relationships and credibility with colleagues. That is why show ponies get little if anything done in Congress, a body that moves forward only through compromise and consensus-building. Show ponies use people; they don’t work with people. Consequently, they marginalize themselves in Congress and become irrelevant except in the alternate universe that is social media.

The stature achieved by Mr. Mfume while he was in Congress was illustrated by the words of former president Bill Clinton upon Mr. Mfume’s resignation to become president of the NAACP:

“When Kweisi called me to tell me he was going to take this job, in the words of an old country song, I didn’t know whether to kill myself or go bowling. I had become almost emotionally dependent upon him being in the Congress – supporting me when I needed it, reprimanding me when I needed it, whether I knew it or not.

He is a uniquely gifted man, with a personal history that shimmers with the promise of America and the possibility of personal renewal and the virtue of never giving up on yourself or your family or your common possibility.”

One of the finest tributes to Mr. Mfume was the reaction to his candidacy to succeed Mr. Cummings by two former colleagues in Congress from Maryland, Bob Ehrlich and Wayne Gilchrest. Both are Republicans who didn’t often agree with Mr. Mfume on the issues but considered him a friend.

Mr. Ehrlich stated that Mr. Mfume’s decision to run was “very, very good news for Baltimore and Maryland and for politics generally,” hailing him as a “throwback to a different era” when legislators were “willing to work across the aisle.”

Mr. Gilchrest went so far as to describe Mr. Mfume not only as a good friend but as a mentor. “Like [Mr. Cummings], he’s a tower of strength and integrity,” Gilchrest added.

And, also like Mr. Cummings, Mr. Mfume is a work horse, not a show pony. There already are too many show ponies in Congress on both sides of the aisle. Baltimore can ill afford a representative in Congress who gets little done other than garner publicity.

I was proud to have Mr. Cummings as my congressman. I look forward to Mr. Mfume continuing the legacy of having the very best people Maryland has to offer represent the 7th Congressional District. People willing to do the hard, unglamorous work necessary to get things done. Work horses, not show ponies.

An investment or a gamble?

The Maryland General Assembly will be asked during its upcoming session to place a $375 million bet on the future of horse racing in Maryland. And it will be asked to do so at a time when the odds of horse racing surviving as a viable industry are dropping rapidly.

The City of Baltimore and The Stronach Group announced last month that they had reached a deal that would keep the Preakness Stakes in Baltimore. Stronach owns Pimlico Race Course in the city, Laurel Park in Anne Arundel County, and the right to run the Preakness.

Amid the rejoicing by politicians and editorial boards over the prospect of the second jewel of horse racing’s triple crown staying in the city was nary a mention that horse racing faces not one but two existential threats. Ignoring the threats will be at the taxpayers’ peril.

The deal to keep the Preakness in Baltimore calls for the state to invest $375 million in racetrack construction. About $200 million would be used to rebuild Pimlico Race Course and about $175 million would go toward renovating Laurel Park in Anne Arundel County.

The Stronach Group would continue to own Laurel, but ownership of Pimlico would be transferred to the city or state, which would lease it back to Stronach for the Preakness. About $27 million of the $375 million would come from money in the state’s Racetrack Facilities Renewal Fund. The rest, $348 million, would be raised by the sale of bonds issued by the Maryland Stadium Authority and repaid by the state over a period of 30 years.

The problem is that no one knows whether horse racing will survive as anything other than a niche industry for the next five years, let alone the next 30.

Two factors have caused the strength of the headwinds facing the industry to increase dramatically. One is competition from legalized sports betting. The other is the growing sentiment that horse racing is inhumane and should be banned.

Competition from legalized sports betting

In 2018, the Supreme Court sent shockwaves through the horse racing industry when it struck down a federal law that banned commercial gambling on sports other than horse racing, dog racing, and jai alai in most states. Some states, including New Jersey, Pennsylvania and West Virginia, already have responded to the decision by legalizing sports betting, including online betting. The Maryland General Assembly is poised to take up the issue in the upcoming session.

The consensus is that legalized sports betting will have a negative impact on horse racing revenues by reducing track attendance and betting handles, although it is too early to tell how significant the impact will be.

The effect in Maryland would depend on which land-based facilities (casinos, racetracks, off-track betting locations) are permitted to offer sports betting, and whether online betting is approved.

Even optimists within the industry acknowledge that it will have to change to survive, believing, for example, that pari-mutuel wagering will have to give way to fixed odds wagering to compete with sports betting. There is no doubt that horse racing in Maryland faces major challenges to its financial model if sports betting is legalized in the state.

Public concern over the mistreatment of racehorses

Even if horse racing can withstand the competition from legalized sports betting, there is a darker cloud on the horizon: An anti-horse racing movement that is gaining momentum.

For anyone concerned about the future of horse racing, the headline of ESPN’s story about the marquee race of the Breeder’s Cup in California earlier this month was ominous: “Breeders’ Cup ends with death of 37th horse at Santa Anita.” ABC captioned its account of the race “Breeders’ Cup, the Super Bowl of racing, marred by another horse’s death at Santa Anita.”

It was the rash of equine fatalities during the 2019 racing season at Santa Anita, owned by Stronach, that propelled animal cruelty accusations into the mainstream media. In April, Sports Illustrated published a story by one of the country’s most prominent sports journalists, Tim Layden. He described the deaths as horse racing’s “biggest problem.” Layden observed that, although there have been “surges of awareness” in the past about the sport’s toll on horses, “this does not feel like a blip.”

In May, National Geographic ran a story titled “Why horse racing is so dangerous.” Ironically, the story featured a photograph of horses running at the 2017 Preakness. There have been many similar stories, and even The New York Times weighed in with a piece captioned “Horse Racing Deaths Threaten the Racing Industry. Is the Sport Obsolete?”

Although the deaths at Santa Anita drew the most attention, it is hardly the only racetrack where they occur. Last month, USA Today reported that its research revealed that an average of more than 600 thoroughbreds a year died because of racing over the past decade.

And then there are the slaughterhouses. USA Today also pointed out that an estimated 7,500 thoroughbreds end up in slaughterhouses in Canada and Mexico after their racing careers are over, with the horse meat shipped to Europe and Asia for human consumption. A previous study calculated that 70% of thoroughbreds bred in the United States end up in slaughterhouses.

The thoroughbred industry, led by Stronach’s president, Belinda Stronach, has been working to burnish the sport’s public image by making it more humane. It may be too little, too late.

Animal rights protests now routinely accompany racing events even in Kentucky, the de facto capital of horse racing in the United States. If anti-racing sentiment reaches a flash point on social media it will only be a matter of time before its impact on the industry becomes catastrophic.

Stop and think

There is a story about an exchange that took place during the first meeting of the Board of Public Works presided over by newly elected governor William Donald Schaefer. Schaefer favored quick action on an agenda item, explaining that as mayor of Baltimore he had a saying, “do it now.”

The state comptroller, the venerable Louis L. Goldstein from Calvert County, replied that in Southern Maryland they had another saying, “stop and think.” This is a stop-and-think moment for the General Assembly.

The threats to horse racing posed by legalized sports betting and the perceived mistreatment of racehorses could accelerate the decades-long decline in the popularity of horse racing. Attendance at racetracks is becoming increasingly geriatric. Suffice to say that the availability of online sports betting and a reputation for animal mistreatment will do nothing to attract a younger crowd.

The deal allows Stronach to divest itself of Pimlico, a derelict racetrack that it doesn’t want. The state would take on the responsibility for building, operating, and maintaining a new Pimlico. The state also would assume the risk of the rebuilt racecourse becoming an expensive white elephant if horse racing revenues tank, putting enormous pressure on the state to increase industry subsidies to protect its investment.

I am not saying that the above concerns necessarily make the proposed deal a bad one. I am saying that it would be absolutely reckless of the General Assembly not to consider them in the course of ensuring that the deal is an investment rather than just a gamble.

[Published as guest commentary by Maryland Matters on November 15, 2019 but not posted to my blog until December 19, 2019. The date of posting that appears above was backdated to place all posts in the order in which they were written.]

Maryland public records board needs more teeth

Many reports done by agencies in the executive branch of state government at the request of the Maryland General Assembly are perfunctory and of limited value. That is not the case with the preliminary report on the Maryland Public Information Act (PIA) by the Public Access Ombudsman and Public Information Act Compliance Board. Their report, issued Nov. 6th, is thorough and thoughtful, detailing shortcomings by state and local government agencies in complying with the PIA.

The report makes two excellent recommendations that should be enacted into law at the upcoming session of the General Assembly. The first is authorizing the compliance board to issue binding decisions on PIA disputes that are not resolved after mediation or attempted mediation with the ombudsman.

That would give persons seeking public records a much quicker and far less expensive remedy than filing lawsuits when requests are denied by records custodians. Under current law a requester may ask for mediation of a dispute but has no recourse to compel compliance with the PIA other than going to court.

The ombudsman and board observed that many routine PIA disputes involve simple fact patterns and the application of a limited body of law not requiring complex judicial proceedings to resolve. They also believed that over time the board’s decisions would lead to a body of published opinions serving as guidance to both requesters and agencies that could reduce the number of disputes.

Based on my experience inside and outside of government, I am confident that implementation of this recommendation by the General Assembly would go a long way toward combating an unfortunate tendency by some state and local agencies to slow-walk and even deny appropriate requests for records. Delay or denial too often is used to protect agencies from public scrutiny. Agencies, backed by taxpayer-funded attorneys, are well aware that the expense of lawsuits can deter even established news organizations from pursuing access to records through the courts.

The second recommendation is that state and local agencies be required to adopt a uniform self-tracking and reporting system to monitor the timeliness of their compliance with the PIA. About 20% of the mediation caseload involves long overdue or missing responses. Based on that experience and on survey data from state and local agencies, the ombudsman and board concluded that many agencies are not adequately tracking PIA requests, leading to tardy responses and other compliance issues.

It may be that sanctions ultimately will have to be added to the law to get some agencies to respond to requests in a timely manner. It makes eminent sense, however, to first gather reliable data on the scope of the problem. Also, the prospect of having to record and disclose their non-compliance alone is likely to induce agencies to improve their performance — a prediction based on the beneficent effect of sunshine illuminating the internal workings of government and a principle at the core of the PIA.

It is important to keep in mind that access to public records is a means to an end, not an end in itself. The goal of the PIA is not simply to satisfy someone’s idle curiosity; it is to enable citizens to gather the information necessary to hold government agencies accountable.

It’s a simple proposition: Without a properly functioning PIA, there is no public accountability. And the absence of public accountability is an invitation to mediocrity and corruption in government.

There is more good news: The compliance board projects that if given the authority to issue binding decisions on PIA disputes it can handle the increased workload by adding only two employees. That is an incredible bargain when considering the savings in time and money not only to citizens and the members of the news media but also to government agencies from a streamlined mechanism for resolving PIA disputes.

On one more positive note, it is gratifying to see the interests of the general public taken so seriously by the ombudsman and the PIA compliance board. Suffice it to say that not all state and local agencies share their commitment to the goals of open and transparent government.

I trust that the final report issued by the ombudsman and compliance board will include the two recommendations described above. If it does, I urge the General Assembly to implement them as quickly as possible.

[Published as an op ed by the Baltimore Sun on November 13, 2019 but not posted to my blog until December 18, 2019. The date of posting that appears above was backdated to place all posts in the order in which they were written.]