By Steven Jonas, M.D., M.P.H.

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

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"To announce that there must be no criticism of the President . . . is not only unpatriotic and servile, but is morally treasonable to the American public. Nothing but the truth should be spoken about him or anyone else. But it is even more important to tell the truth, pleasant or unpleasant, about him than about anyone else."

Theodore Roosevelt, Editorial in The Kansas City Star May 7, 1918

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This is Part 1 of a two-part series dealing with the subject: "Some Basic Infectious Disease Epidemiology on COVID-19, and then How D.J. Trump Uses it --- Well mainly abuses it."

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Trump's Way of Thinking About the Pandemic --- And its True Clinical Expression

To get an idea of 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. And so . . .

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. And that science (to repeat) is: this is a disease that is caused by a tiny micro-organism called a "virus." It is transmitted from one person to another through the air by tiny droplets of saliva and/or mucous. There are many diseases that are transmitted that way but: this one is highly infectious while at the same time it has a wide range of clinical expressions in an infected person from none ranging to a syndrome that causes death.

There is a very wide range of clinical expressions of this infection/disease. There is only way to find the full extent of the disease in populations: testing for it. Then, the only way to reduce the spread of the disease in a population is by separating infected person from non-infected persons. Among the ways to that are, as is well-known, "stay-at-home" orders, mask-wearing (which reduces the probability of transmission of the virus from an infected person to a non-infected person), and "clinical-distancing."

One reason that Trump cannot get on board with any of these measures is that he simply does not understand the disease and how it is transmitted. Furthermore, in his repeated public statements throughout the spread of the epidemic across the country he has shown that he is not the least bit interested in learning about it nor, apparently, would he have the ability to learn about it (which requires such skills as reading, listening [which skills by many reliable reports he simply doesn't not have], and then being able to turn knowledge and understanding into policies designed to deal with the issue, in this case this deadly pandemic).

The other reason Trump cannot get on board with the program that would work (and has, in numerous other countries) is his "Magical Thinking" (about which I have written extensively). In using it, Trump equates the virus of which he has little or no understanding, with a number. In turn, that leads him to think that if can just somehow keep the reported number (not the real number) down --- as revealed in the quote above --- the disease will just go away, or at least he can say that it is going away. Which, finally, is all wrapped up in his magical strategy for re-election, which totally depends upon the disease going away and an economy which has been devastated to an extent not seen since the Great Depression, in a two-month period, miraculously (and magically, because he wants to limit spending on aiding the recovery) returning to health in a period of time only slightly longer. In that regard, it should be pointed out that even with all the interventions of the New Deal, the U.S. economy did not start to fully revive until the serious ramping up of military production began coincident with Fall of France in May 1940 and the beginning of the Battle of Britain in June of the same year.

Known knowns; Known unknowns; and Unknown unknowns

In the context of the BushWar on Iraq, GW's Minister for War (ooops, I mean Secretary of Defense) Don Rumsfeld famously said:

"There are known knowns. These are things we know that we know. There are known unknowns. That is to say, there are things that we know we don't know. But there are also unknown unknowns. There are things we don't know we don't know."

In many quarters this was regarded as nonsense intended to confuse people the matter of the war, the "fact" that it was claimed that it was started by the Bushites on the grounds that "Saddam Hussein possessed weapons of mass destruction," and that it was totally justified. (Just bye-the-bye, one "known known," known to the Bushites but kept pretty well undercover in the run-up to the attack, was that Saddam did not possess any nuclear weapons. After the occupation of Iraq by the U.S., no chemical weapons were found either. In the month prior to the invasion, that there were no nuclear weapons was attested to by the UN nuclear arms inspector on the ground, Hans Blix. But that minor (sic) piece of intelligence would have gotten in the way of the war-plan the Bushites came into the White House with in 2001. So it was pretty well hushed-up.)

In the context of the COVID-19 pandemic, as I call it, the Trumpidemic2020©, there are indeed "known knowns," "known unknowns," and "unknown unknowns." I shall return to a consideration of some of those elements of our collective knowledge and current gaps in it (in Rumsfeld-speak both the known and unknown unknowns) below.

BUT, as noted above, national policy to deal with the Trumpidemic2020© is in the hands of a man who is ignorant about the disease, both its pathology (how it affects individuals) and its epidemiology (how it appears in populations). Further, as also noted, he has no understanding of what he is ignorant of, has no ability to learn, and is thus totally dis-interested in learning. At the same time, he thinks that he does know everything, from how the disease spreads and does not spread in populations to what are useful, safe, and effective interventions for it.

On May 18, 2020, he announced that for some days he had been taking hydroxychloroquine as a "preventive." Of course there has never been any indication that it is an effective preventive measure and the FDA has halted its in-hospital use as a therapeutic one. (On "Destination White House," MSNBC, 5-18-20, the political historian John Heilman said that Trump was probably not really taking hydroxychloroquine, but made the announcement for political reasons. In his announcement to the gathered media, Trump did say that "I was just waiting to see your eyes light up when I said this."  But then again, there was much opinion that he really was taking a drug, known to be dangerous for a person of his age and state of health. ) But then again, Trump has never given any indication that he knows the difference between a preventive intervention (and yes, the proper word is "preventive," not preventative) and a treatment intervention.

Finally, and most unfortunately, it is safe to say that when he is forced to adhere to policies based on science and developed by scientists he does it very grudgingly and then only for what he perceives to be his political advantage, not having anything to do with effectively combating the disease. Thus, our nation and our people have already suffered much on account of this man.

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This column was previously published at: https://www.opednews.com/articles/Infectious-Disease-Science-by-Steven-Jonas-Disease-Epidemics_Disease-Virus-Epidemics_Epidemiology_FDA-200518-842.html