May 14th 2020

By Steven Jonas, MD, MPH       

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 which in the previous month was attested by the UN nuclear arms inspector on the ground, Hans Blix.   But that minor piece of intelligence would have gotten in the way of the war-plan the Bushites came into the White House with in 2001.)

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 is known for sure, 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, 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.  I think that it is safe to say that when, fortunately for our nation and its people, he is forced to adhere to polices 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 combatting the disease.  Thus, our nation and our people have already suffered much on account of this man.

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

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

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

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

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

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

So, as recently as May 11, 2020 (and this President does change his mind so often about a whole range of policies, most often he is responding to some political imperative as he sees it) Trump still would not permit the development and implementation of a national testing-and-etc. program.  He describes what he has done as a “national-program-done-through-the-states.”  But that is not a national program if for no other reason than that the virus does not know from state boundaries.  Further, for everything ranging from being able to fully understand the disease as it expresses itself in populations to having the mobilization of resources and their standardization so the testing-contact-tracing-isolation can be truly effective, it has to be run on a national scale.  For proof of this statement, just see what is happening and not happening as (some) states try to do it on their own.

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

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

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

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

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

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

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

And so.  Here come: the “China virus/””Wuhan flu.”  “Obamagate” (remember the “Truthers”).  “They want to take away your guns.”  (Actually, I’ll settle for licensing, registration, and insuring, you know --- like for cars.)  The “illegals” are spreading it.  The “pointy-headed” scientists --- what do they know (see Dr. [!!! – where did this guy go to medical school?] Rand Paul).  The Democrats --- not just political opponents, but truly evil people conspiring against you.  “Always attack; Never defend.”  And then the standard distractions, like rallying behind a confessed (twice) perjurer, who “Obama [you know, the black guy] was out to get” (even though it was to the Vice-President that Flynn lied and it was Trump who demanded his resignation.  But logic simply does not work in Trump-land.) And so on and so forth. 

At least when they do this sort of thing, and the Republicans, particularly the Trumpublicans© and Trump TV/radio/web, do it over-and-over again, they make no secret of it. 

Steven Jonas, MD, MPH, MS is a Professor Emeritus of Preventive Medicine at StonyBrookMedicine (NY) and author/co-author/editor/co-editor of over 35 books.  He is an occasional contributor to BuzzFlash (reborn) (after having been along-time contributor to the Original). In addition, he is a “Trusted Author” for Op-Ed News. a contributor to Reader Supported News/Writing for Godot; a contributor to From The G-Man; a Contributor for American Politics to The Planetary Movement; and a Deputy Editor, Politics, and a “Witness to History,” and an occasional contributor for The Greanville Post;   He is also a triathlete (36 seasons, 256 multi-sport races).

He has a distribution list for his columns.  If you would like to be added to it, please send him an email at sjtpj@aol.com.

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