The Rise of COVID Denial

The human brain makes decisions in two basic modes. One is analytic, which involves carefully weighing costs and benefits and choosing the best option. The other mode is intuitive: doing what feels right. Both have their merits. Intuitive thinking allows us to make split-second decisions. It helps guide our romantic lives and our lunchtime sandwich choices. But it is not the mode that should inform a strategic response to a pandemic.

Even casual observers of President Donald Trump’s mode of thinking long ago abandoned hope that he might embrace analytic reasoning (sometimes referred to simply as “science”). But if there were ever a possibility that he might at least come to terms with the power of the coronavirus, it would have been when it sent him to the hospital. Barely a month ago, recall, we had cause to speculate that the president might soon be dead. Although details of Trump’s illness remain concealed—including abnormalities in his chest CT scan and the date that he first tested positive for the virus—the known facts of his case indicate that it was not mild. He received supplemental oxygen to keep his red blood cells saturated, and he was prescribed dexamethasone, which is recommended only in serious cases.

Many patients emerge from illness having had a come-to-Jesus moment that reorients their thinking. Former New Jersey Governor Chris Christie, for one, issued a mea culpa last week after he was discharged from a COVID-19 hospitalization that included a week in the intensive-care unit. “When you get this disease, it hits you how easy it is to prevent,” he wrote under the headline “I Should Have Worn a Mask” in The Wall Street Journal. “We are asked to wear cloth over our mouth and nose, wash our hands and avoid crowds. Seldom has so little been asked for so much benefit.”

Trump had no such revelation. Instead, in the weeks since his illness, he has escalated from downplaying or neglecting the virus to outright denialism. After returning to the White House and sanctimoniously removing his mask, he has centered his reelection campaign around the notion that the pandemic is over. “With the fake news, everything is COVID, COVID, COVID,” he said at an Omaha, Nebraska, rally this week. “I had it. Here I am, right?” He cited the illness of his son Baron—who contracted the virus shortly after his father tested positive—as being extremely mild. He did not mention the first lady, Melania, who described having COVID-19 as “a rollercoaster of symptoms,” the experience of which “gives you a lot of time to reflect” and reminded her of the need for “compassion and humility.”

At a few points in the pandemic, Trump displayed these qualities. He regularly stood beside the doctors on his task force, such as Anthony Fauci and Deborah Birx, and nodded as they warned that this disease is indeed serious (even if he contradicted them later at rallies, and ignored their recommendations about masking). Now, Trump has taken to mocking social distancing and pushing a conspiracy theory wherein the basic facts of people dying are an attempt to hurt him. He has accused doctors of exaggerating the disease, and vilified them as enemies in his crusade to return to “normal,” even as the daily death toll has topped 1,000 people in recent days.

Read: The pandemic is in uncharted territory.

To look on, inert, as Americans suffer and die is one thing; to deny that it is happening is another. This is a clear and ominous glimpse of how the pandemic will continue to play out if Trump remains in power. During America’s final lurch into the election, the president has become an even darker caricature of himself, laying bare his willingness to abandon Americans’ health and well-being for his own self-preservation. He is now even more dangerous as a vector of disease than when he was actively shedding the virus.

On Wednesday, Brett Giroir, an assistant secretary of health and human services, appeared on the Today show and made the rare move of directly contradicting the president’s claims. “The cases are actually going up,” he said. “They’re real.”

When a public-health official has to go on TV to debunk a conspiracy theory, it is not typically one that originated with his boss. But Trump has embraced the bizarre idea in recent days that doctors are inflating case numbers for profit. He has also repeated his old standby lie that the counts are increasing simply because of more testing throughout the country. Giroir clarified that in fact it’s not just the case numbers that are rising, but the numbers of people who are hospitalized and dying each day. He held up a mask and implored Americans to wear one.

To suggest anything less in this moment seems unconscionable and unimaginable. In the past week alone, more than 5,000 Americans have died of COVID-19. The country is on pace to experience some 400,000 excess deaths this year, directly or indirectly attributable to the pandemic. The virus’s global surge this month has compelled leaders across Europe to order curfews and lockdowns. Trump, meanwhile, has been crisscrossing the country and holding mass gatherings. He has continued promising that we are “rounding the turn.” Although in the past he has recommended that people wear masks, in recent weeks, he has repeatedly, falsely claimed that masks are ineffective and that experts are divided over their use; he has even implied that they spread the disease.

Read: How we survive the winter

Trump is no longer simply undermining the voices of his own experts, but baldly urging people to disregard them. According to Fauci, Trump has not met with the task force in months. He has taken to mocking Fauci as weak, fixating on his ability to throw a baseball and his outdated early statements about masks. The president has berated and undermined Robert Redfield, the director of the Centers for Disease Control and Prevention whom Trump himself appointed. He has attacked his election opponent, Joe Biden, by saying, “He’ll listen to the scientists,” as though this were an innately bad thing.

By failing to encourage prevention, Trump has all but guaranteed that many state and local officials will have to order shutdowns. At the same time, Trump has left many Americans without the economic stability or political will to close businesses in any unified way, as many places did in March. No bailout package is forthcoming from Congress, and unemployment insurance is running out in many states. The president is supporting a lawsuit that would overturn the Affordable Care Act and cause millions of people to lose their health-care coverage.  

Insofar as Trump addresses the virus itself, it is to insist that he deserves praise for implementing a travel ban in March, saying he “saved millions of lives.” (The move was prudent, but its impact was probably modest.) He has promised imminent “cures” that do not exist. He has lied about the availability of a vaccine, again and again. The cumulative effect has been the dilution of crucial public-health messaging. Trump is known to use an approach called censorship through noise: a suppression of truth by making ever more bizarre claims. But the extremity of his recent tack is jarring even for a president who has all along insisted on calling it “the China virus” and who has consistently promised that it was “going away.” As the facts accumulated to confirm his wrongness, he has only committed harder to the lies—to sowing confusion to distract from his failures.

For the past four years, psychologists and psychiatrists have attempted to fit Trump’s behavior into a diagnosis. They note his textbook disconnection from reality and from the consequences of his decisions as they affect other people. Many have settled on various personality disorders: Narcissistic, antisocial, and borderline have been the most common. Even to the dispassionate scientific mind—the clinicians usually indisposed to weigh in on political matters, attempting to be as objective as possible—Trump can seem to fit the criteria as if the disorders’ Diagnostic and Statistical Manual entries had been written to describe him.

But none of the diagnoses stuck. The clinical labels that initially felt so transgressive to apply to a sitting president have lost their gravitas through overuse. Petitions bearing hundreds of signatures from mental-health professionals deeming Trump cognitively unfit for office and a danger to the global population led to no practical end. The extreme abnormality of his behavior faded into simply Trump being Trump. He developed immunity to condemnation by way of lowered expectations.

A numbness to Trump’s behavior has emerged again and again, in response to issues like his undisclosed tax returns and the numerous sexual-assault charges against him. Many Americans have become so weary as to tolerate Trump’s denialism as normal regarding public-health emergencies like climate change and gun violence. Now it is happening with an actively spreading and deadly infectious disease. Our neurological capacity to be shocked depends on novelty. As that fades, anything can lose its feeling of absurdity or danger. This is partly for our own health; the stress of living in a state of constant incredulity would kill us young. But this adaptive, self-protective numbness also has the effect of training us to accept the unacceptable—the ridiculous counter-reality that Trump is attempting to construct.

Read: America is trapped in a pandemic spiral.

In any given moment, Trump’s behavior may seem confounding, vexing, self-defeating, unconscionable, unpredictable. But he is behaving exactly as he taught us to expect. In fact, what we know about Trump’s psychology might be understood through the lens of the coronavirus itself. He has met a foe that he cannot bluff into submission or wear down with insults. A virus is a physical force, like gravity or fire. It has no intention. It is not alive, and it cannot think. It can only react to its immediate environment. It can thrive only when it can invade functioning, living cells nearby. The virus forces entry and makes thousands of copies of itself and, having no further use for the cell, destroys it and abandons the remains.

All of the flaws in Trump’s character and psychology have come to light through this virus. He reacts to immediate circumstances. He hijacks, pillages, and moves on. He has done this to America’s public-health institutions, which are wobbling and could topple under the continued weight of his negligence. He presides over a country where people are dying all around him, and he appears to see this only as a messaging issue.

If Trump were to win a second term, he has made clear how this pandemic would play out. He is to have no moment of revelation. Americans would continue to die by the thousands. The president would devote his time and energy not to lowering that number, but to denying its existence. He has said the virus would disappear, and he would cling to that narrative regardless of the body count. If we joined him in this ignorance, the pathology would be ours.

James Hamblin, M.D., is a staff writer at The Atlantic. He is also a lecturer at Yale School of Public Health, co-host of Social Distance, and author of Clean: The New Science of Skin.