You Cannot Fool Mother Nature

 Why am I reminded of the satiric BBC show of the 1960s That Was The Week That Was? Except the past week was not satire, it was reality and reality coming at you with the speed of an artillery shell. I feel like Alexandra Petri -- every time I blink some new horror appears, over and over again.As she says, my fragile system can only take so much.

To recap briefly, one week ago Donald Trump hosted a Rose Garden event to present Amy Coney Barrett, his nominee to replace the late Ruth Bader Ginsburg on the Supreme Court. There are numerous photos and videos of the event with several hundred people in attendance. There is no social distancing and few are wearing masks. This in the midst of a pandemic of coronavirus, violating the reasonable public health measures to lower risk of infection as well as, well, common sense.

Forward to Tuesday and the first presidential debate. Cleveland Clinic and Case Western Reserve University and the presidential debate commission set ground rules for attendance at the event, including limiting the number of people present, social distancing, and requiring that all wear masks except for the president, his opponent, and the debate moderator. They also required preentry testing for SARS CoV-2 but allowed an honor system for compliance. After entering the venue, the Trump family and their guests promptly removed their masks and refused to put them back on. There followed not a debate but a yelling session, with Trump leading with screaming at the top of his voice for much of the 90+ minutes -- a perfect aerosol generator.

And then Hope Hicks, a close presidential advisor, tests positive for SARS CoV-2. She has been in very close contact not only with Trump but with many other White House personnel and in the past week traveled aboard Air Force One several times. The White House did not announce she was positive; instead, it was a leak to Jennifer Jacobs at Bloomberg News. Apparently, senior White House staff wanted to hush up the face that she was infected. So much for transparency in the Trump administration (sarcasm intentional).

And on to Thursday night. As usual, Donald Trump announces with a tweet that he and Melania have tested positive for Covid-19. On Friday, the news came rapid fire, often by Twitter, of many others connected with Hicks, Trump, and the Rose Garden event testing positive. A superspreader event overtook Trump and the GOP after months of downplaying the pandemic. Some call it karma but it is just what one would expect when utter disregard for public health meets a relentless virus. And this virus is relentless -- evidence is accumulating that it is mutating so that strains that are more contagious than at the beginning of the pandemic are coming to predominate. We are also learning more about the nonlinearity of spread of this virus and why the pandemic models using influenza were not as useful for SARS CoV-2. Superspreader events are a major factor in transmission.

Late Friday Trump was airlifted to Walter Reed National Military Medical Center in Bethesda, Maryland, about ¾ of a mile from where we lived and my wife was on staff. Trump is male, old, obese, and has at least mild hypertension from what we know about his medical conditions. He has already received an experimental cocktail of monoclonal antibodies and infusions of remdesivir; as an infectious diseases physician that seems reasonable because with his risk factors it is wise to try to bolster his defenses early. Parenthetically, the monoclonal antibody cocktail is only otherwise available through randomized clinical trials. And now we will watch to see how well he does in his personal contest with the virus.

The news conference his physicians held this morning was not entirely revealing. Questions regarding when his diagnosis was made were answered obliquely. It was unclear what his exact medical status is and Mark Meadows muddied the field after the doctors spoke. Sadly, this is the historical norm when presidents are ill. Woodrow Wilson contracted influenza in 1919 and never fully recovered. It may have affected how the Treaty of Versailles was worded; his stroke in fall of 1919 left him paralyzed and his wife effectively the president until 4 March 1921. Franklin Delano Roosevelt famously was crippled by polio; he also had malignant hypertension and congestive heart failure during the final years of his presidency, papered over by his doctors. Dwight Eisenhower’s heart attack in 1955 was disguised as a “gastrointestinal upset.” There are other examples in other countries as well. Transparency is sadly not the norm when it comes to understanding the health of leaders.

We are 31 days from the most important election since 1860. The president is ill and his recovery is not assured. Who is in charge? The 25th Amendment provides for continuity of government in the event of the incapacitation or death of the president. The sad state of political affairs in the United States today leaves me uneasy that the current administration is not up to the job of governing but remains intent on campaigning. Pence is scheduled for a rally later this week that may be indoors. Has he not seen the evidence that this is a foolhardy exercise? Or, perhaps like his superior, he believes this is a virus that can be trifled with. If so, the sooner we are rid of this administration’s hubris and incompetence, the better.

When history is written, what will be made of the Rose Garden Superspreader Event? Will this become That Was The Week That Was? My best guess is that there are more surprises to come. May they not be surprises that are fatal for American democracy.