Epidemiologist details the long-term impact of coronavirus pandemic: A 'mass trauma' that will change American society

In many ways both obvious and subtle, Donald Trump is precisely the wrong person to be president of the United States during the coronavirus crisis. Almost everything he does makes matters worse and imperils lives.

Over the weekend, Trump threatened to instigate civil war, if perhaps only through his own ignorance, by suggesting he might quarantine New York, New Jersey and parts of Connecticut. Of course the president has no such power under the law, and his administration pivoted instead to issuing a travel advisory. This is but another example of the way Trump, like other authoritarians, tests the norms and limits of law and society before finding a way to shatter them.

Trump and his followers believe him to be a king or an emperor who is above the law. In that role, Trump has punished states whose governors he deems "disloyal" and not "respectful" of him, making them wait for much-needed federal relief and emergency supplies of ventilators and other equipment. When aid is granted, it appears that Trump's regime is delivering supplies more rapidly to Republican loyalists than leaders in states or cities that support Democrats.

Trump is a pathological liar, and now his many false, fantastical and ill-informed statements, are making the coronavirus pandemic more lethal because his cult members and other ignorant Americans follow his dictates without question.

What would responsible presidential leadership look like in response to the coronavirus pandemic? How is this public health crisis a type of stress test for the United States that exposes underlying problems of social inequality and injustice? What has the pandemic revealed about the indifference, moral degeneracy and wanton cruelty of today's Republican Party and the conservative movement more generally? Will America ever be able to go back to "normal" after the coronavirus, and what will "normal" look like?

To answer these questions, I recently spoke with Dr. Abdul El-Sayed, a public health expert, physician and professor of epidemiology at Columbia University. His forthcoming book, "Healing Politics," examines America's deep levels of structural inequality and proposes a type of "empathy politics" to treat it. El-Sayed is also the host of the podcast "America Dissected," and has been a guest on Michael Moore's podcast Rumble, CNN and Democracy Now!. In 2018, he was a Democratic candidate for governor in Michigan, and previously served as health commissioner for the city of Detroit.

This conversation has been edited for clarity and length.

As a medical professional, how are you personally managing the coronavirus pandemic on an emotional level?

First and foremost, I am grateful that I am privileged enough to not have to be worried about my family's income and safety. I am a bit frustrated not to be on the front lines of responding to the coronavirus in the way that I was in the past. I was a former health commissioner. I feel a little bit like a general who is missing the war. I am now trying to get accurate and meaningful and insightful analysis and information out to people — and to do that even as the story changes and evolves on a day-to-day basis.

Most important, I am frustrated by the fact that we should have seen the coronavirus pandemic coming here to the United States, and we didn't. Now a lot of people are suffering for that decision, whether it's because of the illness itself or because of the consequences of a failed response in this country

The fact that we're choosing between lives and livelihoods right now in the United States is a choice that nobody should have to make. We're actively making that choice every day, right now, and it's sad to watch because so many people are suffering unnecessarily.

You use the analogy of being a general who is not allowed to fight in the war. You plan and train, have the skills and expertise, but the leadership is not letting you do your job by helping the country to win. It appears that for President Trump, his personal politics and ego are more important than public safety and saving lives.

What would be worse is trying to be a general under a president who does not let you do the things that you need to do to win. There are no shortcuts or going around the coronavirus pandemic. Our response as a country has been laggard, and the reason it's been laggard is because key people in leadership want to pretend the situation is not immediate and upon us.

There are people on the front line of fighting the disease who see exactly what this is and what needs to be done to address it. But they are not empowered to do what is necessary, because of the indecisiveness and unwillingness to deal with reality on the part of people in the White House and some members of Congress. The governors have been doing much better in that regard.

I've been talking to my contacts at the CDC and they are trying to do what is necessary and needed but are being consistently stopped by Donald Trump. He and his administration are more concerned with optics than in doing what is necessary. If the proper interventions against the coronavirus were made earlier, lives could have been saved.

Medical professionals were trying to warn the American people and the country's leaders about the coronavirus pandemic, but few listened.

Experts have the insights and are speaking from a place of knowledge. But in a moment such as this, the country's leaders need to be proactive in the face of bad news. They can't ignore the facts. Health professionals have been telling the government what needs to be done to save lives — but the response for too long was that we were exaggerating the threat. The virus is now a pandemic. Health professionals who were sounding the alarm about the pandemic are somehow being attacked for not warning the country. It is all very frustrating. If Trump and other leaders had listened to medical professionals and other experts, the country would have been way ahead of the coronavirus. Instead the country is now fighting from behind.

Medicine is politics. How would you explain that relationship to the general public?

Politics is the process by which we allocate scarce resources in the world. The decisions we make about who gets those resources — and therefore a happy, healthy life — are political decisions. Decisions of that sort are being made all the time.

There is this false narrative that science and medicine are these sterile fields, that everybody just pays attention to the data and findings and that the field itself is somehow outside of the world of politics. That is not true. In society, decisions related to science are political ones.

For example, most of the Republican Party has shown, be it through denying the facts of global climate change or the coronavirus pandemic, that such decisions are driven by politics.

The choice to invest in science, and the choice to invest in what science tells us we ought to do, these are all political choices. The decision to have unequal health outcomes in the world is a political one. As health professionals our work must be to make those outcomes more equitable and just. This involves political choices about resources, access and the importance of science and scientific knowledge to society. The goal is for people to live long, healthy lives.

In a time of crisis there are all these political leaders who could be better allocating resources to stop the pandemic now saying, "We shouldn't be politicizing the pandemic." Well, those leaders made that choice a long time ago. Many of those leaders have shown themselves to be incompetent and not able to lead the country in a crisis such as this one. They should be replaced by people who understand the importance of science and are capable of making good, competent decisions.

There are decades of data showing that the Republican Party and its policies actually make the American people sick. The coronavirus is just another part of that story.

The premise of my new book is that the epidemic underlying the coronavirus pandemic is one of deep insecurity caused by social inequality. This involves a systematic redistribution of resources away from the American people and upward to the very rich through massive tax cuts. In practice, this transfer of resources up to the rich means that the country as a whole has seen the infrastructure necessary to prevent and now stop the coronavirus pandemic severely hobbled, if not destroyed.

Funding for local and state public health has dropped by 45% in the last 15 years. Right now, people are asking, where is America's public health system? That money was used to give tax cuts for rich people. We did not prepare as a country for this crisis because the necessary money was transferred to the very rich.

The coronavirus pandemic has tested the values of Trump, the Republican Party and the right-wing media. They have consistently failed the test. Now they suggest that older people should be willing to die, like human sacrifices to "the economy." They also believe it is "natural" and "normal" that rich people get access to testing and medical help before other people. 

That is the world as they see it. They live and make decisions from that rule. Early on in the pandemic, Republicans and other right-wing media personalities were downplaying the dangers by saying that hundreds of thousands of people die of the flu all the time. "That's just the way the world works."

The entire premise of public health and medicine is that people shouldn't get diseases and that we as a society should be doing something about protecting them from diseases. We here in the United States must not forget that the coronavirus is a global problem, and while this is a global crisis it is made up of individualized catastrophes. For example, every time someone dies of the flu it is a catastrophe for them, their family and friends, their community, etc.

Every time somebody goes without the health care that they need and then dies, it is a catastrophe. Every time a cancer patient goes into debt and clears out their entire life savings in an effort to survive, that is a catastrophe.

These catastrophes have been happening all the time. Using them to justify inaction in the context of the coronavirus pandemic speaks to the moral bankruptcy of an entire worldview and political ideology. This is obviously present on the part of Republicans. It is also present among those people who think that somehow everything is just going to go back to "normal" after the coronavirus pandemic.

We as a country have got to be honest and serious about recognizing that "normal" was not that great for a lot of folks. It's just that too many people have allowed themselves to choose inaction because they were not personally suffering. It wasn't happening to them. They weren't experiencing it directly. Such a way of thinking is the epitome of privilege, and that's a problem.

Republicans and conservatives do not believe in social democracy or that government can be a force for good. The coronavirus has exposed, again, the fallacy and moral emptiness of such beliefs.

The working assumption for too many people in America was that "the market" would somehow solve all our societal problems. Over the last few years this has been exposed as being untrue.

We're starting to realize that government must be a key player in solving our collective challenges and problems. Yes, our democracy is undermined by voter suppression and how corporations are defined as "people." That must be corrected. But government can do good and be productive, and with a crisis like the coronavirus is an essential player in solving problems.

If the United States were a more humane society — one with a robust social safety net, a living wage and national health care — how would it be better able to confront the coronavirus pandemic?

A humane society would have invested in collective public health and the institutions that provide it. We would have been able to confront the pandemic when it was a toaster fire and not an inferno. Perhaps we would not be dealing with a pandemic at all here in the United States. And if it had spread, then we would not have to engage in social distancing on the scale we are now. If we had a humane society in America, then there wouldn't be all this economic calamity because there would be a basic social safety net. In total, life in the country would not have been so disrupted.

The coronavirus is exposing many of the our problems as a society and culture. There is going to be a lot of collateral damage. Stress and anxiety are one such example. 

The American people are more socially isolated than they have ever been. The coronavirus is making that worse. What this moment does is that it preys on all of our deepest weaknesses. One of them is struggling alone. As health professionals we know that social isolation is deadly. Stress is also deadly. This causes an elevation in the brain chemical known as cortisol. Our bodies are basically fighting anxiety and fear and loneliness as if they were infections.

The irony of this is that we're fighting a pandemic and our bodies are also operating like they are infected — except we're not all being infected by the coronavirus but by social isolation and stress.

This will have very long-term health consequences. And as our health care system becomes overwhelmed, all the other problems are still present. People are still getting ruptured gallbladders and complications from diabetes and heart attacks. A system's ability to deal with those routine health challenges is imperiled by the coronavirus pandemic as well. Of course, businesses and the economy are complex systems which are going to be dealing with disruptions and losses for a long time going forward as well. There are going to be many compounding problems across society from the coronavirus.

What do we know about the long-term impact of pandemics such as the coronavirus on individuals and society?

We know that the consequences of mass traumas are great and they have a negative impact on the cohort of people who lived through that moment. The Great Depression is an obvious example of that intergenerational trauma.

But in terms of the coronavirus, this is not the first trauma that young people in this moment have lived through. They lived through the Great Recession. I graduated right into that economy. Now 10 years later there is the coronavirus pandemic, which is going to cause another recession or perhaps even an economic depression. The impact of those multiple generational traumas is going to last for a century. The consequences are going to change American society.

How would you assess Trump's leadership and behavior in response to the coronavirus pandemic?

Donald Trump is a master class on how not to respond to a crisis. In responding to the coronavirus pandemic we need a leader who is science-oriented and science-driven; empathetic and willing and able to put themselves in the shoes of other people; is decisive and able to make hard decisions quickly; good at mastering a changing situation and delegating decision-making. A good leader is also able to understand the public mood and rally people to work together to defeat the coronavirus. Donald Trump has not been able to do any of those things well.

Trump views politics as more important than science. He insults a reporter who asks a basic question about how the American people are feeling, their fears and anxieties. He makes bad decisions and misrepresents what was going on with getting testing kits for the coronavirus. He distorts and misrepresents the facts more generally. He can't answer basic questions about the pandemic. He is also not engaging in the proper type of foreign policy and political leadership for this moment. Trump is also incapable of empathizing with people, especially those who are vulnerable and in need of the most help.