Sunday, August 09, 2020

Next Installment: How Can We Fight the Coronavirus Pandemic Under Political Leaders Who Enable the Spread of the Virus?

While the US continues to suffer from one of the worst outbreaks of the novel coronavirus pandemic to beset any developed nation, as we have discussed, President Trump and his administration have hindered pandemic management in the US and around the world. In particular, last month we noted what appeared to be a well developed pattern of behavior by the president and political leaders who support him in which they acted as if the were trying to enable the spread of the virus.  These instances included leaders purposefully avoiding wearing face masks and social distancing in instance in which disease transmission was likely, eg, government meeting and political session, and engineering crowded events in which social distancing and wearing of face masks were rare.

Only a month has past, but there have been too many new instances of political leaders acting as if they were actively trying to increase the spread of COVID-19 to ignore.  So we will again summarize new cases by category, and within categories, chronologically.

President Trump Acting Personally to Enable Viral Spread

Trump Attended Political Fundraiser Unmasked, Mingled in Crowd and Shook Hands

On this occasion, as is typical for him, the president avoided a mask and social distancing at the same time.  Per the Independent on July 21, 2020:

Video from an congressional candidate’s fundraiser in Washington shows Donald Trump mingling with a small crowd without a mask – even as he finally began wearing one in public after months of resistance.

Mr Trump appeared at a fundraiser for Madison Cawthorn, a young congressional candidate in North Carolina who defeated a Trump-backed contender in his recent primary – thereby breaking the president’s perfect endorsement record.

In Mr Cawthorn’s video of the fundraiser, held at the Trump International Hotel near the White House, he is enthusiastically greeted by various high-profile guests, including South Carolina senator Lindsey Graham – also unmasked – and the president’s attorney, Rudy Giuliani, who shakes his hand saying 'you can touch me'.

Mr Trump did not appear to be carrying a mask in either hand, and Mr Cawthorn himself was not wearing a mask either.

Trump, Unmasked, Invited Crowding at Various Somewhat Impromptu Events

Sometimes a Trump event starts with social distancing.  For example, per the Washington Post reporing on August 7, 2020, Trump attended an event at a:

facility [which] is larger than conference spaces in the White House, providing room for guests to spread out and safeguard against the coronavirus.

As the president spoke, he invited several guests, including Florida Gov. Ron DeSantis (R), to speak at a lectern set apart from his own to observe social distancing guidelines.

However, at the behest of Trump, social distancing soon vanished:

after his remarks, Trump invited a dozen people to crowd behind him shoulder-to-shoulder as he signed several executive actions and handed out ceremonial pens. Four wore face masks, while the others did not, including the president and four doctors in white medical smocks.

he article also noted several previous events at which Trump managed to omit masking and invite crowding in a somewhat impromptu manner:

On a trip to Tampa last week, Trump held an event on the airport tarmac in which he touted the endorsement of local sheriffs in front of more than 150 supporters, most of whom were clustered tightly and did not wear masks. At the White House this week, he invited 21 guests, including two children, to gather behind him as he signed a bipartisan bill on national parks.


On Thursday, Trump visited Ohio, where he wore a mask during a factory tour but also delivered remarks to dozens of supporters clustered at the airport.

Trump "Press Conference" at the Trump Organization's Bedminster, New Jersey Golf Club Attended by Paying Club Guests Sans Masks or Social Distancing

Most recently, the Washington Post reported on August 8, 2020:

Just before 7 p.m. Friday evening, members of President Trump's private golf club here began streaming into a gilded ballroom by the dozens. Some carried wineglasses — few wore masks.

The happy hour scene just steps from the golf course was orchestrated by Trump, who decided late Friday to hold an impromptu news conference and invite his club members to gather indoors in defiance of state restrictions aimed at slowing the spread of the novel coronavirus.


The pandemic, he told the room, 'is disappearing. It’s going to disappear.'

Many in the crowd behaved as if the pandemic had already vanished, forgoing guidelines on social distancing, face coverings and avoiding nonessential gatherings.
So by my count, President Trump held at least six events in the last month in which he did not wear a mask, most guests did not wear masks, and in which guests were crowded together.  All these circumstances favor transmission of the coronavirus, to Trump, and to everyone else there who failed to wear a mask while closer that six feet to other people. 

The Trump Administration, Family and Close Associates

Herman Cain, Prominent Trump Supporter and Former Presidential Candidate, Died of COVID-19 After Attending Packed Trump Rally in Tulsa Without a Mask

This is a tragic followup to a case we discussed last month.  The Trump campaign had organized and promoted a crowded campaign rally in Tulsa, Oklahoma over objections of local public health authorities and physicians.  The campaign actively worked to prevent social distancing and did not encourage masks.  Several campaign workers and Secret Service agents tested positive around the time of the rally, and prominent Trump supporter and former presidential candidate Herman Cain, who was photographed without a mask and crowded together with other at the rally, tested positive afterwards and was hospitalized.

On July 30, 2020, the Washington Post reported that Mr Cain passed away:

Herman Cain, the former pizza chain executive who sought the 2012 Republican presidential nomination, has died weeks after testing positive for the coronavirus.

A commentary in the New York Times noted that Mr Cain had personally scorned the public health measures meant to control the pandemic:

Mr. Cain was eager to display his disregard for the experts and their warnings. Before the Trump rally in Tulsa, which local public health officials had urged the campaign to postpone, Mr. Cain urged people to 'Ignore the outrage' and to defy 'the left-wing shaming!'

There is no record of whether Mr Cain later was outraged that he became a victim of the virus, and of Trump's campaign to minimize its risks.

Trump Supporters in the US Congress

Political leaders who support Trump also have been eager to show their disdain for measures meant to slow the spread of the pandemic.

Senator Ted Cruz (R-TX) Maskless on an Airplane

As reported by the Independent, July 13, 2020:

Texas senator Ted Cruz appeared to contravene an airline’s mandate on masks this weekend when he was pictured without one.

In a picture shared online on Sunday, Mr Cruz was onboard an American Airlines departure when he was seen unmasked.

The airline’s own mandate on masks says all passengers should wear one, unless when eating and drinking onboard.

Mr Cruz, who was pictured with a coffee in hand, was said to have 'not worn a mask once'.

'Captured today at 10:45am – Ted Cruz on a commercial flight, refusing to wear a mask,' wrote Twitter user Hosseh Enad with the picture.

He added: 'This was on an American Airlines flight — their policy clearly states that masks should be worn on the flight.'

Mr Enad said Mr Cruz had not been asked to wear one on Sunday, and was not seen masked.

Given the close quarters on commercial aircraft, social distancing may not always be possible, placing the emphasis on masks to decrease spread of the virus.  As noted above, Sen Cruz not also put himself at higher risk of contracting COVID-19, he increased the risk of passengers around him of contracting the disease from him.

Representative Louie Gohmert, Who Insisted on Attending Sessions Without a Mask, Tested Positive for COVID-19

Last month, we noted that Rep Gohmert (R-TX) often appeared at the House of Representatives without a mask and without maintaining social distancing.  On July 29, 2020, Politico reported:

Rep. Louie Gohmert — a Texas Republican who has been walking around the Capitol without a mask — has tested positive for the coronavirus, according to multiple sources.

Gohmert was scheduled to fly to Texas on Wednesday morning with President Donald Trump and tested positive in a pre-screen at the White House.

The article noted that Gohmert seemed to have ample opportunity to transmit the virus, for example:

Gohmert attended Tuesday's blockbuster House Judiciary Committee hearing with Attorney General William Barr in person, where lawmakers were seated at some distance from one another.

But footage from before the hearing shows Gohmert and Barr walking together in close contact, with neither wearing a mask. 

Trump Supporters in State Governments

 Republican State Legislators in Minnesota Refused to Wear Masks During Sessions

On July 13, the Minneapolis Star Tribune reported:

It was the closing hours of the last special session.... there was a stark contrast: Every Democrat entered the room with a face covering; but not one Republican wore a mask

Some particular examples:

For state Rep. Jeremy Munson, R-Lake Crystal, a state mandate would not change his decision not to wear a mask. At a recent groundbreaking event, he showed up without a mask. When one was offered, he refused it. Munson said a photo from the event captures everyone else — including City Council members and Republican Sen. Julie Rosen — in masks, while his face is bare.

'I just haven’t seen a need for it,' said Munson, maintaining that his focus is on washing his hands and social distancing.

The Senate Majority Leader Paul Gazelka

said he tries to be socially distant, but has not worn a mask at the Capitol and generally prefers not to use them.

His rationale for that, and for opposing any sort of legal mandate to wear a mask:

'People are tired of ... being micromanaged,' Gazelka said. 'It’s a sense of controlling your own destiny.'

Of course, failing to wear a mask could control the destiny of people nearby, who would be at increased risk should the person refusing to mask have coronavirus, even without symptoms.

Oklahoma Governor Kevin Stitt Got COVID-19 Infection After Scoffing at Pandemic Control Measures

Republican Governor Stitt, who had defiantly posted a picture of himself with his family at a crowded restaurant in March (look here), tested positive in July.  Per the New York Times, July 15, 2020:

Gov. Kevin Stitt of Oklahoma announced on Wednesday that he tested positive for the coronavirus, becoming the first governor in the United States known to have been infected during the pandemic.

But he

said that his own infection had not prompted him to second-guess his response to the virus, which has been less aggressive than in many other states, including some led by fellow Republicans. The governor has resisted issuing a statewide mask order, and continued to do so on Wednesday. He faced criticism early on in the outbreak, in March, when he posted a photo of himself with his children inside a crowded restaurant at a time when many people in the state were following social distancing protocols.

Gov Stitt apparently had continued to eschew masks right up to the moment he got the positive test, so he may well have spread the virus to other people

On Tuesday morning, hours before he received his test results, Mr. Stitt attended a special meeting of the state’s Land Office in a conference room at the State Capitol in Oklahoma City. He did not wear a mask.

Lt. Gov. Matt Pinnell, who serves in the governor’s cabinet as secretary of tourism and branding and who sat unmasked at a conference table across from Mr. Stitt at the Land Office meeting, said in a Facebook post that he was going to be tested after learning the news and was self-isolating at home.

Missouri Governor Mike Parson Derided "Dang Masks," Encouraged Maskless People to Crowd Together at Political Events

As reported by the Springfield (MO) News-Leader, July 18, 2020:

Missouri Gov. Mike Parson isn't always practicing what he and top state public health officials are preaching.

On July 10, a post on his official Twitter account instructed Missourians to social distance and wash their hands and added, 'If you can't social distance, wear a mask.'

The next day, his campaign posted photos of him mingling sans mask at a Missouri Cattlemen's Association steak fry in Sedalia, where he also lampooned the idea of mask mandates like those now in place in 28 other states.

'You don’t need government to tell you to wear a dang mask,' he said. 'If you want to wear a dang mask, wear a mask.'


At a ceremonial bill signing inside the Springfield Regional Police and Fire Training Center, a maskless Parson actually invited police officers and other dignitaries to gather behind him for photographs as he went about signing bill copies, and waved over more as time went on.

Utah Governor Gary Herbert Held Party at Governor's Mansion Sans Masks and Social Distancing

According to the Salt Lake City Tribune on July 23, 2020, on the day before a person who happened to work for the city Department of Public Health, walking by the Utah Governor's Mansion saw:

a harp sitting outside the stately residence. Illuminated by overhead string lights, caterers balanced trays of food and cleared away dirty dishes.


The roughly 20 guests who were milling around the mansion lawn were dressed to the nines.... Only, some of them were lacking the trademark coronavirus-era accessory — a mask.


only half the partygoers were wearing the masks, meant to curb the spread of COVID-19. Some people appeared to have removed their face coverings to eat, he said, but others without masks were clustered in groups and chatting.

That pedestrian's husband took a photograph which

depicts at least one partygoer not wearing a face covering and another person whose mask was pulled down. Both appear to be standing in close proximity to other guests.

Note that Utah's Republican Governor had declined to issue a face-mask mandate at the time the party was held.


 As the US count of COVID-19 cases grows, now exceeding 5 million, while the death count grows  past 160,000, we continue to  see instances in which President Trump and his political supporters, including state governors and members of congress personally ignore common-sense, simple measures meant to better contain the pandemic.

There is growing evidence that wearing face masks decreases the likelihood the wearer will transmit or contract the infection, and the likelihood that any such infection will be severe.  Keeping people physically separate, particularly by more than six feet, and particularly when they are indoors, also decreases transmission in either direction.

Yet the leader of the US government, and many of his supporters in the US legislature and state governments continue to ostentatiously dismiss masks and social distancing, and to encourage others to do the same.  They continue to do this even as their ranks include more people who have caught the virus, some who have been symptomatic, and at least one who died.

Even after that death, per the New York Times

Even some of the harshest critics of Republican leadership said they did not think that Mr. Cain’s death would cause much reflection inside the party.

Evan McMullin, who ran against Mr. Trump as a third-party candidate in 2016, wrote on Twitter that Mr. Cain was 'the first senior casualty of the science denial Trump cult.'

In an interview, Mr. McMullin said he had little hope this was a wake-up call. 'I wish that was the case,' he said. 'Many voters who support the president live in a totally different, alternate information environment in which the news of Herman Cain’s death — his visit to the Trump rally, his decision to not wear a mask — won’t reach them.'

But as long as the political leadership remain unreached, not only will their personal actions continue to enable the spread of the coronavirus, they are unlikely to support effective policies to contain it.

Of course, such strongly partisan political leaders are not likely to change their thinking based on criticism from their political opponents. Yet most of the criticism they have faced has been clearly political.

Many health care professionals have been overwhelmed by the need at the front lines during the pandemic.  However, I have not heard a lot coming from those who have a bit more time to think, especially from the leaders of big health care institutions, directed at the political leaders who take the virus most casually.

I know many health care professionals are afraid of appearing partisan.  It is not partisan to speak up for common sense public health measures to combat a deadly pandemic.  If there was ever a time for us health care professionals, especially those in the most senior and/or leadership positions to speak up, it is now.  Who will hear the call? 

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