I'm an ER Doctor Fighting COVID-19. Trump's Medical Opinion Means Nothing | Opinion

I'm a public health professional and an ER doctor treating coronavirus on the frontlines in New York. I've seen hundreds of COVID-19 patients and held the hands of many who died from this horrible disease.

This pandemic has rattled families across the United States and the world. At a time of such uncertainty, the public needs clear and consistent messaging about risk, testing, treatments and all aspects of COVID-19. But instead of letting respected experts directly address the American public, President Donald Trump has amplified his personal and political opinions about the virus. His incorrect statements have conflicted with those of experts, leading to confusion about who is in charge and who should be trusted.

Although many of his false claims and suggestions have been immediately dismissed, such as using disinfectants to treat the virus, many others have become entrenched, making it more difficult for those of us on the frontlines to combat the disease. In an era of increasingly worrying attacks on science and public health, the president's misguided statements—especially on testing, deaths and the long-term effect of COVID-19—need correcting.

Testing

In the United States, coronavirus testing has been fraught with challenges since the outset of the pandemic, and the president has only exacerbated the confusion.

The problems started when the U.S. Centers for Disease Control and Prevention decided to create its own test rather than use one developed by the World Health Organization. The early CDC test kits were delayed and provided false results; an internal investigation later found them to be contaminated. Even when this misstep severely strained testing capacity, Trump falsely told reporters on March 6 at a visit to the CDC in Atlanta that "anybody that wants a test can get a test."

Since then, Trump has swung between boasting about the record number of COVID-19 tests done in the United States and calling testing a "double-edged sword" that he blames for the country's surge in cases. In June, at a campaign rally in Tulsa, Oklahoma, he even said he ordered the government to "slow the testing down."

This Monday, Trump said, "When you test, you create cases."

First of all, no, those cases exist regardless of whether you test and find them or not. Without testing, they simply remain undiagnosed. And that, in itself, is a problem because people with COVID-19 who aren't diagnosed cannot know that they need to isolate to prevent infecting others—and are thus more likely to spread the virus.

Second, the reason we have so many cases is because we have greater community spread of the virus, not just more testing. Across the country, the percentage of tests that are positive has nearly doubled in the past month, from 4.4 percent to 8.7 percent. This increase reflects the rising community spread and points to the need for significantly more testing, especially in areas hit hard by the virus.

To prove that increased testing alone isn't responsible for increase case counts, take a look at New York. It is doing significantly more testing per capita than any other state, but only approximately 1 percent of tests are positive.

Deaths

Trump has also misled the American public with regard to COVID-19 deaths. To counter the criticism of the U.S. government's coronavirus response, he has pointed out that the curve of new reported deaths by day has been dropping since mid-April. However, there is no recognition of the fact that the United States has the most COVID-19 deaths of any country in the world

"We have one of the lowest mortality rates anywhere," the president said Monday.

False. The truth is that the United States has one of the highest mortality rates per capita. Of the 20 countries currently most affected worldwide, the U.S. has the second-highest rate of deaths per 100,000 people, behind only the United Kingdom.

These boasts reflect a stunning lack of insight into how this disease works, as well as a repudiation of public health experts' warnings that the recent surge in cases may well lead to a surge in deaths. This is because COVID-19 deaths are a lagging indicator, meaning they take time to occur after someone is infected. It takes up to one month for someone to be exposed to coronavirus, fall severely ill, need mechanical ventilation and ultimately die from the disease.

And now, one month after experts noted a surge in U.S. cases, the death toll has started to tick up. Florida and Texas are reporting record-high death rates for their states. The seven-day average of deaths in the United States is now the highest since mid-June and likely will only continue to rise as hospitals in hot spots are overwhelmed.

Long-Term Effects

However, for a clinician taking care of COVID-19 patients, the most unsettling of Trump's claims have been his medical musings that have no basis in science. This includes his comments undermining the severity of infection.

In February, the president told Americans to treat the novel coronavirus "like the flu." Most recently, at a Fourth of July celebration, Trump falsely claimed that "99 percent" of coronavirus cases are "totally harmless."

Pinning down an exact infection fatality ratio—the likelihood that someone will die if they contract COVID-19—is hard, but many experts believe it may be close to 1 percent. Perhaps that is what the president meant. However, even with such a low rate of death, if all Americans were infected with this virus, that means over 3.2 million would die. That would be about three times as many Americans who have died in all U.S. wars combined.

But just because someone survives the coronavirus doesn't mean it was "totally harmless." As someone who survived Ebola, I know very well that viral illnesses often cause chronic conditions, and there is a growing body of stories and evidence that suggest survivors of COVID-19 suffer from debilitating long-term consequences. We don't know exactly how survivors will be affected over the years, but we have already seen an increase in the rate of strokes, heart problems, blood clots and mental health disorders.

President Donald Trump
U.S. President Donald Trump speaks to reporters on the South Lawn of the White House before boarding Marine One on July 15 in Washington, D.C. Drew Angerer/Getty

What we have witnessed throughout this pandemic in the United States is a deliberate undermining of science and public health expertise by the president. Our greatest medical experts have been sidelined, while the opinions of Trump and other politicians unqualified to comment on scientific issues have been amplified. This, more than any other factor, explains why we have the greatest number of COVID-19 cases in the world. And the greatest number of COVID-19 deaths.

If Trump truly wants to pull America from this unprecedented crisis, he needs to give public health professionals a stage and a microphone. Not yell and tweet falsehoods over them.

Craig Spencer, M.D., M.P.H., is the director of Global Health in Emergency Medicine at New York-Presbyterian/Columbia University Medical Center. His Twitter handle is @Craig_A_Spencer.

The views expressed in this article are the authors' own.