Some fictional scenarios to contemplate:

• What would happen to a military leader who was briefed and admitted to knowing of severe threats but downplayed them, resulting over a few months to the United States seeing its Indo-Pacific and European Commands wiped out — combined losses of roughly 180,000 in U.S. forces?
• How would the governor of Maryland be treated if he was told of a public works problem but belittled it and in less than a year the cities of Columbia, Bethesda, and Annapolis and all the people in them were destroyed?
• What would be the public reaction to the CEO of an overseas car maker if the public found out that he knew his company’s vehicle, perhaps a model as popular as the leading best-sellers, posed grave risks but he persistently glossed over them until the sedan had killed  200,000 owners?

The toll of the Covid-19 pandemic is rising in relentless fashion toward the ugly milestone of 200,000 deaths in this country (it may have exceeded that figure, because experts say  fatalities are under counted). More than 6.4 million Americans have been infected with the novel coronavirus.

And, after months of public appearances, news conferences, twitter blasts, and broadcast remarks — all with the White House and its crew insisting that Covid-19 was a “hoax” or that it was overblown, or it would disappear — President Trump has been tape recorded by a noted journalist in February as acknowledging that he knew just how deadly the coronavirus would be.

What the president says, on tape

Bob Woodward of the Washington Post reported in his book “Rage,” officially published this Tuesday, that national security adviser Robert C. O’Brien told the commander-in-chief on Jan. 28 about the virus:

“This will be the biggest national security threat you face in your presidency. This is going to be the roughest thing you face.”

On Feb. 7, Trump — who, for unknown reasons, consented to repeated, recorded interviews with Woodward for a second book about his presidency, even though he had ripped the first — told the author that he knew this about Covid-19:

“You just breathe the air and that’s how it’s passed. And so that’s a very tricky one. That’s a very delicate one. It’s also more deadly than even your strenuous flus. This is deadly stuff.”

On March 19, the president explained to Woodward why he publicly dismissed, downplayed, and belittled rising public concerns about the novel coronavirus and would keep doing so:

 “I wanted to always play it down. I still like playing it down because I don’t want to create a panic.”

Trump has defended his minimizing the threat to the nation posed by Covid-19 and argued that he and his administration deserve praise for the months-long federal response that has matched the president’s wish to deny, deflect, decline, and do less than public health experts recommend to combat an infection that also has staggered the economy. Almost 30 million Americans are jobless and receiving public assistance, with as many as 23 million renters (roughly 1 out of 5 households that rent their homes) at risk of eviction by year’s end, even with state and federal efforts to help. Hunger, already a big problem, is soaring across the country.

Following the leader

The Trump Administration has sustained an ever-soggy, shifting, and shambolic reaction to pandemic-related problems, including in leaving Congress in an impasse over a package to address a range of needs, including assistance for schools, hospitals, and the unemployed.

The president’s counter factual, erratic messaging has undercut public health officials and medical scientists, most recently marring efforts to establish the effectiveness of a coronavirus treatment (convalescent plasma) and slashing at public confidence in the frenetic efforts to develop a safe, effective, affordable, and available Covid-19 vaccine.

The young, their parents and families, and schools, colleges, and universities have gotten caught up in the whirlpool of misinformation, partisanship, and falsehood-spreading about the coronavirus. Children can contract the illness and spread it. So, too, can their older siblings, as has been underscored by the spiking number of diagnosed infections — heading toward 90,000 by one county — showing up on college and university campuses. Great uncertainty and spare leadership have led many parents to struggle and keep their kids at home, wrestling with the less than optimal option of distance learning.

The federal government shoved on to the states the responsibilities and duties of coronavirus testing, contract tracing, and isolating the infected, with the administration declining to offer a sustained, consistent, national Covid-19 strategy. While experts have insisted that ever-increasing testing would help Americans battle the disease, especially by identifying who and where infections were occurring so they could be dealt with, testing is going down — while cases keep rising. With kids, especially as they return to school, it has become a big problem that it is tough to get youngsters tested for the coronavirus, and this may be creating a major public health blind spot.

White House meddling with medical experts

Confused? Americans have come to rely on experts like Dr. Anthony Fauci, an outspoken and leading infectious disease expert. But news reports show the administration has made concerted efforts to wrap him with bureaucrats and red tape, reducing his public exposure.

Those same heavy-handed political appointees also have been pawing work by the federal Centers for Disease Control and Prevention, infuriating doctors, scientists, and experts who rely on credible, independent information from one of the leading federal agencies with deep experience and knowledge about infection fighting.

Although Trump keeps insisting that a coronavirus vaccine may be ready imminently (before the November election) or that Covid-19 will, magically, disappear, Fauci has warned Americans to keep taking the disease seriously and to prepare for illness to disrupt their lives at least until the end of 2021.

By this year’s end, with cold weather and seasonal infections like the flu also kicking in, controversial and disputed expert estimates forecast that Covid-19’s death toll could be as high as 410,000 in the United States, roughly doubling where it stands.

That is not a fictional scenario. But how will Americans react to its president and his men if they have brought us then to the equivalent of slightly less than the population of Virginia Beach being dead?

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent medical care. This was an ordeal before the pandemic, driven by the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.

Isn’t there ‘informed consent’ at national level?

Covid-19 has made U.S. health care ever more complex, costly, and confusing. Still, patients in the system have the fundamental right to informed consent. This means they are told clearly and fully all the important facts they need to make an intelligent decision about what treatments to have, where to get them, and from whom.

When the president steps into health care information sharing and decision making for all of us, how is he any different than a quack M.D., say, who decides against telling patients they have a raging cancer or that a procedure might debilitate or kill them?

How and why did it get so partisan and political to share grown-up information? Americans don’t give a blink to the notion that swimsuits are a good idea to don in public pools. Why is it controversial to wear face coverings to deal with contagions when out and about in the vast pool of public air? Why, after centuries of progress, are we tussling over vaccination, and the testing, tracing, and quarantining of people with infectious and hugely harmful illness?

Must we really go into cool, riskier weather in a Covid-19 pandemic spiral, whirling with all the wrong thinking, perplexity, and anxiety that months of experience were supposed to help us escape?

Leadership matters. We will have the chance to do more, in just a few weeks, than contemplate hypotheticals like those sketched above. We will pick powerful people to help us navigate a better course. We have much work to do to stop Covid-19 from bringing the nation to its knees.