Trump made Covid misinformation mainstream. It may be his most dangerous legacy.

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Disinformation and misinformation are now the biggest factors in our pandemic response. For a physician and a public health worker like me, one of the most heartbreaking figures to circulate after last week’s election was the poll that said almost half of U.S. voters think the pandemic is somewhat or mostly under control.

The United States has officially entered what is likely to be the worst surge of Covid-19 it has seen to date. On Tuesday, around 62,000 people were hospitalized in the country, breaking prior records, and 49 states reported increased hospitalizations Over 1,000 deaths were recorded every day of the past week. And yet, the counties worst hit by the coronavirus all overwhelming voted for President Donald Trump. How can all these facts coexist in one reality? And what does it mean for how we control the pandemic moving forward?

A few dynamics, which are likely to collapse in the near future, may be able to explain this disconnect. First, two powerfully deceptive narratives, sometimes driven by our own politicians, have become deeply rooted. These narratives are the false dichotomy between our pandemic response and a seeming economic recovery, and the conflation of public health measures like masks and physical distancing with lockdowns. Both of these myths are likely to have helped convince many millions that voting for Trump was a vote for economic survival.

No amount of data showing that pandemic control is the key to economic resurgence has been able to penetrate the cloud of GOP misinformation. No number of studies about how measures like masks actually reduce cases, save the economy and stave off lockdowns has been able to break through a continuous stream of false and misleading statements, sometimes propagated by the White House itself. We have been living in a country where your political affiliation predicts whether you will wear a mask and keep physically distancing.

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But this might change as the pandemic continues to grow between now and when a vaccine is widely available. The next peaks in hospitalizations and deaths are only just beginning. So far, the crisis in Midwestern states has unfolded a little differently from the spring peaks in hard-hit Northeastern states. These new numbers don’t have to be as massive to overwhelm health care networks, because there is less resilience in rural health care systems to absorb the shock. And like other communities, minority groups are suffering the worst outcomes in hard-hit counties, particularly among younger patients. Meanwhile, in Wisconsin, where the pandemic surged right before the election, more voters were likely to identify the pandemic as not being under control.

Perhaps then, as this crisis grows and more Americans experience its impact personally, we will see a change in behavior. But we can’t wait for, wish for or depend on our fellow Americans to feel the pain of this pandemic personally. The rest of the country is starting to feel the twin effects of both flu and the coronavirus. And in just a few weeks, much of the country is planning to travel for the Thanksgiving and Christmas holidays. We are about to experience multiple epicenters, each with their own needs of medications, hospital beds, personal protective equipment (shortages of which are already being reported) and health care workers (who are already burned out from having responded for months). In North Dakota, a shortage in nurses has already led to a policy which now allows coronavirus-positive nurses to continue working.

In outbreaks, as health care systems get overwhelmed, case fatality rates start going up again. This threatens some of the advances we have made in decreasing Covid-19 mortality. Although some states are starting to roll back reopening, others haven’t taken even simple steps, such as passing mask mandates. And yet again, widespread disinformation and misinformation is going to delay buy-in from a large segment of the population even if new measures are introduced, resulting in unnecessary deaths.

We can’t prevent the dire winter ahead of us without bridging this divide. Even as Pfizer announced a potentially effective vaccine, Trump appears to be sowing political discord about its development process, which may have disastrous consequences for participation. This in turn will delay vaccine-induced herd immunity and a return to normalcy. Any adversarial country that wants to delay our return to normalcy can also easily use disinformation to feed anti-vaccination sentiment.

On Saturday, Biden said, “This is the time in America to heal.” He has already appointed a Covid-19 task force. Regardless, the period between now and the inauguration in January (when the U.S. is projected to suffer an additional 100,000 deaths) is going to be a scary time. Because what the incoming Biden administration can do is limited, and it may well be hampered by the Trump White House.

President-elect Joe Biden needs to start working with governors to build a common vision for what needs to happen. The most powerful intervention the Biden team can make is to create and share a common message alongside national GOP leaders. But it remains unclear whether the other side of the aisle will agree to this, particularly as it is still entrenched in invalidating the results of the election.

Biden and his transition Covid-19 task force also need to reach out to those communities that have been targeted by widespread disinformation. Biden speaks of healing America metaphorically, but a similarly urgent and far more literal interpretation is also needed. Close to half of the country is still not taking the pandemic seriously. And without having them as part of the solution, “healing” won’t be happening for anyone anytime soon.

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