Americans' cherished belief in our own exceptionalism is often warranted. However, in some cases, we have clearly failed. Such is the case in our management of the COVID-19 pandemic. The question is why?

Why was the most medically sophisticated nation in the world, which had advance notice of a brewing pandemic first in China and then in Europe, so poorly prepared for the largest health emergency in over 100 years?

Why can an innovative and industrial powerhouse not produce enough personal protective equipment and COVID-19 tests to adequately protect and diagnose its citizens?

Why can’t we get our citizens to wear masks and socially distance while we wait for the definitive treatment, a COVID-19 vaccine?

Why, when we have only 4% of the world’s population, do we have 25% of the COVID-19 cases, and 20% of the world’s deaths?

Why, when President Trump knew of the grave threat that COVID-19 posed to Americans, did he lie about its seriousness and recommend actions that were just the opposite of what any selfless steward of the health of American citizens should have advised?

Revelations in Bob Woodward’s latest book, “Rage,” have made the answers to these questions clear. Simply put, Trump unconscionably prioritized his reelection hopes above Americans' health. From this sick reality emanated a series of policy blunders and incompetence, resulting in over 195,000 deaths and the worst economic downturn since the Great Depression.

It would have been infuriating if this scientifically ignorant man had simply grossly underestimated the viral threat. But no, on Jan. 28, he was told by his national security team that this virus posed the most formidable national security risk of his presidency and had the potential to rival the influenza pandemic of 1918, which killed 675,000 Americans and 20 to 50 million human beings.

According to Woodward, this warning made a strong impression on the president. Trump knew that this virus was very serious, far more serious than the common flu, but he opted to downplay the threat because he didn’t want to “create a panic.”

What he obviously meant was that he did not want to spook the financial markets and slow down the economy which he was counting on to justify another four years as president.

As for fear of causing panic among the public, that is a lie, and an exceedingly rich one in light of the fact that Trump’s modus operandi is to create fear … fear of a caravan on the southern border full of rapists and criminals, fear of Black people moving into white suburbs, fear of leftist anarchists overrunning our cities and fear of Joe Biden destroying the economy and your 401(k).

A steward for American health would not have willingly deceived the public for months. No, he would have coordinated the production of personal protective equipment and testing reagents and a national response of test, trace and quarantine. But that didn’t happen, and still hasn’t happened.

A steward for health would have “trumped” loudly and unambiguously: Wear a mask, social distance and avoid large indoor gatherings. Trump promoted just the opposite by politicizing mask wearing, cheering on large social gatherings and the opening up of state economies before the virus was adequately contained.

if Trump had told the full truth early, and acted like leaders of peer nations such as Germany, Australia and South Korea, it is estimated that 70 to 99% of the deaths from COVID-19 could have been prevented. Instead, Trump squandered valuable time which resulted in approximately 165,000 avoidable deaths and counting.

And after all, he refuses to accept any responsibility on the one hand, yet tells us what a great job he is doing on the other.

Unlike many leaders, Trump is not a man who leverages his abilities for the benefit of others or his country. He is not a man who understands how a soldier can be willing to die for his fellows and for his country. No, to understand this “me, myself, and I” president, one only has to consider one question, “what’s in it for me (Trump)?” This is the sad reality.

That it has taken the gross mismanagement of a pandemic and 165,000 unnecessary deaths to unequivocally demonstrate his unfitness to govern for all to see is a shared avoidable tragedy.

Many in this administration and in Congress have known for years that Trump is temperamentally and intellectually unfit to govern, but have stayed quiet. Many are Republican senators who shamelessly acquitted Trump in February 2020 of charges of abuse of power and obstruction of justice. Like Trump, they valued their own political power more than the truth or what their constitutional oath demanded and our democracy required.

By enabling him, these senators share in the responsibility for these needless deaths, and are arguably unworthy of the office they hold.

It’s an ugly reality that should that should torture them at night. Or, if they’re like Trump, it may not bother them at all.

Justin F. Thulin, M.D., is a dermatologist practicing in Salt Lake City.

Justin F. Thulin, M.D., is a dermatologist practicing in Salt Lake City.