According to a new Quinnipiac poll, a majority of Americans believe that Donald Trump is unfit to be president. That’s pretty remarkable. But you have to wonder how much higher the number would be if people really knew what’s going on.

For the trouble with Trump isn’t just what he’s doing, but what he isn’t. In his mind, it’s all about him — and while he’s stroking his fragile ego, basic functions of government are being neglected or worse.

Let’s talk about two stories that might seem separate: the deadly neglect of Puerto Rico, and the ongoing sabotage of American health care. What these stories have in common is that millions of Americans are going to suffer, and hundreds if not thousands die, because Trump and his officials are too self-centered to do their jobs.

Start with the disaster in Puerto Rico and the neighboring U.S. Virgin Islands.

When Hurricane Maria struck, more than a week ago, it knocked out power to the whole of Puerto Rico, and it will be months before the electricity comes back. Lack of power can be deadly in itself, but what’s even worse is that, thanks largely to the blackout, much of the population still lacks access to drinkable water. How many will die because hospitals can’t function, or because of diseases spread by unsafe water? Nobody knows.