We knew this presidency would be deadly. We were not exaggerating when, three years ago, we put together the public-service book, The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President. We meant in part that the president would be dangerous to civic life, to democracy, and to the nation’s mental health — but we also meant that he would endanger lives.

Politics did not concern us. We are health professionals. Everything falls secondary to life and death, including politics.

After we got together to write the book, hundreds, and later thousands, more mental health professionals gathered from all over the country and the world with their shared concerns. Together we formed first the National Coalition, and then the World Mental Health Coalition, to organize around our goal of societal safety.

Through consultation with Congress members, letters, petitions, and education of the public, we tried to emphasize that mental impairment in the office of the US presidency is a serious matter.

“Donald Trump may not have been expecting this, but a lot of other people in the government were—they just couldn’t get him to do anything about it,” an intelligence official recently said about the lack of mobilization around the now deadly coronavirus pandemic.

His behavior is exactly of what we expect of someone who is dangerously lacking in mental capacity. Just when surveillance was needed, he was more preoccupied with “keeping the numbers low” than testing and containment. And when behavioral change would decide the scale of the eventual calamity, he defiantly appeared in crowds, shaking hands and touching surfaces all the more.

As his rallies were canceled, he used daily press conferences for his emotional compulsion to create a desired, alternative reality, through delusional-level distortion and misinformation, rather than working to save lives. The pandemic makes stark the deadliness of his symptoms, and if we believe those around him will be able to contain or go around them, we are mistaken.

Here we enter the realm of pathology. What is truly dangerous is not the overt symptoms — even a psychotic patient wearing a tinfoil hat is not very dangerous — but the denial and the extent to which one would go to cover up symptoms. And this also goes for the president's handlers, by extension. We call this “loss of insight.” It is the loss of ability to take care of oneself or to see that one has a problem, which diminishes all the more in those who need intervention the most.

Trump calls journalist's coronavirus question "nasty"

On top of this, mental symptoms such as denial, projection (blaming others for what one is doing), and the inflation of non-realities while suppressing reality will be all the more unrelenting and non-negotiable when severe. Not only that, but where there is prolonged exposure to severe symptoms, previously sound individuals will start losing their own grounding in reality and take on similar symptoms.

Disease is unlike normal variation. It brings damage and death, which is why we treat. Just as with the viral pandemic, early signs may be difficult to detect, and warning signs may not always be visible to the untrained eye. But those who have seen similar cases in the past can recognize the signs early, know how serious will be their course, and bring greater precision to needed management, even if the circumstances are novel. In other words, expertise makes a difference. Without it, the danger of minimizing and normalizing pathology is too great.

Normal choices are flexible, adaptable, and life-affirming. Pathology is rigid, stereotypical, and follows very closely other cases of disease. No matter the immediate, accidental advantages — which the president calls his “gut”, when they are actually symptoms — the course is destructive: whether we look at healthcare, domestic tranquility, global security, pandemic preparedness, or an artificially bloated economy, pathological decisions have one eventual trajectory. It is the definition of disease.

As the death toll from coronavirus mounts, we have a decision to make. We have learned from the pandemic that prevention is key. A leadership worse than its absence can mean the difference between a contained outbreak and a catastrophe.

There will be many more critical junctures in not just the coming months but days and even hours as the crisis deepens. A president’s mental incapacity, at this level of severity, is not an issue that non-experts can grasp or handle. Whether it is impeachment, the 25th Amendment, or an ultimatum on resignation is for the politicians to decide, but our prescription is removal. It is a prescription for survival.