The Puerto Rico crisis grows more dire with each passing hour. Hurricane Maria has decimated the island's power grid, and much of its population remains without food or potable water. San Juan's Mayor Carmen Yulin Cruz put things frankly during an interview with CNN's Alisyn Camerota Friday morning: "People are dying here."

Donald Trump, meanwhile, has spent a good portion of the week tweeting about the NFL, both its owners and the players protesting the national anthem. He took days to dispatch aid via the USNS Comfort, and had to be pressured into waiving the Jones Act, an arcane maritime provision that prevents foreign vessels from docking in U.S. ports. Trump initially refused because, "a lot of people that work in the shipping industry don't want it lifted."

We should hardly be surprised, writes Paul Krugman. In his Friday column, he argues the president's narcissism could end up getting hundreds if not thousands of people killed.

Krugman focuses on twin catastrophes, both of which he believes prove Trump is manifestly unfit for office. The first is the disaster in Puerto Rico and the surrounding U.S. Virgin Islands. Nearly a week after Maria made landfall, the president has yet to submit a formal request to Congress for a federal relief package.

"None of the extraordinary measures you’d expect to see have materialized," Krugman continues. "The deployment of military resources seems to have been smaller and slower than it was in Texas after Harvey or Florida after Irma, even though Puerto Rico’s condition is far more dire."

The second catastrophe is the ongoing sabotage of America's health care system, which Trump appears to be encouraging purely out of spite. Graham-Cassidy was a spectacular failure, like all of the GOP's previous efforts to repeal and replace the Affordable Care Act, and the president has responded as only he would: by hinting he'll cut off federal subsidies to the ACA, refusing to clarify whether its regulations will be enforced, and subverting all of its outreach efforts. The administration even plans to pull the Obamacare website down during open enrollment.

"These actions translate directly into much higher premiums," Krugman reasons. "And it’s too late to reverse the damage: Insurers are finalizing their 2018 rates as you read this."

The damage done by Trump's presidency may prove no less irreversible.