Which One Is the Elephant?

Ninety-nine days to the first million confirmed cases, 43 days to the second million, 28 days to the third million and a mere 16 days to the fourth million, with 2,600 new cases reported every hour in this country.¹ We are now approaching 4.2 million confirmed cases with nearly 147,000 COVID-19 deaths in the United States.² Eighteen states set single-day records for newconfirmed cases last week. Our country’s 14-day rolling average of new cases and deaths was up 20% and 39% respectively. Only four countries worldwide have a higher number of confirmed cases per 100,000 residents than the U.S.: Oman, Bahrain, Panama, and South Africa.³ Millions are unemployed.

We are definitely on a roll, and with the possibility of widespread opening of schools looming and many still balking at wearing masks, who knows what’s next.

Last week, the administration deployed heavily-armed, anonymous, quasi-military units of the Department of Homeland Security to Portland, and was planning to deploy more units to Seattle, Chicago, Albuquerque, Cleveland, Detroit and Milwaukee. In Portland, these forces, wearing military-style camouflage and driving unmarked vehicles, illegally detained U.S. citizens at or near demonstrations, tear-gassed and attacked peaceful protesters, and shot others with ‘impact munitions,’ fracturing the skull of one victim. All in an effort to ‘address violent crime.’⁴ The deployment, while not illegal, appears to many like an invasion by federal forces, especially given that local and state officials were not consulted prior to their arrival and have asked that they leave or not be sent at all. (Portland’s mayor Ted Wheeler was tear-gassed as he stood among protesters and demanded that the troops depart.⁵) All of the cities listed above have Democratic mayors, a point emphasized by the president and trumpeted by Fox News’s evening talk show hosts. Their spin aside, this strongly suggests that the deployment is largely political in nature and possibly linked to the president’s reelection bid. We will take up this serious and ominous topic next Monday.

In the meantime, while COVID-19 continued to ravage many parts of the country, the president spent much of last week extolling his ‘amazing’ performance on a cognitive test that was administered during his annual physical examination. He took the Montreal Cognitive Assessment (MoCA), a test designed to detect cognitive impairment related to dementia, Alzheimer’s disease, Parkinson’s disease, schizophrenia, and, among others, brain tumors.⁶ The president took the test because of his age, as it is administered routinely to older adults. That he boasted about his performance repeatedly throughout the week — telling Fox News’s Sean Hannity that he ‘aced it’⁷ — indicates that he misunderstood its purpose and/or needed something to flaunt.

The test does not measure intelligence, intellectual prowess, IQ or superiority. A high score does not vindicate the president, nor does it provide any insight whatsoever to his intellect. One does not ‘ace’ the MoCA; one hopefully passes it.

On a very personal note, I happen to know this test well. I was with my father when it was administered to him. Mild dementia or, worse, Alzheimer’s was suspected. He did not do well. His life was never the same, nor was ours. It was a day I will never forget.

The MoCA takes about 10 minutes, less if you have difficulty finishing it. It challenges the individual with basic tasks, like copying a cube, drawing an analog clock displaying a specific time (e.g., 2:10), repeating a set of five random words and then restating them in order later during the test (Trump’s person-woman-man-camera-TV), naming three common animals, and counting backwards from 100 by, say, 7. Despite the president’s claim, the vast majority of people on Earth without cognitive impairment score well on the test. My father did not.

You know you’re in trouble — or, more accurately, you know your father is in trouble — when the administrator stops the test midway and asks the individual a series of basic questions, like ‘What day is it today?’ ‘What is today’s date?’ ‘Who is the president?’ ‘Do you know where you are?’ My father could answer none of these. The look on his face at that moment, the embarrassment and pleading in his eyes, is seared into my memory. He knew he was lost.

We learned my father’s diagnosis immediately afterward. It confirmed our fears. Mild dementia, the Veteran’s Administration doctor told us. It may progress or it may not. We know little, the doctor added, about the speed and the extent to which cognitive abilities deteriorate. Your father may get worse or he may not, but he will not recover. He will need care, as his physical abilities will likely decline in parallel with the loss of his cognitive abilities.

In other words, he’s still your dad, but not entirely. And there’s every reason to believe that the dementia will progress, slowly taking who he is from you. Which it did.

The doctor seemed genuinely concerned. She knew what my father would face, what we would face.

So while the president touts that he ‘aced’ the test, and challenged all takers to match his performance — including his interviewer Chris Wallace of Fox News⁸ — forgive me for not sharing his glee or his misplaced pride. Truthfully, I resented his braggadocio, which seemed insensitive to the millions of people worldwide who are struggling with dementia. And the family members who struggle or, in my case, struggled with them.

After all, it was a test for dementia, a medical diagnosis. Not for intelligence, leadership or what we need most now: the ability to navigate a pandemic with honesty, wisdom, compassion and strength. On these essential dimensions, Mr. President, you remain lacking. And, based solely on the data, failing miserably.

¹ https://www.ibtimes.com/us-records-2600-new-coronavirus-cases-every-hour-1-million-16-days-3016414

² As of 9:00 p.m., ET, July 26; https://www.cnn.com/interactive/2020/health/coronavirus-us-maps-and-cases/ These data are from the Department of Health and Human Services (HHS), so who knows?

³ https://www.nytimes.com/interactive/2020/07/23/us/coronavirus-hotspots-countries.html?action=click&pgtype=Article&state=default&module=styln-coronavirus&region=TOP_BANNER&context=storylines_menu

https://www.jsonline.com/story/news/crime/2020/07/23/president-trump-send-federal-agents-officers-milwaukee/5496276002/

https://www.washingtonpost.com/politics/trump-derides-portland-mayor-for-joining-protesters-and-getting-tear-gassed/2020/07/24/bd8d1884-cdbd-11ea-91f1-28aca4d833a0_story.html

https://www.mocatest.org

https://www.washingtonpost.com/politics/trump-bragging-cognitive-test-dementia/2020/07/22/6578e826-cb65-11ea-91f1-28aca4d833a0_story.html

https://www.foxnews.com/politics/transcript-fox-news-sunday-interview-with-president-trump

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