Even in these extraordinary times, the sight of the president of the United States presenting a slide which announced as a “goal” the death of up to 240,000 of its citizens was almost beyond belief. To hit the lowest end of the target, a staggering 100,000 American deaths, would show that his administration had done “a very good job”, Donald Trump claimed this week. The highest end would be more than double the US casualties in the first world war. This could only be considered a positive outcome because the alternative is so shocking: without mitigation measures, if people fail to stay at home as advised, the US could be heading for between 1.5 million and 2.2 million deaths.

The US is now the new centre of the pandemic, with more than a fifth of the million cases reported worldwide, and more than 5,000 deaths. The vast majority of Americans – more than 300 million – are now under some form of lockdown, though the stringency of restrictions varies greatly and a few states are still holding out. Those measures have come too late to stop hospitals from being overwhelmed.

The richest country in the world is structurally ill-equipped to cope with such a crisis. The lack of universal healthcare or basic employment rights such as statutory sick pay, and the low incomes on which so many Americans survive, are conducive to the spread of disease and to it having the most serious consequences.

But an utter failure of leadership – the lack of will, intelligence, basic competence or even consistency on the part of the Trump administration – has turbocharged the problem. And without the work of state governors and institutions, who have pre-empted the administration and gone far beyond it in taking action, matters would be even worse. Mr Trump has at best left them to fend for themselves and at worst actively hindered the fight against coronavirus.

His culpability actually predates the virus’s emergence in China. The administration got rid of most of the staff who worked on identifying global health problems in China, while repeatedly attempting to slash funding for the Centers for Disease Control and Prevention. A comprehensive document on battling pandemics, drawn up under the Obama administration, was “thrown on to a shelf” by its successor. Only last October, an internal federal government report warned that the US was woefully underprepared and underfunded to tackle a virus without a cure.

Even after the virus was confirmed to have reached the US, Mr Trump downplayed the crisis at every opportunity, fearing the impact on the economy. As late as 25 February he called it “very well under control”. He has touted unproven remedies. Last week, he said he wanted to reopen large sections of the country by Easter and to see “packed churches all over our country” – though he has, thankfully, since extended the federal “stay at home” guidance until the end of this month. The federal government should have mobilised long ago to acquire an appropriate supply of testing kits, protective equipment and ventilators. It did not. This week, he was forced to acknowledge that the government’s emergency stockpile of protective equipment is almost exhausted.

The economy is reeling. An astonishing 6.6 million Americans signed on for unemployment welfare last week. The emergency $2tn relief package, while necessary and welcome, offers more to corporate America than those on the breadline.

Some wonder if this could finally break his spell. So far, people are rallying around the flag: a national crisis tends to prompt people to support the leadership. Despite his dereliction of duty, Mr Trump’s approval ratings have actually increased, as they have for leaders in almost every democratic nation. He may also benefit from the rock-bottom expectations people have of him. And he is already trying to rewrite the facts and pin the blame on others, attacking governors both for failing to prepare and for hoarding equipment.

These efforts may yet succeed. But the truth is that, as he has finally acknowledged, the coming weeks will be “very, very painful” – and that his inaction has made them much more so.