The president’s hands were shaking. In August 1944, Franklin Delano Roosevelt, even as he led the American and allied effort to win World War II, could not pour cream into his tea. Then-Senator Harry Truman closely observed the shakes and spills at a meeting about becoming Roosevelt’s vice president, and later recalled the 62-year-old president “got more cream in the saucer than he did in the cup.” Within eight months, Roosevelt was dead, leaving Truman a war to win, a White House to run, and little time to cry over spilt cream.

Truman’s stark inheritance is one reason why the U.S. government has taken deliberate steps and developed robust systems, often after the jolt of presidential illness or incapacitation, to ensure the ship of state remains in steady hands. Unfortunately, before President Donald Trump was diagnosed with COVID-19 and hospitalized on Oct. 2, he had spent the better part of his term dismantling that system and shunning – or outright dismissing — those there to help. The result is not just a deeply personalized foreign policy but an unstable federal government, the risks of which increase with each day of Trump’s illness, notwithstanding his own and his doctor’s questionable claims of improving health.

Much of the modern U.S. national security apparatus was established because of the instability wrought by infirm or injured presidents.

During World War II, Roosevelt drove Washington mad not just because of what he did to personalize nearly every aspect of the U.S. effort — personally strategizing, managing allies, and commanding the U.S. government — but how he did it. The 32nd president called himself a juggler: “I never let my right hand know what my left hand does … I may be entirely inconsistent, and furthermore I am perfectly willing to mislead and tell untruths if it will help win the war.” The concerns that a frail Roosevelt, juggling mostly alone even as his hands grew shakier, would let a ball drop, drove calls for postwar reforms to how Washington worked. As a result, Congress and Truman later established the National Security Council to keep the president, vice president, Cabinet officials, the military brass and their staffs on the same page to ensure steadiness in national security.

Evolving Buttresses for Decision-Making

Crises, particularly those involving the president, reshaped that system in the decades that followed. When John F. Kennedy was shot and killed, Lyndon Johnson publicly adopted the late president’s advisors and systems, despite their bad fit for his very different style. Following Johnson’s discomfort — as well as his disastrous decision on Vietnam — Washington came to allow presidents some leeway in managing their affairs. Another evolution took root in the minutes and hours after Ronald Reagan was shot in 1981. Although, most remember Secretary of State Al Haig’s breathless — and incorrect — declaration, “I’m in control here,” it was the scene down in the Situation Room, where information was incomplete and communications spotty, that led members of the National Security Council staff to try to give the 20-year-old Situation Room a technological upgrade.

Unfortunately, Trump has either ignored or destroyed much of the resulting system of committees and communication meant steady the U.S. government. He has declined to meet in formal sessions, preferring the clubby informality of the Oval Office and a small cadre of aides. He has cut off access to his phone calls with those abroad, and to subsequent records generated by those conversations. His team has dramatically scaled back the schedule of meetings that bring officials from around government to one table for discussions without the president. He had the NSC staff, usually charged with sharing the best information with the president and communicating his decisions with the rest of government, downsized by more than a third just as the pandemic was beginning. And he has limited how he receives intelligence reports and who on his staff learns what he’s hearing.

In all, Trump has personalized foreign policy and juggling in a way unseen in the Oval Office since Roosevelt. Few in government know everything he’s working on, and few abroad trust anything but a White House back channel. The current president cuts ad-hoc deal after ad-hoc deal in one-on-one calls with foreign heads of state and WhatsApp messages by his family and personal aides, with no regard for the chaos he creates. Along the way, the formal system meant to add rigor to decisions, redundancies when crisis arise, and a regular rhythm to America’s relationship with the world, no matter the health of the person in the Oval Office, has atrophied.

The degeneration of the American national security state became apparent slowly over three years and then all at once, the minute Trump stepped aboard Marine One on that Friday afternoon to go to Walter Reed National Military Medical Center.

Of course, there are some who believe that the government can continue to function with an ill president, in the hospital or back in the Oval Office with extra precautions. Before Trump returned to the White House from Walter Reed, National Security Advisor Robert O’Brien said, “There are many men and women on the watchtower at the Pentagon, at the State Department, here at the White House, making sure that the country is safe.” Others made similar points: the government and chain of command exist to function no matter what happens to one person.

A Personalized System … Without Trust in the Person

But it’s not Trump’s illness that’s a risk to national security; it’s the way he has undermined the trust that government can function well without him. As Truman and others feared, a personalized foreign policy collapses without the person who owns it. Trump’s juggling risks becoming as belabored as the breathing he exhibited in the video shot on the Truman Balcony. Even worse, because of the damage that Trump has done to government institutions, he has made it that much harder for any one person, or everyone in Washington, to pick up the pieces, creating risks at home and abroad. This became even more true when the news broke that the Joint Chiefs of Staff were in quarantine because they had been in a meeting with an admiral who had tested positive with COVID-19. All had been at an event with Trump at the White House on Sept. 27.

In terms of the risks at home, Trump has made it his modus operandi since his January 2017 inauguration to wage war against what he calls a “deep state” of unelected officials in the military, diplomatic corps, and intelligence community. But that has meant purging and punishing the very part of government that provides continuity amid crisis and political change. The effect has been to leave critical officials out of the loop. Unused, untrusted, and under-informed, these career officials would struggle in the event of Trump’s incapacitation to work with his political appointees, increasing the chances of a mistake or even inertia during a crisis.

Trump’s personalization of foreign policy also has implications abroad. In Moscow, Pyongyang, Beijing, Tehran, and elsewhere, officials surely have been making quick calculations – and just as quickly adjusting them in the confusion about Trump’s real health status – about what even a temporary absence of this president means for them and for U.S. foreign policy more broadly. And amid such shifting re-calculations, the potential for mistakes, misperceptions, and miscalculations soars both in a chaotic Washington and abroad.

Three-quarters of a century after Roosevelt and Truman took tea together, the hands at the helm of U.S. foreign policy have grown even less steady. Unfortunately, the United States plays a far greater role in global affairs than in 1944. As a result of Trump’s management of foreign policy and the inability and unwillingness to force the president to work in a more formal or organized manner, his illness further disrupts the global order and places American national security at even greater risk.

IMAGE: US President Donald Trump looks out from the Truman Balcony as he arrives at the White House upon his return from Walter Reed Medical Center, where he underwent treatment for Covid-19, in Washington, DC, on October 5, 2020. (Photo by NICHOLAS KAMM/AFP via Getty Images)