The president could enter a “psychotic spiral,” as narcissism expert Dr. Craig Malkin has noted, but I gauge delusion outside a clinical context through the social psychology or public health perspective. Delusions are “transmitted” more rapidly to a population than simple lies.
This does not let him off the hook for criminal responsibility. He observes how effective his symptoms are (his “gut”) and mobilizes them to get what he wants, not caring about consequences. He decides he does not have to change his behavior because he can “get away” with it.
This is at least criminal negligence, but could verge on murder in the case of the pandemic based on motives (this does require a personal interview). Since the law does not give allowance for lack of empathy or conscience, a clearing for murder conviction is not implausible.
This comes to show how important mental health expert voices were, to refer for an evaluation when we said medical criteria called for it, and not to treat a president like a king. Treating him as above the law and natural law (mental health) facilitated his myth as a demigod.
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