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As Donald Trump began speaking in the Oval Office on Tuesday afternoon, many Americans were less interested in what he had to say than how he looked. Was he wearing more makeup than usual? Any new visible bruises? Was he steady? It was perhaps a reasonable response after much of social media had spent several days declaring Trump on his death bed—or worse.

After years of being told Trump is the model of health, an exemplar of youth, and a man always in his prime, there is well-earned skepticism about his wellbeing—so much so that the public is conditioned to doubt even their own eyes when it comes to Trump’s existence. Trump’s unhinged cognitive swerves—a constant but perhaps intensifying trait—don’t much help, either.

After all, earlier this year the White House physician praised the President’s health by boasting that he logs “frequent victories in golf events.” During his first term, Trump’s doctors kept him just one pound away from being classified as obese but said he was nevertheless a machine. “Some people just have great genes. I told the President if he had a healthier diet over the last 20 years he might live to be 200,” Dr. Ronny Jackson said in 2018, years before joining Congress. During the 2016 campaign, Trump’s personal physician released a letter lauding his excellent health—one that Trump himself prescribed, it was later reported. “He dictated that whole letter. I didn’t write that letter,” Dr. Harold Bornstein said three years later. “I just made it up as I went along.”

So it is completely understandable why tin-foil conspiracists of all stripes would buy into the rumors of Trump’s imminent, or possibly recent, demise. It builds upon the White House’s announcement that Trump had been diagnosed with chronic venous insufficiency, which was offered as the reason for his cankles. Big-handshake energy was the excuse offered up for the clear bruising on his hands, despite visible make-up deployed to hide it. During an Alaska summit with Russian President Vladimir Putin, questions emerged about his gait. And Tuesday’s announcement followed almost a week away from the cameras, leading to claims that the event was a show-of-life move from a Potemkin presidency.

“I didn’t see that,” Trump said on Tuesday, dubiously brushing off a question about the buzz about his decline. “I didn’t hear that,” he shrugged off when asked again. 

For that media-obsessed President, the protest rings hollow and will not serve his flaking credibility. But it also reinforces a trend that should leave Americans regardless of party affiliation nervous: when Trump came to power in 2017, 49% of Americans saw him as not honest or trustworthy, according to YouGov polling. The same survey now finds 56% don’t believe what he says. 

(In fairness, CNN’s final poll on Bill Clinton’s presidency had 58% of Americans saying he was not honest or trustworthy.)

Presidencies crumble when they lose credibility. President George W. Bush arguably never recovered after he seemed untethered from reality in the response to Hurricane Katrina in 2005. It’s why Republicans thought they had their version of that when Barack Obama seemed drifting in 2012 after the attack in Benghazi, Libya. Joe Biden aborted his re-election bid last year after a public meltdown on a debate stage. (A must-read book detailing Biden’s decline roiled Washington earlier this year, too.)

That last example has even Trump’s fanboys asking questions. “There is obviously something going on with Trump that the White House is covering up,” Nick Fuentes, a white nationalist and influential far-right figure, asserted on social media. “This is literally Biden 2.”

Trump and his team have tried to dismiss the comparison but these things tend to snowball. Trump knows this. It’s why, nine years ago, he amplified the viral moment of Hillary Clinton stumbling at a Sept. 11 memorial in the final stretch of the 2016 campaign. “She’s supposed to fight all of these different things and she can’t make it 15 feet to her car? Give me a break. Give me a break,” he said. “Give me a break! She’s home resting right now. She’s getting ready for her next speech which is going to be about 2 or 3 minutes.”