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The world’s most prestigious medical journal has broken with tradition, and for the first time in its 208-year history has published a political editorial, blasting the Trump administration’s handling of the coronavirus.

The New England Journal of Medicine did not specifically endorse former Vice President Joe Biden, but made its feelings on President Donald Trump’s handling of the crisis abundantly clear, saying “The magnitude of this failure is astonishing.”

The editorial, which was signed by all of the journal’s editors, said: “Instead of relying on expertise, the administration has turned to uninformed ‘opinion leaders’ and charlatans who obscure the truth and facilitate the promulgation of outright lies.”

“The magnitude of this failure is astonishing.”

The New England Journal of MedicinE

Dr. Eric Rubin, the editor in chief, told the New York Times, “It should be clear that we are not a political organization, but pretty much every week in our editorial meeting there would be some new outrage. How can you not speak out at a time like this?”

The editorial follows a similar decision by the magazine Scientific American, which backed Biden in the first presential endorsement in its 175-year history.

The editorial did spare a few of the nation’s governors, noting: “Governors have varied in their responses, not so much by party as by competence. But whatever their competence, governors do not have the tools that Washington controls. Instead of using those tools, the federal government has undermined them.”

The journal ended the editorial with a call for change, saying, “When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent. We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs.”

There have only been four other editorials collectively signed by all of the journal’s editors in the recent past, according to CNN: one in 2014 about contraception, an obituary that same year for a former editor-in-chief, an editorial that year about standard-of-care research and an editorial in 2019 about abortion.