How should a decorated public health professional serving in the White House react when the president of the United States stands next to her and openly muses about the medical potential of injecting disinfectant? This is the moral dilemma facing Deborah Birx, Anthony Fauci, Robert Redfield and other physicians and scientists coordinating the government’s pandemic response. When President Trump offers sorcery over evidence-based medicine — as when he said, in February, that warm weather would make the coronavirus go away, or when he touted the anti-malaria drug hydroxychloroquine as a “game changer” before it was adequately studied — an expert can’t ethically stand by, tight-lipped, saying nothing. She has two choices: She can either quit or object.

Except the public health experts working for Trump don’t truly have either of those options. If they complain, publicly or even privately, there is ample reason to believe that Trump will shut them out, feel provoked and turn away from their sound, lifesaving counsel. (That’s how he treated Jeff Sessions and Marie Yovanovitch when they tried to take the high road.) And if they quit, there is ample reason to believe that the president will replace them with someone worse: a crony who lacks their expertise or capability. (The current defense secretary, attorney general and acting director of national intelligence were all brought in to replace agitators and proffer the advice Trump wants to hear. Rick Bright, removed last month as director of a government vaccine-development unit, had reportedly voiced doubts about an unproven therapy Trump praised.)

It is, truly, an impossible position, so don’t begrudge their work. Given the stakes, they have to stay.

The overriding reason for career public servants like Birx and Fauci to remain on the job is to influence the work from the inside. Staying on the coronavirus task force allows them to hang onto some measure of authority over how the crisis is managed behind closed doors. By at least one account, Fauci played a key role in persuading Trump to abandon his push to reopen the country by Easter.

The president’s bombastic daily press “briefings” captivate cable news but appear largely divorced from the daily work of fighting the pandemic. Trump is famously removed from the quotidian details of governing, and this crisis is no different: He reportedly doesn’t even attend most meetings of the task force, which directs agencies across the federal bureaucracy. If these internal deliberations give experts the chance to effectively advocate for, and help implement, even marginally better policies, that justifies remaining aboard.

Continuing to serve also enables experts to communicate accurate information directly to the public. Fauci has harnessed his official position to speak to Americans across a wide range of media, debunking myths and inaccuracies that spout from the same White House briefings he attends. On CNN, for instance, Fauci went out on a limb by acknowledging that more lives could have been saved if the administration had acted sooner. Even in the briefing room, his occasional facepalm speaks volumes. Perhaps that’s why 78 percent of voters approved of Fauci’s response to the crisis, compared with 46 percent for Trump, in an early April Quinnipiac poll. Only 23 percent of Americans have high levels of trust in what Trump is telling the public about the crisis, while 60 percent say he’s not listening to health experts enough, according to a late April Associated Press-NORC Center for Public Affairs Research survey. Politico reports that new White House press secretary Kayleigh McEnany and new communications director Alyssa Farah will control media appearances for experts like Fauci and Birx going forward. But presumably, for now, at least they’ll be allowed to make appearances. For many Americans, it’s comforting simply to observe that there are some serious professionals who help set policy.

And who would replace those experts if they quit? This administration’s talent pool was memorably described by the conservative scholar Eliot Cohen as comprising “invertebrates and opportunists, schemers and careerists.” When I served as a “holdover” from the Obama National Security Council to the Trump staff, I used to half-joke that, given the new president’s attacks on the press and political opponents, my “director for democracy” job would eventually be taken by someone interested in being “director for authoritarianism.” In the case of the coronavirus task force, the wrong person could materially jeopardize the lives of Americans by acquiescing to the president’s whims and fiats.

A dramatic take-this-job-and-shove-it exit might feel good, momentarily. But for public servants who care about seeing the country through this crisis, it would yield little benefit beyond that. If one of them resigned or was fired for contradicting the president, their next step could be a media tour evangelizing about the flaws of the Trump administration. But many Americans already know about these and need no further convincing. The rest will probably never be persuaded. Further, the president himself would be unmoved: The history of his administration has featured a near-constant parade of dramatic exits — from Defense Secretary Jim Mattis to White House chief of staff John Kelly to national security adviser H.R. McMaster to communications director Anthony Scaramucci — and it’s doubtful whether any prompted the president to reconsider a single policy stance.

An expert who resigns to express dissent on a specific policy matter can at least call public attention to that policy, as with Mattis’s resignation over a Syria withdrawal decision. But the president’s mishandling of the coronavirus has been not one discrete choice but a rolling, catastrophic muck-up. People keep dying while the president keeps spouting drivel, so stemming that misinformation is arguably the most urgent priority. We got a taste of this Tuesday, when the president claimed that “our experts believe the worst days of the pandemic are behind us” and said that he was looking forward to the “safe and rapid reopening” of the country. Fauci immediately stepped up to clarify that “if we are unsuccessful, or prematurely try to open up . . . it could be a rebound to get us right back in the same boat.” Resigning over a difference like this, in this context, is counterproductive: Would Americans suffer less after a principled resignation, or with ongoing engagement to try to stave off the worst outcomes?

There are, admittedly, some situations where leaving is the best course. Each public servant pledges an oath to defend the Constitution, and if staying on the job seems to demand abandoning that oath, resignation is the only option. Timothy Snyder’s “On Tyranny: Twenty Lessons From the Twentieth Century” (a book I consulted more than once during my Trump NSC stint) shows just how cataclysmic the consequences can be if civil servants let professional ethics slide in times when political leaders set a troubling tone. Moreover, the distinction between effectively shaping the system from the inside and being corrupted by it can become invisible. It was in the Vietnam era that analysts first identified the “effectiveness trap” — many officials’ impulse to stay silent about bad policies so they could “live to fight another day, to give on this issue so that you can be ‘effective’ on later issues,” as James Thomson wrote in the Atlantic. Being in the room where it happens is seductive.

These hazards are even more perilous when a respected expert is called upon to publicly vouch for a policy approach, often because she is a respected expert. Birx has at times sidestepped or excused the president’s dangerous falsehoods — including last weekend, when she suggested that the news cycle should move on from questioning his remarks about ingesting bleach — raising concerns about whether she is using her solid reputation to enable irresponsible leadership. Fauci has instead often contradicted the president’s egregious falsehoods, earning him constant rumors of a potential firing but modeling how civil servants can do their jobs without conforming to Trump’s funhouse-mirror version of reality.

For me, imagining these dilemmas is easy. In early 2016, I joined President Barack Obama’s National Security Council staff. My role was to help coordinate other parts of the government in supporting democratic governance around the world, in line with the president’s priorities: encouraging fair elections, freedom of the press and accountable institutions. But one year later, as one of a rapidly shrinking number of civil servant “holdovers” in the new administration, I found myself in a White House whose chief executive regularly attacked the independent media, flattered dictators, targeted political opponents and assailed the very institutions he now led. My job title, “director for democracy,” now prompted dizzying cognitive dissonance. At the same time, I still cared deeply about the work and still collaborated with colleagues across government toiling diligently to advance it, away from the spotlight of the Oval Office. If I left, who would monitor elections in key countries or help coordinate the stabilization of war-torn states? And so, for months, I grappled with the question: How long should I stay? In the end, I chose to keep doing my job the way I felt it should be done, until my bureaucratic rotation came to an end, and a capable successor was in place.

My dilemma was comparatively simple: I was lower-profile and less senior than Fauci and Birx. Ultimately, my hope for these experts serving Trump in the era of the coronavirus is that they can take a similar approach.

Twitter: @franceszbrown