Donald Trump had only been president for about four months when the Washington Post published a piece noting the “outlandish” praise his aides use when talking about their boss. The article quoted Mike Murphy, a longtime Republican consultant, saying at the time, “It’s insecure, over-the-top. I call it Great Leader-esque.”

A couple of weeks later, Trump presided over his first full White House cabinet meeting, which was an exceedingly creepy affair featuring officials telling the president how amazing he is as he nodded in agreement, basking in his underlings’ adulation. John Harwood‏, flabbergasted, said via Twitter at the time, “Honestly this is like a scene from the Third World.”

It’s unnerving how little has changed. On Friday afternoon, Trump visited the CDC in Atlanta, where he invited CDC Director Robert Redfield to make “a little statement” to the press. According to the official transcript, this was the entirety of Redfield’s unscripted response:

“Well, I think I — first, I want to thank you for your decisive leadership in helping us, you know, put public health first. I also want to thank you for coming here today and — and sort of encouraging and bringing energy to the men and women that you see that work every day to try to keep America safe. So I think that’s the most important thing I want to say, sir.”

About 48 hours later, U.S. Surgeon General Jerome Adams sat down with CNN’s Jake Tapper, who asked about whether the remaining presidential candidates from both parties — each of whom are in their 70s — should alter their campaign schedules. The doctor’s answer was quick to praise Trump for the frequency with which he washes his hands.

Adams added that Trump “sleeps less than I do, and he’s healthier.” (This, naturally, led the president to retweet the praise.)

It’s hardly reassuring when those responsible for helping respond to a viral outbreak seem a little too eager to let the president know how impressed they are with how awesome his awesomeness is.

What’s less clear is what’s driving this. Is it a dynamic in which Trump has chosen sycophantic officials who volunteer gushing praise? Or is it one in which officials feel pressure to genuflect?

A Politico report over the weekend pointed in the latter direction: “Trump’s unpredictable demands and attention to public statements — and his own susceptibility to flattery — have created an administration where top officials feel constantly at siege, worried that the next presidential tweet will decide their professional future, and panicked that they need to regularly impress him.”

There’s nothing healthy about any of this, but it’s likely to persist for the remainder of Trump’s presidency.