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Uncontrolled Spread; Why Covid-19 Crushed Us and How We Can Defeat the Next Pandemic
Physician and former FDA commissioner Scott Gottlieb asks: Has America’s COVID-19 catastrophe taught us anything?
In Uncontrolled Spread, he shows how the coronavirus and its variants were able to trounce America’s pandemic preparations, and he outlines the steps that must be taken to protect against the next outbreak. As the pandemic unfolded, Gottlieb was in regular contact with all the key players in Congress, the Trump administration, and the drug and diagnostic industries. He provides an inside account of how level after level of American government crumbled as the COVID-19 crisis advanced.
A system-wide failure across government institutions left the nation blind to the threat, and unable to mount an effective response. We’d prepared for the wrong virus. We failed to identify the contagion early enough and became overly reliant on costly and sometimes divisive tactics that couldn’t fully slow the spread. We never considered asymptomatic transmission and we assumed people would follow public health guidance. Key bureaucracies like the CDC were hidebound and outmatched. Weak political leadership aggravated these woes. We didn’t view a public health disaster as a threat to our national security.
Many of the woes sprung from the CDC, which has very little real-time reporting capability to inform us of Covid’s twists and turns or assess our defenses. The agency lacked an operational capacity and mindset to mobilize the kind of national response that was needed. To guard against future pandemic risks, we must remake the CDC and properly equip it to better confront crises. We must also get our intelligence services more engaged in the global public health mission, to gather information and uncover emerging risks before they hit our shores so we can head them off. For this role, our clandestine agencies have tools and capabilities that the CDC lacks.
Uncontrolled Spread argues we must fix our systems and prepare for a deadlier coronavirus variant, a flu pandemic, or whatever else nature -- or those wishing us harm -- may threaten us with. Gottlieb outlines policies and investments that are essential to prepare the United States and the world for future threats.
In Uncontrolled Spread, he shows how the coronavirus and its variants were able to trounce America’s pandemic preparations, and he outlines the steps that must be taken to protect against the next outbreak. As the pandemic unfolded, Gottlieb was in regular contact with all the key players in Congress, the Trump administration, and the drug and diagnostic industries. He provides an inside account of how level after level of American government crumbled as the COVID-19 crisis advanced.
A system-wide failure across government institutions left the nation blind to the threat, and unable to mount an effective response. We’d prepared for the wrong virus. We failed to identify the contagion early enough and became overly reliant on costly and sometimes divisive tactics that couldn’t fully slow the spread. We never considered asymptomatic transmission and we assumed people would follow public health guidance. Key bureaucracies like the CDC were hidebound and outmatched. Weak political leadership aggravated these woes. We didn’t view a public health disaster as a threat to our national security.
Many of the woes sprung from the CDC, which has very little real-time reporting capability to inform us of Covid’s twists and turns or assess our defenses. The agency lacked an operational capacity and mindset to mobilize the kind of national response that was needed. To guard against future pandemic risks, we must remake the CDC and properly equip it to better confront crises. We must also get our intelligence services more engaged in the global public health mission, to gather information and uncover emerging risks before they hit our shores so we can head them off. For this role, our clandestine agencies have tools and capabilities that the CDC lacks.
Uncontrolled Spread argues we must fix our systems and prepare for a deadlier coronavirus variant, a flu pandemic, or whatever else nature -- or those wishing us harm -- may threaten us with. Gottlieb outlines policies and investments that are essential to prepare the United States and the world for future threats.
512 pages, Unknown Binding
First published January 1, 2021
329 people are currently reading
1459 people want to read
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Displaying 1 - 30 of 141 reviews
September 28, 2021
Full disclosure: I’m a Democrat who differs with Gottlieb’s politics on nearly everything.
Bottom line: this is an important book if for no other reason than because the author is so prominent in discussions about the pandemic.
My issues with him are: 1) he has his fingers/hands in many, many proprietary healthcare businesses so he will profit mightily from everything he recommends here; 2) he only uses Republican administrations and deeply conservative sources/think tanks to back up his allegations and recommendations; 3) he is one of those guys who has moved seamlessly between government agencies and the corporations they regulate repeatedly, a red flag for me and others; 4) at the time he headed the FDA, he had to recuse himself from decisions about drugs/devices from TWENTY companies with which he had business relationships.
That said, this book is revealing in how government does/doesn’t work on behalf of the people it is supposed to protect. It is hard to argue with any of his main criticisms: we have no manufacturing base or excess capacity to turn to in an emergency; we never commit to preparedness once the threat passes; the CDC is a retrospective, academically focused organization with zero capacity for leading real-time operational initiatives; we are poor at rapidly adapting to new information on public health threats. There is more, but these are significant. The chapters on China’s history re: emerging viral threats is eye-opening and very important. He isn’t trying to hang this pandemic on China but his description of how China behaves and the role of the WHO in facilitating bad behavior was more than I knew about from other sources. He puts together a lot of information that we need to be clear-eyed about if we are going to seriously protect ourselves from future pandemics (because there will be another, sooner rather than later).
He spends too little time exploring the role that politicians and the populace (via social media) play in undermining our capacity to respond effectively. His stated goal is to avoid politics in this book. He does recognize that Trump et al made things worse but he minimizes that. He clearly is trying to absolve certain people in the administration of poor performance, one being Deborah Birx.
So, here’s the thing, we need to seriously consider and likely implement many if not most of what he recommends. But without addressing the role of bad actors in government and the media/citizenry, I don’t know how much better we would have done or can do in the future. Gottlieb seems oblivious to that component and dances around the reality that his conservative buddies opposed most public health actions from the get-go. He cannot wash his hands of that or pretend that is not going to be a major barrier in the future to public health in general.
Despite my strong reservations about some of his book and him as a truth-teller, I highly recommend the book. There is too much here that all of us, regardless of party, need to know, accept and act on to dismiss it because of our disagreements with the author’s politics.
(One star withheld because he is too detailed on some of the science and is unnecessarily repetitious. He could have used a more skilled editor.)
Bottom line: this is an important book if for no other reason than because the author is so prominent in discussions about the pandemic.
My issues with him are: 1) he has his fingers/hands in many, many proprietary healthcare businesses so he will profit mightily from everything he recommends here; 2) he only uses Republican administrations and deeply conservative sources/think tanks to back up his allegations and recommendations; 3) he is one of those guys who has moved seamlessly between government agencies and the corporations they regulate repeatedly, a red flag for me and others; 4) at the time he headed the FDA, he had to recuse himself from decisions about drugs/devices from TWENTY companies with which he had business relationships.
That said, this book is revealing in how government does/doesn’t work on behalf of the people it is supposed to protect. It is hard to argue with any of his main criticisms: we have no manufacturing base or excess capacity to turn to in an emergency; we never commit to preparedness once the threat passes; the CDC is a retrospective, academically focused organization with zero capacity for leading real-time operational initiatives; we are poor at rapidly adapting to new information on public health threats. There is more, but these are significant. The chapters on China’s history re: emerging viral threats is eye-opening and very important. He isn’t trying to hang this pandemic on China but his description of how China behaves and the role of the WHO in facilitating bad behavior was more than I knew about from other sources. He puts together a lot of information that we need to be clear-eyed about if we are going to seriously protect ourselves from future pandemics (because there will be another, sooner rather than later).
He spends too little time exploring the role that politicians and the populace (via social media) play in undermining our capacity to respond effectively. His stated goal is to avoid politics in this book. He does recognize that Trump et al made things worse but he minimizes that. He clearly is trying to absolve certain people in the administration of poor performance, one being Deborah Birx.
So, here’s the thing, we need to seriously consider and likely implement many if not most of what he recommends. But without addressing the role of bad actors in government and the media/citizenry, I don’t know how much better we would have done or can do in the future. Gottlieb seems oblivious to that component and dances around the reality that his conservative buddies opposed most public health actions from the get-go. He cannot wash his hands of that or pretend that is not going to be a major barrier in the future to public health in general.
Despite my strong reservations about some of his book and him as a truth-teller, I highly recommend the book. There is too much here that all of us, regardless of party, need to know, accept and act on to dismiss it because of our disagreements with the author’s politics.
(One star withheld because he is too detailed on some of the science and is unnecessarily repetitious. He could have used a more skilled editor.)
September 24, 2021
This is the best book about COVID-19 and the response to it. It's also one of the best post-mortems of a public policy fiasco I've ever read -- on par with Richard Feynman's post-mortem of the Challenger shuttle disaster. There's a common element -- the author in each was a highly intelligent expert in the domain, but not directly involved in a leadership position at the time of the incident, so as to be a truly impartial expert. Gottlieb was formerly head of FDA, one of the government entities key to the response, and intimately familiar with the strengths and challenges of different parts of the US Government, yet was willing and able to point out these issues publicly.
Essentially, there are a few specific problems with the USG (and to some extent, world) Covid response which are now clear, and which unfortunately still exist and are likely to contribute to a future pandemic (likely much worse).
1) China's ongoing secrecy, control of WHO, lax domestic controls, and generally being a bad actor seems to be increasing
2) CDC is not operational -- they are largely backward-looking and focused on producing academic after-the-fact papers on rock-solid science, rather than providing as-needed surveillance and actionable information in an uncertain environment. CDC either needs to be completely reprogrammed, or all operational aspects of CDC moved to another entity. When even FDA is faster and more responsive (itself a too-slow and too-cautious regulator), you know you're doing it wrong.
3) No "JSOC-equivalent" entity in USG for pandemic response which could coordinate across all of government (and industry, and society) and which actually had expertise and experience in dealing with these threats. (To extend this analogy -- we were similarly unprepared for counterterrorism on 9/11, and only developed this capacity through 20 years of war.)
And specific flaws:
1) China failing to share data, and local authorities in China likely not releasing information to the central government -- strong possibility of spread late 2019 well before it was announced. China still hasn't provided early samples to anyone (and the way we got the DNA sequence was likely an unsanctioned release by a scientist)
2) The politicization of response, especially in the US (and to some extent, Europe), and differential costs/benefits to the population (younger, healthy, small business owners suffered, minorities suffered, but the "public policy class" who could work by Zoom didn't to the same degree.)
3) The CDC testing fiasco -- for which individuals probably should be removed, in addition to regulatory and organizational changes -- which largely precluded any possibility of US containment of covid, forcing us to costly mitigations. We burned through public goodwill by doing nationwide lockdowns early when spread was much more localized, such that no public willingness for NPIs existed in other areas by the time they were needed there. The root causes of this were CDC being basically organizationally unsuited for the task, but specific decisions to try for a perfect test vs something adequate, a slow contracting process which encouraged them to do things in-house (which they didn't know how to do well at large scale), rather than contracting efficiently to expert companies, and poor oversight leading to continued delays rather than working on multiple solutions in parallel. We could have simply guaranteed purchase of tests in a certain quantity from private manufacturers early on who would have produced them -- instead there were intellectual property issues with CDC, unwillingness to share information, production problems, and a risk that the CDC tests would eliminate demand for private tests. These private companies had been burned during Zika a few years earlier.
4) US response was largely designed for influenza rather than covid, and covid accelerated timelines for a lot of things. There was some lingering post 9/11 biowarfare defense capability from DOD/DHS which was also not general enough for this. Absent more specific data, we made bad decisions (focus on surface spread/fomites vs. aerosols, weird focus on rules like 6' separation for droplets for far too long)
5) CDC being an active impediment to various efforts by other entities throughout the crisis - restricting independently developed tests, etc
And new concerns:
1) Countries are now highly likely to delay reporting any new infectious disease outbreaks due to risk (well, certainty) of being isolated with travel bans and other economic hardships
2) Now that we've seen how much a relatively low fatality respiratory disease can wreck a country, and this is specifically worst in the US and Western democracies, the risk of a terrorist or military employment of a future pathogen is higher -- way easier to re-create something after you know it's possible, and all the components are out there already.
The one bright spot appears to be vaccine technology and genetic/molecular medicine (i.e. things largely in the private sector). I'm not particularly convinced we'll get better US Government (or international governmental) pandemic preparedness, although the need for a better response is clear.
Essentially, there are a few specific problems with the USG (and to some extent, world) Covid response which are now clear, and which unfortunately still exist and are likely to contribute to a future pandemic (likely much worse).
1) China's ongoing secrecy, control of WHO, lax domestic controls, and generally being a bad actor seems to be increasing
2) CDC is not operational -- they are largely backward-looking and focused on producing academic after-the-fact papers on rock-solid science, rather than providing as-needed surveillance and actionable information in an uncertain environment. CDC either needs to be completely reprogrammed, or all operational aspects of CDC moved to another entity. When even FDA is faster and more responsive (itself a too-slow and too-cautious regulator), you know you're doing it wrong.
3) No "JSOC-equivalent" entity in USG for pandemic response which could coordinate across all of government (and industry, and society) and which actually had expertise and experience in dealing with these threats. (To extend this analogy -- we were similarly unprepared for counterterrorism on 9/11, and only developed this capacity through 20 years of war.)
And specific flaws:
1) China failing to share data, and local authorities in China likely not releasing information to the central government -- strong possibility of spread late 2019 well before it was announced. China still hasn't provided early samples to anyone (and the way we got the DNA sequence was likely an unsanctioned release by a scientist)
2) The politicization of response, especially in the US (and to some extent, Europe), and differential costs/benefits to the population (younger, healthy, small business owners suffered, minorities suffered, but the "public policy class" who could work by Zoom didn't to the same degree.)
3) The CDC testing fiasco -- for which individuals probably should be removed, in addition to regulatory and organizational changes -- which largely precluded any possibility of US containment of covid, forcing us to costly mitigations. We burned through public goodwill by doing nationwide lockdowns early when spread was much more localized, such that no public willingness for NPIs existed in other areas by the time they were needed there. The root causes of this were CDC being basically organizationally unsuited for the task, but specific decisions to try for a perfect test vs something adequate, a slow contracting process which encouraged them to do things in-house (which they didn't know how to do well at large scale), rather than contracting efficiently to expert companies, and poor oversight leading to continued delays rather than working on multiple solutions in parallel. We could have simply guaranteed purchase of tests in a certain quantity from private manufacturers early on who would have produced them -- instead there were intellectual property issues with CDC, unwillingness to share information, production problems, and a risk that the CDC tests would eliminate demand for private tests. These private companies had been burned during Zika a few years earlier.
4) US response was largely designed for influenza rather than covid, and covid accelerated timelines for a lot of things. There was some lingering post 9/11 biowarfare defense capability from DOD/DHS which was also not general enough for this. Absent more specific data, we made bad decisions (focus on surface spread/fomites vs. aerosols, weird focus on rules like 6' separation for droplets for far too long)
5) CDC being an active impediment to various efforts by other entities throughout the crisis - restricting independently developed tests, etc
And new concerns:
1) Countries are now highly likely to delay reporting any new infectious disease outbreaks due to risk (well, certainty) of being isolated with travel bans and other economic hardships
2) Now that we've seen how much a relatively low fatality respiratory disease can wreck a country, and this is specifically worst in the US and Western democracies, the risk of a terrorist or military employment of a future pathogen is higher -- way easier to re-create something after you know it's possible, and all the components are out there already.
The one bright spot appears to be vaccine technology and genetic/molecular medicine (i.e. things largely in the private sector). I'm not particularly convinced we'll get better US Government (or international governmental) pandemic preparedness, although the need for a better response is clear.
July 9, 2021
In a world struggling to get back to normal after a devastating pandemic, especially when false information and theories are rampant, this book piqued my interest when it appeared on Net Galley. Former commissioner Gottlieb is someone I’ve trusted for information for years, and he doesn’t disappoint in this book.
I was curious to see how this book would share information. The tone of the book is extremely factual, and it doesn’t feel like it pushes an agenda. In cases of potential controversy, like how the former President handled the crisis, Gottlieb explains the situation from both sides and shares the outcome, as well as information on how the situation could have gone if the opposite decision was made. He takes the same approach with the CDC’s decisions, and ultimately many shortfalls. He also draws a lot of analogs to prior pandemics, like the Spanish flu, and scenario planning from potential flu pandemics.
I respect the former commissioner after his years at FDA, and his ability to share some really scientific information in a meaningful way with a lay audience shines in this book. He specifically shares what mRNA vaccines are in a way that anyone can understand, which is the mark of both how brilliant he is and that he is extremely well written.
One warning though, the material is very dense and it will take you time to get though, so this isn’t a quick read. The other big flag for me was if you are unfamiliar with government agencies, public health policy and general processes of the CDC/FDA, you may have a little more trouble in some of the places he talks about the specific ways in which the agencies responded.
I was curious to see how this book would share information. The tone of the book is extremely factual, and it doesn’t feel like it pushes an agenda. In cases of potential controversy, like how the former President handled the crisis, Gottlieb explains the situation from both sides and shares the outcome, as well as information on how the situation could have gone if the opposite decision was made. He takes the same approach with the CDC’s decisions, and ultimately many shortfalls. He also draws a lot of analogs to prior pandemics, like the Spanish flu, and scenario planning from potential flu pandemics.
I respect the former commissioner after his years at FDA, and his ability to share some really scientific information in a meaningful way with a lay audience shines in this book. He specifically shares what mRNA vaccines are in a way that anyone can understand, which is the mark of both how brilliant he is and that he is extremely well written.
One warning though, the material is very dense and it will take you time to get though, so this isn’t a quick read. The other big flag for me was if you are unfamiliar with government agencies, public health policy and general processes of the CDC/FDA, you may have a little more trouble in some of the places he talks about the specific ways in which the agencies responded.
October 11, 2021
I disagree with several of Gottlieb's policy guidances, and I think he has some blind spots. Him reserving all his ire for the CDC and almost none for the agency he used to run (FDA) is a bit revealing. But in general this is a readable survey of the pandemic and the many U.S. missteps. It's also genuinely surprising to see an American Enterprise Institute fellow endorse public provisions for manufacturing. He was very well read into what the Trump administration was doing and it's interesting to get this perspective.
I ended up doing an interview that involved Gottlieb where I tried to press him on a couple things. It's here: https://www.kcrw.com/news/shows/left-...
I ended up doing an interview that involved Gottlieb where I tried to press him on a couple things. It's here: https://www.kcrw.com/news/shows/left-...
June 25, 2021
I enjoyed this book. Dr. Scott Gottleib gives a clear explanation of what happened to detour an adequate US response to the COVID pandemic. Gottleib covers the bases in this in-depth analysis but at times, especially when discussing testing, I felt that the analysis was too detailed. The book also paid too much attention to the lab-leak hypothesis which Gottleib later slightly walks back. I also felt that baked into the text was a bias towards criticizing the CDC but supporting the FDA, the latter of which Gottleib was once Commissioner. Overall, this book is a mostly non-partisan overview that is worth reading. Thank you to Edelweiss and HarperCollins for the advance reader copy.
September 26, 2021
Anything natural is uncontrolled. If it is controlled, it is artificial.
No, it wasn't Covid that ”crushed” ”us”, but a handful of governmental bureaucrats with too much power over the lives of others.
And this is all this book stands for: if the said monster bureaucrats can't control nature, at least they can rule your life and decide, like with Covid, who lives and who dies.
Or short: how to use the WHO technology to make the United States of North Korea.
No, it wasn't Covid that ”crushed” ”us”, but a handful of governmental bureaucrats with too much power over the lives of others.
And this is all this book stands for: if the said monster bureaucrats can't control nature, at least they can rule your life and decide, like with Covid, who lives and who dies.
Or short: how to use the WHO technology to make the United States of North Korea.
October 20, 2021
Gottlieb spends a lot of time criticizing the CDC (CDC has been the world standard for an organization of this kind) and makes the twice impeached loser criminal seem almost normal. In fact, he never acknowledges the ex-presidents responsibility for the near complete failure in his administrations response to the pandemic. This might be interesting for readers in government or the medical fields. I DO NOT RECOMMEND this book for general readers.
December 28, 2021
Truly one of the best, most interesting books I’ve read this year. Dr. Gottlieb has been my go-to for pandemic information since February 2020, and here he provides a history that is wholly apolitical of what went wrong and why it went that way. An incredibly detailed account of why our federal bureaucracies weren’t prepared for a coronavirus pandemic, Dr. Gottlieb goes through each major issue in the pandemic (testing, non-pharmaceutical interventions, therapeutics, and vaccines) and discusses why they were implemented so poorly and what needs to change to improve our response to the next pandemic. If you’re looking for a simplistic, political book on covid or its solutions, this isn’t it. The spoiler alert here is that regardless of who was in charge of government, our bureaucracies weren’t designed to handle the responsibilities placed upon them. Am utterly fascinating and frustrating read.
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December 8, 2024Skimmed because not much new to learn here now (2024). Does seem like pretty evenhanded summary of standard information, considering the source. I'm not so sure that more spying is the top priority for preventing the next disastrous pandemic.
October 28, 2021
If you were, like many of the book's presumed audience, working from home and hyper-online during the 2020 pandemic, you can skip this. While it's straightforward and interesting, it could use a solid edit (and less self-congratulatory prose on being apolitical, and, therefore, "objective"). If you're the exceptional human who protected their mental health by not constantly refreshing the NYT (or your news media drug of choice) for updates on the pandemic's origins, spread, historical context, and management missteps, this is a decent summary of the past two years, if not the most engaging choice.
April 9, 2024
This is the most comprehensive book about Covid yet and reveals a lot of the details about how poorly the US managed this pandemic.
I really enjoyed the science in this book and wish that many of the conservatives who are anti vax and anti-mask could read how a conservative scientist sees these topics.
I really enjoyed the science in this book and wish that many of the conservatives who are anti vax and anti-mask could read how a conservative scientist sees these topics.
March 25, 2022
I really enjoyed this book.
One of the better books on COVID that I have read lately.
I especially liked the way this book described the politics and tactics behind COVID, be it on the side of China, or the WHO or CDC. It was an interesting read.
4.8/5
One of the better books on COVID that I have read lately.
I especially liked the way this book described the politics and tactics behind COVID, be it on the side of China, or the WHO or CDC. It was an interesting read.
4.8/5
December 1, 2021
Dr. Scott Gottlieb is a hero and his book is absolutely brilliant. We owe him huge debt, not only for his countless insights throughout the pandemic, but as perhaps the only person who could have written this book, given his public health expertise, his nuanced understanding of the inner workings of federal public health agencies and political processes, his access to decision-makers at every level, and his candor. The book has lots of clear explanations of scientific topics (he explains a “cytokine storm” and why monoclonal antibodies are most useful for immunocompromised patients, which I found fascinating), but Gottlieb’s greatest service involves diagnosing the government’s long series of compounding failures, walking through the miraculous advances in science that are saving lives, and suggesting how to fix the problems and design systems that will prepare us better for next time.
There are lots of reasons for the pandemic. It starts with China’s coverup, which Gottlieb details and which reminded me of HBO’s portrayal of Chernobyl, where warped incentives within the government motivated officials to hide the truth and punish those who were raising concerns.
Gottlieb rightly spends more time on our missed opportunities. Those mistakes start with U.S. pandemic plans that presumed influenza was the most likely threat and didn’t consider how we would respond differently to a coronavirus, despite our brushes with MERS and SARS. Better planning would have prepared us to respond to a wide range of potential viruses with systems and platforms that could be customized quickly. Among other things, better planning might have led us to recognize that testing would play a much bigger role in combatting a coronavirus than influenza because of the longer incubation period and wider set of symptoms.
The U.S. testing debacle is a major theme of the book. Everyone paying attention by now realizes the CDC blew it with testing, but the depth and reasons for their failure are much worse and more inexcusable than what I realized. As an organization, the CDC was riddled with nearly every imaginable strategic and organizational behavioral defect. CDC’s leadership was parochial, lacked accountability, succumbed to group think, allowed one of their fundamental missions to atrophy, refused to change course or ask for help, displayed certainty that was totally unjustified, communicated poorly, and got outside their lane. Not all of this is their fault—successive Congresses and Presidential Administrations, and HHS leadership themselves, should have asked better questions and realized that CDC was unequipped to play the role they were given, but that doesn’t absolve them of their abysmal failure over the past two years.
Gottlieb explains in great detail the culture at the CDC that led them to insist on a more complicated test than was necessary and then to botch even that test with careless procedures that contaminated thousands of test kits that were then shipped to labs across the country. But this is really just the tip of the iceberg. From the beginning, CDC didn’t enlist the help of commercial labs and wouldn’t let academic labs do any testing. In January of 2020 a brilliant team at the University of Washington was desperate and fully prepared to do lots of testing, including testing thousands of samples they had taken for an unrelated flu study that could have yielded early clues on COVID spread, but CDC dithered and said no. Eventually CDC let them do some limited testing for research purposes but not for diagnosing patients. The same dithering characterized CDC’s actions for critical months in late 2019 and early 2020. The CDC wouldn’t share its samples or methodology with anyone, they dickered over patent issues instead of considering the fastest way to scale up mass testing with all available academic, commercial, and independent labs. It was gross negligence and a complete failure of leadership, especially at CDC but also at HHS.
It’s hard to overstate how devastating the testing failures were and the series of further disasters that came as a result of the testing mistakes. The following are a few of the cascading impacts Gottlieb outlines:
1) Because we lacked testing, the government took far too long to conclude there was asymptomatic spread occurring through aerosols, and as a result they incorrectly concluded lots of people were getting sick from touching contaminated surfaces. That meant we overemphasized and overinvested in cleaning surfaces, hand sanitizer, etc. and under emphasized the importance of masks, better ventilation and other measures that make a difference on the aerosols through which COVID actually spreads.
2) Perhaps more importantly, because we lacked testing the government relied on syndromic data streams they had access to, which were based on flu models and simply weren’t effective for identifying COVID spread. Even into February 2020 the CDC and other federal authorities were still desperately clinging to these inadequate data streams and they continued assuring us that there were only a small handful of COVID cases. Subsequent sequencing has shown that at the beginning of March 2020, when there were only 75 known cases nationwide, there were in fact around 28,000 cases in the U.S. As Gottlieb writes, “we were more situationally blind than we assumed.” This failure to tell the public the truth about their uncertainty only compounded the testing failures and cost the administration and public health authorities enormous credibility.
3) Because we were blind to how much actual spread there was in early 2020 in a given area, most states took more drastic measures than was necessary at the time. In most states there was no need in March 2020 to ask people to stay at home, but because we were totally blind (because there were no tests), we had no way to know that large scale community transmission was limited to major cities, mostly on the coasts. With adequate testing, we could have focused our efforts and used contact tracing effectively (as South Korea did). As a result of deploying those harsh population wide mitigation measures too early, we lost the public’s willingness to make those sacrifices later, when they actually would have helped.
4) With very few tests, the CDC narrowed the criteria for who should be tested, so that criteria was not based on who should actually be tested but rather to prevent demand from exceeding testing supply. That meant that we obviously missed lots of cases that we could have otherwise identified and isolated. And although Gottlieb doesn’t mention this, a consequence of that flaw we saw in Utah was that as testing capacity increased we had to work really hard to convince test providers to broaden eligibility for getting tested. It took months for us to get to the point where anyone with any symptom could get tested, and of course even more time before we were testing lots of asymptomatic people.
Gottlieb contrasts our testing failures with South Korea, which managed to have an overwhelming degree of testing in the early weeks of the pandemic. It took the U.S. four months to reach the equivalent amount of testing per capita that South Korea was doing at the beginning of its outbreak.
And besides all testing problems, the CDC lacked candor about what it knew and didn’t know, and how it was developing recommendations. The CDC never really explained how it arrived at the 6-ft distancing recommendation. They never even said, “it’s somewhat arbitrary, but it’s the best we’ve got”, which would have been better than leaving everyone to wonder.
In explaining why CDC was so unprepared, Gottlieb details how the CDC, over time, came to focus more on their mission to prevent chronic disease than their mission to envision, prevent, and respond to catastrophic scenarios like pandemics. As he describes it, the CDC has become a “high science organization” that is very retrospective in nature, wanting to be the final voice on questions of science rather than a national security oriented organization that was focused on intelligence gathering and operational capacity, prepared to coordinate and lead the nation in preventing or responding to a pandemic.
“In a crisis, we often don’t have time to wait for deep analysis. We’re forced to make the most effective decisions we can on the best information we have available at the moment. In a moment of public health crisis, that information is always going to turn on some complement of raw data and conjecture. However the CDC isn’t in the business of providing this kind of real-time, actionable, but often notional information. It’s counter to the agency’s culture.”
This rang true. In Utah’s response we relied heavily on a spectrum of experts (often Gottlieb himself), who were publishing data and offering recommendations far faster than the CDC. We would often get recommendations from the Administration and CDC several weeks or even many months after we’d had to make the decisions that could have been aided by that data or information.
In short, we have an agency whose name, “The Centers for Disease Control and Prevention” led everyone to believe they were equipped to lead us responding to a pandemic but which in reality didn’t (and still largely doesn’t) have the culture, vision, and operational capability to do so and whose poor planning and lack of candid communication exacerbated the problem. It took HHS and the Trump White House a long time to figure that out, and when they did, their efforts to fix CDC’s inadequacies on the fly were often interpreted as trying to sideline the public health experts.
Gottlieb doesn’t reserve his criticism for only the CDC. He is quite candid about the failures of President Trump and his role in fostering misinformation and division and in pressuring public health leaders in ways that were counterproductive. He suggests the FDA could have authorized the Pfizer and Moderna vaccines earlier for use in long term care facilities but “the political pressure by the White House to hasten vaccine approval may have had the opposite effect on its commissioner, instigating a series of actions that ultimately might have delayed those products from reaching patients sooner.” (pg. 301)
Gottlieb also offers a useful take on the controversy over hydroxychloroquine and the series of missteps by the President and agency leaders that prolonged the misinformation. In short, “a false perception of the drug’s benefits was able to fester because we didn’t firmly settle these questions early, through the conduct of good studies. . . We failed to produce an early and conclusive study to frame accurately its risks and benefits and put some of the original speculations to rest. When that firm evidence finally arrived, the perceptions were already deeply embedded, and the data didn’t break through.” (pg. 295)
The book details our supply chain problems and shortages of PPP and other critical materials. He even briefly mentions Utah’s public health lab where our scientists were trying to do lots of sequencing in the spring of 2020 but continued running out of key specimen collection materials.
The problems go on and on, but Gottlieb does offer concrete and realistic suggestions for fixing the failures across government. Several of the suggestions that stood out to me:
1) As a government we should be willing to pay key industries to build excess capacity into their systems, whether commercial labs, swab manufacturers, or key pharmaceutical products, so that the companies are not utilizing their full capacity on a regular basis but can ramp up if necessary in a crisis. Right now these industries are understandably focused on operating facilities for maximum efficiency, but we need to have excess capacity to use in an emergency.
2) The CDC needs to standardize in advance the terms that would be used with commercial test manufacturers if they were asked to help ramp up testing, so that the handoff of viral samples, intellectual property, etc. happens quickly and smoothly in a crisis.
3) Because “it’s too hard to guess where the next threat is going to come from” we should develop “core capabilities that can allow us to quickly fashion countermeasures against a broad selection of potential threats and then manufacture drugs and vaccines in the quantities required to protect us.” The advent of the mRNA vaccines is a huge piece of this because they don’t require the log lead time that traditional vaccines have.
4) We need something like the Defense Production Act for clinical trials, something that would allow the FDA to “be traffic cops on clinical trial enrollment in the setting of a public health crisis”, prioritizing “the conduct and completion of certain trials over others, or to steer enrollment toward higher-value studies.”
5) We need to develop a national security mindset when it comes to pandemic preparedness—”we need to leverage our intelligence assets—as much for advancing our public health goals as for guarding against adversaries who would try to exploit the chaos to weaken our response.” (pg. 346) Gottlieb points out again that the CDC’s retrospective mindset is a weakness. We need intelligence gathering tools that allow us to scan the horizon and look for new threats AND to be less dependent on the goodwill of other nations in disclosing troubling news. One specific idea he offers is an “epidemiological equivalent of the National Weather Service . . . tasked with developing sophisticated disease modeling to help guide public health policy” and “rebuild the nation’s data infrastructure for pandemic monitoring and preparedness” (pg. 248). He also suggests plugging more health reporting into intelligence assessments like the CIA’s World Intelligence Review so that policymakers are regularly keeping up on public health threats the same way they do other threats.
6) Along the same lines, Gottlieb suggests the development of a Joint Special Operations Command for biothreats that would coordinate the various public health roles currently spread across CDC, NIH, USAID, DARPA, and other agencies. “In many respects, our lack of preparedness for a threat like COVID is not a lack of technology to deal with these threats, it’s the absence of policy coordination and an integrated approach between the different components that had relevant capabilities and expertise to inform and advance our response.”
7) Woven throughout the book is the theme that the federal government needs to have an agency that is responsible for pandemic preparedness and response. Gottlieb says this could be built into CDC or it could be another agency, but someone needs to be accountable and responsible.
Gottlieb offers a startling point about why we should develop a national security mindset around pandemic preparedness: “It was once thought that a terrorist or nation-state would be unlikely to weaponize a pathogen that could easily blow back on them. COVID may have changed some of that calculus . . . . Terrorists along with more traditional nation-state adversaries may now see that respiratory pathogens are a poor man’s nuclear weapon. Viruses are far more accessible than enriched uranium, and easier to engineer—but still capable of unleashing mass destruction.” (pg. 379).
I think my favorite part of the book is the chapter titled “mRNA Breakthrough”. It’s hard to appreciate just how remarkable the mRNA vaccines are—what a miracle of human ingenuity, vision, great management, operational foresight, and logistical mastery the Pfizer and Moderna vaccines represent. I loved the description of the board meeting when Pfizer scientists announced that the vaccine was an astounding 90+% effective.
“It was an emotional call. We had confidence that the vaccine was going to be effective, but I don’t think any of us expected it to be this successful at preventing COVID. Albert shared a video with us, recording the moment when the results were first reported to the management team by Dr. Kathrin Jansen and Dr. Bill Gruber, Pfizer’s senior vice president of vaccine clinical research and development. Everyone in the room stood up and screamed in joy. It was clear at that moment that the world had changed.”
Gottlieb also spends some time talking about genetic sequencing and genetic epidemiology, another emerging scientific miracle which gives us a tool for “evaluating the evolution of an epidemic and uncovering how a virus spreads across a population.”
Finally, scattered throughout the book are a number of important points about the nature of information in a crisis and the importance of candor in preserving the government’s credibility, a theme that struck me about both Gottlieb’s book and John Barry’s “The Great Influenza”, which I read last year at the beginning of the pandemic. As just one sample:
“In a public health crisis, eventually, you’ll need to ask the public to do hard things, and the public will have to trust the integrity of your appeals. You cannot advance policies or appeal for collective action if the public isn’t on board. Once you pursue a policy, and get met with public rejection, or noncompliance, your capacity to implement future actions is eroded. If the public refuses to follow guidance in a public health crisis, if there’s widespread opposition or protest, it becomes difficult or even impossible to advance additional measures, to take strong actions. This is what happened with COVID. The federal government lost trust and credibility early, by its inability to accurately convey the true scope of the hazard. The lack of reliable information on COVID’s spread, and the inability of people to access testing, degraded the integrity of the response."
Gottlieb has acknowledged that he deliberately focused less on President Trump’s failures of leadership, not because he’s ignoring those failures but because he believed the value in his book would be in shedding light on failures within federal agencies that could be addressed. I think that was a wise choice and it certainly helped shift my paradigm. I have plenty of strong feelings on failures of political leadership and I remain deeply disappointed in our society’s inability to rally together and fight a common enemy, but I now put much more blame than I did previously on the failures of public health leaders at CDC and elsewhere. The good news is that we now understand those government failures and I think Gottlieb offers a powerful guide for fixing those problems if decision-makers will heed his counsel.
There are lots of reasons for the pandemic. It starts with China’s coverup, which Gottlieb details and which reminded me of HBO’s portrayal of Chernobyl, where warped incentives within the government motivated officials to hide the truth and punish those who were raising concerns.
Gottlieb rightly spends more time on our missed opportunities. Those mistakes start with U.S. pandemic plans that presumed influenza was the most likely threat and didn’t consider how we would respond differently to a coronavirus, despite our brushes with MERS and SARS. Better planning would have prepared us to respond to a wide range of potential viruses with systems and platforms that could be customized quickly. Among other things, better planning might have led us to recognize that testing would play a much bigger role in combatting a coronavirus than influenza because of the longer incubation period and wider set of symptoms.
The U.S. testing debacle is a major theme of the book. Everyone paying attention by now realizes the CDC blew it with testing, but the depth and reasons for their failure are much worse and more inexcusable than what I realized. As an organization, the CDC was riddled with nearly every imaginable strategic and organizational behavioral defect. CDC’s leadership was parochial, lacked accountability, succumbed to group think, allowed one of their fundamental missions to atrophy, refused to change course or ask for help, displayed certainty that was totally unjustified, communicated poorly, and got outside their lane. Not all of this is their fault—successive Congresses and Presidential Administrations, and HHS leadership themselves, should have asked better questions and realized that CDC was unequipped to play the role they were given, but that doesn’t absolve them of their abysmal failure over the past two years.
Gottlieb explains in great detail the culture at the CDC that led them to insist on a more complicated test than was necessary and then to botch even that test with careless procedures that contaminated thousands of test kits that were then shipped to labs across the country. But this is really just the tip of the iceberg. From the beginning, CDC didn’t enlist the help of commercial labs and wouldn’t let academic labs do any testing. In January of 2020 a brilliant team at the University of Washington was desperate and fully prepared to do lots of testing, including testing thousands of samples they had taken for an unrelated flu study that could have yielded early clues on COVID spread, but CDC dithered and said no. Eventually CDC let them do some limited testing for research purposes but not for diagnosing patients. The same dithering characterized CDC’s actions for critical months in late 2019 and early 2020. The CDC wouldn’t share its samples or methodology with anyone, they dickered over patent issues instead of considering the fastest way to scale up mass testing with all available academic, commercial, and independent labs. It was gross negligence and a complete failure of leadership, especially at CDC but also at HHS.
It’s hard to overstate how devastating the testing failures were and the series of further disasters that came as a result of the testing mistakes. The following are a few of the cascading impacts Gottlieb outlines:
1) Because we lacked testing, the government took far too long to conclude there was asymptomatic spread occurring through aerosols, and as a result they incorrectly concluded lots of people were getting sick from touching contaminated surfaces. That meant we overemphasized and overinvested in cleaning surfaces, hand sanitizer, etc. and under emphasized the importance of masks, better ventilation and other measures that make a difference on the aerosols through which COVID actually spreads.
2) Perhaps more importantly, because we lacked testing the government relied on syndromic data streams they had access to, which were based on flu models and simply weren’t effective for identifying COVID spread. Even into February 2020 the CDC and other federal authorities were still desperately clinging to these inadequate data streams and they continued assuring us that there were only a small handful of COVID cases. Subsequent sequencing has shown that at the beginning of March 2020, when there were only 75 known cases nationwide, there were in fact around 28,000 cases in the U.S. As Gottlieb writes, “we were more situationally blind than we assumed.” This failure to tell the public the truth about their uncertainty only compounded the testing failures and cost the administration and public health authorities enormous credibility.
3) Because we were blind to how much actual spread there was in early 2020 in a given area, most states took more drastic measures than was necessary at the time. In most states there was no need in March 2020 to ask people to stay at home, but because we were totally blind (because there were no tests), we had no way to know that large scale community transmission was limited to major cities, mostly on the coasts. With adequate testing, we could have focused our efforts and used contact tracing effectively (as South Korea did). As a result of deploying those harsh population wide mitigation measures too early, we lost the public’s willingness to make those sacrifices later, when they actually would have helped.
4) With very few tests, the CDC narrowed the criteria for who should be tested, so that criteria was not based on who should actually be tested but rather to prevent demand from exceeding testing supply. That meant that we obviously missed lots of cases that we could have otherwise identified and isolated. And although Gottlieb doesn’t mention this, a consequence of that flaw we saw in Utah was that as testing capacity increased we had to work really hard to convince test providers to broaden eligibility for getting tested. It took months for us to get to the point where anyone with any symptom could get tested, and of course even more time before we were testing lots of asymptomatic people.
Gottlieb contrasts our testing failures with South Korea, which managed to have an overwhelming degree of testing in the early weeks of the pandemic. It took the U.S. four months to reach the equivalent amount of testing per capita that South Korea was doing at the beginning of its outbreak.
And besides all testing problems, the CDC lacked candor about what it knew and didn’t know, and how it was developing recommendations. The CDC never really explained how it arrived at the 6-ft distancing recommendation. They never even said, “it’s somewhat arbitrary, but it’s the best we’ve got”, which would have been better than leaving everyone to wonder.
In explaining why CDC was so unprepared, Gottlieb details how the CDC, over time, came to focus more on their mission to prevent chronic disease than their mission to envision, prevent, and respond to catastrophic scenarios like pandemics. As he describes it, the CDC has become a “high science organization” that is very retrospective in nature, wanting to be the final voice on questions of science rather than a national security oriented organization that was focused on intelligence gathering and operational capacity, prepared to coordinate and lead the nation in preventing or responding to a pandemic.
“In a crisis, we often don’t have time to wait for deep analysis. We’re forced to make the most effective decisions we can on the best information we have available at the moment. In a moment of public health crisis, that information is always going to turn on some complement of raw data and conjecture. However the CDC isn’t in the business of providing this kind of real-time, actionable, but often notional information. It’s counter to the agency’s culture.”
This rang true. In Utah’s response we relied heavily on a spectrum of experts (often Gottlieb himself), who were publishing data and offering recommendations far faster than the CDC. We would often get recommendations from the Administration and CDC several weeks or even many months after we’d had to make the decisions that could have been aided by that data or information.
In short, we have an agency whose name, “The Centers for Disease Control and Prevention” led everyone to believe they were equipped to lead us responding to a pandemic but which in reality didn’t (and still largely doesn’t) have the culture, vision, and operational capability to do so and whose poor planning and lack of candid communication exacerbated the problem. It took HHS and the Trump White House a long time to figure that out, and when they did, their efforts to fix CDC’s inadequacies on the fly were often interpreted as trying to sideline the public health experts.
Gottlieb doesn’t reserve his criticism for only the CDC. He is quite candid about the failures of President Trump and his role in fostering misinformation and division and in pressuring public health leaders in ways that were counterproductive. He suggests the FDA could have authorized the Pfizer and Moderna vaccines earlier for use in long term care facilities but “the political pressure by the White House to hasten vaccine approval may have had the opposite effect on its commissioner, instigating a series of actions that ultimately might have delayed those products from reaching patients sooner.” (pg. 301)
Gottlieb also offers a useful take on the controversy over hydroxychloroquine and the series of missteps by the President and agency leaders that prolonged the misinformation. In short, “a false perception of the drug’s benefits was able to fester because we didn’t firmly settle these questions early, through the conduct of good studies. . . We failed to produce an early and conclusive study to frame accurately its risks and benefits and put some of the original speculations to rest. When that firm evidence finally arrived, the perceptions were already deeply embedded, and the data didn’t break through.” (pg. 295)
The book details our supply chain problems and shortages of PPP and other critical materials. He even briefly mentions Utah’s public health lab where our scientists were trying to do lots of sequencing in the spring of 2020 but continued running out of key specimen collection materials.
The problems go on and on, but Gottlieb does offer concrete and realistic suggestions for fixing the failures across government. Several of the suggestions that stood out to me:
1) As a government we should be willing to pay key industries to build excess capacity into their systems, whether commercial labs, swab manufacturers, or key pharmaceutical products, so that the companies are not utilizing their full capacity on a regular basis but can ramp up if necessary in a crisis. Right now these industries are understandably focused on operating facilities for maximum efficiency, but we need to have excess capacity to use in an emergency.
2) The CDC needs to standardize in advance the terms that would be used with commercial test manufacturers if they were asked to help ramp up testing, so that the handoff of viral samples, intellectual property, etc. happens quickly and smoothly in a crisis.
3) Because “it’s too hard to guess where the next threat is going to come from” we should develop “core capabilities that can allow us to quickly fashion countermeasures against a broad selection of potential threats and then manufacture drugs and vaccines in the quantities required to protect us.” The advent of the mRNA vaccines is a huge piece of this because they don’t require the log lead time that traditional vaccines have.
4) We need something like the Defense Production Act for clinical trials, something that would allow the FDA to “be traffic cops on clinical trial enrollment in the setting of a public health crisis”, prioritizing “the conduct and completion of certain trials over others, or to steer enrollment toward higher-value studies.”
5) We need to develop a national security mindset when it comes to pandemic preparedness—”we need to leverage our intelligence assets—as much for advancing our public health goals as for guarding against adversaries who would try to exploit the chaos to weaken our response.” (pg. 346) Gottlieb points out again that the CDC’s retrospective mindset is a weakness. We need intelligence gathering tools that allow us to scan the horizon and look for new threats AND to be less dependent on the goodwill of other nations in disclosing troubling news. One specific idea he offers is an “epidemiological equivalent of the National Weather Service . . . tasked with developing sophisticated disease modeling to help guide public health policy” and “rebuild the nation’s data infrastructure for pandemic monitoring and preparedness” (pg. 248). He also suggests plugging more health reporting into intelligence assessments like the CIA’s World Intelligence Review so that policymakers are regularly keeping up on public health threats the same way they do other threats.
6) Along the same lines, Gottlieb suggests the development of a Joint Special Operations Command for biothreats that would coordinate the various public health roles currently spread across CDC, NIH, USAID, DARPA, and other agencies. “In many respects, our lack of preparedness for a threat like COVID is not a lack of technology to deal with these threats, it’s the absence of policy coordination and an integrated approach between the different components that had relevant capabilities and expertise to inform and advance our response.”
7) Woven throughout the book is the theme that the federal government needs to have an agency that is responsible for pandemic preparedness and response. Gottlieb says this could be built into CDC or it could be another agency, but someone needs to be accountable and responsible.
Gottlieb offers a startling point about why we should develop a national security mindset around pandemic preparedness: “It was once thought that a terrorist or nation-state would be unlikely to weaponize a pathogen that could easily blow back on them. COVID may have changed some of that calculus . . . . Terrorists along with more traditional nation-state adversaries may now see that respiratory pathogens are a poor man’s nuclear weapon. Viruses are far more accessible than enriched uranium, and easier to engineer—but still capable of unleashing mass destruction.” (pg. 379).
I think my favorite part of the book is the chapter titled “mRNA Breakthrough”. It’s hard to appreciate just how remarkable the mRNA vaccines are—what a miracle of human ingenuity, vision, great management, operational foresight, and logistical mastery the Pfizer and Moderna vaccines represent. I loved the description of the board meeting when Pfizer scientists announced that the vaccine was an astounding 90+% effective.
“It was an emotional call. We had confidence that the vaccine was going to be effective, but I don’t think any of us expected it to be this successful at preventing COVID. Albert shared a video with us, recording the moment when the results were first reported to the management team by Dr. Kathrin Jansen and Dr. Bill Gruber, Pfizer’s senior vice president of vaccine clinical research and development. Everyone in the room stood up and screamed in joy. It was clear at that moment that the world had changed.”
Gottlieb also spends some time talking about genetic sequencing and genetic epidemiology, another emerging scientific miracle which gives us a tool for “evaluating the evolution of an epidemic and uncovering how a virus spreads across a population.”
Finally, scattered throughout the book are a number of important points about the nature of information in a crisis and the importance of candor in preserving the government’s credibility, a theme that struck me about both Gottlieb’s book and John Barry’s “The Great Influenza”, which I read last year at the beginning of the pandemic. As just one sample:
“In a public health crisis, eventually, you’ll need to ask the public to do hard things, and the public will have to trust the integrity of your appeals. You cannot advance policies or appeal for collective action if the public isn’t on board. Once you pursue a policy, and get met with public rejection, or noncompliance, your capacity to implement future actions is eroded. If the public refuses to follow guidance in a public health crisis, if there’s widespread opposition or protest, it becomes difficult or even impossible to advance additional measures, to take strong actions. This is what happened with COVID. The federal government lost trust and credibility early, by its inability to accurately convey the true scope of the hazard. The lack of reliable information on COVID’s spread, and the inability of people to access testing, degraded the integrity of the response."
Gottlieb has acknowledged that he deliberately focused less on President Trump’s failures of leadership, not because he’s ignoring those failures but because he believed the value in his book would be in shedding light on failures within federal agencies that could be addressed. I think that was a wise choice and it certainly helped shift my paradigm. I have plenty of strong feelings on failures of political leadership and I remain deeply disappointed in our society’s inability to rally together and fight a common enemy, but I now put much more blame than I did previously on the failures of public health leaders at CDC and elsewhere. The good news is that we now understand those government failures and I think Gottlieb offers a powerful guide for fixing those problems if decision-makers will heed his counsel.
November 10, 2021
Lots of great info here, from a semi-inside view. I really like how he focuses on the programmatic, bureaucratic, and policy issues, without majoring on the political noise we’ve all seen so much of. Now he’s NOT shy about criticizing Trump and others when they’re in for it. However, those issues were NOT the biggest thing messing up our response, and we’ve all heard a ton about that already.
I don’t agree with all his ideas for change, but the information is very helpful.
I don’t agree with all his ideas for change, but the information is very helpful.
December 27, 2021
When I read the book "Premonition" by Michael Lewis, we learned a lot about the CDC's handling of the COVID-19 pandemic from an outsider's perspective. In "Uncontrolled Spread" we learn a lot about the CDC's handling of the pandemic from an insider's perspective. Bottom line, the CDC is not set up to handle a national health emergency and we need another organization in the National Security Agency to plan and execute a national strategy to ensure our national security in the event of a health threat.
There is an incredible amount of information in this book, which can make for dry reading at times. The author covers past pandemics and what went right/wrong. He also covers government action in the face of such pandemics, going back to the Clinton era's response to HIV/AIDS. The sad part is how our interest and funding dries up once the crisis is past, setting us up for failure when the next one hits.
I gave this book 4 stars, not 5, as it seems repetitive in many places. Continual bashing of the CDC and its policies, for example. Also, it goes into a lot of technical depth that can lose the audience. I think the text in these parts of the book should have been simplified for the general reading public and the technical details put into an appendix.
Highly recommended.
There is an incredible amount of information in this book, which can make for dry reading at times. The author covers past pandemics and what went right/wrong. He also covers government action in the face of such pandemics, going back to the Clinton era's response to HIV/AIDS. The sad part is how our interest and funding dries up once the crisis is past, setting us up for failure when the next one hits.
I gave this book 4 stars, not 5, as it seems repetitive in many places. Continual bashing of the CDC and its policies, for example. Also, it goes into a lot of technical depth that can lose the audience. I think the text in these parts of the book should have been simplified for the general reading public and the technical details put into an appendix.
Highly recommended.
May 26, 2022
Scott Gottlieb discusses the United States’ response to the COVID-19 pandemic. He talks about what we did wrong and how we can improve our response to the next major plague.
I thought the book was okay. I could not get into it at all. I suppose it's because we are still living with COVID-19, and it comes across as too real for me. Thanks for reading my review, and see you next time.
I thought the book was okay. I could not get into it at all. I suppose it's because we are still living with COVID-19, and it comes across as too real for me. Thanks for reading my review, and see you next time.
October 25, 2021
Best book to date on Covid response in the US. What we did wrong , what worked well,such as vaccine development, and what we could do better in the future.
Easy to read and comprehend.
Easy to read and comprehend.
February 1, 2022
Really important information here. Anyone who wants to understand the "perfect sh*& storm" that underpinned the pandemic needs to read this one. Forget that Gottlieb is Republican, that he was an advisor to Trump and Trump's appointee as FDA Commissioner (if this dyed in the wool Democrat can set that aside, believe me so can anyone). Gottlieb details each element of what was ostensibly the pandemic preparedness plan pre-Covid19 and how and why it failed. Using this analysis, he then very clearly, if not necessarily succinctly (he tends to repeat a lot of his points multiple times), details what that plan should actually encompass in the future, and most importantly, why each element of the plan is necessary. None of it is an easy ask-- it would require a lot of current federal government agency players to give up some of their turf-- but it needs to be done. One weakness with his analysis, however, is the downplaying of the role of the misinformation campaigns and the persistent mistrust of science and government health experts that resulted from them. He lauds Trump for the success of Project Warp Speed, which is fine, but he fails to point out that the false narratives that Trump and Fox News, et al. promoted in vain for political gain completely negated the success of the swift development of the vaccines. The very people that Trump encouraged to mistrust science and government are, in large part, the same ones who refused to get vaccinated. Instead of vaccinating our way out of the pandemic, we are now two years into it with no end in sight. If Gottlieb's vision for pandemic preparedness is to come to fruition, the politics has to be removed from the process. Given our current divide, it's hard to imagine this happening.
February 11, 2022
I didn't quite understand how much I needed a step-by-step tik-tok of how Covid hit and how various executive agencies responded, but I did, and this does a remarkably good job at providing that service. The obvious question to ask is whether Gottlieb is trustworthy: he used to run FDA, and that agency definitely gets off easily compared to others, especially the CDC (it's hard to finish the book without getting the sense that the CDC should simply be dissolved and replaced with a new organization staffed by entirely different people).
But if you read with that slant (conscious or unconscious) in mind, it's very informative and is an incredibly useful synthesis of two years' worth of story/scoop barrages.
But if you read with that slant (conscious or unconscious) in mind, it's very informative and is an incredibly useful synthesis of two years' worth of story/scoop barrages.
December 16, 2021
This is necessary reading for anyone who wants to understand the frustrating CovID-19 response in the US, where (in limited circumstances) we did succeed, and what we need to do to avoid another pandemic. Gottlieb is ideally situated to explain a lot of this since he was FDA commissioner for part of Trump's term, although notably had departed prior to the start of the pandemic.
What becomes clear from this book - and matches what I've read elsewhere - is that the CDC and FDA were never set-up to handle a pandemic like this. While more funding from the Trump administration would've helped, there were greater institutional problems that standing in the way that had nothing to do with funding. I do think that Gottlieb goes slightly easy on the FDA and I'd take that with a grain of salt, but he is sharply critical of them too.
What do we need to do better? A few things - first is building out domestic capacity for production of of all supplies we'd need in a pandemic (PPE, test manufacturing, drug supplies & manufacturing) and paying to keep them operational. Second, is we need to a national security apparatus that is tracking disease abroad - it's good to have strong global institutions, but countries like China have repeatedly shown that they will withhold information as long as possible. Lastly, we need government institutions in the US that can become more flexible and fast-moving as crises evolve.
Sadly, I finished this just as Omicron is about to take over in the US and we still don't have approval/distribution of key drugs, no widespread available free testing, and almost no sequencing to track the spread of variants. Two years in and we're still making the same errors...
What becomes clear from this book - and matches what I've read elsewhere - is that the CDC and FDA were never set-up to handle a pandemic like this. While more funding from the Trump administration would've helped, there were greater institutional problems that standing in the way that had nothing to do with funding. I do think that Gottlieb goes slightly easy on the FDA and I'd take that with a grain of salt, but he is sharply critical of them too.
What do we need to do better? A few things - first is building out domestic capacity for production of of all supplies we'd need in a pandemic (PPE, test manufacturing, drug supplies & manufacturing) and paying to keep them operational. Second, is we need to a national security apparatus that is tracking disease abroad - it's good to have strong global institutions, but countries like China have repeatedly shown that they will withhold information as long as possible. Lastly, we need government institutions in the US that can become more flexible and fast-moving as crises evolve.
Sadly, I finished this just as Omicron is about to take over in the US and we still don't have approval/distribution of key drugs, no widespread available free testing, and almost no sequencing to track the spread of variants. Two years in and we're still making the same errors...
September 27, 2022
I wasn’t sure if I was up to reading this book, or if it was too soon after being on our state’s response team to Covid that it might give me PTSD. Instead it helped me process why we were so frustrated with the information coming from the CDC at the time and more understanding of the testing debacle. Ironically, I ended up reading this when I was home for the first time with Covid.
October 27, 2021
Hope we learn
Great analysis of what we did wrong and how we can do it better in the next pandemic. The author writes very dynamically.
Great analysis of what we did wrong and how we can do it better in the next pandemic. The author writes very dynamically.
March 20, 2025
Informative and well described, with insightful into the pressure of political policy on public health. Interesting ideas about future epidemiological preparedness. Some sense of a slight bias toward the premise that pharmaceutical companies are driven only by the desire to defend the health and wellness of humanity, and not to make a profit.
January 19, 2022
Very Informative and Even-Handed
I know you don’t want to read a book about COVID while we’re still in the midst of this pandemic; but, this is an important book. The author has been deeply involved in the American healthcare system and in planning for pandemics. He provides a former insider’s view. He points out things we did well and things we did very poorly. He strikes me as very fair. The best part of the book is that it’s forward looking - pointing out how we can do a much better job in the future.
Recommended
I know you don’t want to read a book about COVID while we’re still in the midst of this pandemic; but, this is an important book. The author has been deeply involved in the American healthcare system and in planning for pandemics. He provides a former insider’s view. He points out things we did well and things we did very poorly. He strikes me as very fair. The best part of the book is that it’s forward looking - pointing out how we can do a much better job in the future.
Recommended
April 5, 2024
FORMER FDA COMMISSIONER OFFERS REFLECTIONS ON HOW WE DEALT WITH COVID
Author Scott Gottlieb wrote in the Introduction to this 2021 book, “The U.S. never developed a pandemic strategy… This mismatch between the scenarios we drilled for and the reality that we faced left us unprepared. Poor execution turned it into a public health strategy. It was an alarming state of vulnerability for a country with the world’s most technologically advanced healthcare system… Yet COVID shouldn’t have been such a surprise. There had been earlier outbreaks of new and deadly strains of coronavirus…” (Pg. 4) He continues, “President Donald Trump and his advisers grew increasingly weary of the economic impact of the measures recommended by the public health authorities, and they were wrongly convinced that uncontrolled spread was inevitable regardless of what steps were taken… That doubt was reflected in public statements, and actions, that were contradictory and harmful… At the same time that many of the president’s top health officials were urging people to wear masks… the president stood on the balcony of … the White House and, in a theatrical gesture, took off his mask while he was still contagious with the virus.” (Pg. 9)
He explains, “To see how the outcome might have been different, we have to put aside the often-shallow politics of our present moment. This book will strive to do that. One of the reasons why I believe I was successful as FDA commissioner is that I avoided looking at things through a political lens… In this book, I examine the shortcomings that exposed America to the worst effects of the virus, and I try to draw some lessons on how we can make ourselves more resilient to similar threats… Reflecting on where our response fell short can provide a roadmap for how to be more effective when the next virus emerges.” (Pg. 11)
He summarizes, “Testing would be a major gap in our response and the most visible symptom of the capabilities that we lacked in confronting a public health crisis of this magnitude. We just didn’t have the resiliency … to quickly step up the production of test kits and testing equipment… Many publicly clung to a tragic view that SARS-CoV-2 wouldn’t become epidemic here. By March, when the evidence that it would spark a global pandemic could no longer be discounted, it was too late. That relative complacency was being fed by reliance on faulty information that had US officials believing that the virus wasn’t spreading here… It was being driven largely by a failure to field a test that would let us screen for it… with all of our advanced technology, our political and public health systems were overwhelmed.” (Pg. 24-25) Later, he adds, “But it’s important to remember that in December 2019 and for the first few weeks of January 2020, the Chinese government didn’t share vital information that could have mobilized an earlier response… We can no longer depend largely on global cooperation … and transparency of other nations.” (Pg. 46)
He observes that by March, ‘We had lost control. Without a widely available diagnostic test, we missed the chance to use … the ability to diagnose the sick, trace their contacts, and place people who had been exposed into quarantine---as a way to limit spread… The U.S. would now be dependent on mitigation … This approach relied on closing nonessential businesses, canceling school, and convincing people to stay at home.” (Pg. 70-71) He adds, “The federal government lost trust and credibility early, by its inability to accurately convey the true scope of the hazard. The lack of reliable information on COVID’s spread, and the inability of people to access testing, degraded the integrity of the response.” (Pg. 76)
He recounts, “On February 20, 2020, Secretary [of Health and Human Services Alex] Azar delivered to the White House leadership what he’d frame as the ‘doctrine’ that we’d follow for addressing COVID… The plan… would shift a lot of the responsibility to the states for taking steps to respond to COVID… By the beginning of March… without a single national strategy, cities and states began to go their own way. Governors were implementing local polities that were beginning to produce regional outcomes on what would be a national epidemic.” (Pg. 201)
By March, “The president seemed to agree on the need for stronger action… the president was sitting down for a series of taped interviews with Bob Woodward… Trump revealed his fears to Woodward and would face understandable criticism for … publicly downplaying the risks while privately he was worrying about the dangers… Trump told Woodward he was expressly downplaying the dangers to avoid creating a panic…” (Pg. 205)
He notes, “the six-foot distancing requirement was a primary reason many schools cited for why they couldn’t open for full-time classroom instruction… They didn’t have enough space to create that much distance between students. It was probably the single most costly intervention the CDC recommended … It was another reflection of how the CDC’s focus on flu as a model for COVID spread ended up being a costly misjudgment… Initially, in February 2020, the CDC had recommended eight to ten feet of distance… the CDC compromised with the White House and settled on six feet. But the CDC’s recommendation for six feet … would persist well past the scientific realization that aerosols might be responsible for a lot of the transmission, and that the requirement … would be less relevant for this mode of spread.” (Pg. 213-214)
In the summer of 2020, he wrote an op-ed for the Wall Street Journal recommending reopening the schools in the fall… President Trump tried to jawbone the schools into opening… The president took to Twitter to rebuke some governors for allowing schools to remain closed… The president was right to focus … on trying to get schools reopened… But the White House had failed to hone in on a root cause for why many districts remained shut. The CDC’s guidelines were the single greatest obstacle… It was a breakdown in policymaking.” (Pg. 226-227)
He reports, “President Trump … [was] emphasizing that the guidance [recommending wearing masks] was ‘voluntary’ and saying that he wouldn’t be wearing a mask himself, undercutting the message while unveiling it. The data showed that masks were not a panacea, but they could help reduce spread… it was unfortunately the president who did the most to turn face masks into a political flashpoint… The president could have found a middle ground on masks. His message could have been: We don’t need mandates…. However, we’re going to act responsibly and wear masks… Personal responsibility; not government control.” (Pg. 253)
He observes, “The controversy surrounding use of hydroxychloroquine to treat COVID would illustrate the risk of allowing critical scientific questions to linger, where the desire for a swift therapeutic solution and the need for public health rigor collided to produce some unfortunate challenges… I didn’t believe the president was being well advised on the drug and research evaluating its use in COVID… The president continued to promote the drug, and pressure to find other ways to broaden access to the medicine would continue among his staff and at HHS… [On] May 19, scientists at the FDA's drug center completed an analysis… [that] found that there had been nearly four hundred adverse health events linked to the medicine including eighty-seven deaths…more data showed that hydroxychloroquine was providing no benefit while introducing additional risks.” (Pg. 290-293)
After Trump came down with COVID, “the president’s condition would deteriorate, distressing his staff and his doctors… Regeneron had already told the White House that it would provide expanded access to its drug … Regeneron immediately shipped a package of doses to the White House… [Trump] had also received an infusion of the drug Remdesivir. However, his medical condition deteriorated over the course of the day, and … he was requiring supplemental oxygen.” (Pg. 305-306)
He explains, “With the mRNA approach, the idea is that you’d manufacture snippets of genomic material that code for these proteins rather than isolating the proteins themselves…. Then, once the mRNA is injected and gets taken up by our cells, its instruction set is read, and our cells start to churn out copious amounts of spike protein… You didn’t need access to the live virus to get started… By the fall, more than twenty-five COVID vaccines would be in development using mRNA as the starting point.” (Pg. 327)
He states, “The proximity of the Wuhan Institute of Virology to the site of the initial outbreak fueled early theories that the WIV could have been the point of origin… Many of these speculations sprung from the kind of high risk studies that was known to take place at the WIV… making it possible that the WIV was in possession of, and had worked with, novel coronavirus specimens that hadn’t been previously shared or disclosed.” (Pg. 355) He continues, “Former CDC director Robert Redfield would… say publicly that he believed SARA-CoV-2 resulted from gain-of-function research… it was speculated that Chinese researchers may have deliberately altered the virus as a way to study it, but then the virus accidentally escaped from the WIV and first started to spread…” (Pg. 359) But he adds later, ‘While COVID likely emerged from a natural origin, and if it was the product of a lab, its release was not a deliberate act, some adversaries … may be … thinking that they can weather an engineered respiratory pathogen better than America can.” (Pg. 379)
He summarizes, “The emergence of SARS-CoV-2 and the pandemic that it caused marked a historical turning point in many aspects of our society and culture, and the application of genomics was one visible crossroad. The scientific advances we achieved in combating COVID gave us one of our few bright spots in this tragic event… Among them was a turning point for how we must view our public health preparedness as a matter of national security… one hopes it will start a cycle of profound change for how we address them.” (Pg. 387-388)
He concludes, “Going forward… [this] means expanding our healthcare system’s capacity to deal with a crisis… There must be no repentances or recriminations if we overinvest in preparedness when a new pathogen emerges only to see the virus fizzle out rather than explode into the next pandemic. Finally, it means bringing back to the US more of the manufacturing of critical healthcare components and finished goods.” (Pg. 394)
This book may interest those studying our response to the COVID pandemic.
Author Scott Gottlieb wrote in the Introduction to this 2021 book, “The U.S. never developed a pandemic strategy… This mismatch between the scenarios we drilled for and the reality that we faced left us unprepared. Poor execution turned it into a public health strategy. It was an alarming state of vulnerability for a country with the world’s most technologically advanced healthcare system… Yet COVID shouldn’t have been such a surprise. There had been earlier outbreaks of new and deadly strains of coronavirus…” (Pg. 4) He continues, “President Donald Trump and his advisers grew increasingly weary of the economic impact of the measures recommended by the public health authorities, and they were wrongly convinced that uncontrolled spread was inevitable regardless of what steps were taken… That doubt was reflected in public statements, and actions, that were contradictory and harmful… At the same time that many of the president’s top health officials were urging people to wear masks… the president stood on the balcony of … the White House and, in a theatrical gesture, took off his mask while he was still contagious with the virus.” (Pg. 9)
He explains, “To see how the outcome might have been different, we have to put aside the often-shallow politics of our present moment. This book will strive to do that. One of the reasons why I believe I was successful as FDA commissioner is that I avoided looking at things through a political lens… In this book, I examine the shortcomings that exposed America to the worst effects of the virus, and I try to draw some lessons on how we can make ourselves more resilient to similar threats… Reflecting on where our response fell short can provide a roadmap for how to be more effective when the next virus emerges.” (Pg. 11)
He summarizes, “Testing would be a major gap in our response and the most visible symptom of the capabilities that we lacked in confronting a public health crisis of this magnitude. We just didn’t have the resiliency … to quickly step up the production of test kits and testing equipment… Many publicly clung to a tragic view that SARS-CoV-2 wouldn’t become epidemic here. By March, when the evidence that it would spark a global pandemic could no longer be discounted, it was too late. That relative complacency was being fed by reliance on faulty information that had US officials believing that the virus wasn’t spreading here… It was being driven largely by a failure to field a test that would let us screen for it… with all of our advanced technology, our political and public health systems were overwhelmed.” (Pg. 24-25) Later, he adds, “But it’s important to remember that in December 2019 and for the first few weeks of January 2020, the Chinese government didn’t share vital information that could have mobilized an earlier response… We can no longer depend largely on global cooperation … and transparency of other nations.” (Pg. 46)
He observes that by March, ‘We had lost control. Without a widely available diagnostic test, we missed the chance to use … the ability to diagnose the sick, trace their contacts, and place people who had been exposed into quarantine---as a way to limit spread… The U.S. would now be dependent on mitigation … This approach relied on closing nonessential businesses, canceling school, and convincing people to stay at home.” (Pg. 70-71) He adds, “The federal government lost trust and credibility early, by its inability to accurately convey the true scope of the hazard. The lack of reliable information on COVID’s spread, and the inability of people to access testing, degraded the integrity of the response.” (Pg. 76)
He recounts, “On February 20, 2020, Secretary [of Health and Human Services Alex] Azar delivered to the White House leadership what he’d frame as the ‘doctrine’ that we’d follow for addressing COVID… The plan… would shift a lot of the responsibility to the states for taking steps to respond to COVID… By the beginning of March… without a single national strategy, cities and states began to go their own way. Governors were implementing local polities that were beginning to produce regional outcomes on what would be a national epidemic.” (Pg. 201)
By March, “The president seemed to agree on the need for stronger action… the president was sitting down for a series of taped interviews with Bob Woodward… Trump revealed his fears to Woodward and would face understandable criticism for … publicly downplaying the risks while privately he was worrying about the dangers… Trump told Woodward he was expressly downplaying the dangers to avoid creating a panic…” (Pg. 205)
He notes, “the six-foot distancing requirement was a primary reason many schools cited for why they couldn’t open for full-time classroom instruction… They didn’t have enough space to create that much distance between students. It was probably the single most costly intervention the CDC recommended … It was another reflection of how the CDC’s focus on flu as a model for COVID spread ended up being a costly misjudgment… Initially, in February 2020, the CDC had recommended eight to ten feet of distance… the CDC compromised with the White House and settled on six feet. But the CDC’s recommendation for six feet … would persist well past the scientific realization that aerosols might be responsible for a lot of the transmission, and that the requirement … would be less relevant for this mode of spread.” (Pg. 213-214)
In the summer of 2020, he wrote an op-ed for the Wall Street Journal recommending reopening the schools in the fall… President Trump tried to jawbone the schools into opening… The president took to Twitter to rebuke some governors for allowing schools to remain closed… The president was right to focus … on trying to get schools reopened… But the White House had failed to hone in on a root cause for why many districts remained shut. The CDC’s guidelines were the single greatest obstacle… It was a breakdown in policymaking.” (Pg. 226-227)
He reports, “President Trump … [was] emphasizing that the guidance [recommending wearing masks] was ‘voluntary’ and saying that he wouldn’t be wearing a mask himself, undercutting the message while unveiling it. The data showed that masks were not a panacea, but they could help reduce spread… it was unfortunately the president who did the most to turn face masks into a political flashpoint… The president could have found a middle ground on masks. His message could have been: We don’t need mandates…. However, we’re going to act responsibly and wear masks… Personal responsibility; not government control.” (Pg. 253)
He observes, “The controversy surrounding use of hydroxychloroquine to treat COVID would illustrate the risk of allowing critical scientific questions to linger, where the desire for a swift therapeutic solution and the need for public health rigor collided to produce some unfortunate challenges… I didn’t believe the president was being well advised on the drug and research evaluating its use in COVID… The president continued to promote the drug, and pressure to find other ways to broaden access to the medicine would continue among his staff and at HHS… [On] May 19, scientists at the FDA's drug center completed an analysis… [that] found that there had been nearly four hundred adverse health events linked to the medicine including eighty-seven deaths…more data showed that hydroxychloroquine was providing no benefit while introducing additional risks.” (Pg. 290-293)
After Trump came down with COVID, “the president’s condition would deteriorate, distressing his staff and his doctors… Regeneron had already told the White House that it would provide expanded access to its drug … Regeneron immediately shipped a package of doses to the White House… [Trump] had also received an infusion of the drug Remdesivir. However, his medical condition deteriorated over the course of the day, and … he was requiring supplemental oxygen.” (Pg. 305-306)
He explains, “With the mRNA approach, the idea is that you’d manufacture snippets of genomic material that code for these proteins rather than isolating the proteins themselves…. Then, once the mRNA is injected and gets taken up by our cells, its instruction set is read, and our cells start to churn out copious amounts of spike protein… You didn’t need access to the live virus to get started… By the fall, more than twenty-five COVID vaccines would be in development using mRNA as the starting point.” (Pg. 327)
He states, “The proximity of the Wuhan Institute of Virology to the site of the initial outbreak fueled early theories that the WIV could have been the point of origin… Many of these speculations sprung from the kind of high risk studies that was known to take place at the WIV… making it possible that the WIV was in possession of, and had worked with, novel coronavirus specimens that hadn’t been previously shared or disclosed.” (Pg. 355) He continues, “Former CDC director Robert Redfield would… say publicly that he believed SARA-CoV-2 resulted from gain-of-function research… it was speculated that Chinese researchers may have deliberately altered the virus as a way to study it, but then the virus accidentally escaped from the WIV and first started to spread…” (Pg. 359) But he adds later, ‘While COVID likely emerged from a natural origin, and if it was the product of a lab, its release was not a deliberate act, some adversaries … may be … thinking that they can weather an engineered respiratory pathogen better than America can.” (Pg. 379)
He summarizes, “The emergence of SARS-CoV-2 and the pandemic that it caused marked a historical turning point in many aspects of our society and culture, and the application of genomics was one visible crossroad. The scientific advances we achieved in combating COVID gave us one of our few bright spots in this tragic event… Among them was a turning point for how we must view our public health preparedness as a matter of national security… one hopes it will start a cycle of profound change for how we address them.” (Pg. 387-388)
He concludes, “Going forward… [this] means expanding our healthcare system’s capacity to deal with a crisis… There must be no repentances or recriminations if we overinvest in preparedness when a new pathogen emerges only to see the virus fizzle out rather than explode into the next pandemic. Finally, it means bringing back to the US more of the manufacturing of critical healthcare components and finished goods.” (Pg. 394)
This book may interest those studying our response to the COVID pandemic.
January 19, 2022
Another of my medical reads. I am a medical professional. This writer is a Republican who focuses on the agencies and systems performance during the COVID crisis. There will be future pandemics and we MUST prepare for them. We must do better. This is a detailed account that is not fundamentally political but instead zeros in on groups that are in place to support medicine and protect the public. I strongly encourage you to read this for an objective look at where mistakes were made and how those can be corrected.
February 9, 2022
Best written history and analysis of what went wrong with the pandemic yet.
February 15, 2022
Don't agree with everything, but some really interesting points and great insight into how our government health agencies work (or don't work) together.
March 28, 2022
My brother suggested this book. My biggest take away was that Gottlieb did an excellent job of detailing how the CDC was totally unprepared for a pandemic and how leadership of the CDC either was blind to the shortcomings of the agency or was in denial. Either way … the agency failed.
Hopefully the agency and others have learned from the mistakes and we’ll be better prepared next time. Maybe …
In general, I don’t think humans are very adept at preparing for catastrophic events … until one happens. One of these days earth will be scorched by a massive geomagnetic solar storm similar to the Carrington Event of 1859. Are we ready for it … no. Does the US produce enough transformers to handle a massive attack on the power grid? Nope. Have people done studies pointing this out? Yep. Has anything changed? Nope. Hopefully the first major attack on the power grid will be small so we have time to change our ways before “the Big One.”
Scott Gottlieb did us all a service by pointing out the inadequacies of the CDC and of our public health system in general.
Hopefully the agency and others have learned from the mistakes and we’ll be better prepared next time. Maybe …
In general, I don’t think humans are very adept at preparing for catastrophic events … until one happens. One of these days earth will be scorched by a massive geomagnetic solar storm similar to the Carrington Event of 1859. Are we ready for it … no. Does the US produce enough transformers to handle a massive attack on the power grid? Nope. Have people done studies pointing this out? Yep. Has anything changed? Nope. Hopefully the first major attack on the power grid will be small so we have time to change our ways before “the Big One.”
Scott Gottlieb did us all a service by pointing out the inadequacies of the CDC and of our public health system in general.
January 16, 2022
I am a general reader. I picked this book from a group of largely medical people reading to become better informed. This can be a slow, dense read. It will not be for everyone. Still, my general observation is while we may have messed up a lot of things on COVID the potential is there to do better. This is not some much about politics as it is about agencies that failed or minimized. It is about China but more broadly about how cooperation needs to improve across many countries. If you truly want detail about how and where we missed but where we can do better to avoid a next time then this must be on your reading list.
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