Silent Invasion: The Untold Story of the Trump Administration, Covid-19, and Preventing the Next Pandemic Before It's Too Late – The Definitive Inside Account from Dr. Birx

by Deborah Birx

"The most revealing pandemic book yet."—The Atlantic

The definitive, inside account of the Trump Administration’s response to the Covid-19 pandemic from White House Coronavirus Response Coordinator and Coronavirus Task Force member, Dr. Deborah Birx.

In late February 2020, Dr. Deborah Birx—a lifelong federal health official who had worked at the CDC, the State Department, and the US Army across multiple presidential administrations—was asked to join the Trump White House Coronavirus Task Force and assist the already faltering federal response to the Covid-19 pandemic. For weeks, she’d been raising the alarm behind the scenes about what she saw happening in public—from the apparent lack of urgency at the White House to the routine downplaying of the risks to Americans. Once in the White House, she was tasked with helping fix the broken federal approach and making President Trump see the danger this virus posed to all of us.

Silent Invasion is the story of what she witnessed and lived for the next year—an eye-opening, inside account, detailed here for the first time, of the Trump Administration’s response to the greatest public health crisis in modern times. Regarded with suspicion in the West Wing from day one, Dr. Birx goes beyond the media speculation and political maneuvering to show what she was really up against in the Trump White House. Digging into the hard-fought victories, the costly mistakes, and the human drama surrounding the administration’s efforts, she examines the forces that crippled efforts to control the virus and explores why these blunders continue to haunt us today.

And yet amid the agonizing missteps were bright spots that point the way forward—the fastest vaccine creation in history, governors that put their citizens’ health first, and Tribal Nations that demonstrated the powerful role of community in curbing spread, despite their criminally underfunded healthcare systems. Collectively these successes reveal the valiant work of many who were committed to saving lives, as well as highlighting the dire need to reform our public health institutions, so they are nimble and resilient enough to confront the next pandemic.

With the pandemic now moving into its third year confounding two presidential administrations, Dr. Birx presents a story at once urgent and frustratingly unfinished, as Covid-19 continues to put thousands of American lives at risk. The end result is the most comprehensive and extensive accounting to date of the Trump Administration’s struggle to control the biggest health crisis in generations—a revelatory look at how we can learn from our mistakes and prevent this from happening again. 

Genres: Politics, Nonfiction, History, Science, Medicine, Memoir, Audiobook

521 pages, Kindle Edition

Published April 26, 2022

About the author

Deborah Leah Birx (born April 4, 1956) is an American physician and diplomat who served as the White House Coronavirus Response Coordinator under President Donald Trump from 2020 to 2021. Birx specializes in HIV/AIDS immunology, vaccine research, and global health. Starting in 2014, she oversaw the implementation of the President's Emergency Plan for AIDS Relief (PEPFAR) program to support HIV/AIDS treatment and prevention programs in 65 countries. From 2014-2020, Birx was the United States global AIDS coordinator for presidents Barack Obama and Donald Trump and served as the United States special representative for global health diplomacy between 2015 and 2021. Birx was part of the White House Coronavirus Task Force from February 2020 to January 2021. In March 2021, Birx joined ActivePure Technology as Chief Medical and Science Advisor.

Reviews

[Mansoor · Rating 1 out of 5]

One memorable pre-briefing during August proceeded with both Birx and me seated in front of the president, in the arc of four or five chairs arranged in front of his desk. To no one’s surprise, the president brought up one of his favorite topics—testing. Testing was a complex policy topic, far more complicated and nuanced than the “test, test, test” mantra voiced endlessly by almost everyone in the media. It was a critical tool that had significant value when used properly. We discussed how testing should be used to help open society safely, rather than be used to quarantine low-risk, healthy people and shut down the lowest-risk environments like schools. Toward the end of this Oval Office pre-briefing, the president asked Birx directly, “Do you agree with Scott on the testing?” I knew where Birx stood on the issue. She hesitantly replied, “Yes, I think so,” and she looked at me for affirmation. I was emotionless, but her half-hearted statement was a lie. I think the president probably sensed that, so he turned his eyes toward me and asked me, “Scott, is that true?” Without hesitating, I answered his question. “No, she doesn’t agree. Dr. Birx thinks we should be testing healthy, asymptomatic people, and if they are positive, they need to be quarantined for fourteen days. And even if exposed people test negative, they still need to be quarantined.” I matter-of-factly went on, eyes straight ahead looking at the president. “And that leads to locking down healthy, low-risk people, and those are the people that make up the workforce. That leads to locking down businesses and closing schools.” The president nodded but said nothing. Since this was the last of many topics covered in this pre-briefing, the president ended the discussion and walked into the room connected to the Oval Office. We all stood to leave. It felt very tense, but there was zero chance I would lie to the president of the United States. He asked me a direct question, and I answered it truthfully. There was no dilemma, no choice in my mind. Birx apparently felt otherwise. She threw a fit, right there, in front of everyone, as we stood near the door before leaving the Oval Office. She was furious, screaming at me, “NEVER DO THAT AGAIN!! AND IN THE OVAL!!”
—Scott W. Atlas, A Plague Upon Our House



نکته‌ی مهمی که پارسال از خواندن کتاب دکتر اتلس دستگیرم شد این بود: با وجودی که انتنی فاوچی-که از قضا میمیک‌ها و اطوارش به دلقک‌ها پهلو می‌زند-جلوی صحنه مثل عروسک خیمه‌شب‌بازی چرخانده می‌شد و در مرکز توجه رسانه‌ها بود، در پس‌زمینه کس دیگری مسئول اصلی لاک‌داون‌های سراسری بود: دبرا برکس. برکس در دسامبر 2020 استعفا کرد. دلیلش؟ مثل خیلی دیگر از مسئولان حکومتی در سراسر جهان مچش را حین نقض مقرراتی گرفتند که خودش واضعشان بود*. برکس در کنفرانسی مطبوعاتی اعلام کرد در دستگاه بایدن هم سمتی نخواهد پذیرفت. البته مدیونید اگر فکر کنید او در این کتاب هرگز اشاره‌ای به آن واقعه کرده باشد. به این ترتیب مسئولیت او در مقام مدیر تیم مقابله با کوید کاخ سفید در حالی پایان گرفت که خساراتی در ابعاد تصورنکردنی به جان و مال و آزادی‌های شهروندان آمریکا وارد کرده بود
برکس به خاطر می‌آورد که چقدر شوکه شده بوده از دیدن ویدیوهای مربوط به ژانویه‌ی 2020 که ساکنین ووهان را در حال بیهوشی و مرگ نشان می‌دادند و از "دکتر باشهامتی" که این ویدیوها را منتشر کرده بود تقدیر می‌کند. فقط یک مشکل کوچک این وسط وجود دارد. قلابی** بودن این ویدیوها در بهار همان 2020 ثابت شده بود، اما گویا، بعد دو سال، هنوز چیزی به گوش دکتر برکس نرسیده. بعد تعریف می‌کند که چطور با شنیدن خبر برپایی بیمارستانی هزار تختخوابی، در عرض ده روز، در چین بیشتر مطمئن شده که ما واقعا با ویروسی مهلک سروکار داریم. باز جعلی*** بودن این خبر هم، به فاصله‌ی چند روز از انتشارش توسط رسانه‌های دولتی چین، روشن شده بود. پس ما با روایت زنی مواجهیم که تقریبا بیش از هر فرد دیگری در ترویج و گستراندن لاک‌داون‌ها در آمریکا نقش داشته و با اتکا به هوچی‌گری رسانه‌ها هر صدای مخالفی را خاموش کرده و حالا برایمان منبر می‌رود که چقدر تحت تاثیر تصاویر ووهان و خبر ساخت بیمارستان در ده روز قرار گرفته بوده، بی آن‌که بعد از دو سال هنوز به قلابی بودنشان پی برده باشد. و اینها فقط مال فصل اول کتابند
برکس به خودش می‌نازد که چطور با حربه کردن دستورالعمل "هموار کردن منحنی" دستگاه ریاست‌جمهوری را به سوی پذیرفتن لاک‌داون‌ها کشاند، لاک‌داون‌هایی که عملا سفت‌وسخت‌تر از چیزی بودند که برکس وانمود می‌کرد. او ناخواسته لو می‌دهد که عدد ده در دستورالعمل‌هایش در مورد تعداد افراد مجاز برای گرد هم جمع شدن از کجا آمده. این عدد کاملا کشکی انتخاب شده. بلافاصله اضافه می‌کند که خواست خودش عدد صفر بوده، یعنی ممنوع کردن کامل هرگونه روابط اجتماعی. بعدش از استراتژی به‌کارگیری مشاوران فدرال رونمایی می‌کند تا توجیه و پوششی باشد برای ایالت‌ها جهت اعمال سیاست‌های اجباری محدودیت و در آخر نمی‌تواند لذت جنون‌آمیزش را از توصیف تعطیلی یکایک ایالت‌ها پنهان کند
شاید تکان‌دهنده‌ترین بخش کتاب پاراگرافی‌ست که برکس اعتراف می‌کند به مجرد آن‌که دستگاه ترامپ را متقاعد به پذیرش لاک‌داون‌های دوهفته‌ای می‌کند، در پی یافتن راهی بوده تا لاک‌داون‌ها را کش بدهد. تکان‌دهنده‌تر این که اقرار می‌کند هیچ آمار و ارقامی نداشته که خواسته‌اش را به آن مستند کند، ولی دو هفته وقت داشته تا چیزی دست‌وپا کند! در واقع برکس، به رغم همه‌ی درازگویی‌هایش، هیچ‌وقت توضیح نمی‌دهد که چرا با لاک‌داون‌ها موافق بوده و بر چه اساسی آنها را مفید می‌دانسته، الا اشاره‌اش به موفقیت ادعایی چین در مهار سارس با استفاده از دستورالعمل رعایت فاصله. و خب ما می‌دانیم که شناخت دکتر برکس از چین چقدر دقیق است
در نهایت این لاک‌داون‌ها به مرگ ده‌ها هزار جوان آمریکایی انجامید (1)، بدون آن‌که تاثیر قابل توجهی بر کاهش شیوع بیماری گذاشته باشد (2)
حالا دموکرات‌های کنگره‌ی آمریکا در جریان وارسی نقش برکس در لاک‌داون‌ها دارند از او دفاع (3) می‌کنند و نیویورک تایمز با آب‌وتاب از کتابش تعریف می‌کند (4). حقیقت این است که عنوان کتاب نه به ویروس کوید، که به خود برکس و نیروهای اطلاعاتی-امنیتی اشاره دارد که او را به این نقش گماشتند


*Birx travels, family visits highlight pandemic safety perils
**How Phony Coronavirus “Fear Videos” Were Used as Psychological Weapons to Bring America to Her Knees
***Chinese State Media Spread A False Image Of A Hospital For Coronavirus Patients In Wuhan
(1)Non-Covid Excess Deaths, 2020-21: Collateral Damage of Policy Choices?
(2)A LITERATURE REVIEW AND META-ANALYSIS OF THE EFFECTS OF LOCKDOWNS ON COVID-19 MORTALITY
(3)Democrats Defend Trump Officials' COVID-19 Response
(4)“Silent Invasion,” an insider’s look at the Trump administration’s pandemic policies, is earnest and exhaustive, our reviewer says.

[Faith · Rating 3 out of 5]

This book has some interesting details about the government’s response to the pandemic. It also has a lot of reasonable sounding recommendations, however, I can see why she had trouble getting herself heard in the Trump administration. She and Trump outdo each other in their certainty that they know everything and that everyone else is an idiot. This book is page after page of her amazing prescience. If only she ruled the world, all would be well. She knew just what to do at each stage of the pandemic. If you annoy people enough, they will stop listening to you. She definitely annoyed me with this book.

[Carrie · Rating 5 out of 5]

From day one in her position on the Coronavirus Task Force, Dr. Birx was between a rock and a hard place. Since she was attacked on both sides of the aisle, she deserves to tell her story. More than that, she intelligently presents what went right with the pandemic and what went wrong, and does so without character bashing. She is not a partisan. She is a very experienced epidemiologist, one who had her finger on the pulse of the virus early on (notably its ability to silently spread, making testing of asymptomatic carriers a vital tool that was woefully underused). If only she’d have been able to do her job without having one hand tied behind her back (and sometimes both) due to the resistance she faced. She also takes the CDC to task on ways the agency can improve, since future pandemics are not a question of if but when.

[Chris Carson · Rating 3 out of 5]

She’s not the modern day Josef Mengele, also known as the Angel of Death, that some have labeled her, but her silence alongside the failed ex-President tRump while one million Americans died has certainly impacted her reputation and legacy. Her advocacy and service prior to Covid is the more interesting and heroic part of her story. It provides some comfort when considering the many failures during the tRump plague years!

[Carolyn F.]

Audiobook

Before I even start this book I want to preface any review by the fact that I am a lifelong Democrat who first voted for Jimmy Carter and whose grandmother thought FDR could do no wrong. Even with that and at first thinking that Trump was running for president like Pat Paulson ran for president - not seriously - I still think when he won we needed to quit spitting at him and give him the respect that the office gave him whether we liked him or not. I realized during the beginning of COVID that Fauci and Birx were between a rock and a rock standing (or sitting if they were in trouble) with wide eyes at what was being said. While Fauci was lauded for his brilliance, for some reason Birx was vilified. I have no idea why. Birx was trying to interject sane thoughts during press conferences, trying to steer conversations away from misinformation when she was alone because Fauci was in trouble again. Should she have stood up and screamed at the president of the United States? When the change in office was happening, I have no idea why Biden didn't keep Birx on his COVID response team but brought Fauci over. I usually don't read these sort of books but I wanted to find out what happened on her end.

Okay, I should mention something else. I'm not that smart and a lot of this book (although probably dumbed down for people like me) is over my head and makes my eyes glass over with minutes (hours?) having passed without me noticing what was just said. I don't know how much more of this I can take. I agree with another reviewer where it's a lot of "They should have listened to me because I figured out what was happening first." Again, she's a LOT smarter than I am, so maybe she's right. Hindsight is 20/20. I will give this book one more day and if it doesn't pique my interest, it will sadly go in my DNF folder. I still like Dr. Birx, I'm just not smart enough to keep up with everything that's going on in this book.

Okay, I'm about halfway into the book and I just can't keep listening to the audiobook. I thought it would mostly be about what happened at the White House and there is that but there's a lot of numbers thrown in too. Other people may enjoy this book more than I did.

[Cinthia F · Rating 3 out of 5]

This is a good account of the pandemic - the struggle with a disease no one knew much about. It shows how unprepared the CDC and other government agencies were for a pandemic of any kind. Birx says she is apolitical but it is obvious which side of the political aisle she resides. Having said that, her beef with Trump is more on a CEO/employee level than a political one. And I can see Trump behaving as she describes. Regardless, she is super-focused on testing as many people as possible between the ages of 18 and 35 because she feels they are asymptomatic but spreading covid unknowlingly - thus the silent invasion. The battle between her and Trump and others in the administration is that he wants to keep the economy opened and moving and she wants to test a lot of people. She has data to prove her point that he won't listen to. Instead he listens to Scott Atlas who says he has data to show the virus does not spread as much as Birx says but won't show it to Birx. That had to be frustrating for her. Birx has nothing but good things to say about Pence who led the Covid Task Force. She and another member of her team worked with governors in blue and red states, traveling all over the U.S., sharing their data and making recommendations. She mostly has good things to say about the governors. The CDC team stayed put in their Atlanta bubble. I didn't get to read the last 3 chapters because I had an ebook from the library and it went away before I finished. I wish the doctors and scientists would put the passion they have for testing, wearing masks, or getting vaccines or for not doing any of these things into solutions like a drug to give ANYONE who gets the virus to help them get over it quicker or an EASILY accessible test to see if you have antibodies for the virus and some good research about how protected those who have had the virus are. We still seem to be focused on who has it and how sick they are. I have just purchased a copy of the book, mostly because of the depiction of how the US reacted to the virus, what we did and did not do as a country and how many people died. I want there to be a book, even if buried among all my other things, so that in 100 years someone may stumble on it and learn a little about how life was with Covid.

[Erin Matson · Rating 3 out of 5]

Oh, what to make of Dr. Deborah Birx and her book, Silent Invasion? Let’s start here: Respect.

At the conclusion of the book, she places her ideas in outline form of what the U.S. should do next to ensure what happened with COVID never happens again.

She details, believably so, the myriad and entrenched dysfunction within the CDC that have led to its failures in assessing the threat of COVID-19, communicating the threat, and managing data.

She made a choice. Not one everyone would make, but she chose to stay put in an incompetent and hostile administration that was blowing it, big time. She clearly outlines how she felt that was the best way she could help.

I admire her brains and drive.

Her narrative still comes off as myopic at times (praising Jared Kushner, whose qualifications were what, exactly?). She lays a persuasive case that the CDC and local officials need more and better data, and yet she also seems to have belief that data will be believed and acted upon. If all we needed was good data, a number of entrenched societal problems would have been solved long ago.

COVID-19 needed centralized, national coordination. That was Deborah Birx’s job. History can judge how she did. I do not doubt she did her best under a toxic president. Still, this book left me wanting less wonk and more introspection about how she might have approached the work another way.

[Sandra Long · Rating 1 out of 5]

Scientists will answer to God

Writing a memoir does not exclude you from the damage to the World population. Our schools children have and continue to suffer irreparable harm. People continue to die from decisions and the deceit
you were complicit with. You will not be able to walk down the street.

[Kellie Reynolds · Rating 3 out of 5]

I avoided other Trump era memoirs, regardless of the author’s political views, because I expect them to be strongly biased. However, I decided to read Dr. Birx’s book to gain insight into the COVID-19 response. My day job involves antiviral drug development, including the COVID-19 therapeutics (not vaccines) and HIV drugs (including those for the PEPFAR program).

I respect Dr. Birx’s prior experience, her general knowledge about emergency response and infectious diseases, and data interpretation skills. The information provided in the book regarding interpersonal dynamics with the White House, other federal agencies, and state leaders was educational. I had not paid attention to the types of communications provided to governors and the positive interactions Birx had with governors I typically disagree with.

The behind the scenes chaos was not surprising. However, her opinion of the CDC was much more negative than I expected. She criticizes almost everything they did and she provides many suggestions for how they should be restructured.

Her descriptions of negative interactions with Trump, Meadows, and Atlas were as expected. Although she is positive towards Fauci, he came across as passive in the book.

Her White House supporters were Pence (up to a point; they did have some harsh interactions) and Kushner. The Kushner interactions were the biggest surprise to me.

In spite of gaining much insight from the book, I rate it a three because it is too long and the overall tone is annoying. There are too many long stories of parallel situations (the success of PEPFAR) and background stories (tribal nations). There are too many day-to-day details that became tedious.

My biggest criticism is the impression that she made no mistakes and if everyone just listened to her, the outcomes would have been significantly better. She spends way too much time explaining “if they only listened to me” and “here is the obvious solution.” It got worse towards the end of the book. There are a lot of suggestions for the future in the latter sections of the book. I have a hard time believing they are ALL her original ideas. Without the tone, I would have a better opinion of the suggestions.

[Cory Wallace · Rating 1 out of 5]

She says she’s bipartisan and in my opinion she didn’t come across that way. Over 400 pages of praising Dr Fauci, Lori Lightfoot and pushing the narrative that Trump only cared about the election. I noticed how key points were left out for example, Obama had his party during the pandemic yet that wasn’t a superspreader event. I wasted about six hours reading this. Expected to gain better insight yet it was a waste of my time. Save yourself the trouble.

[Anne · Rating 2 out of 5]

I'm (Birx) the only person that knew what was going on and nobody would listen to me. I could have completely destroyed the economy, but they would not let me.

This arrogant soul is responsible for more pain and suffering than I ever realized.

[Colleen Fletcher · Rating 1 out of 5]

I learned why she always wears scarves. She needs to hide the bite mark from having her soul sucked out of her. Birx and The Science (Lord Fauxi) are made for one another. A match made in hell.

[Ashley · Rating 3 out of 5]

I picked up this book, because I was curious to see what went wrong, and what went right during the time of Covid-19. I didn’t intend to read this to lay blame at anyone in particular, but I wanted to see if it confirmed my thoughts I had during such strange time in our lives.

Before I continue with my thoughts, I gave this book 3 and half stars, because I feel that some parts could honestly have been a bit more condensed, and less repetitive. Overall, I found this book to be engaging, and informative.

I learned why COVID-19 was such a confusing virus to understand, and the way Debbi explained was easy to follow. Easy to understand as a layman. I appreciated that.

The book confirmed that nobody really had their shit together, and that was why it turned out the way it did. I didn’t want to reveal too much, as to spoil the book, and I had to take breaks, not because it hit too close to home, but I was frustrated at the idiocy of the bureaucracy.

It was a stark reminder that we could have easily ended up living in a situation similar to Stephen King’s The Stand.

I should start doom prepping, because it’s not a matter of if this will happen again, but when. Better be prepared. 😜

[Barbara · Rating 3 out of 5]

3.5. Comprehensive but somewhat repetitive.

[Steven H · Rating 5 out of 5]

THE FORMER CORONAVIRUS TASK FORCE COORDINATOR TELLS A REVEALING STORY

Dr. Deborah Birx wrote in the Preface to this 2022 book, “In [this book], I share with you my insights while serving at the highest level of the Trump administration’s response to the SARS-CoV-2 virus pandemic, and as a private citizen … As the White House Coronavirus Task Force Coordinator, it was my responsibility … to coordinate efforts across a broad range of federal agencies…”

She recounts in the Prologue, “It is March 2, 2020. I’ve just flown in overnight… to take on the role of response coordinator for the White House Coronavirus Task Force… After weeks of urging from Matthew Pottinger---President Trump’s deputy national security advisor… I finally gave in to Matt’s request that I come on board… Today I have two primary goals: I want to gauge the president’s sense of urgency and convey to him how strong mine is… I believe that the president, as a businessman, will be persuaded by the figures… They are at odds with what most others are forecasting. Things are much worse than he likely believes… I wonder what the president has been told… the presidents I served under before, Geroge W. Bush and Barack Obama, had the ability to …direct their focused attention in a way President Trump has not. I’m not going to get him to change. I have to change my approach… Finally, I get a chance to speak with him. ‘Mr. President…This is far more serious than the flu… This virus is very deadly…’ ‘Well, the people I’m talking to say that this isn’t going to be any worse than the flu…’ His eyes return to his television screens… the voice of someone at Fox News enters what passed for a conversation between us… Someone takes a few steps toward me and gestures toward the door. I’ve had less than thirty seconds to speak with the president…” (Pg. 1-4)

She recalls, “many of the efforts the task force appeared to be focusing on---various travel restrictions, symptomatic screening, and voluntary quarantine---belonged under the … heading… containment… the primary belief that we could prevent the virus from coming ashore in the United States was still very much alive… in the minds of those who should have known that containment had already failed.” (Pg. 42) She adds, “A government should not base its public health policies and emergency measures on miracles and hope. No one preventive measure is every 100 percent effective, not even vaccines. You must have overlapping measures, duplications and redundancy.” (Pg. 55)

She wonders, “I had to consider the possibility that I was a ‘gendered’ choice, the lone female medical doctor on a team that had six male doctors already on board… Would I, as a multidecade civil servant become a victim of the civil servant/politician divide?... when things went awry… They would easily blame the civil servants and characterize us as members of the ‘deep state.’” (Pg. 64-65)

She laments, “The American people would have understood clear messaging that laid out what we knew, what we didn’t know, and what we were recommending… But the CDC didn’t do this. More frustratingly, it didn’t even say, ‘Wear a mask. It might save your life.’ Those at the CDC held themselves back… In the midst of an enormous health care crisis, you can’t wait until a definitive, tightly controlled… study that has been done to make a recommendation that will likely save lives while costing none.” (Pg. 85-86) She adds, “I could have, and should have, done better myself to push the importance of masks, testing, and data collection…” (Pg. 88) She continues, “I wasn’t about to use the words ‘lockdown’ or ‘shutdown,’ If I had uttered either of those in early March… nonmedical members of the task force would have dismissed me… They would have campaigned to lock me down and shut me up… [I] was familiar with the slippery slope of being pegged as ‘hysterical’ and ‘overreacting’…” (Pg. 95)

She suggests, “this specific issue was not a Trump administration problem: it was a CDC problem… It’s convenient to solely blame President Trump, and while he certainly deserves his share of the blame and then some for his response, blaming only his failures and letting the CDC and other HHS agencies off the hook would be… repeating the same mistakes… Ultimately, the CDC’s greatest sin was not recognizing and acknowledging that it had sinned…” (Pg. 108-109)

During a team meeting, “As a woman, I was used to certain adjectives being used to describe my aggressive pushing for lifesaving policies… Behavior in men … became ‘bitchy’ when I exhibited it… a line had been drawn… Those early months would come to be defined by the medical professionals on one side of the divide and the economics team on the other. What on the surface looked like agreement was, for some in the room, a call to action.” (Pg.114-115)

When Trump agreed to extend the 15-day ‘Stop the Spread’ campaign for another thirty days, she comments, “What mattered … was that the president … had done the right thing, though I suspected his decision wasn’t one that pleased most of his advisors in the economy wing… In this one instance, he had listened to the data… and in doing so, he was helping us deliver a crucial message to the American people… I just hoped that he had the political will to keep them in place.” (Pg. 150-151) But in the first week of April, Trump insisted, “‘We will never shut down the country again. Never.’… I didn’t know what precisely had brought about his change of heart… but his belief in me… seemed to have disappeared overnight.” (Pg. 152) Later, she adds, “Somehow, from the time had agreed to the thirty extra days, the president had convinced himself … that if he didn’t do everything he could to get the country… running at full speed, he would be politically vulnerable come November.” (Pg. 162)

She reports, “Steve Hahn and I bore the brunt of the intellectual assault that was hydroxychloroquine… Instead of the president’s delivering a consistent message about what we knew were effective mitigation measures and effective treatments, he was more preoccupied with touting the benefits of unproven, untested, potentially counterproductive drugs that had been brought to his attention daily by his inner circle… By June… the FDA has reversed their position on ‘hydroxy’ and revoked their EUA… Pater Navarro… [asserted], ‘This is a Deep State blindside by bureaucrats who hate the administration they work for more than they want to save lives.’ … Some people in the White House seemed to believe that when reason failed, passion might carry the day. Peter Navarro crossed a line.” (Pg. 171-174)

She notes, “the CDC recommendation on masks did not pass the commonsense test. How could the material absorb what they exhaled but not what they inhaled? … Without a definitive statement one way or the other about the effectiveness of masks as two-way protectors, the public became confused… Americans wanted and needed clear, evidence-based guidance on masks, and they weren’t getting it… The idea of wearing a mask to protect OTHERS while doing nothing for them made the guidance easier to ignore.” (Pg. 180-182)

She recalls an April 23 briefing by Trump, where he said, “‘I see the disinfectant, where it knocks it out in a minute… is there some way we can do that by injection inside or almost a cleaning?’ … I sat there unmoving, my hands clasped tightly in my lap… How had he gone from sterilizing children’s playground equipment … [to] INJECTING DISINFECTANTS---to treat the human body?... Many people thought I should have run up to the microphone and shouted, ‘Not a treatment!’ … ‘This is nonsense!’ … To say that I was caught completely off-guard by the absurdity of what was being said … is an explanation, but not an excuse. Yes, I should have done better… Instead, in that moment, I thought, ‘Correct what needs to be corrected and move this along.’ … The next day, the president said he had been ‘joking.’” (Pg. 190-193)

She recounts, “On May 6… the president casually said the White House Coronavirus Task Force would soon be disbanded… a new task force would be created, one focused on getting the country’s economy fully recovered… I couldn’t believe it… the president was essentially declaring victory over Covid-19. Though he’d be keeping Tony [Anthony Fauci] and me … as the lone survivors of the public health wing … the economic wing … would be getting not just the green light, but the keys to all the cars… I stayed---knowing that if I didn’t no one else would be brought in to replace me, leaving Tony to flounder in the wake of the president’s now disregard for public health.” (Pg. 195)

She observes, “I turned my attention to … testing… President Trump continued to assert that testing led to more cases… Some in the administration used … misdirection, and labeling things ‘fake news’ while producing their own, to effectively change public perception. Call it bizarre, call it brilliant… the intention was always the same: hope that the doubt or alternative reality would find fertile ground somehow, somewhere… The fact that President Trump himself apparently didn’t want to know what was really happening spoke volumes about how far down into a facts-don’t-really-matter hole we’d fallen… He was getting his information … from others… who were cherry-picking data… Telling him the … deaths were exaggerated. He was hearing from doctors who told him we were lying… to do damage to him and his reelection.” (Pg. 212, 214)

She recounts that “someone named Scott Atlas … [had] been in regular communication with the White House senior advisors… since early spring…. Collectively, these people had encouraged Atlas to continue his good work in spreading a message that supported the president’s position that Covid-19 was of low risk and more like the flu. Testing wasn’t needed, Atlas claimed, unless you were really sick. The headline for one of Atlas’s op-eds reinforced my initial perception that he was out of his depth… Mistakenly, I at first assumed that, given his lack of direct experience or background in pandemic response, Atlas could be easily dismissed. Clearly, he was a contrarian… he preached to a converted segment of the population, and within the administration the benefits of let-it-rip ‘herd immunity.’… this set of beliefs… was dangerous… That Scott Atlas had found a receptive listener in Paul Alexander at HHS was not surprising… he had managed to put Scott Atlas more prominently in front of the president and his senior advisers… In this White House, appearances mattered most…. Scott Atlas’s … advice to the president and others … instigated an ongoing battle between two very different points of view.” (Pg. 249-252)

She laments, “If I was guilty of one thing during my tenure at the White House, it is that, for too long, I clung to the notion that reasonable, intelligent people would eventually see the light. I trusted that data, that logic, that a … critically reasoned approach would win out over suspect science and entrenched wishful thinking… In the end, I suppose, it didn’t matter…Scott Atlas was an insidious presence in the White House… He had made himself comfortable, and now he seemed poised to make me and many others very UNcomfortable.” (Pg. 275-276)

On August 2, she appeared on ‘State of the Union,’ and explained, “I want to be very clear: What we are seeing today is different from March and April. [The virus] is extraordinarily widespread…’” The president called her the next day, and said, “Don’t you ever do that again. ‘Extraordinarily widespread’? So you know how those words scare Americans?’ … I didn’t want to frighten them; I wanted to INFORM them… with a rationale for changing their behaviors… Trump continued, ‘That’s it!... Never again! The virus is under control.’ This conversation had only hardened my resolve not to back down… The president went on the offensive, using the kind of divisive rhetoric and tactics that had marked his entire presidency… He didn’t want to listen to me… Scott Atlas was a false prophet with a ready group of followers.” (Pg. 277-279)

She notes, “By mid-September, I was worn out from dealing with the politicization of the entire enterprise… the picture was plain: if I left, more people would die… because [of] … the willingness of the Trump administration to bend data to their desired ends…” (Pg. 358-359) But eventually, “Scott Atlas faded into oblivion after the election…” (Pg. 383) She concludes, “It is my greatest hope that 2022 will see our response to this pandemic, individually, and collectively, adapt to the evolving nature of the outbreaks… we can learn to live with this virus, while we continue… to develop better tools.” (Pg. 474)

This book will “must reading” for anyone studying our response to COVID.

[Lisa · Rating 4 out of 5]

Dr. Deborah Birx was the response coordinator for the White House Coronavirus Task Force beginning March 2, 2020--not long after most of us learned that a new virus had begun to be a problem in Wuhan, China. She had been the U.S. global AIDS coordinator and had once been working for the State Department to oversee the President's Emergency Plan for AIDS Relief (PEPFAR), which had been started under the George W. Bush administration and has had a lot of success. She had worked in public health in both Democrat and Republican administrations and was trying very hard to do medicine and public health, not politics.

At first I was reluctant to read anything from a person who had worked for the Trump administration in any capacity, as I have never been a fan of him or the way he ran the country, and certainly not the way his administration responded to the pandemic. But I had read that Birx was one of the few people in the Trump administration (along with Anthony Fauci and a few others) who were trying to "follow the science" with respect to SARS-CoV-2 and the awful pandemic we are still not (as of August 2022) really free of, no matter how people are behaving.

Birx's central point is that we didn't get control of the coronavirus pandemic because most of the people in charge of the pandemic response were unwilling to accept the idea of "silent spread"--that people who are not showing symptoms can give Covid-19 to others. An understanding of this point could have helped people accept required mitigations such as the lockdown, masks, distancing, and other restrictions.

Birx's book is long and detailed, and she is determined to show all the ways she tried to manage the pandemic response and the ways her efforts were thwarted. The CDC comes in for especial criticism but the chief culprits were the economists and politicians in the Trump administration who didn't want to hear, much less let the American people know, about the size of the pandemic, its dangers, and how to mitigate them, because they didn't want to bear bad tidings or affect the President's approval ratings, even though people were in dire need of correct information. President Trump was in the forefront of this effort, caring only about how he and his administration would look in the news and on social media, regardless of the lives at stake. Mixed messages abounded from government speakers on the severity of the epidemic, the need for testing, and the meaning of surges and declines as shown by accumulating data at the overall level and at the county and community levels. Because testing was not emphasized (and still is not), many elderly and vulnerable people were and are infected, suffer, and die when they catch the virus from friends, family, and staff in nursing homes. There were tens of thousands of preventable deaths.

Birx also compares the U.S. response to that in other countries; our methods and practices failed us, unlike in the UK and elsewhere, where widespread testing and tracking of infections were implemented. Problems also arose because many people in the United States do not have reliable healthcare and because our public health systems are underfunded and understaffed.

The shocking and deadly aspect of the U.S. response is that many people never got the message that the vaccine, while it creates lower risk of severe disease, hospitalization, and death, for those who receive it, does not make you completely immune from the coronavirus or confer lifelong immunity, and that they could still give the virus to others even though they had been vaccinated. People should have been told from the start that their immunity would wane and they would need boosters and still need to mask and limit interactions. The government needed to find an effective "marketing strategy" to overcome vaccine hesitancy.

It was interesting to learn Birx's perspective on Trump's Covid-19 infection--that a vaccinated man with significant comorbidities (age, obesity, at least) had to be medevacked to the hospital and then got the best care and all treatments available means his case was not the easy-to-treat, no-big-deal experience that he kept telling the public it was.

Birx's epilogue contains her recommendations for how we can prepare better for this continuing pandemic and future pandemics. While the Trump administration had lots of problematic responses, the Biden administration also is missing some needed aspects. Biden's people have more consistent messaging but still fall short on testing and on tailoring government advice to different communities. We need more, not fewer, tests and reports and better data. We need to fund these steps and make reporting of viral diseases mandatory as it is for bacterial diseases. We need to streamline the agencies involved and choose a lead agency for the federal response. Lack of awareness of many people's distance from services and the inability of people to stop working when they are sick (because they need the money) should be better addressed. Birx suggests that we decentralize the CDC and instead create more field offices and workers across the United States rather than having them all huddled together in Atlanta.

Birx and her team visited universities and communities and made a difference for good in those organizations' responses to the pandemic, although she was banned by the White House from going on national media outlets (her frankness could have alarmed people and made the Trump administration look bad). We can keep schools and businesses open if we test, mask, and distance and keep a close eye on silent community spread, reacting to upticks in case numbers before they become a surge in a particular area. "If 9/11 permanently altered the intelligence community, Covid-19 must similarly force a reckoning at HHS and other related agencies" (p. 488).

[Michele Martin · Rating 4 out of 5]

This provides previously-unknown insight into what was happening behind-the-scenes re: the Trump White House's response to the pandemic and specifically about the issue Dr. Birx was most concerned with -- silent/asymptomatic spread of the virus, especially among young people -- and the various reasons why this wasn't addressed better. It does get repetitive in places, and Dr. Birx spends a lot of time slamming the CDC but gives the FDA something of a pass (or just fails to mention the ways in which, IMHO, they also failed), but I think it's especially relevant to read now given that the Biden administration is making some of the same mistakes, especially in terms of downplaying/ignoring the fact that pandemic isn't over and that we need a multi-layered defense (not just vaccines!!) to try and minimize the impact on those who are still vulnerable.

[Libby · Rating 1 out of 5]

I picked this book up because I wanted to learn more about what went on behind the scenes during the pandemic. I was interested in learning about what the government was doing that I had no idea about and how doctors were discussing course of action. I was majorly disappointed. This book is so slow and incredibly verbose. The author makes her points 100x over within a single page and maybe that comes from some frustrations she has with the government at the time, but it makes for an incredibly difficult read. I so badly wanted to like it and wanted to keep reading, but I was pushing myself through something with no chance of a reward to come. So I put this book down at the end of part 1 and I have no intentions of picking it back up.

[Dara Grey · Rating 4 out of 5]

Interesting to see an insider perspective on what was really going on in 2020 and 2021 to mitigate (or not) the COVID-19 pandemic. Debbie Birx admits to her flaws and shortcomings but overall conveys an impression of a tough as nails, determined and dedicated public servant whose focus is on the bottom line numbers and what they mean - saving lives (or not). Kind of an exhausting read but very thorough and detailed, with actionable recommendations for future U.S. public health improvement.

[Tricia McGinn · Rating 1 out of 5]

This 470+ page book is at least 200 pages too long… makes me doubt her leadership skills even more than I already did.

[Tom Schulte · Rating 4 out of 5]

The "Silent" in the title is the transmission of infection by asymptomatic and pre-symptomatic carriers that could have been blunted by widespread masking. That's Birx's message, as I understand it. One thing she goes back to is the Diamond Princess which could have been an excellent opportunity to gather real data on asymptomatic spread, but instead became a foundation for a mistaken theory of surface transmission:

And then there was the surface sampling on the Diamond Princess. It was bad enough that not everyone on board her was tested every day, but after passengers disembarked, surfaces on the ship were swabbed for the virus. Of course, the PCR test showed SARS-CoV-2 everywhere. RNA fragments can survive on surfaces where the full-length infectious virus may not. What was left behind, therefore, couldn’t infect people. Experts should have understood this immediately, or investigated it quickly. By doing that, they would have eliminated the possibility that surface contamination was contributing to spread. Inadvertently this swabbing led to the “surface transmission” theory of Covid-19 spread, producing the run on disinfecting wipes across the globe, the religious quarantining of packages, and the habitual wiping down of all groceries for weeks. And it was another distraction from the true source of continued spread: the infected experiencing no symptoms and transmitting the virus to others.

She places blame on poor decisions made based on garbage data from the Diamond Princess at the feet of Robert R. Redfield who served as the director of the Centers for Disease Control and Prevention. She blames Secretary of Health and Human Services Alex Azar for being one of the conduits of injecting Trumpism into what should have been a more purely data-driven, scientific process. (This offsets my view of Azar from I Alone Can Fix It: Donald J. Trump's Catastrophic Final Year.)

One of the many points she wanted to see clarified and explained as part of educating the public is the different between "sterile immunity" afforded in some instances of lifelong protection, such as with measles and the "protective immunity" of both natural infection and vaccines related to COVID where re-infection is possible.

Funny while reading this, I noticed this in news from the Santa Fe Institute"

Research News
COVID’s Catch-22: The paradox of masking and disease
There's a paradox at play in the dynamics between mask-wearing and the spread of disease: While masking reduces transmission rates and consequently disease prevalence, the reduction of disease inhibits mask-wearing — thereby promoting epidemic revival. A new study led by researchers at the University of Virginia, co-authored by SFI's Simon Levin and Stefani Crabtree, explores these dynamics.

I also took in Birx on the politics of COVID on the radio and also the Select Subcommittee on the Coronavirus Crisis hearing with Birx where she had a prepared presentation that was buffeted about by political questioning. Well, her Epilogue here is an excellent summary of her focus on transparency, county-level data gathering, proactive public-private partnering, and improvements she sees could be made such as a decentralized CDC.

She singles out Jared Kushner and VP Pence for some muted, strategic help, even during the transition, but mostly comes across as a voice in the wilderness hampered both by being outside the Trump inner circle and being a woman often dismissed as such in that workplace.

[Inca · Rating 3 out of 5]

I'm really happy I read this book.

First of all, I missed Dr. Birx when she just disappeared from the scene, leaving behind Dr. Faucci. I always found her to be such a sane voice, staying focused on her research and information, staying out of controversy.

Second, there were so many conflicting voices all screaming so loudly that it was hard to believe any of it at all (by the way, a point Dr. Birx makes several times in the book. That all that false info, or not being completely transparant with info, created a terrible situation where the public just couldn't believe anything...because how do you know?). So I thought I might get some clarity.

This could never be a 5-star read for me because look, I am not in the medical field nor am I a scientist. I am a layman. So for me, there was just too much info in there with all the figures, ratios, etc. I also got whiffs of her resentment of being treated differently because she was a woman which annoyed me a bit. While I am sure there is some truth to it, we also have to acknowledge that she may have been treated differently not just because she was a woman, but because she acted like, and indeed was, to her credit, always a Lady. She always had her eye on the goal of getting a good read on the pandemic and how to slow, or ideally, stop it. She did not allow herself to go down the path of ego, self-serving, "winning", etc. A person like that among the savage, dirty, fighters that reside in DC is always going to get squashed, mistreated, or whatever you want to call it. But not just because she's a female. There were a few other things that I wasn't in total agreement with but I can't intelligently refute them because I didn't do research to back myself up with and she has research galore. I don't say she is wrong; just that I don't agree. She is a doctor and is coming from that point of view alone, and while she can hear what other think who have to weigh more than just the pandemic-factor, she doesn't give it the same value as perhaps it deserves as well. Oh, and let's not forget that she never once mentionned anywhere in the book about the awful consequences many people...including many young men....suffered from having taken the vaccine!! That was awful. So perhaps when she was "in" that wasn't so believed. But for someone who keeps reiterating that she follows the data and the importance of gathering good data, where was the data gathering about the serious consequences of vaccinating??? And, even if there couldn't be enough data at the start, by the second epilogue (yes there are 2) she surely had heard about it.

Anyway, as I said, I'm glad that I read it.

[Sara · Rating 3 out of 5]

Skimmed it last year. Thought she was whining. Read it this year, and sensed she was explaining her side, but jeez. Walk on and walk away. I don't know how much she helped the people or how much the Covid experience helped her.

I'm reading these books now to understand what will happen when this admin gets re-elected. Everything will be the opposite. Whatever they say, just think opposite and keep moving forward. I didn't like that she was not the person for this job. I can't even tell you her title. She was the white Donna Brazille, for sure. I don't know why Pottinger selected her only to get cut off at the knees on March 21st. No woman worked well in this admin, and her constant alarms only made them roll their eyes. I didn't know that Atlas had so much power or how he blew himself off the charts in the end. I don't know why they didn't fire her. I really think people are picked in this admin to be pegged the scapegoats. That is their title.

Like most women, she stayed in for the team (Tony, Bob, Steve) but when she needed the team, they weren't there for her.

Covid showed me that the citizens could handle it. No matter what was thrown at them, if people wanted to hunker down, they did. If people wanted to test their chances, they got sick, and many died. Others recovered. Still others got long Covid. But this blatant denial of asymptomatic spread was stomach churning. The gov't was not ready at all. Nor did they want to be. It was all about the $$$/economy. And that came through very clearly.

I am glad I read it a 2nd time. But I am getting tired of people "sticking it out to the end" in this admin, only to resign later and then write a book. It does nothing but show they don't have leadership. It's humanity, but not leadership.

She blames it on the military mindset. Or the police mindset. Following orders, not leaving your post. But I never sensed she was in danger like the real Americans. She was always working, always protected, getting her benefits while pushing against an Admin that didn't care but for the economy.

Well, this is unfortunate.

[Regan · Rating 5 out of 5]

Dr. Birx's story was not what I was expecting. After reading at least two dozen books on the Trump administration, both before and after he was out of office and several on the pandemic I expected a bit more of the same. Not that I thought that was a bad thing. I was just ready to read another book of similar events. There is some of that, but Birx tells an amazing personal story. Her basic humanity comes through the pages as well as what is her personal drive to save lives.

Birx gives readers insight into what drove her for forty years of government service and still, to this day, despite being retired, is still dedicated to saving lives. She intersperses her experiences dealing with HIV/AIDS and working in Africa with her work in COVID-19. She shares her frustrations with how various entities, not just former president Trump, threw up road blocks to dealing with the pandemic. People with their own agendas, mainly their political futures, cost lives. What surprised me was how much support former vice president Pence gave her, despite his own staff often getting in the way. It was a side of Pence the media and therefore the public seldom hears about.

At 500 pages, packed with information, Silent Invasion is not a quick or easy read. Birx tells the story in a readable language -- anyone can understand what she is talking about because of how she presents the material. I highly recommend this book if for no other reason than to educate yourself on how the FDA. CDC and other health agencies approach not just a pandemic, but epidemics and your basic seasonal flu. If many of us knew some of nuances between the agencies before COVID hit us perhaps more could have been done sooner.

Birx is quick to give credit where it is due. At the same time she is diplomatic when it comes to those that should probably be chastized. An excellent read.

[Alison · Rating 4 out of 5]

An interesting look at behind the scenes as the COVID 19 pandemic unfolded in the US. Dr. Birx begins by telling us this is not a Trump bashing book as the focus was on the efforts made by the task force to analyze the data and make sound recommendations to help stop the spread of this deadly virus. Dr. Birx's recommendations were clearly data driven and had no political bent.

She quickly learned what it meant to be working in and for the White House, and, yes, many of her observations of how the President behaved and how his decisions were made are consistent with many of the other other White House staffers who wrote books. As others have stated, whomever had the President's ear last is how the decision was made.

Dr. Birx rapidly saw the division between making decisions by policy makers based on medicine vs the economy. Although Dr. Birx's data, including field visits to most states and speaking with most governors, clearly shows how mitigation actions can and would slow the spread of the virus, the economic policy makers (who had the ear of the president) clearly ignored hard data and went with their gut because the economy was more important that people's lives. Dr. Birx didn't want the country shut down either, but if people were not going to follow sound, proven mitigation actions, then the shutdown was inevitable.

To get a behind the scenes look at how the task force operated, the obstacles in their way, the White House perspective, and the White House players who actually supported her recommendations, this book is a must read.

[Sophia · Rating 4 out of 5]

Silent Invasion is an interesting insider's take on how the Trump administration handled the COVID-19 pandemic from the White House Coronavirus Task Force coordinator. Before reading this, I didn't know much about Dr. Birx other than the fact that she wore colorful scarves at press conference. She was the head of President's Emergency Plan for AIDS Relief (PEPFAR) when she was recruited by a friend in the National Security Council to serve in this role. Previously she was in the military and worked at Walter Reed and CDC.

The main thesis is that asymptomatic transmission (silent spread) was missed or underestimated by everyone else, which led to large gaps in the response. Other interesting things I gleaned:
-Her heaviest criticism was for Scott Atlas and rank and file CDC (not the director, Bob Redfield)
-Jared and Pence seemed to understand the gravity of the situation and work with her
-There was a disconnect between what the President said and what the administration was doing behind the scene

I knew reading this book, written in 2022, would be upsetting because it would bring back all those memories from 2020, but I'm glad I finally thought I had enough distance to do so. Stylistically, I found it repetitive. Readers who are pressed for time can probably skip to the outline at the end to learn her thoughts on how we should prepare for the next response. Rounded up from 3.5 stars.

[Jeff Bobin · Rating 5 out of 5]

Birx served in the public health field her whole career and the last few was the pandemic coordinator in the Trump administration. You will find that while she was recruited by a career diplomate in a key role in the administration she was an outsider from day one.

This is a detailed account that touches on the politics it is mainly about the pandemic response. What was done well, what was done poorly and what could have been done better. I found it really interesting that her experience in Africa, where she served many years, show better preparation for pandemic type response than the United States with all our technology.

She does a great job of explaining why understanding the unseen is critical and that building and using data is necessary to a powerful response.

It is also interesting her criticism of the CDC since that is the organization she spent most of her time with. It was eye opening how disconnected they are with the diversity of the people across the county simply because they are not really present.

The epilogue is long and somewhat rambling and expresses her disagreement with some of the ongoing response. Some of her frustration in no longer being a voice at the level she wants is clear. That is the cost of taking a position that is political even when you try and keep it apolitical.

Well worth the read.

[Aldo J. Marchioni · Rating 3 out of 5]

everything you wanted to know about the dysfunctional Trump Covid response….and more

Another exhaustive, and exhausting , expose of the Trump administrations response to the Covid pandemic. While Dr Brix obviously knows more about COVID, epidemiology, and what should have been done as anyone on earth, but as one reads her memoir it very quickly becomes apparent that she lacked the skills to effect important directional change within the politically charged environs of the White House. Too bad, because she could have saved thousands of lives if she could have convinced the administration to implement many of her recommendations.
This book drones on forever, repetitively, and redundantly reminding us of how much smarter she is than the rest of the Administration until one can’t help but believe that her memoir is just an exhaustive exercise in protecting her own reputation.
A shame, because Dr Brix is extremely epidemiologically competent, committed to the use of facts and data to deal with pandemics, but her potential was circumscribed by her inability to deal effectively within the politics of a totally dysfunctional White House. I’d hire her any day but would never put her in the situation she was in. Dr Brix could have made her points successfully in a memoir half this length and that may be an indicator of the crux of her problem.

[JoAnne · Rating 3 out of 5]

I struggled with my review because this book was quite an eye opener about the high hurdles Dr.Birx faced, and it breaks my heart that so many lives were lost because she was so often blocked from doing what she believed was needed and her expertise (especially about the role of silent spread and how testing could have been used to reduce it) was largely ignored at the highest levels. I was impressed with what she was able to do behind the scenes, with her state specific communication to Governors of their local data and appropriate action steps based on that data.

This book helped me truly understand the difficult position she was in and I applaud her commitment to stay for the sake of what she could accomplish despite the roadblocks.

My problem with the book was twofold. First, it really needed a good editor. The repetition was more than annoying. And second, while she was unfairly stymied and silenced, the tone of the book was a bit whiny and defensive. I suspect if it had been more concise, the tone would have been easier to take.

[Antoinette Maria · Rating 3 out of 5]

This is the second book I've read by a high-profile person that made me ask, Where was the editor?? The writing seesaws between giving too much detail (a large part of one chapter was spent on one meeting) and almost no detail (she says the Trump administration eliminated processes and red tape to speed up vaccine development which is believable but she gives absolutely no evidence to support it). It's really hard for me to imagine someone who's not a public health geek being able to stick with this book as a lot of it's really in the weeds of public health bureaucracy. Birx has a lot of interesting things to say about the pandemic response, how woefully underprepared our public health infrastructure was and remains, and about all the BS you have to put up with as woman in leadership which is why I lean more positive than negative towards this book. I just wish the writing rose to the level of the ideas.