Lessons from the Covid War: An Investigative Report

by Covid Crisis Group

This powerful report on what went wrong—and right—with America’s Covid response, from a team of 34 experts, shows how Americans faced the worst peacetime catastrophe of modern times
 
Our national leaders have drifted into treating the pandemic as though it were an unavoidable natural catastrophe, repeating a depressing cycle of panic followed by neglect. So a remarkable group of practitioners and scholars from many backgrounds came together determined to discover and learn lessons from this latest world war. 
 
Lessons from the Covid War is plain-spoken and clear sighted. It cuts through the enormous jumble of information to make some sense of it all and answer:  What just happened to us, and why?  And crucially, how, next time, could we do better? Because there will be a next time.
 
The Covid war showed Americans that their wondrous scientific knowledge had run far ahead of their organized ability to apply it in practice. Improvising to fight this war, many Americans displayed ingenuity and dedication. But they struggled with systems that made success difficult and failure easy. 
 
This book shows how Americans can come together, learn hard truths, build on what worked, and prepare for global emergencies to come.
 
A joint effort from:

Danielle Allen • John M. Barry  • John Bridgeland • Michael Callahan • Nicholas A. Christakis  • Doug Criscitello • Charity Dean • Victor Dzau • Gary Edson • Ezekiel Emanuel • Ruth Faden • Baruch Fischhoff • Margaret “Peggy” Hamburg • Melissa Harvey • Richard Hatchett • David Heymann • Kendall Hoyt  • Andrew Kilianski • James Lawler • Alexander J. Lazar • James Le Duc • Marc Lipsitch • Anup Malani • Monique K. Mansoura • Mark McClellan • Carter Mecher • Michael Osterholm • David A. Relman • Robert Rodriguez • Carl Schramm • Emily Silverman • Kristin Urquiza •  Rajeev Venkayya • Philip Zelikow

Genres: Nonfiction, Medicine, Health, Science, Audiobook, History, Medical

352 pages, Paperback

Published April 25, 2023

Reviews

[Brice Karickhoff · Rating 3 out of 5]

This book was comprehensive, in-depth, informative, up-to-date (as up summer 23), and relatively agenda-free. I specifically learned a LOT about the inner workings of the CDC, NIH, FEMA, CMS, etc., and the interplay between the federal, state, and local governments in response to the pandemic. When the book did assign blame, it felt fair and measured, and it never got too partisan for my taste. The solutions and policy proposals of the authors seemed a bit lofty and unrealistic, but that is why they’re academics not legislators, so whatever.

So with all that said, why only three stars?

First off, I am not sure that I liked how this book was written by a team of 34 experts. For some reason, whenever a critical mass of experts is achieved, proclamations take on this air of irrefutability, and this book was no exception. Plenty of audacious claims presented as absolutes. One lesson I learned from COVID is that just because 100 experts say something is absolutely true or untrue does not mean that it is so. I thought that the group-author aspect of this book allowed it to ignore that reality.

Secondly, this book committed a sin that the econometrician in me always struggles to forgive: country-to-country comparisons without statistical (or even qualitative!) Mention of covariates. I think the main reason I still haven’t considered socialism is because everyone who advocates for it loses me the second they mention Norway. I don’t want to belabor this point, so I’ll just say that this book talked about Germany more than a book on the US’s pandemic response should, in my opinion.

All that being said, this was a good book. The thesis was that we have a 19th century public health system that remains unprepared to confront 21st century challenges. I agree with this thesis and I’m glad I read a book on it.

[Xander Dale]

read for security policy

great review of American policy failures during COVID, from huge collection of esteemed scholars

[Dbishai]

If USA had had an average rich country response to the pandemic 300,000-400,000 people would not have died. So if you are an American and want to have your death prevented--you should read this book. The bell of ineptitude is tolling for you. It already tolled for someone you loved and lost in the pandemic.

The book tries to avoid blame and shame, it covers systematic and structural failures. The book also avoids pining for tougher lockdowns and mask mandates. It never was a war between the economy OR the public's health. The biotech saviors held the pen for far too many pages in my opinion. But the health systems writers manage to encapsulate the crux: America still has a 19th century public health workforce addressing 21st century problems.

That is a wake up call for a lot of people--especially people who teach public health.

[Steven H · Rating 5 out of 5]

A REASONABLY ‘OBJECTIVE’ HISTORICAL PERSPECTIVE OF THE ENTIRE CRISIS

The first chapter of this 2023 book explains, “The Covid Crisis Group formed at the beginning of 2021, one year into the pandemic. We thought the U.S. government would soon create … a commission to study the biggest global crisis so far in the twenty-first century, It has not,. The thirty-four members of our group have done a lot of work on the Covid war, both as part of this group and in our day jobs. We held listening sessions with nearly three hundred people. We organized task forces… We shared insights across our different backgrounds and did a substantial amount of research… With no commission in sight, we feel a duty to share, at the beginning of 2023, how we size up the Covid war… What we can offer is our sketch of the whole picture… We step back and appraise the entire landscape, focusing on what we believe mattered most… We wrote this book for our fellow citizens… who have already read hundreds if not thousands of articles about the pandemic as it happened… We try to be more analytical, to zoom in on what mattered most.” (Pg. 1-3)

They state, "Despite extraordinary efforts by countless committed individuals, the story of the Covid pandemic … is a story of how our wondrous scientific knowledge has run far, far ahead of the organized human ability to apply that knowledge in practice.” (Pg. 14)

They explain, “the CDC was never set up as an executive agency to orchestrate large-scale operations or deploy thousands of people in the field. It does not really manage pandemic preparedness and biodefense around America. The executive agents were still supposed to be those state, local, territorial, and tribal health departments… but---except for mavericks like New York City---the departments have fallen into the habit of just looking for guidance from the CDC, an agency established for research and not equipped to provide executive leadership, not equipped to manage the front lines of a nationwide battlefield.” (Pg. 61)

They state, “During the first weeks of February, when [Alex] Azar was leading task force briefings in the White House press room with the ‘low risk to the United States’ message, President Trump---joining that message in public---was privately telling reporter Bob Woodward, ‘… It’s [COVID is] also more deadly than even your strenuous flus.’ But, on March 19, now in full public emergency mode, Trump explained to Woodward, ‘I wanted to always play it down. I still like playing it down, because I don’t want to create a panic.’ The panic was there without any presidential help. What was missing was the mobilization and readiness that would reassure the American people with action.” (Pg. 93)

They point out, “Innumerable speeches, books, and articles have stated that the Obama administration gave the incoming Trump administration a ‘playbook’ on how to confront a pandemic and that this playbook was ignored. The Obama administration did indeed prepare and leave behind the ‘Playbook for Early Response to high-Consequence Emerging Infectious Disease Threats and Biological Incidents.’ But the playbook … did not explain what to do… it was really a diagnostic manual. It provided sets of questions… But … the ‘how’ part, was never mapped out in the playbook. It did not outline just how to go about screening millions of incoming travelers. There was no description of just what… the assistance teams were supposed to do. The relevant officials in January 2020 had not ignored the so-called playbook… But when it came to the job of how to contain a pandemic that was headed for the United States… the playbook was a blank page.” (Pg. 95-96)

They recount, “President Trump, [Mark] Meadows, and others at the White House decided that the experts were exaggerating the seriousness of the public health problem. President Trump had already been taken with the idea that the Covid outbreak was no worse than a bad flu season… They reached out to sympathetic healthcare pundits, like Scott Atlas… [who] believed that the American death toll from the pandemic might be about ten thousand. The White House later recruited Atlas to join the White House staff as an adviser on the crisis.” (Pg. 127)

They observe, “The net effect of the White House abandonment of federal crisis management in March and April 2020 was that … the White House task force supposedly being run by Vice President Pence and the newly recruited coordinator, [Deborah] Birx, became even more disconnected from what was going on. On March 31, Birx helped persuade President Trump to endorse a thirty-day extension of lockdowns to ‘slow the spread.’ … on April 3, the President turned angrily on Birx… [saying], ‘We will never shut down the country again. Never.’ The president acted as if Birx had betrayed him. Birx soon realized… that her month-old relationship with President Trump was irretrievably torn… some of the president’s economic staff had assured the president that Birx’s estimates of the public health danger were greatly exaggerated and that, by Memorial Day, the United States might suffer only about 26,000 deaths (Birx’s staff had predicted 100,000 to 240,000)… The economic staff estimate was wrong… Birx also realized that much of the White House was actually becoming an adversary in her efforts.” (Pg. 128-129)

They summarize, “there is a common view that politics, a ‘Red response’ and a ‘Blue response’ were the main obstacle to protecting citizens, not competence and policy failures. We found, instead, that … Incompetence and policy failures, including the failure of federal executive leadership, produced bad outcomes… Those failures and tensions fed toxic politics that further divided the country in a crisis rather than bringing it together.” (Pg. 156-157)

They note, “Because of misjudgments about aerosol spread and fears about shortages of masks, leading public health voices cautioned against their use in the formative early weeks of the pandemic. The Surgeon General…sent out a widely noted tweet in February: ‘Seriously people---STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus…’ During that time, [Anthony] Fauci and Birx were not mask advocates. The CDC did not recommend their use among asymptomatic people until April.” (Pg. 174) They continue, “The reluctance to require masks was fueled by politics… many voters were angry and frustrated about the disruption they had experienced: shuttered businesses, closed schools… and the loss of friends and family members. In an election year, President Trump understood this anger and frustration and exploited it by, among other things, publicly opposing masks.” (Pg. 177)

They comment, “The president said schools should reopen, with little advice about how. The CDC’s official position during the spring and summer of 2020 was to support reopening, but its successive… guidances during 2020 … [were] often impractical… During the 2020-2021 academic year, manyK-12 schools tried to reopen for in-person learning, then closed as the second wave of the virus swept the country during the fall months… Closed schools, even with remote education, failed many students, particularly those already at risk for disrupted learning.” (Pg.181) They go on, “The toll on children from the failure …to develop and implement a … toolkit for schools cannot be overstated. Almost all children suffered important setbacks in skills development and knowledge… And when these buildings are shuttered, what is at stake is much more than what can be measured on standardized test scores.” (Pg 185-186)

They recall, ‘as Covid hot spots popped up around the country, many rural hospitals were simply overwhelmed. Doctors managed heavy caseloads in makeshift ICUs… Patients died in hallways… Unable to expand their supply of ICU beds quickly, they restricted demand instead by cancelling elective surgeries.” (Pg. 193) They continue, “Before COVID-19 arrived, clinicians were already in a crisis of burnout… Exhausted and fearing for their own safety, they suffered anxiety, depression, and emotional distress… In the first year of the pandemic one in five healthcare workers resigned, retired, or were fired.” (Pg. 194-195)

They observe, “By May 2020 and on through the rest of the year, President Trump and some of his key advisers were effectively at war with much of their own government. The war usually took the form of constant public sniping, above all from the president. Behind the scenes, this warfare took the form of constant effort to muffle, delay, or critique public guidance.” (Pg. 208)

They explain, “the process for evaluating drugs had already become politically charged. The opening gun was the battle over whether Covid could be cured by … hydroxychloroquine… TV hosts … praised it on Fox News. President Trump rushed to endorse it… The government had not yet been able to rapidly organize high-quality trials of hydroxychloroquine. The president pressured his new FDA chief… to approve the drug immediately… The FDA quickly gave in… [and] agreed to issue an EUA for the use of the drug against Covid… the FDA granted an EUA …. On March 28. The EUA was revoked on June 15. The damage to the FDA’s reputation was not so easily undone.” (Pg. 226-227)

They report, “President Trump became seriously ill… As soon as he was hospitalized he received the Regeneron… treatment… these drugs were still in clinical trials, not available to the general public… [His] dosage appears to have been more than twice the amount being used in Regeneron trials. President Trump also received remdesivir…” (Pg. 240) They add, “In sum, Operation Warp Speed was the best marriage of policy design and operational implementation of the Covid war. Its success was remarkable and fortunate.” (Pg. 252)

They conclude, “We now see the need for concerned governments to develop a whole new system for governing exceptionally risky biological research… We see that any hope of containing an outbreak before it becomes a pandemic requires more ambitious and realistic national and international preparation… we also learned more about how to prepare to produce tests at scale… The war has shown us that practical preparation means advance investment and ready access to emergency funds, along with a proactive and multi-year approach to preparing partnerships with private industry to meet public needs.” (Pg. 280-281)

This book will be of great interest to those studying the COVID pandemic, and its aftermath.

[Tofupup · Rating 5 out of 5]

This is an alarming analysis of what went wrong (and a few things that went right) in the world's and the United States' COVID response. Certain things did not happen by accident; this left me with a lot of a-ha moments. Hopefully we can learn from these shortcomings and missteps and respond better to the next pandemic.

[Julia · Rating 4 out of 5]

Great learnings and insights here. Eloquently highlighted the bravery + resiliency of ordinary Americans, while calling for federal leadership to be smarter and more firm. Ongoing investment in our public health infrastructure is CRITICAL. ✨✨

[Bart · Rating 4 out of 5]

Written with appropriate indignation and nearly willing to concede the beginning of an end to American leadership round the world

[Shelley · Rating 5 out of 5]

This book is well written…researched…and organized to present an in-depth description and evaluation of the efforts throughout the world to contend with Covid-19. While there are a few parts that are very dry and bog down in acronyms and statistics, overall the book is fascinating. It’s also unsettling as the authors present ample evidence to show that experience, research, analysis and broad discussions on lessons learned has not led to the installment of programs, agencies, or oversight groups needed to prevent a repeat of the devastations wrought by the recent pandemic.

[Matthew · Rating 3 out of 5]

Apparently I am a glutton for punishment, so right after reading a detailed account of the 1918 flu pandemic, I decided to see what was maybe a consensus book regarded as one of the best, if not the best, book about the Covid-19 pandemic. After weeding out books at the tops of several lists that turned out to be written by right-wing nutjob "skeptics," I came upon this book, with 34 credited writers—including John M. Barry, who had written The Great Influenza . I really like the premise of this book being that we should have had a Congressional commission for a 9/11 Commission-style report on Covid-19 and never got one (talk about stunningly shortsighted), and so this group of experts came together to create the next-best thing by putting together this book. On the one hand, this book is far less dense, shorter (at just under 300 pages), and reads far more easily than The Great Influenza did. On the other hand, the details shared here are far more broad in scope, otherwise focusing on, as the title suggests, lessons learned from the many things done wrong and the few things done well in response to a 21st-century pandemic. This means there are no gripping stories of death and danger in this book, like there was in the middle section of The Great Influenza. As a result, this book is kind of more blandly academic in tone, as opposed to getting into what actually happened from the start and how we got here—to be fair, a lot of that remains unknown, thanks to the virus having begun in China and China's unwillingness to share those details. Maybe one day those details will be better revealed and we can get a book with a better narrative. Or, I can find another book about covid to try and read after a while.

[John · Rating 3 out of 5]

The lessons learned from this investigative report will be difficult to implement and help future inevitable crises. Good luck to all of us.

[Rae]

Fair assessment of the pandemic policies and reactions. Government response was basically a shitshow. State responses were MacGyver’d. Have we learned anything?

[Leon Robertson · Rating 2 out of 5]

This book is mainly a collection of anecdotes about various episodes in the political fights over COVID-19 policies at various levels of government in the U.S. -- most previously reported in media and memoirs of participants. Politics were an important factor but the book neglects facts and quantitative studies of how and why the virus spread so differently among and between countries and counties in the U.S. The 8 democratic countries that contained the virus, most unnamed in the book, are dismissed as "island countries". The procedures in these countries are discussed in my book, Roads to COVID-19 Containment and Spread. Finland and Norway are among the 8 and are not islands and the United Kingdom, an "island country", did about as badly as the U.S. The book implies that the U.S. did not do enough testing but mentions that Germany's tracing was overwhelmed by mass testing in the second year. On 70 percent of days in U.S. states there were more positive test results than tracers had time to contact. Many of the infected would not name contacts or comply with quarantine recommendations. Those who tested positive traveled an average of 208 miles that they would not have otherwise in the following week and many picked up the virus in the process. Slovakia was doing as well as the "island countries" until it started mass testing and its death rate then soared to among the highest in the world in the following year. There is not a word in the book about wastewater testing that would avoid the post-test behavior problems. Chapters 7 on the healthcare system and 9 on vaccine development are worth reading.

[Jean · Rating 3 out of 5]

Bottom line: I'm glad this was written. I appreciate that the Covid Crisis Group did all of this work. Since reading The Fifth Risk, I have been more cognizant that we have some heroes working in the federal government, and some of those heroes are part of the Covid Crisis Group. It is 3 stars because I still have some questions. For example, there is much talk that the US should conduct biomedical tracing, but there's not really a discussion of how. It comes back around in later chapters, but to me it just seems like requiring health care to report numbers rather than voluntary reporting isn't going to move the needle much. Unless they think somebody can build a system to extract the numbers electronically. And I don't think such a system could be built in my lifetime. I also note that the beginning says this got out of hand because there was asymptomatic spread; however, later they imply we should have relied on antigen tests, which gives high false negatives if you are asymptomatic but "at least they show positive if you are symptomatic and spreading the virus." But would that really have helped if we had a lot of asymptomatic spread in the beginning? It kind of drives me nuts a little, like the CDC saying "The virus can't live on surfaces. Wash your hands." Finally, I went down a rabbit hole at one point trying to figure out what happened to Robert Bright. It's finally covered in a later chapter. He should be counted as one of the governmental heroes even though what he did was not effective through no fault of his own. Anyway, I once again am just glad this was written.

[Anna]

I wish more readers would encounter this apolitical, nonpartisan investigative report on the lessons to take away from the war on COVID. This report attempts to combat what Dr. Ashish Jha calls “reflection deficit disorder” by examining the government’s role to prevent, contain, defend, and fight back dangerous pathogens with pandemic potential. The authors are part of the COVID Crisis Group of 34 members formed in 2021. Their goal was to push for a National COVID Commission, which was killed in Congress. Thus the book. In an environment where most favor any narrative that would fit their own amateur perceptions, such a candid view and big picture of the origin, prevention, and effective management of this and future pandemics is refreshing. Not to mention informative and sobering. Especially poignant is the idea that confronting bad governance is not unAmerican. To do otherwise is to dishonor the millions who died from this pandemic. So grateful for the collaborative effort of experts who care. However, for this group’s efforts to be fruitful, we need government leaders who would work for the welfare of our land. That’s my takeaway from this book.

[Natalia · Rating 4 out of 5]

Oof. This was a hard slog. It's a very dense book, with a lot of footnotes. But it's definitely worth reading - it's a fairly objective look at what was handled well, what was handled poorly. It peels back a lot of the bluster and media spin - for example pointing out that while governors talked about their Covid policies very differently based on party affiliation, often their actual actions weren't that different. They basically read most of the federal government the riot act, and rightfully so. And point out a lot of weaknesses in our public health system that continue. As if we haven't really learned a thing.

[Nils · Rating 3 out of 5]

A provisional attempt to sun up what went right and wrong in the USG response to Covid-19. Marred by a rigorous effort to separate the human from the natural world by way of “warfare” metaphors describing the relationship between the government and the virus. Also painfully methodologically nationalist, not grasping that although national responses (specifically through well coordinated public health measures at local levels) may have been able to mitigate the worst effects of the pandemic, only a planetary-scale governance institution can have effectively manage and contain pandemic risk.

[Nikki · Rating 4 out of 5]

I picked this book up because one of the authors, Dr Michael Osterholm, is someone I've been trusting for covid information and he mentioned it. It was interesting and frustrating to read. I wish we would learn more from this pandemic to help in future global crisis like this but it seems like it just isn't meant to be.

Another stretch but I'm using this for the "About your favorite science or nature topic" prompt in the 2023 BYL Reading Challenge. Favorite isn't right but I am interested in what was done out of sight of the public in this pandemic.

[Dee · Rating 5 out of 5]

An unusual book to rate because this is something of a report in book form from individuals who all played a role in the pandemic in one form or another. But their analysis and their description of the what happened, what should've happened, and what should happen now is easy to read and understand - not your typical government report. I applaud the group that came together to realize this after-action report and only wish this were on every desk in Washington D.C. It's a must-read for public health practitioners, policymakers, and anyone interested in health issues.

[Aaron · Rating 4 out of 5]

Definitely an interesting read. In the same vein as the 9/11 report, this is a nonpartisan summary of the Covid 19 policies and procedures that the US handled. They don't pull any punches in outlining where the government and industries together went bad, but it's not entirely doom and gloom. The hard pill to swallow however, is that the people who tend to be the most trustworthy in this subject seem to think that we are not any better off now for the next pandemic or major disaster....

[B · Rating 4 out of 5]

This was compelling enough to read in two days and focuses mainly on how prepared our government was, and how it responded to the crisis, in many aspects from vaccine creation to therapeutic drug development to decision making etc. Some comparison to what other countries were doing is included. It is not an uplifting read but if you have ever wondered what it takes, on an organizational level to fight a threat like Covid19 this is the book for you.

[Scott Southworth · Rating 4 out of 5]

I have no interest in political or speculative material on the pandemic, especially anything based on conspiracy theory. This was a relatively objective look at what we did wrong and what could have been done better. Style was a bit too academic; could have explored things at a deeper level. Needs more personality.

[Jasmine · Rating 4 out of 5]

I did not think I was going to learn much from this, but I was absolutely wrong. This connected so many dots for me and did a good job of outlining what happened across government agencies and Operation Warp Speed. It makes some recommendations for how things could have been improved, but honestly a lot of it seems really difficult to accomplish with the way things are in America.

[Lori Evenhouse · Rating 3 out of 5]

Extremely in-depth information on the federal COVID response, but the book suffers from having been written by committee.

"(For the United States to) build that capacity, it must take these threats seriously and put in place competent technical leadership that can answer 'how' questions. It has to rebuild deep scientific expertise both at home and around the world."

[JennerallySpeaking · Rating 3 out of 5]

2.5/5 - It was interesting to read about something that I have clearly deleted out of my memories. It was almost jarring to semi relive the reality that was three years ago. Seeing it in hindsight really highlights how absurd the response was and how unprepared people are

[Susan Kraus · Rating 5 out of 5]

Just released, and my husband bought two copies on Amazon. It's like a post 9/11 investigation, so hard to read. But necessary to read. Critical to read. We will repeat our mistakes if we do not learn from them. I am only part-way through it, but determined.

[Carolyn Leshyn · Rating 4 out of 5]

This is a solid book on the COVID situation. Although, we need a national program for the next event, I don't know if we or the other countries can successfully prepare. I hope each country has learned many things and will use the info properly.

[Nancy · Rating 3 out of 5]

As a person in local public health, I find some of the recommendations to be unrealistic. Easy to do from the academic ivory tower, difficult to do on the ground in the trenches. That being said, a good overview of the problems facing government and public health.

[TelynLl · Rating 2 out of 5]

How could this book not mention Doctors Atlas and Ladopo and others who railed against vaccines, masks and containment measures? Did I miss it? They aren't in the index. Neither is Rochelle Walensky who gave up on fighting the virus as soon as she started.

[Alan F · Rating 4 out of 5]

Informative, very dry, but it’s good because it felt non-political (which I appreciated.) A lot of the information was already known, but I did find the explanation about the inner workings of the response organizations interesting.

[Anthony Murphy · Rating 4 out of 5]

I actually liked this book quite a bit. It gave a good summary of what went well and what didn't go well during Covid. I think it was written a little to heavy on the science stuff, but the solutions seem to be helpful. The question is "Will we listen?"