Scott Gottlieb - Uncontrolled Spread: Why COVID-19 Crushed Us and How We Can Defeat the Next Pandemic

Chapter 1:
America the Vulnerable

Chapter 2:
Confusion and Subterfuge

Chapter 3:
Pandemics as National Security Threats

Chapter 4:
The Outbreak We Didnt Want to See

Chapter 5:
Looking for Spread in the Wrong Places

Chapter 6:
The Zika Misadventure

Chapter 7:
The CDC Fails

Chapter 8:
Not Enough Tests and Not Enough Labs

Chapter 9:
Shortage after Shortage

Chapter 10:
Preparing for the Wrong Pathogen

Chapter 11:
Stay-at-Home Orders

Chapter 12:
A Plan Gone Awry

Chapter 13:
The Information Desert

Chapter 14:
Hardened Sites

Chapter 15:
Evidence Is Hard to Collect in a Crisis

Chapter 16:
Getting Drugs to Patients

Chapter 17:
The mRNA Breakthrough

Chapter 18:
A New Doctrine for National Security

Australia

HarperCollins Publishers Australia Pty. Ltd.

Level 13, 201 Elizabeth Street

Sydney, NSW 2000, Australia

www.harpercollins.com.au

Canada

HarperCollins Publishers Ltd

Bay Adelaide Centre, East Tower

22 Adelaide Street West, 41st Floor

Toronto, Ontario, M5H 4E3

www.harpercollins.ca

India

HarperCollins India

A 75, Sector 57

Noida

Uttar Pradesh 201 301

www.harpercollins.co.in

New Zealand

HarperCollins Publishers New Zealand

Unit D1, 63 Apollo Drive

Rosedale 0632

Auckland, New Zealand

www.harpercollins.co.nz

United Kingdom

HarperCollins Publishers Ltd.

1 London Bridge Street

London SE1 9GF, UK

www.harpercollins.co.uk

United States

HarperCollins Publishers Inc.

195 Broadway

New York, NY 10007

www.harpercollins.com

To my three daughters.

You make the world a better place.

Declare the past, diagnose the present, foretell the future.

HIPPOCRATES

In New York City, fourth-year medical students at New York University Grossman School of Medicine were given the option of graduating early if they agreed to work on the hospitals COVID wards. It was an eerie throwback to events that unfolded one hundred years earlier, during the Spanish flu, when Philadelphiacritically short of healthcare workerspressed medical students into service.

In March 2020, it wasnt only medical students who were thrust into improbable circumstances. New York City had become the initial epicenter of the COVID-19 pandemic in the United States. In its hospitals, surgical residents were running makeshift intensive care units that were fashioned out of operating rooms. Pathology residents were reassigned to the medical wards.

New York State had issued a jarring directive urging EMS crews and other emergency service workers to forgo attempts to revive anyone without a pulse when they got to the scene of a medical emergency, amid the intolerable strain caused by COVIDs surge.

Id completed my medical training in New York City as a resident in internal medicine twenty years earlier, and I went to medical school at Mount Sinai Hospital in Manhattan. Among my most vivid memories from training were covering the medical floors at Elmhurst Hospital in Queens. The hospital was located in one of the most ethnically diverse neighborhoods in the country, and the communitys rich culture deepened the complexity, and gratification, of practicing medicine there. I knew the hospitals capable staff, and its immense capacity. Watching the scenes unfoldof Elmhurst Hospital being overrun with COVID patients, of refrigerator trucks parked outside, and of doctors and nurses describing their harrowing experienceswas hard to bear.

It was stunning, and it was shocking. But above all, it was terrifying. What my medical colleagues in the city described to me again and again was pervasive fear: Fear that they could spread the virus to their families, as each day New York hospitals were using as many masks, gloves, and gowns as they normally consumed in an entire month during usual times, quickly draining whatever stockpiles they had. Fear that they didnt know how to care properly for the sick patients overwhelming their wards, suffering from a virus that nobody yet understood. Fear that they couldnt predict how or when the arc of infection would start to ebb. And fear that a lot of lives would be lost.

It was a harrowing epidemic that brought the citys vaunted healthcare system much closer to the brink of collapse than most people, even now, recognize.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2 or SARS-2) is the virus that causes the disease that weve come to know as COVID-19. By the time the first cases of community spread were diagnosed in late February, SARS-CoV-2 had already rooted itself in our communities. It had been here for a while, at least since January, replicating, spreading, and doubling its numbers every two to three days. Then, in March, after thousands of cases had accumulated, the virus abruptly burst into public view.

The virus didnt arrive with a group of visitors from China, where it originated, or from Italy, where it established its next major foothold. Instead, it likely rode along the breath of probably hundreds of different travelers from a variety of locations, each ferrying the infection, and evading the porous controls that the federal government had put in place at US airports. At the time nobody knew what was happening. Nobody knew how much virus was being carried by people who showed no outward symptoms of the disease. These were people who might never manifest any signs of illness but were still contagious. Without the ability to test people for the virus, we had no way of detecting its spread. We certainly had no way of stopping it.

This wasnt because the United States had never imagined it might fall victim to a deadly pandemic. We certainly had imagined the possibility. In some respects, we had been preparing for this moment through three presidential administrations, starting with George W. Bush, who warned in a 2005 speech, following the outbreak of Severe Acute Respiratory Syndrome, or SARS-1, and then avian flu, that scientists and doctors cannot tell us where or when the next pandemic will strike, or how severe it will be, but most agree: At some point, we are likely to face another pandemic.... Our country has been given fair warning of this danger to our homeland and time to prepare. We had a pandemic playbook on the shelf, ran exercises simulating the threat countless times, and developed the Strategic National Stockpile to store the medical countermeasures that the top experts thought the country would need. But when the pandemic we long feared finally arrived, we werent ready. Many of the plans and preparations turned out to be a technocratic illusion. The stockpile lacked key essentials. A lot of what it contained didnt work. It was a metaphor for our fragile response.

When I worked in the federal government in public health roles, we would say that planning for medical calamities provides you with no assurance that youre prepared to deal with one. That was certainly true for COVID. The US never developed a pandemic strategy that would be broadly relevant to a range of predictable and unexpected viral threats, and the country was slow to realize the ways in which the plan we had created and tried to work from, which focused almost exclusively on the risk from flu, wouldnt apply to COVID. The federal government started off in a weak position, with plans that were ill suited to countering a coronavirus. This mismatch between the scenarios we drilled for and the reality that we faced left us unprepared. Poor execution turned it into a public health tragedy.