I finished “Uncontrolled Spread”, Dr. Scott Gottlieb’s book on why COVID crushed us and how to defeat the next pandemic. It’s not a perfect book – the narrative part ends with the vaccines are here and how great the mRNA vaccines are now and they’ll be even more wonderful in the future but it does get us through the pandemic phase so I suppose if we adopt his proposals the next pathogen won’t become endemic. The focus is on the institutions, mainly governmental, so Dr. Fauci and Dr. Birx get like 3 mentions each, and Trump comes up in a single chapter mainly about messaging. And you have to remember that Gottlieb is a former FDA commissioner and on the board of Pfizer so those institutions mainly (only?) get praise.
Before COVID I thought the CDC was pretty good for a government agency, after COVID crushed us but before I read the book I thought the CDC is just another lousy government agency, and after reading the book hoo boy they come off as one of the crappiest government agencies ever, on a par with the Austrian army of WWI. Everyone looked to them as the field general who was going to lead the public health team to victory; they saw themselves as an historian who years later would write the definitive account of the war. They screwed up testing, both by botching the initial test and then delaying all other entrants by every means at their disposal like insisting on IP protection and not providing samples of the virus. And it was all downhill from there.
The basic science was also lousy. Everybody wanted to get in on a study of some sort and most were basically worthless. For instance, 90 percent of the COVID trials run were designed in a way that would never yield actionable results that could change medical practice. That means all those participants time were wasted and it was hard to get people to enroll in the trials that could make a difference. The NIH set up the ACTIV clinical trial database and refused to participate in the British RECOVERY trials because they viewed it as insufficiently rigorous i.e. too simple. Not a single therapeutic would be authorized by the FDA based on ACTIV, the use of dexamethasone in severely ill COVID patients came from RECOVERY.
Ultimately, our failures on COVID were the failures of our public health institutions. For instance, the reason politicians up until mid march were assuring us there was nothing to worry about is that that was the message from CDC, NIH, etc. They kept saying it wasn’t here based on our data and that if it does show up we will be ready. Ha. The fact that we couldn’t test for it? We have our flu like illness system and it doesn’t show an uptick in cases. They didn’t realize the lag involved in much of the data from that system, set up by “historians”, or that the signal from COVID would be swamped by the decline in numbers at the end of a flu season. Their overconfidence was only overshadowed by their incompetence.
I could go on and on but then few have read even this far, so you get the idea. And if you want to read more, go read the book.
Lots of good recommendations in the book, but since they involve spending money in a way that doesn’t buy votes and/or a change in the way government agencies operate, I have little hope that any will be adopted.
