UNCONTROLLED SPREAD

The former commissioner of the Food and Drug Administration assesses the systemic failures underlying the world response to the Covid-19 pandemic.

Numerous public entities within the federal government, writes Gottlieb, are charged with preparing for the outbreak of epidemic diseases. Most of their energies were directed toward fighting the flu. “The federal government started off in a weak position, with plans that were ill suited to countering a coronavirus,” writes the author. “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.” It took time, of course, to recognize fully that Covid-19 spread through a handful of “superspreaders” and mostly indoors in areas that were both crowded and poorly ventilated—the White House during Trump’s frequent self-congratulatory public events, for one. Trump, Gottlieb makes clear, bears plenty of responsibility for the government’s inadequate response, as do lieutenants who politicized the Centers for Disease Control and Prevention, suppressed information, and followed Trump’s lead in rejecting mask-wearing and other safety measures. “The president could have found a middle ground on masks,” Gottlieb writes. “His message could have been: We don’t need mandates….However, we’re going to act responsibly and wear masks.” The author argues that even under different leadership, the response would likely have been little better, at least in part because there is not enough coordination among agencies. He urges that preparation for pandemics be considered a part of national security, with the Pentagon fully involved and with a system that works its way around informed consent “to address a public health emergency” so that data is quickly shared. Moreover, he argues that testing procedures be standardized, as they are not now, with a full inventory of equipment in both public and private hands. These and other measures are urgently needed: If Covid-19 was the worst pandemic in recent history, “it won’t be the last.”

Of considerable interest to health policymakers and public-safety officials as well as students of epidemic disease.