Summary of the book "Uncontrolled Spread" - By Scott Gottlieb
Key Insights in this book:
- It was difficult to find early information on the COVID-19 outbreak.
- Delays and suppressed information, along with insufficient testing, have resulted in a serious issue for the United States.
- The United States was prepared for flu outbreaks and bioterrorism, but not for a coronavirus.
- The CDC was ill-equipped to handle the COVID outbreak.
- It wasn't simply the CDC that was involved. During the crisis, the government's leadership also generated issues.
- South Korea had all of the necessary testing, stocks, and surveillance to deal with a pandemic.
- The United States must begin to handle public health in the same way that it treats other sorts of intelligence.
- People are keen to learn more about the US’s response to the COVID pandemic.
- Anyone interested in how we can be more prepared against future threats.
What am I getting out of it? Learn what went wrong when COVID-19 arrived in the United States.
It was always going to be tough to contain a highly contagious coronavirus pandemic, but it didn't have to be impossible. There had been numerous warnings. There were epidemics of Zika, avian flu, SARS, and Ebola viruses in the years running up to 2020. Some countries paid note and established plans to defend themselves in the event of future disasters. The United States was one of many countries that did not.
In the United States, a variety of things went wrong. Some of these events were caused by bad planning and decision-making on the part of officials, while others were beyond their control. However, their combined efforts created a perfect storm that allowed a novel coronavirus to spread unchecked across the country for months.
In this summary,
- You'll learn why the CDC in the United States was unprepared to handle the crisis.
- Why South Korea was better able to control epidemics.
- And why public health is becoming a national security issue.
1. It was difficult to find early information on the COVID-19 outbreak.
Scott Gottlieb, the author, exchanged worrisome messages with Joe Grogan, the White House's Domestic Policy Council, on January 18, 2020. Both men had previously worked at the Food and Drug Administration, or FDA, and were concerned about a new viral pneumonia outbreak in China. Gottlieb had just stepped down as commissioner in April 2019, after working there since 2003.
Gottlieb had been following SARS, MERS, Ebola, and Zika epidemics for years. Some were very personal, while others stayed away. On January 18, though, Gottlieb informed Grogan that he wasn't so sure about the new outbreak.
He was concerned, to be honest.
The main point is this: It was difficult to find early information on the COVID-19 outbreak.
One of the first warning signals Gottlieb observed was the unreliability of the information coming out of China. The exact number of affected patients was unknown, as was the possibility of the virus spreading from person to person. Both China and the WHO – the World Health Organization – maintained that the outbreak had only affected those who had come into contact with a specific zoonotic source at an outdoor food market in Wuhan. In other words, they claimed that people had contracted the infection from an animal.
However, the United States Centers for Disease Control and Prevention, or CDC, was already detecting evidence that the virus was spreading among these people's family members and infecting others who hadn't been near the food market. China's withholding of information didn't surprise Gottlieb. The Chinese government attempted to conceal the SARS-1 pandemic from the rest of the world, as well as its own citizens, in 2005.
It seems to be doing it again now. Multiple persons with strange and aggressive pneumonia-like symptoms showed up at hospitals across Wuhan in mid-December. Doctors sent lung fluid samples for genetic sequencing studies after being unable to determine the cause.
On December 27, one of the first results was received. Confirmation: it was a new respiratory virus, similar to SARS-1, which had killed roughly 800 individuals throughout the world. The discovery was alarming, but instead of raising the issue, Beijing's National Health Commission ordered that all sequencing data be kept confidential.
Weeks later, China and the WHO continued to downplay the risk, claiming that "no concrete proof" of person-to-person transmission existed.
2. Delays and suppressed information, along with insufficient testing, have resulted in a serious issue for the United States.
Fortunately, not everyone in the Chinese medical community followed the directive not to reveal the virus's sequencing data, which was previously known as SARS-CoV-2. The hazard was obvious: this was a brand-new coronavirus that appeared to be highly contagious.
Some doctors were concerned enough to take to social media and publicize the genetic information. Even after the material had been disseminated, there was still a reluctance to issue warnings.
The WHO continued to defer to Chinese authorities, who opposed designating the outbreak as a Public Health Emergency of International Concern – a designation that would signal the need for international assistance – or as an official pandemic, which would have triggered health protocols in many countries.
It wasn't until March 11, 2020, that the declaration was made. It was too late by then.
The main point here is that delays, hidden information, and poor testing all contributed to major issues in the United States.
The pathogen had already departed China by early March. On January 13, it arrived in Thailand. On January 15, it was released in the United States, and on January 20, it was released in South Korea. Months, if not weeks, of delay can make a significant impact on the control of an outbreak. SARS-CoV-2 had already spread widely by the time the WHO decided to proclaim a pandemic. Given how much China has downplayed the virus's seriousness, many Americans still believed it wouldn't be a major issue in the United States.
It was, of course, already the case. Cases appeared in Chicago and California just days after the first sick patient was diagnosed in Seattle. This sparked immediate concerns regarding testing. How might doctors and health officials screen their patients, as well as those who had come into touch with them, to try to stop the spread? There was just one option at the time: the CDC.
The CDC was the only agency in the United States with copies of the virus, which could be used to test new cases. The CDC, on the other hand, kept this material under wraps for a long period. Anyone who wanted a test had to send a sample to the CDC and wait for the results, which could take a long time.
It wasn't long before there was a backlog of submissions that greatly outstripped the CDC's capacity to process them. The United States was on its way to disaster.
3. The United States was prepared for flu outbreaks and bioterrorism, but not for a coronavirus.
Early on, the US government took the approach of treating the pandemic like a flu outbreak, as President George W. Bush had done in 2005.
At the time, there were concerns about the H5N1 avian influenza virus. Bush read The Great Influenza, a book that detailed how pandemics are an inevitability that occurs once every century, and it had an immediate influence on him. He promptly put together a team to devise a more effective national plan.
During the following administrations, the focus remained on how to deal with a pandemic flu outbreak or a bioterrorist strike, such as a chemical or anthrax attack. SARS-CoV-2 and the sickness it causes, COVID-19, don't act like either of these things, as the US would find.
The essential takeaway is that the United States was prepared for flu-like outbreaks and bioterrorism, but not for a coronavirus.
Understanding and detecting any new virus is crucial to combating it. However, in the early days of the outbreak, there was little comprehension of SARS-CoV-2 due to a lack of knowledge – simply a lot of supposition.
Given that the US's preparedness was focused on a flu-like virus, the government's early guidance emphasized the need for handwashing and cleaning surfaces. The virus that causes COVID-19, on the other hand, isn't like influenza in the way it moves and spreads.
The CDC took nearly a year to amend its guidance to reflect the fact that this virus was largely transmitted through the respiratory tract, rather than by touching infected surfaces and then contacting your face.
The United States also depended significantly on a system that was meant to detect flu outbreaks. The CDC uses the Influenza-like Illness Network (ILI) to track the number of people who have flu-like symptoms and where they are. This was the only nationwide method available to detect COVID epidemics at the time. However, as we now know, many persons who contract the condition are asymptomatic while still spreading the virus.
There was a need for greater testing. Officials sought a mechanism to test people quickly, find out who had come into touch with a positive case and then communicate that information with a nationwide database. None of this, however, was possible. The United States was smack dab in the middle of a COVID crisis.
4. The CDC was ill-equipped to handle the COVID outbreak.
President Bill Clinton declared the global spread of AIDS a danger to US national security in April 2000. It was a significant step forward, and it was the first time an infectious disease had been given such a title. Regrettably, it never resulted in a nationwide program that examined additional infectious diseases in the same way.
For a long time, scientists have cautioned that the United States can no longer expect to be immune to diseases that were formerly thought to be rare or limited to far-flung corners of the globe. Then, in 2006, after the highly publicized SARS outbreak, Congress appropriated funds to establish a public health awareness network.
The funds were intended to assist the CDC to communicate data across the country, allowing for faster reaction and pandemic-related crisis management. The CDC, on the other hand, never followed through.
The major takeaway is that the CDC was unprepared to handle the COVID problem.
The CDC has always been a regressive organization. It gathers data, analyzes it, and gives recommendations for resolving or preventing an existing problem. Its internal systems aren't designed to identify or block the spread of something like a new coronavirus. Despite this, the US government entrusted the CIA with leading the response to the fast escalating situation.
Consider the company's testing strategy. The government asked the CDC to produce a quick COVID test, even though the agency had never done so before. The CDC is designed to conduct systematic investigations and research. Its design and manufacturing capabilities aren't particularly quick. As a result, obtaining those critical quick tests was a disaster.
When the initial community spread was discovered in California in February, the CDC should have seen the writing on the wall. The fact that the CDC was in charge of every test throughout this outbreak proved that the policy would slow things down and make things worse. New guidelines might have been developed at this point, and the CDC could have the licensed testing capability to clinics across the country.
Instead, it was faced with the pressures of both processing the tests sent to it for analysis and attempting to do something it had never done before: mass-producing a testing kit.
5. It wasn't simply the CDC that was involved. During the crisis, the government's leadership also generated issues.
When dealing with a pandemic, you'll need two types of tests: PCR tests and antigen tests. For a time, the CDC was in control of both, but it was unable to meet their requests.
PCR tests, which are performed in a lab, are often the more accurate of the two. The CDC sought to process all of these cases itself to better track the virus, but due to a large number of cases, this caused a lot of delays.
Antigen tests are less time-consuming. They don't need to be analyzed in a lab and can provide results in 30 minutes. Although they are less accurate, their ease of use and quick results make them an important tool in crisis management. The CDC failed yet again in this regard: after months of waiting, the CDC's antigen testing kits were tainted and rendered useless. It was more time squandered.
The main point here is that it wasn't simply the CDC. During the crisis, the government's leadership also generated issues.
Finally, the government sought assistance from the corporate sector. The FDA began to approve the first antigen testing on May 9, 2020.
The new tests were primarily purchased by the government. It has spent roughly $760 million on over 150 million tests by September. Regrettably, the issues persisted.
Knowing which tests to apply to certain persons is a science. Due to a lack of coordination, many antigen tests were sent to facilities such as nursing homes, where the more accurate PCR tests were better suited to the higher-risk population. This meant that 30 per cent of the 13,000 facilities that received antigen tests did not use them.
Then there were the White House's contradictory messages. Given the threat posed by asymptomatic carriers and the lack of widespread testing, "nonpharmaceutical interventions" – such as masking, social distancing, closing non-essential services, and working from home – were some of the best defences the US had. Researchers used modelling exercises to show that depending on how timely, fast and coordinated the effort was, these steps could significantly reduce disease spread.
But the response was none of those things: lockdown rules were left up to individual states and governors to decide, and when it came to masks and social distancing, even White House staffers didn't follow the rules consistently.
It didn't have to be this way, as we'll see in the next insight.
6. South Korea had all of the necessary testing, stocks, and surveillance to deal with a pandemic.
One country, in particular, stood out in stark contrast to the United States' chaotic and poorly thought-out response. The COVID situation in South Korea was unfolding in a totally different way. In mid-January, both the United States and South Korea discovered their first cases of COVID-19. But, unlike the United States, South Korea was well-prepared.
This was partly due to the country's experience with a serious MERS outbreak in 2015, which resulted in 82 cases, making it the largest outbreak outside of the Middle East. As a result of the previous event, South Korea made a series of decisions that would demonstrate to the rest of the world what true pandemic preparedness looks like.
The main takeaway is that South Korea had the testing, stockpiles, and surveillance systems in place to deal with a pandemic.
South Korea set up hundreds of testing stations in the aftermath of the MERS epidemic. They'd also made sure there was a stockpile of equipment on hand so that in the case of another crisis, each of these facilities would have everything they needed to operate at full capacity.
They also established a rapid approval, manufacturing, and distribution process for testing kits. When the first cases of COVID were verified in late January, the first order of business was to create those diagnostics. At the time, there were just four cases, but two companies moved into full production right once. The South Korean CDC was also willing to provide virus samples with the manufacturers so that they could independently verify the accuracy of their testing.
Meanwhile, the CDC in the United States guarded its samples as if they were intellectual property. It took months to create and distribute testing kits. Furthermore, once the kits were disseminated, the US stockpile couldn't even cover the number of testing swabs required.
South Korea stepped up to 20,000 tests per day in a couple of weeks, while the US would take four months to reach that level. As a result, South Korea was able to keep its outbreaks under control.
A nationwide testing and tracking database was also available in South Korea. This required some privacy-invading surveillance that would not be practicable in the United States, but America might have used hundreds of epidemiological investigators to some effect.
Things would likely have turned out a lot better if these agents had been able to hunt down and trace a percentage of the cases earlier.
7. The United States must begin to handle public health in the same way that it treats other sorts of intelligence.
If there's one silver lining to the COVID-19 dilemma, it's that vaccine manufacturing technology has proven capable of meeting the task. Vaccines are traditionally made using a culturing procedure that necessitates a large number of chicken eggs. Moderna only needed the sequencing of the virus's genetic code, known as RNA, at this point. It had a vaccine six weeks later that it could begin testing.
mRNA technology is used in the Moderna and Pfizer-BioNTech vaccines, as well as others. This results in a vaccination that stimulates the immune system to develop antibodies against a specific pathogen. What's more, mRNA vaccines are not only straightforward to create in big numbers, but they're also simple to change when a virus mutates.
Even as scientists around the world were praised for manufacturing vaccines at breakneck speeds, the entire process was revealing itself to be profoundly politicized. In fact, it had become a national security issue.
The main point here is that the United States needs to start considering public health as seriously as it treats other sorts of intelligence.
Both Russia and China were discovered snooping and attempting to steal secrets at the same time that the United States was producing vaccinations. In order to promote its own version, Sputnik, Russia launched a disinformation campaign against the Pfizer vaccination.
Furthermore, given how widely travel bans were utilized during the epidemic, it's difficult to believe that governments won't continue to act in their own interests, or, as China has done, be hesitant to be forthright about the next outbreak. Isolation by other countries can be detrimental in more ways than one. However, as we've seen, suppressing critical information can be harmful.
Many countries were left unprotected and at a disadvantage due to China's refusal to exchange viral samples. We'll probably never know for sure where the outbreak began, though there's a lot of evidence to suggest it originated with an accident at a coronavirus-handling lab in Wuhan.
All of this leads to the conclusion that public health is a national security concern. The United States requires a federal program that can both manage and prevent outbreaks by keeping abreast of global events. The US gathers a lot of information on other potential dangers. It needs to start treating things like coronaviruses with the same level of seriousness.
The main message is that the proliferation of COVID-19 has had a significant impact on the United States for a variety of reasons. For starters, Americans were ignorant of how widespread and deadly the virus was due to a dearth of information coming from China. Second, the United States was woefully unprepared. There were no plans or mechanisms in place for producing or tracking the necessary tests, and there was no powerful central agency to take responsibility. While diagnostics and vaccines were finally developed, the delay was so long that the virus was able to spread unchecked. To be ready for the next pandemic, the United States must establish a powerful federal agency to oversee a supply stockpile and organize a response that relies on testing and tracking to limit harm.
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