This Is How Covid Crushed Us
A review of "Uncontrolled Spread: Why Covid-19 Crushed Us and How We Can Defeat the Next Pandemic" by Scott Gottlieb
Harper, 512 pages, 2021
You could easily stage Oedipus Rex against the backdrop of March 2020. The story begins with a plague, after all—and very likely was the product of the one that swept an Athens sealed against wartime incursions in 430 BCE, the year before its first performance.
Sophocles wrote about more than Oedipus’s quest to discover who killed his predecessor: this begins as a way to rid Thebes of a pestilence that’s killing people, cattle, and crops. Oedipus seems like the man for the task. He’s a rationalist and empiricist, clearly the smartest person in Thebes. His intellect has already rid them of one threat—the Sphinx—and brought him to the kingship. Sophocles pits Oedipus’s method—secular, almost scientific—against a view that looks to prophecy and believes in fate’s control. It’s not so much that Oedipus’s methods fail as that his personality does. What he examines, he examines with rigor. But there are things he simply can’t allow himself to know.
It won’t be too long, I suspect, until we see that production, its stage filled with terribly smart people devoted to public service who, cut off from the information they need, compounded their errors by refusing to acknowledge them. After all, that’s the one-sentence summary of Scott Gottlieb’s account of America’s failures in the first year of Covid-19.
Uncontrolled Spread is most valuable as a clarifying and dispassionate history of those early months. In its pages, the former FDA Commissioner and current Pfizer board member shows that once SARS-CoV-2 escaped China—once it went pandemic—our plans for mitigation and containment and the agencies tasked with carrying them out were simply too fragile to succeed.
Fragile systems might be complex, effective, and well-constructed—but they can suffer cascading failures when faced with the unanticipated. They can’t, as economist Nassim Nicholas Taleb has illustrated, learn from errors. America’s pandemic response, like Oedipus’s intellect, proved fragile in this way, each suffering the curse of knowing what we already knew a little too well.
One thing we knew—and knew early—was that, as the public health refrain went, “Covid-19 is not like the flu.” It’s strange to think of this as a kind of failure; it shouldn’t have been. But it was. The two diseases were dissimilar in infectiousness, in death rates, and in the ways they affect the body. Such differences helped raise public alarm.
But there were more ways, ways more important to shaping a public health response, in which the illnesses were not alike. These differences were not only unknown, or overlooked—but actively resisted: that, unlike influenza, Covid spreads primarily not by microscopic droplets but by much smaller aerosolized particles; that schools and schoolchildren play a far smaller role in transmission than is the case for influenza; and—most importantly—that those not yet showing symptoms could be important, perhaps even primary, drivers of viral spread.
The pandemic response plans which the CDC, White House officials, and other public health agencies followed, however, were designed on the assumption that a pandemic would be caused by a strain of flu. It’s not an unreasonable prediction. But the result was systemic fragility: a plan designed for a single category of virus and the specific ways it spreads.
So, in the absence of Covid-specific diagnostic tests, the CDC relied on