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Uncontrolled Spread: Why COVID-19 Crushed Us and How We Can Defeat the Next Pandemic Hardcover – September 21, 2021
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NEW YORK TIMES BESTSELLER
“Uncontrolled Spread is everything you’d hope: a smart and insightful account of what happened and, currently, the best guide to what needs to be done to avoid a future pandemic." —Wall Street Journal
“Informative and well paced.”—The Guardian
“An intense ride through the pandemic with chilling details of what really happened. It is also sprinkled with notes of true wisdom that may help all of us better prepare for the future.”—Sanjay Gupta, MD, chief medical correspondent, CNN
Physician and former FDA commissioner Scott Gottlieb asks: Has America’s COVID-19 catastrophe taught us anything?
In Uncontrolled Spread, he shows how the coronavirus and its variants were able to trounce America’s pandemic preparations, and he outlines the steps that must be taken to protect against the next outbreak. As the pandemic unfolded, Gottlieb was in regular contact with all the key players in Congress, the Trump administration, and the drug and diagnostic industries. He provides an inside account of how level after level of American government crumbled as the COVID-19 crisis advanced.
A system-wide failure across government institutions left the nation blind to the threat, and unable to mount an effective response. We’d prepared for the wrong virus. We failed to identify the contagion early enough and became overly reliant on costly and sometimes divisive tactics that couldn’t fully slow the spread. We never considered asymptomatic transmission and we assumed people would follow public health guidance. Key bureaucracies like the CDC were hidebound and outmatched. Weak political leadership aggravated these woes. We didn’t view a public health disaster as a threat to our national security.
Many of the woes sprung from the CDC, which has very little real-time reporting capability to inform us of Covid’s twists and turns or assess our defenses. The agency lacked an operational capacity and mindset to mobilize the kind of national response that was needed. To guard against future pandemic risks, we must remake the CDC and properly equip it to better confront crises. We must also get our intelligence services more engaged in the global public health mission, to gather information and uncover emerging risks before they hit our shores so we can head them off. For this role, our clandestine agencies have tools and capabilities that the CDC lacks.
Uncontrolled Spread argues we must fix our systems and prepare for a deadlier coronavirus variant, a flu pandemic, or whatever else nature -- or those wishing us harm -- may threaten us with. Gottlieb outlines policies and investments that are essential to prepare the United States and the world for future threats.
- Print length512 pages
- LanguageEnglish
- PublisherHarper
- Publication dateSeptember 21, 2021
- Dimensions6 x 1.53 x 9 inches
- ISBN-10006308001X
- ISBN-13978-0063080010
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Editorial Reviews
Review
“Uncontrolled Spread is everything you’d hope: a smart and insightful account of what happened and, currently, the best guide to what needs to be done to avoid a future pandemic." — Wall Street Journal
“In his narrative of the most severe pandemic in a century, Gottlieb lets us know what he has seen, what may well come next and what we can do before the next pandemic arrives. The book is informative and well paced.” — The Guardian
“In Uncontrolled Spread, one thing is certain: Scott Gottlieb is in total control. Throughout the pandemic, my friend Scott consistently provided remarkable insights and clarity that advanced our collective knowledge. Through his medical acumen, decades of experience and insider access as former FDA commissioner, he was able to paint a clear portrait of what was happening, even as it was still blurry to everyone else. Uncontrolled Spread will make you anxious, and it should. It is an intense ride through the pandemic with chilling details of what really happened. It is also sprinkled with notes of true wisdom that may help all of us better prepare for the future.” — Sanjay Gupta, M.D., chief medical correspondent, CNN
“Gottlieb has written a contemporary tragedy in multiple parts. Decision making should be based on the data, but we did not muster the forces to obtain the data. Nor did we coordinate a response. Instead of ‘never again’ it will be ‘again and again,’ until we learn from our failures, and promote our successes. This thoughtful and detailed account of how the United States dealt with the pandemic has so much to teach us, from ordinary citizens to policymakers at the highest levels. When will we ever learn?”
— Francis Arnold, Ph.D, inventor, bioengineer, Nobel Laureate
“Throughout the pandemic, no one — and I mean no one — has provided a clearer and more correct picture of what was happening to our country than Dr. Gottlieb. All the while he was sought out to provide more advice to decision-makers on all sides of the aisle than anyone. In Uncontrolled Spread, he is doing perhaps the ultimate service in telling the story to us in a gripping, no holds barred, yet highly constructive fashion. This book will be one of the bibles of this era.” — Andy Slavitt, former White House senior advisor for the COVID-19 response
“This is the book for anyone who wants to really understand the true story of how the COVID-19 pandemic unfolded in our country. In Uncontrolled Spread, Dr. Scott Gottlieb provides a gripping and rich narrative of the worst public health and economic crisis of our lifetime. His book is extremely well-researched and enriched by firsthand exchanges with key leaders in government, academia, and the private sector. It offers unique perspectives from the vantage point of one of the most experienced public health leaders in America. Importantly, it provides a lucid assessment of what we need to do to avert a repeat catastrophe.” — Luciana Borio, M.D., former director for Medical and Biodefense Preparedness, National Security Council
“Dr. Gottlieb not only served as a trusted advisor to the NYSE and many of the companies listed on our Exchange throughout the pandemic but also consistently delivered expert analysis and pragmatic advice to all Americans. Now, with Uncontrolled Spread, he is stepping up again to share the many lessons learned from this challenging chapter in our country’s history.” — Stacey Cunningham, President, New York Stock Exchange
“At a time when many of our leading public health experts were blinded by the fog of viral war, Scott Gottlieb was always one step ahead -- warning of the pandemic danger and the urgent steps needed to protect the country. When public health bureaucrats were searching for people with symptoms, he was warning of asymptomatic spread. When public health officials were focused on a doomed effort to screen infected travelers, he was pushing for widespread testing at home. When government scientists still believed the virus wasn't spreading here, he was pushing for a whole-of-government mobilization to stop it. If we had listened to Scott Gottlieb, 2020 might have been a very different year. We must listen to him now, before the next pandemic arrives. Uncontrolled Spread is a must read for anyone who wants to understand why we failed to stop the worst pandemic in modern history -- and why it could happen again if we don't act now.” — Marc Thiessen, Washington Post columnist and bestselling author
“In Uncontrolled Spread, Dr. Scott Gottlieb provides us a detailed account of the COVID-19 pandemic and of the U.S. response....The book is a 'must read' for anyone interested in learning how to prepare for the next pandemic. For starters let’s begin by investing the necessary resources in public health and shield it from partisan politics.” — Carlos del Rio, M.D., infectious disease specialist and professor of global health and epidemiology at the Rollins School of Public Health of Emory University
"I believe Uncontrolled Spread will be the most authoritative book on the COVID-19 pandemic in the U.S. out of the many books that will be written." — Martin Makary M.D., M.P.H., Editor-in-Chief, MedPage Today
"I have known Scott for many years… and can verify that when he was FDA Commissioner, he was a force against useless bureaucracy... He is a reformer, and this book reveals his laser focus on trying to stay ahead the pandemic from the beginning." — Marc Siegel, M.D., RealClearHealth
"The past two years should lead to a wholesale transformation of the CDC, and Gottlieb offers a lot of ideas about what that should involve." — National Review
About the Author
Dr. Scott Gottlieb served as the twenty-third commissioner of the US Food and Drug Administration and is a resident fellow at the American Enterprise Institute. He is a regular contributor to the business news channel CNBC and a partner at the venture capital firm New Enterprise Associates. Dr. Gottlieb serves on the board of directors of the pharmaceutical company Pfizer Inc. and the genomic sequencing company Illumina, Inc. Fortune magazine has recognized him as one of the “World’s 50 Greatest Leaders,” and Time magazine has named him one of its “50 People Transforming Healthcare.” A graduate of Wesleyan University and the Mount Sinai School of Medicine, Dr. Gottlieb is an elected member of the National Academy of Medicine. He lives with his family in Westport, Connecticut.
Product details
- Publisher : Harper (September 21, 2021)
- Language : English
- Hardcover : 512 pages
- ISBN-10 : 006308001X
- ISBN-13 : 978-0063080010
- Item Weight : 1.45 pounds
- Dimensions : 6 x 1.53 x 9 inches
- Best Sellers Rank: #225,440 in Books (See Top 100 in Books)
- #63 in Epidemiology (Books)
- #84 in Health Policy (Books)
- #169 in Health Care Delivery (Books)
- Customer Reviews:
About the author
Dr. Scott Gottlieb served as the twenty-third commissioner of the US Food and Drug Administration and is a resident fellow at the American Enterprise Institute. He is a regular contributor to the business news channel CNBC and a partner at the venture capital firm New Enterprise Associates. Dr. Gottlieb serves on the board of directors of the pharmaceutical company Pfizer Inc. and the genomic sequencing company Illumina, Inc. Fortune magazine has recognized him as one of the “World’s 50 Greatest Leaders,” and Time magazine has named him one of its “50 People Transforming Healthcare.” A graduate of Wesleyan University and the Mount Sinai School of Medicine, Dr. Gottlieb is an elected member of the National Academy of Medicine. He lives with his family in Westport, Connecticut.
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From the beginning, Dr. Gottlieb has had an outlook on the COVID-19 pandemic that was both prophetic and personal. He carefully tracked the early spread of the coronavirus from it’s early days in Wuhan, China and then in Lombardy, Italy. Most of the country didn’t take the pandemic seriously at that point, but Gottlieb - who left his post as FDA commissioner in 2019 – sounded the alarm. In January, 2020, he warned that the outbreaks in other countries were previews of what would happen in the U.S. It’s one of many predictions Gottlieb got right when so many were wrong.
One of the first places in the U.S. hit hard was a hospital where he had trained as a medical resident--Elmhurst hospital in Queens, where refrigerator trucks lined up outside to receive some of the earliest Covid victims. He could personally feel the weight of the tragedy. Testing was a mess. In his book, Dr. Gottlieb does a root cause analysis. As he writes, the original sin of our pandemic response was relying on government bureaucracies to guide us using legacy systems that no one understood or dared to question.
The U.S. took a top-down approach that created bottlenecks, when what we needed was decentralized action that would allow for a nimble response. It began with a regulation that no doctor or medical center could test a person for Covid – even though they could easily do so - unless their test had been authorized by the government. The test the CDC put out was flawed, but that was entirely avoidable. Moreover, any lab that wanted to develop a test needed a sample of the virus which only the CDC could provide. Without a sample, there was no way to prove that Covid tests would work. But like an angry librarian who gets mad if you want to borrow a book, the regulators made it hard for the labs and public health experts around the country to do their jobs. This hamstrung the U.S. response, causing us to be far behind other countries in testing. By the time we had testing, the virus was on the run and it was hard to catch up.
Without good information about the number of Covid cases we were flying blind. U.S. public health officials used hospitalizations as a proxy indicator for the epidemic, which was not accurate. Government doctors had been accustomed to relying on hospitalizations as a key indicator in the influenza-like surveillance system. But since it was a mild flu season and Covid hospitalization are a lagging indicator, many, including all of our nation’s top physician-public health officials, falsely concluded that we did not have widespread community transmission when, in hindsight, we obviously did. In fact, the coronavirus was seeded all over the country. Like sheep, the media and public health leaders got caught up in the debates, while being myopically dependent on ‘confirmed cases’ on the Johns Hopkins Covid map, as if two cases on a map really meant there were two cases. It didn’t. Meanwhile, in the absence of data, political opinions filled the void and became louder over time.
Gottlieb argues that these critical mistakes are not just interesting tidbits of historical trivia. These are structural problems that desperately need to be fixed today. The CDC has consistently delivered tardy and inadequate data throughout this pandemic, leaving both the public and the medical community with few tools to address the onslaught of the pandemic. He attributes this to an agency culture that has historically performed “high-scienced” and “retrospective reviews” as done in MMWR.
Remarkably, the CDC, an agency with 21,000 employees, does not have much of a rapid response team. But in a pandemic, we need the CDC to deliver real-time data. Have you ever wondered why so many of our insights about Covid come from Israel, and the best study about masks comes from Bangladesh? We spend more than $100 billion on taxpayer funded medical research each year in the United States. But the CDC has failed in its primary function to deliver data to guide our pandemic response.
Even today, as policymakers discuss vaccine booster shots, we don’t have the information we need. We currently have about 100,000 Americans in the hospital with Covid. The CDC has data on the small subset of those who were vaccinated, including which vaccine they had, how long it’s been since their shots, and whether they have any pre-existing conditions. Analyzing and sharing this information would help shape our booster plan and inform vaccinated Americans of their current risk. But sadly, the CDC is not providing this data.
One of Gottlieb’s main themes in “Uncontrolled Spread” is that we need to stop treating pandemics as a boutique medical subject. The preparation for the next public health emergency needs to begin right now. Moreover, it needs to recruit our clandestine services to assess threats early. Doing so in Wuhan would have helped us get an important head start. Getting ready for the next crisis may sound esoteric, especially since we all seem to have post-partum depression as we try and claw out of this one. But it may not be a viral pandemic that’s generations away that will require that we have enough ventilators, PPE, or reliable data to guide our response. It may be a tsunami, antibiotic-resistant bacteria, a mass shooting, or biological warfare. The next crisis could be right around the corner.
In fact, for those wanting to harm masses of people, the pandemic introduced a new weapon. Gottlieb sternly concludes that we must treat labs as sources of biologic weapons and that this activity should be monitored around the world, just as nuclear weapons are monitored globally.
Throughout the pandemic, Gottlieb spoke with the front-line physicians, researchers, and top decision makers at the highest levels in government. He became a leading voice of reason as the American people tried to make sense of Covid and policymakers and business leaders struggled to protect the public. I would encourage every clinicians to read his new book. He gives detailed guidance on what needs to change and we should all listen to him. This is the time to re-design our health care agencies, not in the future when the urgency is forgotten.
There are many books on Covid, and there will be more to come. I believe “Uncontrolled Spread” will be emerge as the best of them. It comes from a unique and impeccably qualified vantage point. Gottlieb’s comprehensive analysis and take-home messages give hope and direction that we can only hope our decision makers will heed.
Recommended
Uncontrolled Spread is an education on the thought processes of public health and political leaders as well as vaccine development, geopolitics, and the problems of the supply chain in a crisis. Only by understanding the problems in these areas can we have any chance against the next global health emergency and Gottlieb lays them out in a way that even the reader with a non-existent or basic understanding of these areas can make sense of it.
Uncontrolled Spread is a book length conversation for the adults in the room who want to move beyond political finger-pointing and try to prevent the next pandemic from creating the absolute chaos of Covid 19. Now will anyone in a position of authority be willing to listen?