Drug Channels Recommends: “Uncontrolled Spread” by Scott Gottlieb

Looking for a thoughtful and timely stocking stuffer?

I suggest Uncontrolled Spread: Why COVID-19 Crushed Us and How We Can Defeat the Next Pandemic, by Scott Gottlieb, M.D. (Amazon link)

This book provides a comprehensive, well-written chronicle of the COVID-19 pandemic (as of mid-2021). Dr. Gottlieb documents—with great specificity—how and why our government’s public health infrastructure failed us during the pandemic. He also offers valuable recommendations for better planning.

Read on for my review of this fascinating and important book, along with notable highlights from the text.

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HOW DID WE GET HERE?

Dr. Gottlieb is uniquely qualified to write this book. He is a former FDA commissioner, sits on Pfizer’s board of directors, and is a thoughtful observer and expert voice on the U.S. healthcare system. During the past two years, Gottlieb has been in the room with key decision makers (though it seems that his advice was sometimes ignored). That’s why Gottlieb is one of only three people I follow on Twitter.

This well-written, serious book begins in China, with the early days of the pandemic. The book does not take a position as to whether the virus's origins were natural or lab-made. However, it does document frightening cover-ups by the Chinese government. Gottlieb notes:

“We can no longer depend largely on global cooperation and the competency and transparency of other nations. COVID wasn’t caused deliberately, but it was enabled and nurtured by the intentional quashing of information.”

The final chapter reports: “China has never shared the initial strains of SARS -CoV2, which are key if we wish to firmly establish the virus’s origins.”

Gottlieb also deconstructs the many missteps and failures of the U.S. government’s public health infrastructure. He is especially critical of the Center for Disease Control’s (CDC) slow and inaccurate responses. As to testing, he describes an overly bureaucratic CDC culture—which, as he puts it, “jealously guarded this turf."

Gottlieb also traces the friction between the CDC and the political staff at the White House and the Department of Health and Human Services (HHS). He describes, for example, how the CDC’s initial data on COVID hospital admissions were based on seemingly flimsy models, rather than actual, reported figures. This inexact modelling was addressed only when the drug remdesivir was made available for the treatment of hospitalized COVID patients.

Consider the titles of chapters 5 through 8, which describe the early 2020 period when the U.S. pandemic was accelerating: “Looking for Spread in the Wrong Places”; “The Zika Misadventure”; “The CDC Fails”; and “Not Enough Tests and Not Enough Labs.” One of the later chapters—“The Information Desert”—sarcastically describes CDC reports as “often thorough, data driven, well researched, and late.”

Gottlieb carefully highlights various problems with the federal response. He writes:

“The federal government lost trust and credibility early, by its inability to accurately convey the true scope of the hazard. The lack of reliable information on COVID’s spread, and the inability of people to access testing, degraded the integrity of the response.”

“The point here isn’t that the federal health officials were wrong. The point is that they were working with faulty tools, and from faulty data sets.”

The recent confusion over the Omicron variant makes me wonder how much has changed.

Chapter 11 contains compelling behind-the-scenes drama between CDC and HHS. Drug Channels readers will benefit from the material in this chapter describing the political pressures the FDA faced over such treatments as hydroxychloroquine and plasma. The book also provides invaluable, accessible context on such topics as the science of testing and previous pandemics (the Spanish flu, the H5N1 bird flu, H1N1 swine flu).

WHAT SHOULD WE DO NEXT TIME?

Gottlieb is careful never to write: “I told you so.” But I believe that he absolutely did warn us. Just read his many prescient articles and opinion pieces from early 2020. (These are cited in the book’s voluminous endnotes.)

The lack of coherent testing and tracing protocols emerges as a theme throughout the book. As Gottlieb repeatedly demonstrates, the absence of timely and reliable information led our government to both underestimate and overestimate the coronavirus. The final chapter—“A New Doctrine for National Security”—links global public health to national security. It offers sage advice on how the U.S. should integrate public health information into intelligence reporting.

I enjoyed the few bright spots of dry humor, such as when Gottlieb observes:

“When people hear the phrase ‘There is no need to panic,’ the first thing that many people will ask themselves is: ‘Should I panic?’”

Be warned. This a lengthy book that provides a highly detailed chronology of events. This material will be crucial for future scholars, epidemiologists, and public health experts. However, the casual reader may consider some sections to be heavy sledding.

I highly recommend Uncontrolled Spread for anyone who wants an objective, thorough, and authoritative examination of the COVID-19 pandemic. For everyone’s sake, I hope that the right people read and consider this book’s lessons and recommendations.