Uncontrolled Spread: What we did Wrong and what we did Right in the battle against COVID

As I got back into my reading habit that was diminished by my reaction to Ian, I picked up Uncontrolled Spread by Scott Gottlieb. The author served as FDA Commissioner for the first two years of the Trump Administration. The book describes Why COVID-19 Crushed US and How We Can Defeat the Next Pandemic. The author is uniquely qualified to tell this story as he was part of the Trump regime without being tainted by it or by COVID. He is a medical professional and scientist who tries to keep politics out of the mix without being deferential. Gottlieb left his post before the onslaught of COVID, but he was well aware of what was going on in the federal government as it tried to meet its obligations. He points out that many mistakes were made in a country that prides itself on its scientific expertise.

It is no secret that we mishandled COVID. Our main salvation was the development of an effective vaccine, that played into our strength as a nation. Like many scientists and epidemiologists Gottlieb anticipates another pandemic. The W. Bush, Obama, and Trump administrations disbanded protections against viral invasions only to replace the defenses in the name of national security. We must realize that the only way to combat a pandemic is to stop the spread. Until we achieve that, hospitalizations and deaths will plague a population.      

Yes, I understand that this topic is not about processed food, but it is about science and the politics of science. I will continue to defend processed food products as I place them into a broader scientific context. I think there are lessons learned here that apply to a discussion of food, nutrition, and health.

What we did wrong

There were many things that we did wrong during the course of the pandemic. The President, governmental agencies, almost all governors, and many public health leaders made mistakes. We were not prepared. We held on to inappropriate explanations and approaches. We were slow to change when it became apparent that we were on the wrong track. Uncontrolled Spread lists and describes 13 major failures and 1 major success. I will describe only a few of those failures and the major success. Will we be prepared for the next challenge?

Sowing confusion. We were caught with our defenses down. We did not have enough protective equipment for medical personnel. We lied about the importance of masks to prevent the spread because we did not want to cause a run on masks making it more difficult for our medical staff to perform their jobs safely. Remember the toilet-paper shortage? Once we were able to import or produce enough safety equipment, too many in the public were convinced that masks were not useful.    

Lacking proper testing. The CDC designed too complex a test for COVID. It was flawed from the beginning. The agency did not bring in industry to help manufacture test kits. Even if the test had been effective, CDC did not have the production capacity to make enough test kits. On top of that, we did not have enough labs to perform the tests. My wife and I had to wait 10 days before we received the results of our first test. By the time the country got enough tests and labs to analyze them, COVID had achieved uncontrolled spread.

The wrong pathogen. An elaborate model provided a roadmap to combatting the spread of a pandemic. The problem? The model assumed the pandemic would be a variant of flu. It wasn’t. Flu spreads through fomites which accumulate on surfaces. COVID spreads through droplets in the air. Remember all the Purell and bleach used to clean surfaces after someone in an office tested positive for the virus? It was not the surfaces that were the problem. It was the air. CDC hung on to the wrong model for too long a time. To top it off the spreaders were not only those with symptoms. Too often asymptomatic carriers of the virus were the biggest spreaders. Once again, we were too late in learning this important factor in transmission.

Limitations of the CDC. The Center for Disease Control and Prevention comes under attack in the book time and time again. Gottlieb notes that CDC may not be the best organization to lead us against a pandemic.

Time out: I remember being crushed as a college Junior with a major in Food Science seeking a summer internship at CDC. I waited in the lobby of the main building for an interview that never happened. My dad, who had contacts in the organization, was not able to get me that interview. Who knows where my career might have gone had I interned that summer in a CDC lab? Anyway, my experience with the agency was not a positive one, and I have no personal basis to defend them.   

The author suggests that the culture within the organization is not suitable to lead the charge. It is a scientific agency that develops theories and seeks to test them. It is unwilling to act until it is sure that it is right. In a fast-moving crisis, it is important to make the best choices on the best information at the time. Then agencies must be willing to change directions when new information becomes available. When changes occur in strategy, the agency must be up front about why it made a change in direction and explain why. CDC was not this type of organization. Having said that, there is a wing of CDC that hunts down food pathogens and traces origins of outbreaks. It seems that this wing could have taken more responsibility in the outbreak. The take-home lesson here is that either the CDC needs a culture change or some other agency needs to take charge next time. I vote to let CDC remain as they are, and charge someone else with communications in the next viral crisis.

Stay-at-home orders were too harsh at first and were not tied to spread in certain locations across the country. We needed better data on location of the greatest rates of infection. With it, we could have programed stay-at-home orders to stop the spread or flatten the curve with greater effectiveness. It is not clear whether such a strategy would have worked. By the time we were able to map the hot spots, the American population was fed up with staying at home. Closing the schools became a point of contention. It made sense early in the pandemic when there were concerns that children would bring it home to their grandparents. It turned out that children were not major spreaders of the disease. Later, it became apparent that remote learning expanded learning gaps between wealth and poor students.

Politicization of all these issues made compliance with common-sense protection difficult. Gottlieb points out that some of the guidance from the administration such as wearing masks in enclosed spaces could have been more effective. It was President Trump’s reluctance to wear a mask that vitiated that message. He felt a mask made him look weak. There was a blue mask with the Presidential Seal on it that he liked and would wear on occasion. The lax attitude toward masks by White House staffers increased the President’s vulnerability to the virus. Mask wearers in the building were shamed by others to remove their masks. Many other issues became politicized throughout the crisis.

Collecting evidence in a crisis is a difficult task. Operating on limited information that changes as more data and studies become available strains trust. As mentioned above, clear channels of communication that are able to tell a story and explain necessary changes are most effective. Scientists and science collectives are not effective in such efforts. Straight-forward communicators are effective at deflecting misinformation from advocates with hidden agendas and in building public trust.   

What we did right

The mRNA vaccine was the triumph of our effort in COVID. Some of the credit must go to President Trump and the leadership of other nations. The President’s push behind Warp Speed allowed scientists and corporations to move ahead at a record pace unfettered by red tape. If governmental agencies like CDC had been leading the charge, development of the vaccine would have taken longer. Sure, the push behind speedy development was with the hope that it would guarantee the President’s re-election. Nonetheless, the vaccine was ready for distribution by the end of 2020.

 Threat to National Security?

The author goes into great detail as to whether the virus emerged from the wet markets or the Wuhan laboratory. The book makes a case that it was likely an accidental release from the Chinese virus lab. The evidence I have read elsewhere suggests that the virus more likely came from the wet markets. One of the few problems I had with the book was ignoring the threat of zoonotic viruses from exotic species. Invasion from nature by declining habitat seems a much greater threat than from man-made accidents.

A question raised in the book is what constitutes a viral threat to National Security? Is it only when the virus is deliberately used as a weapon? If a virus results from an accidental release by a lab or medical facility, does that constitute a threat to national security? Or does the threat only need to pose a danger to a large population within the country? Both Gottlieb and I consider a threat to national security if it affects a large portion of the population. Determining the cause will always be difficult. Determining the extent of damage to the country should be the primary determinant.

When a virus or other biological agent poses a major threat to the population, mobilization of the national security apparatus is necessary. Control should be in the hands of elected officials. They must learn what they can from their scientific advisors, make the difficult decisions on policy, communicate those decisions to the public, and then own it. The broader the base of political support for the policy, the greater acceptance by the American public.

Lessons Learned

Uncontrolled Spread concludes that “Our system was set up well to handle singular, technology-intensive, and complex problems like developing a novel vaccine or antibody drugs. We do this better than anyone.” Where we failed was in

  • clearly communicating the dangers we face while keeping up with changes in our understanding of the pandemic,
  • lack of effective testing kits and the ability to rapidly process the results,
  • understanding the behavior of the specific pathogen we face and developing effective measures to combat it,
  • developing a clear plan that neither underestimates nor overestimates the challenges posed, 
  • preventing politics to get in the way of actions and solutions, and 
  • treating a pandemic as a threat to national security.

Perhaps the saddest part of the whole effort to combat COVID was the politicization of the attempt to control the spread. Battle lines were drawn, and people died as a result. It is interesting to contemplate the perspectives if the vaccine had been distributed before the 2020 election. Would each side have switched its perception of the virus, the vaccine, and ways to combat the spread?

Can we learn these lessons to prevent the next pandemic? Can we apply some of these lessons to developing better handling and distribution efforts at getting food into the hands, mouths, and stomachs of the population?

Coming soon: In defense of the Food Safety and Modernization Act

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