New book shows how failure to implement quick, accurate testing compounded COVID’s spread

The United States has now passed yet another tragic pandemic milestone. COVID-19 has now claimed the lives of more than 700,000 Americans. William Brangham talks to Dr. Scott Gottlieb, a former FDA commissioner and author of new book "Uncontrolled Spread: Why COVID-19 Crushed Us and How We Can Defeat the Next Pandemic" about where the U.S. response failed and how it can do better next time.

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  • Judy Woodruff:

    The United States recently passed yet another tragic milestone. COVID-19 has now claimed the lives of more than 700,000 Americans.

    William Brangham is with the author of a new book about the failed U.S. response and how it can do better next time.

  • William Brangham:

    As we near two years since this coronavirus first emerged, plenty of questions still remain as to why the U.S. suffered so badly compared to other nations. Why did this virus not only kill so many Americans and cause so much emotional and financial ruin, but why did it divide us so badly?

    A new book is out that tries to address some of these questions. It's called "Uncontrolled Spread: Why COVID-19 Crushed Us and How We Can Defeat the Next Pandemic."

    And it's by Dr. Scott Gottlieb. He ran the Food and Drug Administration from 2017 to 2019. And he joins me now.

    Dr. Gottlieb, thank you very much for being here.

    There are so many elements that you recap in this book, China's secrecy, our fixation on focusing on the flu, rather than a coronavirus, failures of our stockpile, multiple, myriad mistakes made by different agencies.

    But one of the failures that you keep hammering over and over again was our recurrent inability to do widespread testing. Can you remind us why testing is so important in the middle of a pandemic?

  • Dr. Scott Gottlieb, Former FDA Commissioner:

    Former FDA Commissioner: Well, testing was important, particularly in this pandemic, because you had a virus that had a long incubation period, meaning that people could get exposed to the virus and get sick a long interval after that exposure.

    So, there was an opportunity to test them and find that they were incubating the virus and get them isolated. And, also, people spread the virus when they were asymptomatic, and some people who went on to spread the virus never developed symptoms. So, testing would be a very important tool in trying to control spread under that circumstance.

    The challenge was that we had prepped for a pandemic involving influenza, and influenza has a short incubation period, and, typically, people aren't contagious until they manifest symptoms. So we just never prepared the capacity or the planning to roll out a diagnostic test at scale.

  • William Brangham:

    And, as you also point out, not only did it make it very difficult for us to spot where the virus was initially and give us a chance to stop it, but it also then, when we did impose fairly draconian lockdowns, we imposed them everywhere because we didn't know where the virus was and where it wasn't.

  • Dr. Scott Gottlieb:

    Right.

    When you look back at the 2005 planning around a pandemic, which is really when we started this sort of modern planning for pandemic preparedness — and I was a part of that. I was in the Bush administration at that at that time.

    But the planning always envisioned that that mitigation would be carried out on a sort of city-by-city basis, because the presumption was, you would know where the virus was spreading.

    But in the early days of this COVID outbreak, not only didn't we know where it was. We didn't know where it wasn't. And so we implemented those mitigation steps across the whole country. But there were clearly parts of the country where this virus hadn't spread to.

    But we implemented a full 45-day shutdown of a lot of nonessential businesses, really an extraordinary step. And what happened was, when the virus eventually spread to the South later that summer, the political support for shutdowns had dissipated. People down there said, look, you told us to shut down in the spring. We did it. We didn't have to. And we're not doing it again.

    And so, without a diagnostic test, we really were blind to the spread and couldn't target the most onerous interventions.

  • William Brangham:

    You lay a lot of the blame in this book on the CDC for botching its initial tests, for how it gathers information, for how it relays that information to the general public.

    When you look back at the near two years of this pandemic, does the CDC's response make sense to you? Does it seem like they should have done differently, or, in fact, this is how the organization was built?

  • Dr. Scott Gottlieb:

    It's the way we built the organization.

    I mean, the organization really wasn't equipped to respond to a public health crisis of this magnitude. They're accustomed to taking a lot of time, getting very bespoke data feeds, and doing very careful, rigorous scientific analysis, and surfacing answers sometimes weeks, maybe months after an event.

    They're not the Joint Special Operations Command. They're not accustomed to surfacing real-time information and surfacing partial conclusions to inform current policy-making. There was a presumption that CDC had the ball, and they didn't have the ball.

    Now, the CDC, I don't think, really raised their hand and said, hey: Guys, we don't have this. We need help. This isn't what we typically do.

  • William Brangham:

    So, was that a failure of leadership at the top to recognize that the organizations we had, in the way they were structured, were maybe not up to the task, and we need to, on the fly, admittedly, deploy new tools?

  • Dr. Scott Gottlieb:

    Yes, look, I think it was a failure of leadership at the top. I also think it was a failure of leadership inside the Department of Health and Human Services, the leadership there, because they had more proximity to what these public health agencies were and were not capable of doing.

    And the testing is a perfect example. Someone needed to pick up the phone at some point in January and call the major diagnostic manufacturers and say, hey, guys, this is concerning. We think this may turn into a global pandemic. We need you to start scaling the production of diagnostic tests right now, because the lead time on doing that is four to six weeks in a best-case scenario.

    That phone call really didn't get made until the end of February.

  • William Brangham:

    When you look at this past almost two years now, do you have a sense as to why we became so politicized?

  • Dr. Scott Gottlieb:

    I think that's where political leadership comes in.

    You have to galvanize the public behind some collective action to try to get some consistent adherence to these kinds of measures. And we didn't really have that. There was a sense in the White House — and I was in touch with the White House a lot over this time period — that uncontrolled spread was inevitable, and there wasn't really much we were going to be able to do about it.

    And the interventions were going to be costly without much benefit. And I simply disagree with that.

  • William Brangham:

    Your book is full of examples of things that we ought to do better, from better surveillance to how we should treat this as a national security threat, which it so clearly is, lots and lots of good suggestions going forward.

    How confident are you, though, that when this crisis passes, we will actually take those lessons on board? Because, as you well know, and as you write in the book, that history keeps showing us that the lessons of pandemics get forgotten the minute the virus dissipates.

  • Dr. Scott Gottlieb:

    Look, I'm hopeful, given the impact that this pandemic had on our public health, the fact that it crowded out all our other national priorities, it has changed the course of history, I'm hopeful that we're going to recognize the devastating costs of SARS-CoV-2 and make — take steps to make sure this doesn't happen again.

    And that really needs to be our goal. You know, we haven't engaged that discussion yet. And that's surprising to me. You know, it could be the fact that we're just in the throes of the current pandemic, so it's hard to reflect on how to prevent the next pandemic.

    But I don't think it's too early to begin that discussion. And you don't see that happening in earnest. You don't see commissions being created. You don't see Congress working on legislation. That needs to start sooner, rather than later, because I think, if we get too far out from this, some of those lessons learned will be lost, and maybe some of the sort of public support that we need will start to dissipate.

  • William Brangham:

    All right.

    The book is called "Uncontrolled Spread: Why COVID-19 Crushed Us and How We Can Defeat the Next Pandemic."

    Dr. Scott Gottlieb, thank you very much for being here.

  • Dr. Scott Gottlieb:

    Thanks a lot.

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