When I first met Dr. Scott Gottlieb, we were both lecturing about the risks of the next pandemic during the H5N1 bird flu scare in 2005-6. He invoked the specter of 1918 Spanish flu as a reason to prepare for this one, while I cautioned that species barriers existed making H5N1 an unlikely pandemic pathogen whereas another kind of flu was likely. His argument was well stated, and he has included it in his new book. Dr. David Swayne, on the other hand, an avian flu expert at the USDA, told me that H5 flus were not the kind to mutate naturally towards human to human spread, even though they had killed millions of birds. Swayne warned that while we were obsessing about H5N1, another pathogen, flu or otherwise, could slip in the back door and kill millions. This warning, of course, proved prescient.
Despite our differences at the time, Gottlieb and I agreed that a massive pandemic was inevitable, and that we were not prepared for it. In his new extremely compelling and devastating book, Uncontrolled Spread, an examination of how America fumbled the ball on COVID, Gottlieb writes about the preparations that were made for H5N1 and subsequently for flu, but unfortunately, over reliance on flu models (including lockdowns and business closures) did not prepare us for a COVID pandemic with a virus that spreads much more easily through the air than flu does. In other words, especially if you lived in an underserved community, spread would continue to occur despite the lockdowns. “There was early evidence that SARS-COV-2 wasn’t spreading like a flu, but the CDC and HHS took a long time to adjust the national approach based on this information…the fundamental challenge remained that we were implementing a plan that was crafted with flu in mind, not a coronavirus.”
In his new book, Gottlieb provides us with a disturbing takedown of our healthcare system’s pervasive inability to stay ahead of the virus beginning with a big fumble in testing by the CDC which has perpetuated. There was also a failure by many public health and political leaders to acknowledge early enough that universal masking was beneficial (studied by Gottlieb’s American Enterprise Institute and others), that schools should remain open, and that a substantial amount of the spread throughout our communities was asymptomatic. Testing needed to involve the same kind of full court press, public/private partnership which later came to characterize Operation Warp Speed and its vaccines, but unfortunately it didn’t. “In the U.S., we turned to our commercial labs and test kit manufacturers late and didn’t coordinate their efforts in any meaningful way. The result was hundreds of different labs and manufacturers entering the market often with custom-made solutions that couldn’t be deployed widely because they would work only on specific instruments or only in certain labs.”
I saw this ‘closing the barn door when the horses have already escaped’ reality unfolding when I visited Dulles airport back in February, 2020, and a Custom and Border Protection agent told me (along with Acting Deputy Director of the Department of Homeland Security Ken Cuccinelli) that despite the travel restrictions from China, countless travelers were slipping in through intermediate countries while others were suppressing their symptoms with ibuprofen and Tylenol at entry points. I also visited the National Quarantine Center at Nebraska Med at the time and was told of much asymptomatic spread throughout our communities, which I warned of on TV, radio, and in print as Gottlieb was issuing the same warnings.
But he does let the World Health Organization off the hook somewhat for its politicking with China and failure to warn the world, suggesting that in order to stay informed WHO and its leader Tedros had to make certain concessions (Gottlieb writes that while others disagreed he advised President Trump to remain in the WHO to help keep the flow of scientific information going - warning of a large COVID outbreak on the Southern Hemisphere, a prediction which proved prescient).
At the same time, Gottlieb deeply laments the disco-ordinated approach by our own federal agencies. He writes, “in the U.S., HHS turned to the CDC, and the CDC didn’t have the policy orientation, operational experience, or industrial expertise to pull off an effort on this scale. As a consequence, we never had enough testing to keep up with the initial spread, and we lost control of the pandemic at its very outset. It made the need for safe and effective therapeutics and vaccines even more urgent.”
Dr. Gottlieb is not just casting stones here. The lack of testing, lack of certainty in the real time info being presented to the public has bred distrust and non-compliance. Going forward, Gottlieb advocates wisely for a coordinated federal response combined with expanded national stockpiles to include masks, tests, vaccines, ventilators, and most importantly, a forward-thinking public/private industrial partnership for rapid production and gearing up in the face of an infectious threat.
I have known Scott for many years, interviewed him multiple times on TV and radio, and can verify that when he was FDA Commissioner, he was a force against useless bureaucracy when it came to drug development, generics, the dangers of E cigarettes, and nicotine. He is a reformer, and this book reveals his laser focus on trying to stay ahead the pandemic from the beginning, which he has also represented in print for the Wall Street Journal, on TV, as well as on twitter.
In fact, one of the most disconcerting events of the pre-pandemic was that the FDA lost Gottlieb just when he was about to be needed there the most.
Marc Siegel MD is a professor of medicine and medical director of Doctor Radio at NYU Langone Health
