May 10, 2021
Maverick doctors, scientists, and public health officials took charge of the fight against Covid-19 when the CDC and the Trump administration failed to act, according to this illuminating rehash of recent history. Lewis (The Fifth Risk) spotlights a group of doctors who overcame bureaucratic inertia and conventional wisdom to write the U.S.'s pandemic response plan in 2007, after President George W. Bush read a history of the 1918 Spanish flu pandemic and asked what the government would do in such a scenario. Carefully reinterpreting data from 1918, Veterans Affairs official Carter Mecher and other group members developed a "Swiss Cheese strategy" of multiple social interventions (school closures, bans on group gatherings, etc.) layered on top of one another to contain a disease outbreak until a vaccine could be developed. In January 2020, Mecher used sketchy, incomplete data emerging from China to forecast the spread of Covid-19 in the U.S., and shared his findings with California deputy chief health officer Charity Dean, who eventually convinced Gov. Gavin Newsom to issue the country's first statewide stay-at-home order. Though the book's first half is somewhat slow-going, Lewis draws vivid profiles of Mecher and Dean, in particular, and litters the narrative with lucid explanations of epidemiology, disease modeling, and genomic sequencing. Readers will be aghast that these experts weren't leading the battle from the start.

Starred review from May 15, 2021
The bestselling author turns to the Covid-19 pandemic and the failure of the U.S. government to contain it effectively. "Trump was a comorbidity," one source told Lewis, speaking of the spread of the virus through the country. The Trump administration ignored the threat, failed to act on it, and then tried to suppress those who were advocating lockdowns, school closures, and other measures to avoid the worst-case scenarios that emerged. As Lewis notes, the Lancet, one of the world's leading medical journals, calculated that if the U.S. had followed the models of its G7 partners, 180,000 of the nearly 600,000 victims would still be alive. In an intricate background section, Lewis delivers a study of how epidemiologists and others had long predicted the pandemic. A high school student, for example, developed a model for a science-fair project in which she determined that an effective means of control would be to vaccinate young people first, since they were the ones who were interacting socially--just the opposite of the tactic later used of vaccinating older people first. Other case studies include the work of a dauntless California public health examiner who tracked the spread of hepatitis and other communicable diseases, all of which provided object lessons that were often lost to political considerations. George W. Bush emerges as a perhaps unlikely case of someone who did the right thing with respect to epidemics while Barack Obama stumbled before getting it right. As for his successor, Lewis writes, "the Trump White House lived by the tacit rule last observed by the Reagan administration: the only serious threat to the American way of life came from other nation-states." The result was a woefully disjointed response that "got pushed down in the system, onto local health officers," most of whom were unprepared for the challenge and lacked the means to do much about it. An urgent, highly readable contribution to the literature of what might be called the politics of disease.

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