The big fail What the pandemic revealed about who America protects and who it leaves behind

Joseph Nocera

Book - 2023

"From the collaborators behind the modern business classic All the Devils are Here comes a damning indictment of American capitalism-and the leaders that left us brutally unprepared for a global pandemic In 2020, the novel coronavirus pandemic made it painfully clear that the U.S. could not adequately protect its citizens. Millions of Americans suffered-and over a million died-in less than two years, while government officials blundered; prize-winning economists overlooked devastating trade-offs; and elites escaped to isolated retreats, unaffected by and even profiting from the pandemic. Why and how did America, in a catastrophically enormous failure, become the world leader in COVID deaths? In this page-turning economic, political, an...d financial history, veteran journalists Bethany McLean and Joe Nocera offer fresh and provocative answers. With laser-sharp analysis and deep sourcing, they investigate both what really happened when governments ran out of PPE due to snarled supply chains and the shock to the financial system when the world's biggest economy stumbled. They zero in on the effectiveness of wildly polarized approaches, with governors Andrew Cuomo of New York and Ron DeSantis of Florida taking infamous turns in the spotlight. And they trace why thousands died in hollowed-out hospital systems and nursing homes run by private equity firms to "maximize shareholder value." In the tradition of the authors' previous landmark exposés, The Big Fail is an expansive, insightful account on what the pandemic did to the economy and how American capitalism has jumped the rails-and is essential reading to understand where we're going next"--

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  • Introduction
  • Part I. Contagion
  • 1. The Scapegoat
  • 2. Sealed City
  • 3. Black Market
  • 4. Safety Net
  • 5. QEternity
  • Part II. A Broken System
  • 6. The Folly of Efficiency
  • Part III. Advice and Dissent
  • 7. The Zoom Class
  • 8. A Very Expensive Lunch
  • 9. Cuomosexuals
  • 10. The Dissidents
  • 11. "The Most Corrupt Market of All"
  • 12. Fever Dreams
  • 13. "There's Nowhere to Hide"
  • 14. To Vax or Not to Vax
  • Part IV. "The Pandemic is Over"
  • 15. "The Free State of Florida"
  • 16. "This Is a Business"
  • 17. Supply Chain Blues
  • 18. The Pandemic Next Time
  • Acknowledgments
  • A Note on Sources
Review by Publisher's Weekly Review

In this withering account, The Free Press columnist Nocera and journalist McLean, who previously collaborated on 2010's All the Devils Are Here, survey the policy decisions, made in some cases decades before 2020, that hampered America's ability to combat the Covid-19 pandemic. The authors highlight the effects of NAFTA, suggesting that it fueled the globalization of supply chains so that by the time the virus hit the U.S., most hospitals bought PPE on an as-needed basis from China and had few domestic alternatives. The industrialization of American hospitals also proved disastrous, they contend, chronicling how the efforts of Nashville internist Tommy Frist Sr. to privatize and franchise hospitals in the late 1960s heralded a noxious trend of prioritizing profits over patient care, leading hospitals to cut costs by reducing the number of available beds and all but assuring medical facilities didn't have the capacity to handle waves of patients as Covid swept the country in 2020. Nocera and McLean excel at teasing out how political polarization, private equity's takeover of nursing homes, and other factors intersected in disastrous fashion during the pandemic, combining first-rate reportage with astute big-picture analysis. It's among the best reports to date on America's botched pandemic response. (Oct.)

(c) Copyright PWxyz, LLC. All rights reserved
Review by Kirkus Book Review

The authors of All the Devils Are Here examine how plutocratic government agencies and self-serving politicians critically mismanaged the Covid-19 pandemic. In their latest eye-opening collaboration, Nocera and McLean document countless mistakes and their consequences in a "series of cascading dominoes." In the early months of the pandemic, Donald Trump's Coronavirus Task Force's obsession with repatriating Americans abroad in China, combined with a marked lack of urgency and transparency from Chinese government officials, delayed deployment of much-needed testing and quarantines. Since then, with death tolls reaching more than 1 million (and counting), supply-chain shortages, hospital overflow, and black-market equipment fraud have persisted. Conveyed in cogent prose, with an impeccably researched timeline, the authors' analysis includes scathing profiles of a host of characters, particularly Ron DeSantis and Andrew Cuomo, who both bungled with rollout of lockdowns and masking. It became a scenario with innumerable variables related to health and illness outcome disparities determined by race, insurance level, income, and age. As the authors show, nursing homes were particularly vulnerable, with many facing lethal staffing shortages. Exacerbated by a reckless, indifferent Trump, masking choices became "a symbol of one's politics," like social distancing and vaccination, while slanderous personal attacks prevented scientists from sharing professional insights. Nocera and McLean also fairmindedly highlight a successful enterprise embedded beneath the pandemic-year failures: Operation Warp Speed, an initiative aimed at accelerating vaccine distribution. This endeavor demonstrated the governmental capacity to work cooperatively with the biomedical industry and develop firm leadership roles and real solutions. At the same time, the hotly debated mistakes were epic, and the authors' text emphasizes how deep and damaging they became. Interestingly, though their report is very much about America's failure in a crisis, it also frighteningly addresses how "the mores of capitalism have encroached upon the morals of society, most notably in caring for the sick and the elderly." A damning report card presenting a distressingly exhaustive array of pandemic fumbles. Copyright (c) Kirkus Reviews, used with permission.

Copyright (c) Kirkus Reviews, used with permission.

1 The Scapegoat The first sighting of COVID-19 in the United States took place on January 19, 2020, when a man in his thirties who had just returned from Wuhan, China, showed up at a clinic in Snohomish County, Washington, with a mild cough and pneumonia-like symptoms. The clinic sent him home. But with a strange new virus already associated with Wuhan, the clinic staff took a nasal swab and notified state health officials. Just over a week earlier, a virologist at the University of Sydney had tweeted that he, along with a consortium led by the prominent Chinese virologist Zhang Yongzhen, had sequenced this novel coronavirus. They posted its genetic sequence on, an open-access site. A week later, the Centers for Disease Control and Prevention-the CDC-had a test that could tell whether the sequence was present. At this early stage of the pandemic, it was almost impossible to get tested for COVID-19. The illness didn't even have a name. The CDC was focused on testing people who had been in Hubei Province, of which Wuhan is the capital, and returned with a fever and respiratory issues. Which meant that if the disease were being transmitted more broadly, there was no way to know. It wasn't clear that the man in Snohomish qualified for a test. Nonetheless, worried state officials shipped his nasal swab to the CDC's Atlanta headquarters and requested that it be tested. It came back positive. On January 21, Nancy Messonnier, a high-ranking CDC scientist, held a press conference in which she confirmed that the first case of COVID-19 had been recorded in Washington State. "Right now," she said, "testing for this virus must take place at CDC, but in the coming weeks, we anticipate sharing these tests with domestic and international partners." For his part, President Donald Trump was sanguine. "It's going to be just fine," he said. "It's one person coming in from China, and we have it under control." But in Washington State, very little felt under control. Health officials wanted to know if the man had infected others, which would require testing. They even had the means to do so. Dr. Helen Chu, an infectious disease specialist at the University of Washington, had started something called the Seattle Flu Study, which included collecting nasal swabs from residents throughout the region. But she was told she couldn't test those swabs for COVID-19 until the CDC had manufactured its test. Chu's lab was also capable of developing its own test. But two of the government's chief health agencies, the CDC and the Food and Drug Administration (FDA), wouldn't allow that without almost insurmountable red tape. Washington State would have to wait. If you think of the government's many pandemic mistakes as a series of cascading dominoes, here was the first domino. Early testing was the only way to find out if the coronavirus was spreading-and the most important tool if the country was to have any hope of containing it. But officials simply didn't view the new virus with any particular urgency. One reason for that lack of urgency was that most pathogens in recent years had largely bypassed the United States. For instance, about eleven thousand people had died during the 2014 Ebola outbreak, but only four cases occurred in the United States. The lack of information coming out of China didn't help either. Wuhan was sealed off. The Chinese government was saying next to nothing about the virus. Western scientists didn't know how contagious it was, or how it spread, or what percentage of the population it was likely to kill. The pandemic's true fury wouldn't be felt outside China until it hit Italy in mid-February. That was still weeks away. The way it's supposed to work is like this: when a country suspects that a deadly virus is circulating-a virus that might lead to a pandemic-it alerts the World Health Organization (WHO) and major governments so that the rest of the world can begin to take precautions. The process relies on transparency. China didn't live up to that responsibility. Alex Azar, who was then Trump's secretary of health and human services, would later say that the first inkling the United States had about the Wuhan outbreak came not from China but from a notification from Taiwan's economic and cultural office in the United States. That was December 30. That same day, a document began circulating on the internet about an urgent notice issued by the Wuhan Municipal Health Commission citing a "pneumonia of unknown cause" and noting that patients had come from the seafood market. A reporter for a Chinese business news website called the Wuhan Municipal Health Commission's hotline and confirmed that the notice was true; just before midnight on December 30, ProMed, a low-tech list manned by part-time employees who try to confirm the truth of chatter like that in Wuhan, sent out a post. These early reports weren't filled with alarm, but some infectious disease specialists were immediately on high alert. "All of us who work in the field worry about the potential jump of a pathogen from an intermediate host to a human, so the live animal market was an obvious concern," says Dr. Kevin Messacar, a specialist in pediatric infectious diseases at Children's Hospital Colorado. It took another three days-an astonishingly long time given the stakes-for a Chinese health official to contact Dr. Robert Redfield, the director of the CDC. Dr. George Fu Gao was his Chinese counterpart; he informed Redfield about the existence of the virus. Redfield then called Azar and said, "I think we have a problem." Azar alerted the National Security Council. With a presidential election less than a year away, this was not welcome news at the White House. When Azar called Trump at his Mar-a-Lago estate, he had trouble getting the president to focus, he later complained to aides. In a follow-up conversation, Gao told Redfield that there was no evidence of human-to-human transmission. But when China shared the initial data on the first twenty-seven human cases, not all of them could be traced back to the market, and some were clustered within families. Redfield would later say he was immediately suspicious, and he was right. According to the Independent Panel, established by the WHO, Wuhan Hospital's chief of respiratory medicine told her superiors in late December that she was concerned about human-to-human transmission. On January 5, the Shanghai Public Health Clinical Center, which was led by Zhang Yongzhen, told authorities that it "should be contagious through respiratory passages," according to internal memos obtained by the Associated Press. But no one seems to have shared this information with a team of researchers from the WHO, who went to China in mid-January to investigate the outbreak. On January 14 the WHO stated that "preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission"-which the Chinese knew by then was at least highly debatable. Redfield wasn't the only one who was suspicious. The deputy national security adviser, Matthew Pottinger, who had been a reporter in China for The Wall Street Journal in the late 1990s, was sure the situation was worse than China was admitting. "He was convinced a disaster was on the way. His Chinese sources were telling him that 'things were much, much worse in China than they were letting it out to be,'" recalls Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases (NIAID), who would become the public face of the pandemic response. Peter Navarro, Trump's irascible economic adviser whose distrust of China had helped spark a trade war, was even more strident. Navarro suggested a travel ban. "The lack of immune protection or an existing cure or vaccine would leave Americans defenseless in the case of a full-blown coronavirus outbreak on US soil," he wrote in a memo. But other White House officials viewed him as something of a nutcase and ignored him. What took place, in those early weeks, was a struggle between those who wanted to do everything and those who wanted to do nothing, a struggle exacerbated by the president's unwillingness-or inability-to choose a path. "There were people who were like, 'This is worse than the 1918 flu!' And then there were others who were like, 'This is no big deal,'" says one person familiar with events. What's more, any possibility of teamwork was atomized by the many loyalties and feuds that had developed during Trump's three years in office-as well as by a Trump-fostered mentality that held that winning the game of public relations was the only victory that mattered. There were constant leaks as various factions tried to influence the president and knife their rivals. "It literally didn't matter who your direct supervisor was," says a former senior civil servant. "What mattered was who you could pick up the phone and call." On January 29, the administration announced the formation of the new White House Coronavirus Task Force. Trump named Azar to lead it. That same day, Azar signed an order declaring a public health emergency. He did so alone in the Roosevelt Room, with his chief of staff taking pictures with an iPhone. The administration didn't have the official White House photographer taking pictures, whether because it was deliberately downplaying the virus, or because it still didn't seem like a noteworthy event. The experts "are on top of it," tweeted Trump. On paper at least, Azar seemed well suited to lead the task force. A former law clerk for the Supreme Court justice Antonin Scalia, Azar worked at Health and Human Services (HHS) from 2001 to 2007, first as general counsel and then as deputy secretary. Those were years that saw the terrorist attack on 9/11, the anthrax scare, outbreaks of SARS and influenza, and, under the George W. Bush administration, the first real effort to come up with a plan in the event of a pandemic or a bioterrorist attack. Azar was in the middle of all of it. Azar immediately began "marching through the pandemic playbook," as he'd later put it, that had been written in the Bush administration and updated by the Obama administration. But for all the man-hours that had been spent putting together the pandemic plans, the documents were essentially worthless. Reality was a lot different from a simulation or war-game exercise. "Nothing is self-executing," says someone close to the events. "It's not just like a bunch of switches you turn. If people in the administration and HHS and the Defense Department and the states haven't been working with this from the beginning, it's not going to happen." For all his experience, Azar never seemed to be in control of the task force. Here is where all those rivalries between various agencies and officials came into play. Key people were left off the task force, whether purposefully or because it wasn't exactly clear what the task force was supposed to do. There was no coordination. "There were a lot of bad interpersonal interagency dynamics," says one senior official. "Nobody really knew what was going on." Instead of focusing on broad pandemic planning, the task force was obsessed with trying to extract the Americans stuck in Hubei Province. They had quickly found that there was no real plan in place to accomplish such a thing. "You cannot overstate how much the repatriation . . . distracted the entire interagency process of the US government during this time period," Azar would later say. Dr. Anne Schuchat, then the CDC's principal deputy director, later told a committee investigating the COVID-19 response that federal leadership in February 2020 was so consumed with repatriating Americans that "key areas, like scaling up PPE [personal protective equipment] and getting our arms around the supply chain and protecting the healthcare system and so forth, didn't get sufficient attention." The Chinese and the WHO both privately criticized the United States in part for the efforts to evacuate people, according to several people who were involved. As a result, partly to placate the Chinese, the planes that collected the Americans in Wuhan dropped off almost eighteen tons of masks, gowns, and other PPE. The federal government still didn't comprehend that America wasn't going to be able to duck this virus. But it wasn't just the U.S. government that lacked the foresight-or the imagination-to see what was coming. So did the WHO. On January 30, the WHO declared COVID-19 a "public-health emergency of international concern." There were by then 7,818 confirmed cases of the still unnamed virus, including 82 outside China's borders. But the agency was not ready to call it a pandemic. "I said to officials at the WHO, 'When are you going to use the word "pandemic"?'" says a former administration official. "But there was tremendous pushback. The thought process was, 'If we use the word "pandemic," people are going to freak out.'" There may be no better illustration of the schizophrenic, scattered nature of the response than that at the very same time the administration was debating taking dramatic action, Pottinger and several others had begun to argue that the United States needed to ban flights from China. Public health scientists had long known that travel bans didn't work. In 2006, for instance, a WHO working group had concluded that "screening and quarantining entering travelers at international borders did not substantially delay virus introduction in past pandemics . . . and will likely be even less effective in the modern era." But then the husband of a Chicago woman who had been infected in China also came down with COVID-19. That settled it: human-to-human transmission had begun in the United States. Almost overnight, government scientists changed their minds about the efficacy of a travel ban. Azar would later tell people that he was shocked by their quick about-face. Trump of course agreed immediately: a travel ban would allow him to appear to be taking action. On January 31, he announced that non-Americans who had been in China during the previous fourteen days could no longer come into the country. But it was already too late. At least 430,000 people had arrived in the United States on direct flights from China, thousands of them straight from Wuhan, since New Year's Eve, The New York Times would later calculate. And the ban was notoriously porous. Hong Kong and Macau were exempted. United States citizens, residents, and their family members were still free to enter. Did anyone really think that all returning Americans would be virus-free? The day after the WHO tweeted that it saw no evidence of human-to-human transmission, Cheryl and Paul Molesky flew to Yokohama in Japan to board the Diamond Princess, a cruise ship owned by Carnival, the largest leisure travel company in the world. It was mid-January. The ship's itinerary called for it to sail from Hong Kong to Vietnam and Taiwan before returning to Japan. The Moleskys were among the 380 or so Americans on a ship with 2,664 other guests and 1,045 crew from fifty-six countries. Cheryl Molesky, a teacher, had just retired, and the couple had always wanted to go to Japan. Just before they left, Paul's brother told them, "Be careful. There's some kind of pneumonia in China." Excerpted from The Big Fail: What the Pandemic Revealed about Who America Protects and Who It Leaves Behind by Joe Nocera, Bethany McLean All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.