“We are always four to six weeks from being able to do what countries around the world have done,” wrote Andy Slavitt in a July 2020 article in which he described how a strict lockdown of the U.S. lasting only six weeks could bring the coronavirus under control: We Can Eliminate Covid-19 if We Want To. In his book published recently, he says that “taming a virus is a simple matter of reducing its circulation” by using public health measures — a national mask mandate, rapid testing, temporary isolation of those with the virus, mandatory quarantines after foreign travel, and a shutdown of crowded indoor places — and that is “hard work.”
In 2020 Andy Slavitt was a private citizen seeking to influence pandemic policy. He was not new to government. In 2013 he had helped rescue the website of the Affordable Care Act. From 2015-2017 under President Obama he had run the Centers for Medicare and Medicaid Services. In 2020 he worked on solving problems the Trump administration was not handling— for example, in March he devised with others the successful Stay Home message because no one in authority was asking people to change their behavior to reduce their exposure to the virus. He became a frequent presence on twitter and TV and communicated his knowledge of the pandemic to millions.
From January through May 2021 Andy Slavitt served as Biden’s Senior Advisor for Covid-19 response, and in June he retired and published his book written in 2020: Preventable, The inside story of how leadership failures, politics, and selfishness doomed the U.S. Coronavirus response. In the book, Slavitt records “one of the great disasters of our time,” saying:
“This is a story full of missed opportunities, willful neglect, and indifference and denial from our president. This was the White House of Donald Trump - a man whose ego wouldn't allow him to acknowledge a problem like the novel coronavirus emerging on his watch. All the things he would have needed to do — beginning with taking accountability, managing a large-scale response, calling for unity, and relying on experts and institutions of science — were anathema to him.”
He says Trump did not have the “personality traits required to face a crisis”—
1) the ability to separate yourself from a problem and continually weigh choices based on current information.
2) The need to focus on the bad news and look skeptically at good news.
3) A willingness to make tough decisions that forgo short-term gains in favor of solutions that work.
4) The ability to communicate in a way that brings people together.
Slavitt says Trump hindered the battle against the virus through his “disorganization, distrust of expertise, lying, over-reliance on instinct, and avoidance of bad news.” Moreover, Trump turned mask-wearing into “a statement about freedom and liberty — what kind of American you were,” and he and his administration “stymied and belittled its scientists at every turn” in the belief that experts were not to be trusted. Trump also distrusted civil servants and important institutions. The chapter of the book titled “anti-expert, pro-magic” describes the “pseudo-expert” and the “elevation of the non-expert.”
In addition to describing Trump’s responsibility for the failed response to the pandemic, the book records many of the pandemic events in 2020. Here is a sample:
Jan. 3, 2020 — Secretary Azar at HHS hears of Wuhan “flu”. By the time Trump acted to restrict travel, 300,000 people had traveled to US from China in January alone.
Jan. 11, 2020 — a gene sequence of the virus posted by officials from China was downloaded by Dr. Anthony Fauci and his team at the National Institute of Allergy and Infectious Disease (NIAID), part of the National Institutes of Health (NIH). On Jan. 13, NIAID sent Moderna everything it needed to begin work on a vaccine.
On March 17 there were 100 Covid deaths in the US. By November, there were 100,000 nursing home deaths.
In March 2020 the Strategic National Stockpile (SNS) had only 12 million N95 masks and needed 3.5 billion. It had been authorized in 1999 to replenish and supplement state and local supplies. But the 85 million N95 masks distributed in 2009 during the swine flu epidemic were not replenished by a Republican House, and Congress cut Obama’s request in half for additional funding during Zika and Ebola.
In April, a plan by Health and Human Services to mail masks to each household in areas “with massive infection and rising deaths” was killed by the White House. “Those 650 million masks would have saved a lot of lives,” writes Slavitt, “and sent the message that mask wearing was not a political ploy but a safety exercise.”
The book includes details about the (discarded) Obama playbook’s directions for what to do in a pandemic; it describes the angry reaction to Nancy Messonnier’s warning in February that a pandemic would be very disruptive; it includes details about rollbacks in the EPA, FDA and other agencies. Slavitt notes that without a strong FDA, there would be a return to “days of traveling peddlers of potions, when everyone picks their own authority.”
The problems and inequities in the U.S. health system are a major theme in the book. Why, for example, do drugs in the US cost ten times more than in Canada or the UK? Contributing to the answer are “insurance companies without losses,” the pharmaceutical financial machine, the $20 billion spent annually on marketing to doctors, the pharmaceutical companies funding political campaigns.
The author’s genuine concern for the poor is apparent throughout the book. He notes that through mid-Nov 2020 the death rate from Covid in the Black community was more than twice the rate for whites, and he explores the reasons. He also tells vivid stories of workers who were sickened by Covid and did not have the luxury of staying home. He says that In April the Bureau of Prisons tested 2000 prisoners and found 70% tested positive.
In dealing with the daily crises of the pandemic, Andy Slavitt’s primary goal became “saving the next life.” He taped it to his desk when he joined the Biden White House in January 2021 and was inspired by it every day. He wrote Preventable in hopes Americans could learn from this pandemic and apply the lessons to the next one. Facing future crises, he says, we will need to “trust experts, trust each other, and see things as they are.”
Fortunately, the book does not end in 2020. The last chapter is dated March 2021, but here we can end with some optimistic tweets from Andy Slavitt on July 4: