Silent Invasion: The Untold Story of the Trump Administration, Covid-19, and Preventing the Next Pandemic Before It’s Too Late, By Dr. Deborah Birx

Dr. Deborah Birx describes her journey as the White House Coronavirus Response Coordinator and the introduction of a new mystery virus that is coming out of China and how it did not seem to have the same characteristics as any known respiratory viruses such as sudden acute respiratory syndrome (SARS), adult respiratory distress syndrome (ARDS), or the Middle East respiratory syndrome (MERS).  People in China were risking going to jail to smuggle out pictures and videos of patients in Wuhan showing the disease is far worse than what China was reporting to the public.  As we learned in the United States, China has a self-serving interest in making sure the severity of any pathogen hospitalizing and killing patients was underreported.  Had the world knew the true severity of this mystery virus, it would have damaged the country’s tourism and economy.

While this mystery virus was novel, Dr. Birx was not new to handling contagions or working in areas with little access to Public Health.  She oversaw the President’s Emergency Plan for AIDS Relief (PEPFAR) and discusses the tactical parallels between this novel virus coming out of Wuhan and her time working in Africa controlling the spread of other diseases at biohazard safety levels 3 and 4 such as HIV, AIDS, and Ebola.  She describes the four types of spreads:

• Asymptomatic – contagious without any symptoms.
• Presymptomatic – contagious right before showing any symptoms.
• Mildly symptomatic – contagious with symptoms so mild they are dismissed.
• Symptomatic – contagious with symptoms.

Part 1: Chapters 1 – 10

While the world is hearing about a mysterious disease in Wuhan, China, not much is known about the disease, including the contagion and severity.  Knowing and understanding the four types of spreads, Dr. Birx knew reported infections were underreported and the true number of infections could be as much as ten times higher.  Other countries, like Japan, had a much better reporting system than the United States.  The blame was not solely on the current administration, rather it was due to decades of underfunding by both political parties while in control.  The media was not helping the situation either by sensationalizing the novel virus and reporting any information by anyone claiming to be a doctor or a scientist that would speak or present information that fit the media’s narrative they were trying to sensationalize.  This new virus was constantly being studied and understood.  Meanwhile, many so-called experts were given media coverage and yet, when something new was learned, infectious disease experts and epidemiologists studying the disease were quickly discredited.

As more is being learned about this novel virus, it was identified as SARS-CoV-2, or commonly known as COVID-19.  Political officials and some health professionals were quickly trying to find similarities with this novel virus comparing it to the common cold (which is also a corona virus) or the seasonal flu.  Even while the intent was to calm the public by connecting this disease with something the people live with daily, it created a false narrative that COVID-19 was another version of the common cold or the seasonal flu.  SARS-CoV-2 is a novel virus and its behavior and effects are not completely known.  As new characteristics of the virus are being discovered, this resulted in changing recommendations and mandates, this causes people to lose confidence in healthcare professionals, “the science”, and political leaders.

One of the most visible confusions was the wearing of masks.  While mask wearing is not part of the culture in the United States, Dr. Birx describes in chapter 9 how guidelines undercut the on silent spread.  In addition, there were mixed messages regarding the efficacy of mask wearing because there was not significant research done on various types of face coverings.  So again, as recommendations changed, so did the confidence in healthcare and public health professionals, unfortunately in a negative way.

Part 2: Chapters 11 – 20

As more is being learned about the virus and how to slow the spread, Dr. Birx and her team took to the road to meet with governors.  The first governor they met was Texas governor Greg Abbott.  Texas was one of the first states to reach out for federal guidance on handling the pandemic.  Dr. Birx introduced a plan based on models and forecasts from the University of Pennsylvania and Children’s Hospital of Philadelphia (CHOP).  In summary, it involved three steps: (1) statewide mask mandates, (2) expanding outdoor dining while reducing indoor dining to 25 percent capacity, and (3) closing of standing room only bars. Theoretically, this model should work.  In contrast, California’s governor, Gavin Newsome, would not even grant Dr. Birx an audience.  Instead, Dr. Birx was speaking to Newsom’s Chief of Staff and senior health advisor spending much time criticizing on the White House’s lack of leadership.

Although the CHOP model in theory should slow the spread, in reality things were a lot different.  People did not take to government ordered mask mandates, even with modified orders, and stand-alone bars would begin serving food to work around the stand-alone bar closure mandate.  After the country and businesses were ordered to shut down, there was a heard immunity mentality or a “let-it-rip” approach.  When businesses were ordered to shut down, people’s livelihoods and way of living were attacked by the government.  Even with the shutdowns, cases and deaths kept rising.  Again, this put the lack of confidence in public health officials in question.

While public health recommendations and government mandates showed little to no improvement, out came a lot of doctors and scientists with conflicting theories and recommendations.  One notably was Dr. Scott Atlas, a board-certified radiologist working on the COVID-19 task force.  Although he was a medical doctor, he was not an immunologist or epidemiologist.  His theories did align with the political views of the White House, so he was elevated as the COVID-19 task force.  Many of Dr. Atlas’s recommendations would conflict with those of Dr. Birx and her team.

Epilogue

Dr. Birx begins her epilogue stating that she believes in the adage “where there’s a will, there’s a way”.  Recognizing there are missteps by the government, the CDC, and problems in tracking transmission of pathogens, the United States needs better tracking and transparency.  In the Epilogue Dr. Birx discusses the vaccine and the rollout to the community and how that did not go as smoothly as hoped.  Also, there was this false narrative the vaccine was the end all to the pandemic when it was just another layer of protection. One point Dr. Birx emphasized, “pandemic responses are political but viral infections and the diseases they produce are apolitical” (Birx, 2022).

Discussion

Dr. Birx does her best not to blame or show bias towards any political party, she does point out how the political narratives and the media were contributing to misinformation and confusion.  While initially brought in because of her experience in handling outbreaks and epidemics in Africa, tactics were viewed as radical and in some cases, discredited by the media.  While there will always be a conflict between public health and public liberties, during a global emergency, there needs to be better response, reporting and leadership.  As a society, we have the responsibility to know what we don’t know.  Public Health professionals have the responsibility to mitigate or eliminate public health risks with little or no impact on our culture.  With more centralized, clear, and transparent communication, there might have been more compliance with some of the public health orders with little media scrutiny.  Vaccines being a good example.  The best analogy in this book was the idea of layering slices of Swiss cheese.  There are holes in the cheese and the more slices piled on, the better the holes get covered.  Vaccines are a slice, masks are another slice, physical distancing was a slice, and herd immunity was yet just another slice.  None, or few alone would solve the pandemic.  When the next pandemic occurs, we need to remove political bias and provide more transparency.

Works Cited

Birx, D. (2022). Silent Invation The Untold Story of the Trump Administration, COVID-19, and Preventing the Next Pandemic Before It’s Too Late. New York: HarperCollins Publishers.