by Sanjay Gupta
“We agreed that you’re gonna do this,” came the curt directive from the other end of the line, Redfield recalled. They squeezed Redfield’s tolerance for psychic pain for another hour. They “dumped on him good,” accusing him of being out of line and asking him to write a foreword in the MMWR that was different from the report’s findings. Redfield told them that CDC directors don’t write editorials in these science-backed, vetted reports—especially editorials that contradict and obfuscate the facts and data. There would be no change in editorial policy, Redfield countered to their demands. Most important for Redfield, however, this was his breaking point. After endless badgering, he drew the line and called out their professional harassment. If they wanted a director who would change the MMWR, they’d need to get another director. Redfield told me, “I finally had a moment in life where I said, ‘You know, enough’s enough. You wanna fire me? Fire me. And I just said, ‘I have to let you all know I’m recording this conversation.’ ”
He wasn’t recording the conversation other than implanting the memory in his own head. But pretending he was documenting the heated exchange was Redfield’s reflexive way of pushing back without quitting. (In a statement, Azar denied putting any pressure on Redfield to revise the reports.)
I asked Redfield the question: Why didn’t you quit? Even his children were suggesting he resign in the spring. One of his sons, a transplant surgeon, called a lot and nudged his father to quit, but Redfield refused. He reminded his son of the Don’t Quit plaque, which his son had given him years ago. “God must’ve had a reason for you to give me this plaque,” Redfield told his son, “so I’d be able to read it back to you at this moment in time.” The unfortunate role that politics played in the American response has led Redfield to urge that leaders at places like the CDC, NIH, and FDA be appointed for seven to ten years so they are less politically aligned with a single presidency or party. He mentioned the example of the FBI, whose director is appointed for a single ten-year term by the president and confirmed by the Senate.
When Birx moved from the State Department over to the White House, leaving Africa and accepting her position as the coronavirus task force coordinator, she found herself among people “who did not take the pandemic seriously.” And she knew taking the job was career suicide. Her first order of business, nonetheless, was to understand the culture so she could then try and make government work efficiently and effectively. But she arrived in the middle of the mess, like a bird touching down on a branch of a tree that has already been uprooted by the violently swirling storm. Her efforts in mid-March to push the administration to declare a fifteen-day time-out to slow the spread came only after many sleepless nights and data presentations with easy-to-read charts and graphs that would persuade Trump and his aides. And when it was abundantly clear at the end of March that another thirty days would be necessary to slow the spread, Birx endured another round of sleepless nights, consultations with Fauci, and grade school chart making to show and convince the president.
By then, people in Trump’s circle were increasingly nervous about what the lockdown would do to the economy. In the end, though, it may not have been the detailed presentations that convinced the president to extend the pause. Trump likely agreed because he had friends dying from the infection, and that may have made this real for him personally. After that second pause, however, Birx was thought to have apparently overstayed her welcome in the eyes of Trump’s coterie and was largely sidelined. She’d never brief the president directly again. “The one policy directive he gave to me in April, which was the last time I really had any briefing with him in that kind of way, was, ‘We will never shut the country down again,’ ” Birx said.
In mid-May the administration sought to artificially attribute some deaths to other causes, skeptical of the CDC’s reporting and hoping to keep the numbers down.12 Debates about how to count the deaths ensued, particularly when it came to people dying with underlying conditions that alone could have been life-threatening. But even when a person lives with heart disease, for example, and then dies soon after contracting the virus, it’s COVID that took that life. You can’t cover up COVID deaths. Or, for one more example, if you go into the hospital for cancer treatment and come out in a coffin because you picked up an infection while there, your death certificate will list “septic shock” due to that infection first as the cause of death.
Over the summer, as Scott Atlas’s extreme ideas about controlling the pandemic, which included letting the infection rip through younger people, ran counter to the rest of the task force, the chaos continued. Atlas questioned the effectiveness of masks too, which went directly against the task force’s messaging. Birx noticed the president was receiving a parallel stream of data, likely from Atlas’s team, that did not jibe with her own data. They were slicing and manipulating the data to try and show that the United States was doing better than Europe. The messages coming from the White House no longer reflected the science-backed truth. “We mitigated too late and opened too early,” Birx said to me in our postmortem analysis. “We didn’t communicate effectively. We need to be better marketers of our message. Our federal messaging was not consistent, and the way you talk to a twenty-something or middle-aged individual, someone in the heartland versus people in New York City or L.A., is very different. If you have 100 messages and 99 percent of them are on focus and 1 percent is off, it only takes that one message to lose trust and create doubt. And that really causes a problem.”
Birx realized how bad the messaging was when she met with communities that had misinterpreted important information that influenced their behavior and adherence to public health measures. In some of the Rocky Mountain states, for example, the CDC found that 94 percent of people who died from COVID had underlying conditions (what are called comorbidities). The headlines at the end of August were everywhere: “CDC Says 94% of COVID-19 Deaths in US Had Underlying Medical Conditions.”13 That led to a claim that went viral within days on social media: that only 6 percent of US pandemic deaths had been from COVID itself. People took a mental shortcut that resulted in faulty causal thinking. They thought the headlines meant the vast majority of people who died from COVID actually died from causes other than COVID, so that gave them permission, they decided, to avoid public health guidelines like mask wearing, or at least not take them seriously if they didn’t have any underlying conditions. It wasn’t that they were antiscience—they were misunderstanding the data and, in turn, what they were supposed to do. Mind you, a lot of people do have risky underlying conditions like high blood pressure and being overweight or obese but either don’t know it or don’t acknowledge it.
Such a fallacy of logic over these percentages and resulting risk assessments would be like concluding 90 percent of the people who died on 9/11 died of heart disease, diabetes, or stroke. Yes, there is a lot of chronic, preventable illness in the United States, and that is a problem we need to confront as a nation. But there were more than half a million excess deaths during the first year of this pandemic (522,368 excess deaths to be exact, according to the Journal of the American Medical Association).14 Those are mothers, fathers, sons, and daughters who would have still been here—even with their conditions to manage—but are now gone. The misunderstanding led to people downplaying the virus in their heads and behaving counter to guidelines. They simply didn’t understand the data that were informing the guidelines. The confusion only compounded our political divides. Rather than uniting to attack a common enemy—the virus—we seemed to fight with one another. But as you’re about to find out, viruses don’t pick a political party. They don’t even pick a fight. They just… are.
I. The New York Times did a marvelous job reporting on the Red Dawn emails based in part on Freedom of Information Act requests to local government officials. It has published more than eighty pages of the exchanges, which started in January 2020 and provide a diary of sorts for experts reacting to the spread of the coronavirus. You can download the file at www.nytimes.com.
Some of the emails were also reported by Kaiser Health News.
This 1975 transmission electron microscopic (TEM) image shows human coronavirus particles. Coronaviruses possess a helical genome composed of single-stranded RNA. The coronavirus derives its name from the fact that under electron microscopic examination, each virion is surrounded by a corona, or halo, due to the presence of viral spike structures emanating from its envelope. SOURCE: CENTERS FOR DISEASE CONTROL AND PREVENTION (DR. FRED MURPHY AND SYLVIA WHITFIELD).
CHAPTER 3 Snakes
April 1, 2020
I wish the news had been different. But it was no joke. On April Fool’s Day, as the pandemic was gaining strength and wizardry in our communities, I was mourning the loss of a dear colleague and friend while putting my thoughts together for a written tribute. Dr. James T. Goodrich was a giant of neurosurgery best known for performing the delicate and daunting operation of separating twins conjoined at the head.1 These separations, which involve months of planning and dozens of procedures, are among the most challenging in medicine. I know, because I was with him for twenty-seven hours as he led a courageous team of forty doctors and nurses to operate on Jadon and Anias McDonald and allowed my crew to document the remarkable event, his seventh separation procedure of his long career. Even as a neurosurgeon myself, I had never seen anything like it.
Our shared world of neurosurgery is a small one. There are just 4,600 neurosurgeons in the United States, and as a result, we all cross paths at one point or another. I first met Dr. Goodrich when I was a resident, and even back then, he had a Santa Claus–like beard and a constant twinkle in his eye. He had a sly grin and always looked as if he knew the punch line of the joke before everyone else did. Along the way, we became close. He was a reader and could speak effortlessly about any topic I had on my mind. He was the kind of guy who performed these astonishingly complex operations on little babies’ brains but also took time to bake cookies during the holidays and hand-deliver them to nurses. Given his stature as a preeminent pediatric brain surgeon, I loved watching people react when he told them he had dropped out of college at one point and became a surfer dude, as he described it. For many of us brain surgeons, he really was the most interesting man in the world.
That’s why it knocked the wind out of me when I heard he had died early Monday morning on March 30. I knew it was only a matter of time before I’d learn of a death from COVID in my own circle, but I didn’t expect it so soon, just a couple weeks after the pandemic had been declared. It felt particularly cruel and unfair. I knew this virus did not discriminate based on who you are or what you do, and yet I still could not believe it would rob the life of someone who had saved so many. I asked him once how he even first thought of performing craniopagus separations, and unsurprisingly, his answer was rooted in humility.
“If I had really done my homework and looked at the literature on craniopagus twins at the time, I would have never accepted them [as patients]. Because the literature was devastating,” he told me. So, with a touch of cluelessness and lots of idealism, he plunged ahead into some of the riskiest and most technical operations one can perform on a human, let alone two humans simultaneously. All along, you might be forced to make the split-second, impossible decision to save one twin over the other. Dr. Goodrich spent more than thirty years at Montefiore Einstein in New York City where the “surfer dude” became the director of pediatric neurosurgery and a professor at Albert Einstein College of Medicine.
While I, like many others, had hoped to never know somebody who became ill or died from COVID, that changed with Goodrich’s death. A few days after his death, I learned of another one too close to home. Charlotte Figi, just thirteen years old, had inspired me to travel the world years ago in search of the truth about medical marijuana.2 It led to my Weed documentary in 2013 that featured her remarkable transformation as she used medicinal cannabis to treat and manage crippling, catastrophic seizures. Charlotte was a little pioneer from Colorado whose legacy is having ignited the entire CBD movement today. To think she worked so hard to enjoy a full life and had much to look forward to, but then succumbed to an aggressive pneumonia that overtook her body. It was so early in the pandemic that COVID wasn’t yet top of mind, and widespread testing wasn’t available. Her mother, Paige, told me all the doctors were convinced it was the novel virus making its way across the country. I wept as I wrote a tribute for her as well.
By the time this pandemic is officially over, millions of stories like those of James and Charlotte—of people old and young—will be told and heard. Tears will flow and sadness will simmer. I thought about all of the lost souls on December 14, the first day someone in the United States was vaccinated. How could I not, for it was the day we could mark the beginning of the end. If only people like James and Charlotte, and countless others, had been able to steer clear of the virus and hold on long enough for its antidote.
V Is for Virus
The word virus has a funny origin. It denotes the venom of a snake and is derived from the Latin for “slimy liquid” or “poison.”3 It’s a misnomer, really, because not all viruses are bad and result in destruction or death. In fact, viruses are necessary. Let me repeat that: Viruses are necessary, which I realize is hard to believe given how much this tiny strand of genetic material making up the coronavirus has traumatized our world. But viruses are the planet’s dominant life-form. They have been an essential part of our very existence—and evolution—for millennia and have made significant contributions to our animal friends and those in the plant kingdom too. In cows, for example, it is a virus that changes the cellulose from grass into sugars that ultimately provide energy and facilitate the production of milk.
We’ve all been trying to avoid one particular virus in the pandemic, but as you read and breathe right now, viruses are entering your body unbeknownst to you—thousands by the day. They thrive in our oceans where, at last count, almost 200,000 different viral populations have been found from the surface down to more than 13,000 feet deep and from the North to the South Pole.4 Think about that the next time you swallow a mouthful of seawater; you’re gulping down about as many viruses as there are people in North America.5 And many viruses flourish inside us, coating our gastrointestinal tract among other organs and tissues, where they serve important roles, such as destroying disease-causing bacteria. Bacteriophages, as they are known, are viruses that infect bacteria and act as soldiers on our mucosal surfaces such as the insides of the nose and mouth and the lining of the gut. You may have heard about the human microbiome—the sum of all microbes that live in and on us in a mostly symbiotic relationship. These commensal organisms, which include bacteria, viruses, and fungi, have contributed to our survival for millions of years and have evolved with us. The bacteria dominate, and their friendly role in our health, especially our metabolism and immunity, is at the forefront of medical research. The next frontier for medicine, in fact, will be unlocking the secrets to our library of viruses that also help us out—what’s called our virome. Our virome is a lifelong companion. Collectively, our microbiome serves many functions that we haven’t begun to crack yet scientifically (more on this in part 2).
World-renowned virus hunter Dr. Nathan Wolfe was among the Cassandras who years ago warned the world it wasn’t ready for a pandemic and who could see COVID coming in his imagination. He has an obsession for what’s called biological dark matter. According to him, we cannot even fully identify 20 percent of genetic material in our noses, and up to half of the genetic mass in our guts is “unidentified life.”6 I had always thought of that term unidentified life being used to describe alien life, not organisms inside my own body. Wolfe, whom you’ll meet in part 2, is founder of Metabiota, a service to evaluate and manage biological threats for governments and corporations. In 2018, he had designed an ingenious insurance policy to help protect large businesses against massive financial losses due to a pandemic. Nobody bought it.7
We have four times more viral genetic material inside our genome th
an our own genes. And the part of our genome that codes for proteins (“genes”) comprises only 2 percent of our DNA. We owe many ancient viruses for our ability to read, write, and remember. No, I’m not suggesting that viruses inside you right now are helping you to read this sentence as if they are butlers to your brain. But from a macrocosmic perspective, viruses that humans have encountered throughout evolution have become part of who we are at a molecular, genetic level, to the point where they’ve had a role in the development of our many cognitive skills and capabilities. They are, after all, pieces of information. They have shaped our DNA and acted as beneficial genetic parasites to give us better ways to think, form memories, and even build immunity. As previously noted, mammalian viruses can help protect against bad bacterial germs and act as anticancerous agents too. Other viral genes have been incorporated into our DNA on several different occasions throughout our evolution. The syncytin-1 gene from a retrovirus, for example (also known as enverin), encodes for a protein essential in the establishment of the placenta. In a way, we owe our ability to have children to ancient viruses.
We don’t know how many species of viruses exist in the world, but it’s suspected that the number is in the trillions. Of the few hundred thousand kinds of viruses that are known, fewer than 7,000 have names. Only about 250, including the new coronavirus, have the machinery to infect us. We aren’t their only targets. Viruses infect mostly bacteria but also other animals and plants, from beans and blackberries to ticks and mosquitos, potatoes and bananas, birds, cats, and dogs. We have no idea where viruses came from originally, and scientists will forever debate whether they emerged before or after living cells on Earth.