World War C

by Sanjay Gupta

  I know I have.

  I. COVID’s case fatality rate is constantly changing and differs throughout the world, depending on public health measures and how the virus is behaving in a community. Clearly, we’ve learned that case fatality rates rise for older individuals and those with preexisting conditions. Interestingly, COVID became the third-leading cause of death for individuals forty years old and over in 2020, with an overall annual mortality rate of 325 deaths per 100,000 individuals, behind only cancer and heart disease. In addition, for individuals forty years old and over, the case fatality rate for COVID was greater than the case fatality rate for motor vehicle accidents.

  Acknowledgments

  We have always shared our beautiful Goldilocks planet with creatures big and small, and yet we are still learning to dance with them. Our moves are sometimes clumsy, and we too often step on our partners’ toes. We infringe on their space, strip away their habitat, and needlessly take their lives. There is a best way to live, where we give as much as we take, protect our precious resources, and respect our Earthmates. It is possible to live well and do the perfect tango at the same time.

  Since the beginning of 2020, I have spent countless hours with the elite of public health, policy, and prediction. They live audacious lives, believing we can become pandemic proof, and rid ourselves of the existential threat pathogens pose to mankind. They are the dance instructors we all need, and they inspired me to write this book. The medical team at CNN are truly the best on the planet, and helped guide my thinking on this book. Ben Tinker, Amanda Sealy, Nadia Kounang, Michael Nedelman, Tia Miller, and Jessica Small have all been completely immersed in telling the story of COVID accurately and fairly.

  Priscilla Painton is blessed with many talents, but it is her gift of clarity that is a blessing to her writers. Having had an extraordinary experience working on Keep Sharp with Priscilla, I wondered if it was a fluke. Now with two data points, it is looking like a trend. I am looking forward to collecting more evidence.

  A book like this is only possible because of the team of dreamers who make the pages come to life and then tell the world about it. Yvette Grant, Megan Hogan, and Hana Park, thank you for your editorial guidance. Julia Prosser, Stephen Bedford, Elizabeth Gay Herman, and Elise Ringo, thank you for finding the best ways to connect WWC to the audience. Jackie Seow and Paul Dippolito, the book is a work of art because of you. While I will never get used to having my picture on the cover of a book, I am grateful for your diligence and brilliance. A book about a pandemic should be available all over the world, and because of the hard work of Marie Florio, it will be.

  Great teams start with great leaders. Dana Canedy, I am appreciative of all your support. Jonathan Karp, our conversations remain some of my favorite of all. I remain mesmerized by your ability to toggle so effortlessly between pandemics and politics, sports, and Springsteen. Tremendously grateful for your warmth and willingness to welcome me to the family.

  Every time I am lucky enough to spend some time talking to the world’s greatest lawyer, Bob Barnett, I walk away more informed and more inspired. I am still not certain why he included me on his list of clients, ranging from presidents to the pope, but being a friend of Bob is one of my life’s greatest honors.

  And Kristin Loberg. An acknowledgment seems hardly enough to best describe our wonderful burgeoning partnership, facilitated by the indefatigable and supportive Bonnie Solow. For the past year, we rode side by side in a speeding car, burning rubber, and even accelerating through the turns. We did it because we knew it was important. When my gas tank started to run low, you were there cheering me on, keeping me awake, and reminding me of the mission. Your light burns bright, Kristin, and I get to be one of the lucky ones, basking in the glow. I will forever be indebted to you, my dear friend.

  More from the Author

  Keep Sharp

  About the Author

  Sanjay Gupta grew up in a small midwestern town, married his college sweetheart, and can now be found getting mercilessly teased by his three teenage daughters. When not receiving unsolicited fashion advice from them, he spends his time as an associate chief of neurosurgery, bestselling author, and award-winning television correspondent. He is a member of the National Academy of Medicine and the Academy of Arts and Sciences. He is particularly proud of his as yet undiscovered shower singing voice and is currently on a hunt for the world’s most perfect nap.

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  Also by Sanjay Gupta

  Keep Sharp

  Cheating Death

  Chasing Life

  Monday Mornings

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  Notes

  Author’s Note

  The selected list of notes to accompany statements made in the book became a tome in itself due to the volume of sources and scientific literature I could have cited. Below is a snapshot of resources that will at least help lead you to more sources and provide a launchpad for further inquiry. Some of the stories in the book were reported on widely by the media, and when it came to the details of COVID victims, either names and identifying materials were changed or their stories had already been made public. I trust you can find a wellspring of references and evidence yourself online with just a few taps of the keyboard, assuming you visit reputable sites that post fact-checked, credible information that’s been vetted by experts. This is especially important when it comes to matters of health and medicine.

  As we all know, the COVID-19 pandemic remains a dynamic event with its growing body of knowledge evolving daily. Unintended omissions in the book are indeed possible as a result, but I’ve done my very best to present the most credible, science-backed information with clarity, transparency, and endless fact-checking. Some of my content is based on my own interactions both in my professional work as a journalist and in personal conversations with colleagues and people who were familiar with the matters and openly shared their insights.

  Introduction: A “Pneumonia of Unknown Origin”

  1 See “China Investigates Respiratory Illness Outbreak Sickening 27,” AP News, December 31, 2019, https://apnews.com/article/wuhan-health-international-news-china-severe-acute-respiratory-syndrome-00c78d1974410d96fe031f67edbd86ec. Several timelines of the pandemic’s development have been published online. You can access these just by searching for “COVID timeline.”

  2 See Michael C. Bender and Rebecca Ballhaus, “A Landmark White House Move Left States to Secure Medical Equipment Themselves, Causing Problems that Still Haven’t Abated,” Wall Street Journal, August 31, 2020, https://www.wsj.com/articles/how-trump-sowed-covid-supply-chaos-try-getting-it-yourselves-11598893051.

  3 See Elizabeth Arias, Betzaida Tejada-Vera, and Farida Ahmad, “Provisional Life Expectancy Estimates for January through June, 2020,” Vital Statistics Rapid Release, Report no. 10, February 2021, https://www.cdc.gov/nchs/data/vsrr/VSRR10-508.pdf.

  4 See Xixing Li, Weina Cui, and Fuzhen Zhang, “Who Was the First Doctor to Report the COVID-19 Outbreak in Wuhan, China?” Journal of Nuclear Medicine 61, no. 6 (June 2020): 782–783, doi: 10.2967/jnumed.120.247262. Epub 2020 Apr 17.

  5 See “Novel Coronavirus—Thailand (ex-China),” Disease Outbreak News, January 14, 2020, World Health Organization, https://www.who.int/csr/don/14-january-2020-novel-coronavirus-thailand-ex-china/en/.

  6 See Keri N. Althoff et al., “Antibodies to SARS-CoV-2 in All of Us Research Program Participants, January 2–March 18, 2020,” Clinical Infectious Diseases (
June 2021): ciab519, doi: 10.1093/cid/ciab519.

  7 See Jamie Gangel, Jeremy Herb, and Elizabeth Stuart, “ ‘Play It Down’: Trump Admits to Concealing the True Threat of Coronavirus in New Woodward Book,” CNN, September 9, 2020, https://www.nytimes.com/2020/09/09/us/politics/woodward-trump-book-virus.html. Also see Bob Woodward, Rage (New York: Simon & Schuster, 2020).

  8 See “Secretary Azar Declares Public Health Emergency for United States for 2019 Novel Coronavirus,” HHS Press Office, January 31, 2020, https://www.hhs.gov/about/news/2020/01/31/secretary-azar-declares-public-health-emergency-us-2019-novel-coronavirus.html.

  9 See Jane C. Hu, “Covid’s Cassandra: The Swift, Complicated Rise of Eric Feigl-Ding,” Undark, November 25, 2020, https://undark.org/2020/11/25/complicated-rise-of-eric-feigl-ding/.

  10 See Maxime Taquet et al., “6-month Neurological and Psychiatric Outcomes in 236, 379 Survivors of COVID-19: A Retrospective Cohort Study Using Electronic Health Records,” Lancet Psychiatry 8, no. 5 (May 2021): 416–427, doi: 10.1016/S2215-0366(21)00084-5. Epub 2021 Apr 6.

  11 Maya Angelou was linked to this saying in 2003, but reports have since emerged to show that the line could have originated from a 1971 collection called Richard Evans’ Quote Book and been ascribed to Carl W. Buehner, a high-level official in the Mormon church who said, “They may forget what you said—but they will never forget how you made them feel.”

  12 See Sanjay Gupta, “The Big One Is Coming, and It’s Going to Be a Flu Pandemic,” CNN, November 7, 2018, https://www.cnn.com/2017/04/07/health/flu-pandemic-sanjay-gupta/index.html.

  13 See Johns Hopkins University Bloomberg School of Public Health, “Global Health Security Index Finds Gaps in Preparedness for Epidemics and Pandemics: Even High-income Countries Are Found Lacking and Score Only in the Average Range of Preparedness,” ScienceDaily, http://www.sciencedaily.com/releases/2019/10/191024115022.htm (accessed June 2, 2021).

  14 See Steven H. Woolf, Derek A. Chapman, and Jong Hyung Lee, “COVID-19 as the Leading Cause of Death in the United States,” JAMA 325, no. 2 (December 2020): 123–124, doi: 10.1001/jama.2020.24865.

  15 See “Bird Flu: Russia Detects First Case of H5N8 Bird Flu in Humans,” BBC News, February 20, 2021, https://www.bbc.com/news/world-europe-56140270.

  16 See Vivian Wang, “A Man in China Is Found to Have H10N3 Bird Flu, a Reminder of a Continued ‘Concern for Pandemic Flu’, ” New York Times, June 2, 2021, https://www.nytimes.com/2021/06/02/world/asia/h10n3-bird-flu.html.

  17 See Peter M. Sandman, “A Severe Pandemic Is Not Overdue—It’s Not When But If,” Center for Infectious Disease Research and Policy, News & Perspective, February 22, 2007, https://www.cidrap.umn.edu/news-perspective/2007/02/severe-pandemic-not-overdue-its-not-when-if.

  Chapter 1: Postmortem

  1 See “What It’s Like to Lose Someone to Covid-19,” New York Times, March 5, 2021, https://www.nytimes.com/interactive/2021/03/05/us/covid-deaths.html.

  2 See Dr. Sanjay Gupta, “The Pandemic Has Become a Humanitarian Disaster in the United States,” CNN, November 13, 2020, https://www.cnn.com/2020/11/13/health/coronavirus-humanitarian-disaster-gupta/index.html.

  3 See Olga Khazan, “A Failure of Empathy Led to 200,000 Deaths. It Has Deep Roots,” Atlantic, September 22, 2020, https://www.theatlantic.com/politics/archive/2020/09/covid-death-toll-us-empathy-elderly/616379/.

  4 See “DHS Issues Supplemental Instructions for Inbound Flights with Individuals Who Have Been In China,” News Archive from the Department of Homeland Security, February 2, 2020, https://www.dhs.gov/news/2020/02/02/dhs-issues-supplemental-instructions-inbound-flights-individuals-who-have-been-china.

  5 See Patricia Mazzei, “A Family’s Search for Answers: Did Their Brother Die of Covid?” New York Times, March 7, 2021, https://www.nytimes.com/2021/03/07/us/florida-family-coronavirus-death.html.

  6 See Charles A. Downs et al., “COVID Symptoms, Symptom Clusters, and Predictors for Becoming a Long-Hauler: Looking for Clarity in the Haze of the Pandemic,” preprint, medRxiv, posted March 5, 2021, doi: 10.1101/2021.03.03.21252086.

  7 See Mark Honigsbaum and Lakshmi Krishnan, “Taking Pandemic Sequelae Seriously: From the Russian Influenza to COVID-19 Long-haulers,” Lancet 396, no. 10260 (October 2020): 1389–1391, doi: 10.1016/S0140-6736(20)32134-6. Epub 2020 Oct 12.

  8 Ibid.

  9 My one-on-one interviews with six of the members of Trump’s coronavirus task force were done in the development of a special report for CNN called “COVID WAR—The Pandemic Doctors Speak Out” that aired on March 28, 2021. The recorded conversations amounted to hours of tape. Many of the quotes and paraphrased material in this book came from those interactions. See Dr. Sanjay Gupta, “Autopsy of a Pandemic: 6 Doctors at the Center of the US Covid-19 Response,” CNN, March 26, 2021, https://www.cnn.com/2021/03/26/health/covid-war-doctors-sanjay-gupta/index.html.

  10 See Fernanda Santos, “Life, Death, and Grief in Los Angeles,” New York Times Magazine, March 2, 2021, https://www.nytimes.com/interactive/2021/03/02/magazine/covid-la-county-hospitals-black-latino-residents.html.

  11 Ibid.

  12 To view cases and deaths from COVID worldwide by country as the numbers changed throughout the pandemic, use the interactive dashboard provided by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University at https://github.com/CSSEGISandData/COVID-19. Also see E. Dong, H. Du, and L. Gardner, “An Interactive Web-based Dashboard to Track COVID-19 in Real Time,” Lancet Infectious Diseases 20, no. 5 (2020): 533–534, doi: 10.1016/S1473-3099(20)30120-1.

  13 See Matthew Mosk, “George W. Bush in 2005: ‘If We Wait for a Pandemic to Appear, It Will Be Too Late to Prepare’, ” ABC News, April 5, 2020, https://abcnews.go.com/Politics/george-bush-2005-wait-pandemic-late-prepare/story?id=69979013. Also see John M. Barry, The Great Influenza (New York: Viking Penguin, 2004).

  14 Ibid. According to the media’s reports, Tom Bossert used the word obsessed to describe Bush’s response. Bossert had worked in the Bush White House and went on to serve as a homeland security adviser in the Trump administration.

  15 Ibid.

  16 See “Crimson Contagion 2019 Functional Exercise Key Findings,” US Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response (October 2019), https://int.nyt.com/data/documenthelper/6824-2019-10-key-findings-and-after/05bd797500ea55be0724/optimized/full.pdf. Also see David E. Sanger, Eric Lipton, Eileen Sullivan, and Michael Crowley, “Before Virus Outbreak, a Cascade of Warnings Went Unheeded,” New York Times, March 19, 2020, https://www.nytimes.com/2020/03/19/us/politics/trump-coronavirus-outbreak.html.

  17 See Susan Davis, Claudia Grisales, and Kelsey Snell, “Senate Passes $2 Trillion Coronavirus Relief Package,” NPR, March 25, 2020, https://www.npr.org/2020/03/25/818881845/senate-reaches-historic-deal-on-2t-coronavirus-economic-rescue-package.

  18 See Maggie Haberman, “Trump Admits Downplaying the Virus Knowing It Was ‘Deadly Stuff,’ ” New York Times, September 9, 2020, https://www.nytimes.com/2020/09/09/us/politics/woodward-trump-bookvirus.html.

  19 The reality distortion field was often used to describe how Steve Jobs would influence his employees at Apple. According to Walter Isaacson’s chronicle of the Apple icon in his biography (Steve Jobs: The Exclusive Biography), Jobs had learned about the reality distortion field—a term used to describe how someone can influence people and convince them of almost anything with a mix of characteristics including charm, bravado, hyperbole, and of course persistence.

  20 Several reprints of Defoe’s Journal of the Plague Year are available online for free or purchase. Here’s one place to read it: https://www.gutenberg.org/files/376/376-h/376-h.htm.

  21 See E. Dong, H. Du, and L. Gardner L, “An Interactive Web-based Dashboard to Track COVID-19 in Real Time,” Lancet Infectious Diseases 20 no. 5 (2020): 533–534. doi: 10.1016/S1473-3099(20)30120-1. Also see the interactive dashboard provided by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins Uni
versity at https://github.com/CSSEGISandData/COVID-19.

  22 Ibid.

  23 See Azeem Majeed et al., “Can the UK Emulate the South Korean Approach to Covid-19?” BMJ 369 (May 2020): m2084, doi: 10.1136/bmj.m2084. Also see Daejoong Lee, Kyungmoo Heo, and Yongseok Seo, “COVID-19 in South Korea: Lessons for Developing Countries,” World Development 135 (November 2020): 105057, doi: 10.1016/j.worlddev.2020.105057. Epub 2020 Jun 28.

  24 See the Centers for Disease Control and Prevention’s data and statistics on obesity at https://www.cdc.gov/obesity/data/adult.html.

  25 See Alireza Bolourian and Zahra Mojtahedi, “COVID-19 and Flu Pandemics Follow a Pattern: A Possible Cross-immunity in the Pandemic Origin and Graver Disease in Farther Regions,” Archives of Medical Research 52, no. 2 (February 2021): 240–241, doi: 10.1016/j.arcmed.2020.10.012. Epub 2020 Oct 17.

  26 Jose Mateus et al., “Selective and Cross-reactive SARS-CoV-2 T Cell Epitopes in Unexposed Humans,” Science 370, no. 6512 (October 2020): 89–94, doi: 10.1126/science.abd3871. Epub 2020 Aug 4.

  27 See Dr. Sanjay Gupta, “The United States’ One-year Coronavirus Checkup,” CNN, January 21, 2021, http://lite.cnn.com/en/article/h_0e1a2ddf94eeb132a5bdeecdda84a602.

  28 See Sen Pei, Sasikiran Kandula, and Jeffrey Shaman, “Differential Effects of Intervention Timing on COVID-19 Spread in the United States,” Science Advances 6, no. 49 (December 2020): eabd6370, https://advances.sciencemag.org/content/6/49/eabd6370.

  29 In addition to sharing these insights with me personally in a formal interview, Dr. Birx also made these statements on Face the Nation with Margaret Brennan on February 24, 2021. The transcript is available here: https://www.cbsnews.com/news/transcript-deborah-birx-on-face-the-nation-january-24-2021/.