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The viruses that cause the common cold, for example. They mutate so rapidly that, inside of a single human being, they replace their entire genome, and escape the defenses created by any vaccine.
From the point of view of a virus hunter, COVID-19 sits in a sweet spot. It mutates, very reliably, every one or two times it transmits from person to person. If I catch the bug from you, the genomes of our viruses will either be exactly the same or they will differ by a single mutation.
Without the genomic information, you might never have any idea that these people had any sort of relationship at all. Even if a test had identified the person who infected the household, and that person were questioned by teams of contact tracers, the connection with the household might never have been made.
Just then, in early April 2020, it was growing clear to a lot of people at once that the coronavirus did not spread in an orderly way.
Across the state her former colleagues, the beleaguered local health officers, were trying to control a virus of which they were catching only the briefest glimpses, in random black-and-white photographs. The Biohub could hand them a movie.
The next week she had on her schedule a rare chance to speak with Governor Newsom, when she updated him on the progress of the testing task force. Others were in the room, and she was meant to keep it brief and stick to her assigned subject. But at the end of it, as he was rising to leave, she took a risk. “Can I just tell you about one more thing?”
We’re going to do this. You two sit down together and figure it out. Charity spent the next two hours at a whiteboard explaining to Shapiro how it all might work—how samples of the virus from all those in California who tested positive could flow to the Biohub, and the Biohub, free of charge, would perform the analysis, provide it to the local health officers, and train them to use it. In the middle of her explanation, Shapiro had blurted out, “This is fucking awesome!”
She also knew that it had turned itself into a black box: it sucked in data from others and seldom shared its own, except in the form of academic papers that brought glory to its authors. At this point she had a long list of the ways the CDC, with the help of their former employee and her current boss, had made it more difficult for her to do her job. Now they were trying to add to it, by interfering with the best chance California had to track the virus and limit its damage.
Joe sensed that he’d found in Charity a person capable of putting him to proper use but unable to, for some reason. “She was somehow forbidden from answering my questions,” he said. “And these were matters of life and death.” He and the Biohub waited, and waited some more, and finally more or less gave up on the state.
“There was something deeply dysfunctional about how the government worked that I never fully grasped,” Joe would later say. “There’s no one driving the bus.” And the CDC—well, the CDC was its own mystery. “God knows what the hell is wrong with them,” said Joe.
Why doesn’t the United States have the institutions it needs to save itself?
I don’t know what I would actually do, if in your position, but I do know what I wish I would do. The first thing would be to face the truth. You and I both know that: 1) Despite the White House spin attempts, this will go down as a colossal failure of the public health system of this country.
Points 2 and 3 followed Point 1. The gist of all three was that the CDC, under Robert Redfield, had been disgraced.
The CDC director was then a career civil servant, and when Jimmy Carter was replaced by Ronald Reagan, Foege remained in his job. But now, when Foege testified before Congress, the White House sent minders to sit with him and monitor what he said.
Any research having to do with AIDS, for instance, had to first be vetted by the White House.
The breaking point for Foege came in 1983, after the CDC’s researchers established a connection between aspirin and Reye’s syndrome in children.
Companies that manufactured aspirin petitioned the White House. “The White House called and told us to cease and desist,” recalled Foege. “Do a new study.”
After Foege resigned, the White House converted the position of CDC director from career civil servant to presidential appointee.
Henceforth the CDC director would not bubble up from inside the CDC, lifted by the approval of his peers, but would be plucked from the supporters of whichever politician happened to occupy the White House.
management jobs once done by career civil servants being turned into roles performed by people appointed by the president. One of the problems this created was management inexperience: the average tenure of the appointees fluctuated between eighteen months and two years, depending on the administration.
The person who did not present risks to the White House’s political operation. The person who deferred, rather than made, hard decisions. A Chamberlain, rather than a Churchill.
The enemy was a virus. The enemy’s chief weapon was rapid and random mutation. It might well necessitate big changes of strategy, and these were bound to be viewed by the public as signs of ineptitude, and the president would need to seem to be the one to rescue these situations rather than be rescued from them.
Not been a good day,” Carter Mecher wrote, on November 23, 2020. “My dad started having cold symptoms a couple of days ago, and had a fever today (there is only one cold going around these days). He was back in the ER and tested + for COVID.”
If Carter had been given a million years he’d never have imagined it as it happened. He’d always kind of assumed that the strategies that he and Richard had cooked up would be used in a smart and targeted way.
“We are the bad example for the rest of the world,” said Carter. “That’s what is so embarrassing.”
From the point of view of American culture, the trouble with disease prevention was that there was no money in it. She needed to find a way to make it pay.
When she said she wanted to build a tool “to save the country,” people just smiled and thought she was goofy in the head. But when she said things like “I’m going to create a data-based tool for disease prevention that companies can use to secure their supply chains,”
