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There is a reason the United States leads the world in COVID, with 42 million out of the world’s 219 million cases and with 675,000 of the world’s 4.5 million reported deaths. 

The reason has most to do with underestimating the number of real cases since the beginning of the pandemic, with an uncoordinated, inconsistent public health response that hasn’t inspired confidence or compliance since, with inadequate rapid cheap testing across the board, and with poor messaging and coordination on vaccines and therapeutics

On a deep level, we haven’t learned from our mistakes. The U.S. has performed 615 million COVID tests since the beginning of the pandemic, top in the world, but too many of these tests haven’t been used strategically to stop spread – too many have been accompanied by a delay in results being delivered to a patient who has already spread the virus by the time they know they have it.


As former FDA commissioner Dr. Scott Gottlieb points out in his powerful new book, "Uncontrolled Spread: Why COVID-19 Crushed Us and How We Can Defeat the Next Pandemic," "The CDC couldn’t deploy a test to screen for the virus, allowing the nation to become heavily seeded with infection before it was detected. This was a historic failure that we would never overcome. …

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"Our system was set up well to handle singular, technology-intensive, and complex problems like developing a novel vaccine or antibody drugs. We do this better than anyone. But it faltered when we were faced with more mundane problems like manufacturing those vaccines in bulk, deploying test centers, or making nose swabs to collect respiratory samples. 

"When we finally developed safe and effective therapeutics and vaccines that could treat or prevent infection, we couldn’t manufacture enough of them in time to supply the nation for the winter surge."

To compound the error, lockdowns, business and school closures, were employed that were based on flu models designed to prevent another 1918 Spanish flu from occurring, but were not equipped to cover a much more contagious respiratory virus like SARS COV2, which spreads through small droplets and aerosols. 

The politics of fear and divisiveness has continued to amplify the public distrust. 

Closing things down not only caused tremendous physical, psychological and economic damage, but it was largely ineffective because people who were locked in close together (especially lower socioeconomic groups) still spread the virus.

Once the government loses trust and credibility, due to its "inability to accurately convey the true scope of the hazard, it is difficult to re-establish this," Gottlieb wisely writes in his new book. "The lack of reliable information on COVID’s spread, and the inability of people to access testing, degraded the integrity of the response."

The politics of fear and divisiveness has continued to amplify the public distrust. The solution is simpler messaging, free rapid testing in every home, and a higher rate of vaccine uptake built on more direct involvement of primary care physicians.  

I believe and have said for months that we primary care doctors need a supply of the vaccine in our offices to have the most effective risk/benefit discussion with vaccine hesitant patients.

The vaccine was supposed to change the game, and in a little island country like Malta, with over 80% of the population fully vaccinated, it has succeeded and the country is thriving and everything is wide open, as I can attest from a recent visit. 


The U.S., by contrast, is number 45 on the list of those fully vaccinated, with close to 55%, helpful, but not sufficient, as the continued high case numbers (more than 150,000 new cases per day), and deaths (more than 2,000 per day) attest. 

As Gottlieb presciently writes, "the vaccine was our only backstop against a relentless surge of infection in winter 2021, and we failed to amplify its timely use…"

The path forward is simple. Increase vaccine uptake to over 80% of the population through additional approval of the Pfizer/BioNTech  vaccine for younger children, while improving vaccine uptake by every way possible, including local and business mandates. 


Opting out requires regular use of our other most effective tool, rapid testing, combined with earlier and more widespread use of monoclonal antibodies for proven infections, and rapid development of new anti-viral drugs that are still at least several months away. 

And yes, with this much virus around, wear a mask, surgical grade or better, in close quarters, whether you are vaccinated or not.