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Thursday, August 05, 2021

Review: Deadliest Enemy

 There's been a plethora of books about the pandemic, but I wanted one that wasn't written to cash-in on the COVID19 pandemic, so picked Deadliest Enemy. Written in 2017, it covers many of the topics relevant to the pandemic, and is impressively prescient:

Shortly before the 2009 H1N1 pandemic, CIDRAP undertook a national survey of hospital pharmacists and intensive care and emergency department doctors, as we detailed in chapter 18. The update of that survey identified more than 150 critical lifesaving drugs for all types of diseases frequently used in the United States, without which many patients would die within hours. All of them are generic and many, or their active pharmaceutical ingredients, are manufactured primarily in China or India. At the beginning of the COVID-19 outbreak, sixty-three were already unavailable to pharmacies on short notice or on shortage status under normal conditions—just one example of how vulnerable we are. And as illness and quarantines idle Chinese factories and disrupt or shut down shipping routes, it won’t matter how good a modern hospital in a major Western city is if the bottles and vials on the crash cart are empty. (kindle loc 112)

It turns out that all those comments about how nobody could have predicted this are false. Plenty of people have thought about pandemics, come up with plans and suggestions, and none of them were done, because as noted in multiple books, public health is simply not something that Americans care to think about or want to spend money on. The shortage of PPEs, etc were all predcitable:

 Project BioShield is now part of BARDA. Its annual appropriated budget must now cover the development of all CBRN measures. In 2016, the budget was approximately $1.8 billion, with no dedicated funds for emerging infectious diseases, including vaccines or drug treatments. And the need to go to Congress and ask for new money every year has all but killed the possibility of major long-term projects, such as the development of game-changing influenza vaccines. While I respect the efforts of the BARDA staff, the way they have to do business is just not sufficient for what we need to obtain the vaccines for worldwide pandemics or epidemics of critical regional importance. (kindle loc 1442)

Even today, in a sort of post pandemic future, I don't see any movement to increase public health funding, or build an enduring public institution (or reform the CDC) to deal with future pandemics. I wonder what it would take to make that happen. Nevertheless, this book elucidates all the issues and then some. Well worth your time.

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