In the fall of 2023, Americans heard unwelcome news that a mutation of the Omicron virus—JN.1—was now accounting for as many as 50 percent of the new COVID-19 cases in the United States. By mid-December, hospitals across the country had reintroduced protective mask mandates for patients, staff, and visitors. For many, it was a reminder of the more than two-year battle against the coronavirus that infected more than 100 million Americans and claimed the lives of 1.1 million of them.

It was also a reminder of the grim, questionable, contentious, and politically charged measures taken by healthcare organizations, public health officials, government agencies, and government officials to check the pandemic. In their new book, The Big Fail: What the Pandemic Revealed about Who America Protects and Who It Leaves Behind, authors Joe Nocera and Bethany McLean have produced a solid work of contemporary journalism that explores the political, cultural, social, and economic facets of the COVID-19 pandemic in a clear, balanced, well-researched and compelling account.

Nocera and McLean previously co-authored the best-selling book about the 2008 financial meltdown, All the Devils Are Here: The Hidden History of the Financial Crisis. McLean, a contributing editor at Vanity Fair, is also known for her Fortune magazine exposé of energy giant Enron’s business practices and as the co-author of The Smartest Guys in the Room: The Amazing Rise and Scandalous Fall of Enron. Nocera is a columnist for The Free Press and a long-time business journalist with work that has appeared in a variety of publications including Esquire, Bloomberg, and The New York Times.

Demand and Short Supply

Given Nocera and McLean’s background as business journalists, it’s no surprise that much of The Big Fail addresses economic issues related to efforts to manage the pandemic. What comes as a surprise are revelations of how corporate healthcare failed catastrophically during the pandemic.

The Big Fail explains how the consolidation of smaller hospitals, clinics, and nursing homes into larger corporate healthcare provider organizations reduced the number of hospital beds available for patients made critically ill by the virus. Nocera and McLean write, “COVID exposed and exacerbated the existing problems in our profit-driven healthcare system—from bare-bones staffing to lack of access to health care” that included the disparities in the outcomes of healthcare and treatment of infected patients in urban vice rural areas. The pandemic also revealed that various socio-economic classes—often populations with co-morbidities including heart disease, kidney disease, and diabetes—were underserved by the sprawling corporate medical care systems whose public statements so often embraced equity as a core principle.

Nocera and McLean note that “the hospitals that provided care to patients without insurance or with Medicaid were increasingly left behind or put out of business, because they struggled to make money.” These “safety net hospitals,” the authors explain, were those most often overwhelmed with critical care COVID patients. “Nor was there any incentive beyond the moral one, for hospitals to help each other—or any way to enforce or coordinate that help,” no way to move patients to hospitals with empty beds, or to share dwindling supplies of Personal Protective Equipment (PPE).

The Big Fail also describes how healthcare companies, manufacturers, and distributors struggled to address massive shortages of PPE: “The policy makers and business leaders who embraced globalization never thought about how America’s dependence on foreign manufacturers—and the lack of resiliency it caused—would virtually guarantee shortages of badly needed equipment.”

Nocera and McLean paint a grim picture of the failure of this global supply system. China, the largest manufacturer of the most effective respirators—the American company 3M patented N95—hoarded supply. International shipping and domestic trucking were strangled by mandatory lockdowns at port handling facilities and distribution hubs. American manufacturers struggled to set up new domestic manufacturing with no protection against future competition of subsidized PPE production from aboard. A global PPE black market sprang up and attracted unscrupulous vendors and greedy speculators and rampant frauds convulsed the PPE supply chain.

Dissent and Denunciation

The Big Fail also tells how robust scientific debate was stifled, even excoriated, during the pandemic. Nocera and McLean describe a sort of social mantra, a strident demand to “follow the science,” that was used to muzzle critics of emerging government policy for mass vaccination and widespread lockdowns to end the pandemic.

The problem with “following the science” is that science, particularly in the early stages of discovery, is not an immutable thing. It rarely offers certainties. It offers theories, models, and probabilities, which are then supposed to be tested against real-world evidence. However, self-righteousness does not easily acknowledge uncertainty.

Along with the mantra came the denunciation of medical and scientific professionals who dissented. The authors, in one example, explore the vitriolic reaction to the Great Barrington Declaration—a call to focus vaccinations and care on the most vulnerable populations and avoid the terrific economic, social, and mental and public health costs of widespread lockdowns. The scientists who signed the declaration were castigated as “fringe epidemiologists,” and for advocating “a dangerous fallacy unsupported by scientific evidence.” Nocera and McLean also describe how the media was quick to pile on and how Silicon Valley technocrats became the gatekeepers of what should have been a rigorous inquiry and open discussion. Instead, scientists with views that diverged from the accepted media narrative and emerging government policies saw their ideas labeled “disinformation” and found their social media accounts disabled.

The Big Fail also explores how nonpharmaceutical interventions raised questions that were quickly swept aside by the media and social pressures. The authors note that “some of the mitigation measures the country was using were far from settled science,” but that did not stop officials from putting them in place. For example, the CDC initially said masks were not needed, then reversed course, and said Americans should wear cloth masks. Tens of millions of people complied. Those who did not mask were banned from stores and public places and often subjected to social shaming. Yet by mid-2022, the CDC acknowledged the cloth masks were not effective. Proper use of N-95 respirators was not well-publicized; most people did not know how to handle or wear them properly in that they needed to be discarded after use in a high-risk setting or if soiled by anything from sweat to makeup.

The authors show how some interventions were absurd on their face and others were simply hypocritical. Masked patrons could enter restaurants, unmask to eat, and only be attended by masked servers. Who and what could be declared “essential” became a matter of lobbying rather than public health:

When a Walmart or a Home Depot managed to be labeled “essential” while mom-and-pop hardware stores were forced to close, who could possibly be surprised that there was so much resentment towards lockdowns in all those red states that were already suspicious of government?

Neither government nor the media would brook dissent and social media shaming and even public harangues were not uncommon.

Vaccines

However, Nocera and McLean observe that “for all the things government did wrong during the pandemic, developing the vaccines by working in tandem with private industry was something it got very right.” The authors describe the American effort to develop effective COVID-19 vaccines as “miraculous.” The project to create vaccines, Operation Warp Speed, was the result of an unprecedented partnership: biotech provided the science, big pharma had the manufacturing and distribution capabilities, and the government guaranteed a seller’s market by buying all the vaccines and bulldozing the administrative silos and obstacles that would have impeded development.

The race to develop vaccines described in The Big Fail reads like a thriller novel. Nocera and McLean conducted dozens of in-person interviews with the leaders of that effort, people largely unknown to the public. These first-person accounts provide remarkable insights into the intensely focused effort to produce the vaccines that would save millions of lives.

Warp Speed succeeded in its ambitious goal of creating viable vaccines and manufacturing hundreds of millions of doses. The vaccines did what they were designed to do—minimize the risk of hospitalization and death. But, as the authors show, government officials oversold the efficacy of vaccines with claims that vaccinated people could neither transmit nor catch the virus. Americans who were enduring a lockdown with the promise of a cure-all vaccine were angry when that proved not to be the reality. Then, the Biden administration pushed for the vaccination of children who were always low at risk, announced booster doses before the FDA had determined whether they would be beneficial, and spent billions on vaccine doses that expired before they could be administered. The miraculous development and manufacture of vaccines became “a success of science and a failure of policy.”

Schools: The Biggest Fail

The Big Fail offers an unflinching assessment of the abject failure of school closings during the pandemic. “Of all the consequences of lockdown,” the authors write, “the most damaging, surely, was the closure of public schools in big cities across the country.” Post-pandemic findings recounted by Nocera and McLean are damning and include not just documented decline in academic achievement, but a host of ills ranging from a rise in domestic abuse to issues of children’s mental health and well-being and especially so among underprivileged children. While “most of the children of the privileged were back in the classrooms of their private schools” by the fall of 2020, public schools remained shuttered.

While children were the least at-risk population (for both infection and transmission) during the pandemic, public school closings were contentious and politicized which the authors attribute to three factors. The first was fear of the virus; no one wanted a child to become infected at school, and no teacher wanted to risk infection. Then, second, teachers’ unions opposed opening schools, and “with 75 percent of the nation’s one and a half million urban public school teachers unionized, they held enormous sway over big-city school systems.” Finally, there was the Trump factor. The President wanted schools to reopen, called on states to do so, and that was reason enough for Democratic-leaning teachers and their unions to keep them closed.

The fight over schools was an early sign of how stupidly polarizing the country had become, and in this case, it wasn’t the red states refusing to follow the science. It was blue-state Democrats who valued their political affiliations over common sense—and even over their pre-pandemic pretensions about protecting the underprivileged.

Nocera and McLean document the extraordinary lengths undertaken by unions to keep schools closed—including unreasonable demands for risk mitigation, social media campaigns, public protests, and lawsuits. “Too many people were simply unable, or unwilling,” the authors write of the school lockdowns, “to judge risk rationally.” This was part of the larger consequences of the political and social decisions that were made not out of malice but hubris, and most often with little real thought to the consequences of those actions. These were decisions that were, instead, an “example of elites failing to understand the effects their edicts had on the larger population.”

The Big Fail is a sobering look at a badly mismanaged response to the pandemic. It’s jarring recognition that health providers, the media, government agencies, and local, state, and federal officials “had all lost a great deal of credibility with their misrepresentations and with a series of recommendations—like school closings—that were now widely accepted as having done more harm than good.”

It’s also the chilling account of how government used fear, falsehoods, and force to control its citizens and dictate what they should think, and say, and do.