The Big Fail by Joe Nocera and Bethany McLean

A brutal, devastating take down of our response to this brutal, devastating and seemingly never-ending pandemic, Joe Nocera and Bethany McLean dig deep into the post-COVID data to tell the stories of everything we did wrong, got wrong, and continue to get wrong even as 2020 fades out of view. Nocera and McLean — both acclaimed authors and columnists who worked together on All the Devils are Here about the hidden history of the financial crisis — spare absolutely no one in The Big Fail by correctly pointing out that Democrats, Republicans, Liberals, Conservatives, multiple Presidential administrations, various government agencies, private actors, the direct and indirect effects of globalization, and the remnants of the financial crisis from 2008 all played a part to ensure that many of the lives that were lost during the height of COVID could have absolutely been saved. Our collective refusal to work together, listen to one another, hear dissenting viewpoints, and, perhaps most importantly, protect the most vulnerable among us while allowing others to live their lives as close to normal as possible all combined to create dissension and disarray, and the lack of trust in government institutions and one another continues to plague us to this day. As a parent, reading about the wholly negative after-effects of school closures is particularly heartbreaking, as millions of kids continue to suffer due to our collective negligence and stubbornness to truly wrestle with the data, and not be overcome by fear, anger, and thinking only about ourselves as opposed to the collective good of society. One can only hope that whomever reads The Big Fail will learn the hard lessons of the past four years, but as Churchill once famously said, “Those that fail to learn from history are condemned to repeat it.”

• we still don’t really know whether masks work
• resorted to rhetoric that divides us further
• we’ve refused to do the work necessary to get answers, refused to listen to evidence that doesn’t accord with our preexisting views
• America did not fare well
• we could not have done better
• an America that was rife with is own preexisting illnessess
• failure of government to set the right rules
• process relies on transparency, which China did not live up to
• early weeks, struggle between those who wanted to do everything and those who wanted to do nothing, exacerbated by the president’s unwillingness or inability to choose a path
• no coordination
• public health scientists had long known that travel bans didn’t work
• for Trump, a ban would allow him to appear to be taking action
• but it was already too late
• CDC’s culture: perfectionist and academic
• no plan to have hospitals or academic labs make tests, or to engage testing companies
• inability to test for COVID in Jan and Feb 2020 was a devastating blunder
• Azar had become Trump’s COVID scapegoat
• editing of scientific communication was going on by people in the administration
• lockdowns became the default strategy for most of the rest of the world
• varying degrees of severity
• US, never any actual scientific studies supporting the strategy
• it was a giant experiment that would bring devastating consequences both social and economic
• Henderson, O’Toole, experience has shown that we respond best and with the least anxiety when the normal social functioning of the community is least disrupted
• one of 2020s enduring mysteries is why Fauci was such an early and unyielding supporter of lockdowns
• he had to know that lockdowns as a mitigation measure had no basis in science
• COVID was a different kind of virus
• Fauci was never willing to acknowledge that uncertainty
• bending the curve, flattening the curve, common parlance
• what was the endgame?
• N95 had been invented in the 70s by 3M
• electostatic charge that ran through its microfibers blocked 95 percent of airborne particles
• “respirator” is the proper term for a N95
• government never had the slightest interest in helping hospitals get PPE
• entire US mask supply was under foreign control
• at least 40 American companies either making or distributing PPE all assumed that once the pandemic ended they would have customers who would stick with them because of the help they had given during the crisis
• response wasn’t being coordinated by the federal government, states and health care institutions were bidding against one another, driving up the price
• many of the purported sellers of PPE were crooks
• lives of the health care haves over those of the health care have nots
• COVID exposed and exacerbated the existing problems in our profit driven health care system
• virus feasted on those with preexisting conditions like diabetes and kidney disease and poor people were more likely to have the condition
• disparate outcomes between white and Black, rich and poor, insured and uninsured
• maximizing profits, a trend that began with the founding of the Hospital Corporation of America in 1968
• closure of a hospital results in a 10 percent increase in mortality in the community
• most rural counties, death rates were 66 percent higher than the rest of the state
• people between the ages of 65 and 74 were 60 times more likely to die of COVID than people between 18 and 29
• more likely to have comorbidities or weakened immune systems
• institutions were unprepared to care for these people
• nursing homes, financiers had loaded them with debt
• nurses at hospitals and homes, hospitals had continually focused on profits, cut back on staff and taken other steps in the name of efficiency
• hospital profits came almost entirely from expensive cancer care and elective surgeries, not from routine care
• as a result of the drop in revenue, many hospitals asked workers to take furloughs, during the pandemic
• CARES act, most of the money benefited big and prosperous hospitals, payout formula was essentially based on past revenues
• payments didn’t take into account need
• next two funding phases directed money to hospitals that were most affected, however
• Fed took actions that prevented the crashes while also creating staggering wealth: hedge fund managers, tech company CEOs, others of that ilk
• measures the fed took dramatically increased wealth inequality, contributed to an onset of inflation in 2008 and beyond
• quantitative easing, idea being that buying a specific quantity of assets would ease long term interest rates
• long term asset purchases
• insistence on maintaining ultralow interest rates
• risk increased
• growth in the shadow banking sector
• low interest rates exacerbated wealth inequality
• companies were using the cheap capital available to them to buy back their own stock
• expanding their businesses and hiring more workers was not happening
• increased relative inequality
• Fed was normalizing a crisis era tool, captive to the markets
• real carnage was US government bonds, treasury bonds
• if the worlds safest asset was no longer liquid
• financial system had devolved into a flawed and fragile thing
• no one asked questions why the market had become so fragile
• Fed moved so quickly, people never noticed how close the system came to collapsing
• it did end the crisis in 2008
• they stopped the panic, so most people forgot there was a panic
• Feds interventions in 2020 were almost 100 percent about the shadow banking system
• rescue widened the wealth inequality, inflation of asset prices, big getting bigger at the expense of the small
• US, globalization meant cheaper goods, domestic factories, people out of work, manufacturing to countries with lower labor costs
• complex just in time global supply chains, reduced inventory and lowered costs
• shortages of medical supplies, rise of PPE black market
• few bothered to look at whether the money being made was really a measure of the value being created
• rise of private equity industry
• primary strategy was adding debt, led to layoffs and even bankruptcy, rewarding itself with various fees and dividends
• have these trends would cause if there was a pandemic
• dependence on foreign manufacturers for equipment, costs spiraled and the country got sicker
• after Clinton signed NAFTA, China decided to enter the personal protective equipment business
• most personal protective equipment had been invented by American companies
• Chinese masks were a lot cheaper
• financialization of the hospital industry began in 1968, Hospital Corporation of America
• Frist, Jr. believed that a hospital company could be built on the same model as a KFC or Holiday Inn
• for profit, publicly traded health care company
• for profit hospitals have brought neither efficiency nor lower costs
• medicare and caid instead of capping what it would pay for a procedure, government agreed to pay hospitals on a cost plus basis
• patients covered by private insurance were where the money really was
• can raise prices almost at will, because it controls the market
• consolidated systems have led to marginally better care at significantly higher costs
• Medicaid patients lost access to care
• separate the wealthy from the poor hospitals
• NYC, kind of hospital that could be closed easily, with little or no power or prestige, was not the kind of hospital that was likely to save the government money
• same pattern played out across the country
• by 2000 most of the big nursing home companies were bankrupt, and enter private equity
• after 2008, Fed lowered interest rates to near zero, private equity went into overdrive as money became really easy to borrow
• quality of care declines after the PE buyout
• leaves more money going toward debt service than to patient care
• if the underlying medical problem was given a more severe rating, “upcoding”, reimbursements rise
• patients might get an enormous bill, “surprise billing” “balance billing”
• no incentive whatsoever for an investor owned hospital to do anything around public health
• we have a system of health or human services
• any savings resulting from a lack of investment would disappear in a poof if a pandemic hit
• pandemic, millions of people became aware of Zoom
• essential workers were overwhelmingly blue collar and poorly paid
• meatpackers, Amazon
• working class was putting their health, potentially their lives, at risk to server those that were lucky enough to lockdown
• unemployed received money that was deeply meaningful
• paled in comparison to the largesse doled out to the wealthy
• nonstop asset purchases, ultralow interest rates
• for investors, the pandemic was financial nirvana
• many small businesses were able to survive because of PPP
• more than half of PPP money went to just 5 percent of applicants
• government made sure big companies were taken care of
• shareholders above employees
• women left the workforce in droves, “shecession”
• most of the pandemic, restaurants were abandoned
• first round of CARES act money wasn’t designed to help independent restaurants
• in 2020, 110K American restaurants closed, about 17 percent of the nations total, 2.5M restaurant workers lost their jobs permanently
• Florida wasn’t taking a one size fits all approach to pandemic mitigation
• DeSantis relied on scientists Kulldorff and Bhattacharya, came to the conclusions that closing schools made no sense
• protect the older, high risk population, school closings would never catch up
• public health is about everyone
• in public health, open civilized debate is profoundly critical
• cloth masks didn’t do much good
• lockdowns save lives, or merely delay the inevitable?
• most scientists who disagreed with the mainstream consensus, there wasn’t much upside in speaking out
• criticizing or praising any state’s approach based on a rapid upsurge or a decline in cases was a fool’s errand — one that far too many journalists fell for
• why the virus took the paths it did, why it crested and fell, remains a scientific mystery
• most Floridians viewed DeSantis hands off approach as a big success
• had come to the conclusion that the risk was acceptable
• BLM, some of the same scientists who had condemned religious or right wing gatherings now said those demonstrations were justified
• Cuomo, delay in taking the pandemic seriously
• disastrous decision to send infected nursing home patients who had been hospitalized back to their residence even if they still tested positive
• simply acknowledging that people were suffering would have made a difference — Newsom never did
• evidence would soon cast doubt on the efficacy of mandates
• apps like Zoom and Uber Eats, Bhattacharya believed, there never would have been lockdowns because the lockdown class would have never accepted it
• couldn’t control human behavior
• Sweden, lockdowns didn’t happen, society kept running
• when vaccines became available, 97 percent got them because people trusted the government
• officials were honest with what they knew and what they didn’t know
• evidence began to pile up that lockdowns not only created economic and social havoc but also didn’t save many lives
• more than 50 studies reaching the same conclusion
• protect the elderly and let those at less risk go about their lives, minimizing the economic and social disruptions — focused protection
• Great Barrington Declaration
• minimize mortality and social harm until we reach herd immunity
• Fauci never backed away from his view that the authors were spreading disinformation
• most damaging from lockdowns was the closure of public schools in big cities
• remote learning was a disaster
• absurd it was that states were reopening restaurants and bars but keeping schools shut
• school offered some stability, domestic abuse was likely to rise, hot meals
• millions of children were left to fend for themselves
• schools and safety were irrefutable, confirmed again and again in studies
• most ignored the data
• fear was a driving point, drastic measures like lockdowns panicked the country
• too many people were simply unable or unwilling to judge risk rationally
• Trump was a factor
• teachers unions were allies of Democrats
• Biden admin had no intention of crossing the teachers union
• millions of kids simply gave up on learning
• less exercise, more junk food, sad and helpless feelings
• parental emotional abuse
• kids who dropped out entirely
• determined to gain back lost market share, Chinese manufacturers were selling masks for less than a penny
• lure of rock bottom prices
• companies went out of business, reverted to their original business
• need for gloves, and masks, was staggering
• Trump admin, developing vaccines by working in tandem with private industry was something it got right
• create something new and better, getting rich — Moderna motivated by both
• if mRNA could indeed be slipped into the body without creating an immune response, human body could be turned into a factory for making its own medicines
• mRNA was akin to software and that Moderna was a “tech company that happens to do biology”
• a decade after its founding Moderna had yet to make a single revenue producing drug
• mythmaking and hype
• near impossible task of getting mRNA molecule to cooperate with the researchers trying to tame it
• mega blockbuster, what you want is a high priced drug that you give someone for the rest of their life
• 2019, company lost 500M, stock below IPO price
• and then world changed
• using mRNA, they could introduce a molecule into the body that would briefly instruct human cells to produce the virus’ spike protein
• immune system would see the protein, recognizing it as alien, and learn to attack the virus
• without the government’s involvement, some companies would no doubt have succeeded in developing vaccines, but it would have taken years
• few other presidents would have been so hands off
• race to develop the vaccine was akin to 60s space race
• in total, Moderna received 10B from the government
• if they had to go to the Hill for a supplemental appropriation, Warp Speed would not have happened
• to do what they did in 6 months normally takes three years
• mRNA was a simpler process, given that it’s chemical rather than biological
• scaling it up is a challenge
• logistical complexity was astounding
• more than 50 percent of the raw material needed to manufacture vaccines comes from outside the U.S. another unforseen effect of globalization
• many of key components were made in Chinca
• industrial mobilization story
• army doesn’t know anything about vaccines, but they know about logistics
• FDA would not be in a position to authorize a vaccine until after the election
• delay appeared to be an effort to prove to the public that the vaccine process was not going to be influenced by politics
• took Europe months longer before it had widely available vaccines
• countries hadn’t done anything to spur manufacturing
• August 2021, Warp Speed Vaccines had saved about 140K lives in their first six months of use
• anti vax movement in the US late 19th century, smallpox
• Wakefield, 1998, claimed a link between autism and the so called MMR vaccine, paper was fraudulent
• 2018, some 20 percent of Americans believed that vaccines were harmful
• Black Americans, insufficient access
• vaccine had become politicized
• example of America at its worst
• questions about the safety of vaccine started early
• Dems, first politicized the vaccine
• Cuomo — “We can no longer trust the federal government”
• once Trump lost, it flipped
• cost of not being vaccinated could be high
• Biden oversold the vaccines
• prevented many deaths, but not the silver bullet
• vaccinated people did get infected
• should simply have stressed that the vaccines minimized the risk of hospitalization and death
• vaccine was a success of science and a failure of policy
• admins booster plan wasn’t the FDAs booster plan
• the way a healthy persons body defends against a virus — long lasting T cells can fend off the serious effects long after the antibodies had failed — importance of boosters was exaggerated
• booster did have benefit for those over 65
• Pfizer and Moderna could waive intellectual property rights, thus allowing countries to make their own vaccine without having to pay an exorbitant fee
• proposal to waive patent rights didn’t accomplish anything
• UK, Canada, Japan, Germany, EU were strongly opposed
• vaccines are not antiretrovirals
• mRNA vaccine required superior manufacturing know how, substantial capacity, access to raw materials
• poor countries lacked this infrastructure
• wastage may have been as high as 40 percent
• inefficiency, which capitalism is supposed to avoid
• mRNA was not a proven lifesaver
• Kyrie forbidden to play in Nets home games but allowed to sit in the stands
• healthy university students were among the least likely to become seriously ill due to COVID
• universities continued to insist that they be vaccinated
• mask mandates were just as illogical
• children should have fewer restrictions than adults, not more
• parents were still irrationally fearful, alarmist messaging
• Floridians filed more than 600K new business applications in 2021, double of NYC
• DeSantis, astonishing heartlessness, willingness to use human beings as pawns to his ambition
• bullying became his dominant public posture
• 2022, he completely switched his position on the efficacy of the mRNA vaccines
• right was demonizing them, now so was he
• Cuomo, pandemic that built him up and then brought him down
• lockdowns and mandates make a difference? anti mandate FLA vs. CA
• when adjusted for age distribution, FLA’s rate dropped to 275 deaths per 100K, CA’s was at 267, small difference
• vulnerable, hard to reach people, SF, because of the AIDS crisis, the city had an infrastructure and protocols that allowed it to find and help such people
• skilled nursing facility in the country, owned by the public health department
• infrastructure of trust and communication
• most important thing in a pandemic is to protect the most vulnerable, which is what SF did
• rotten state of health care in US
• increasingly unaffordable, medical debt number one source of debt collection
• patient care mattered less than profits, nurses underpaid and leaving
• have not hospitals never stopped struggling, especially true of rural hospitals
• nursing homes lost 200K workers during the pandemic
• PE firms collectively managed to make hundreds of millions of dollars from health care companies that they then left on the brink of failure
• PE was moving into autism therapy
• home health care, travel nursing companies
• operate within laws, allowed it to happen
• just in time supply chains that lacked resilience
• semiconductors
• handed China at least some of the keys to the kingdom
• Trump began speaking out against the Chinese absorption of so many US industries, body politic started paying attention
• pandemic, along with China’s COVID strategy, lengthy lockdowns
• America’s manufacturing ability was mostly gone
• Chips and Science Act
• good thing that the US is taking China seriously now
• unclear whether it will work
• shortage of truck drivers
• dont’ get overtime pay if they work more than 40 hours per week
• annual turnover rate of long haul truckers is 94 percent
• deregulation, race to the bottom, whoever could haul it cheaper
• hardest hit businesses were restaurants, retail stores, bars, beauty salons, gyms
• inevitable that some of the money would wind up in the hands of fraudsters
• instead of reining in the economy when it feared inflation might exceed 2 percent as the Fed had historically done, it let inflation run higher, “flexible inflation targeting”
• inflation could nullify any wage gains
• Fed had repeatedly mischaracterized inflation as transitory
• Fed raised rates, asset prices plunged
• decade of distortion following financial crisis, Fed would have had more room to maneuver in the pandemic
• May 2023, three of the largest bank failures in US history had occurred in the past two months
• transformed the Fed from an efficiently scaled institution conducting policy with a small imprint on financial markets into a behemoth
• direct correlation between the trust of a country’s citizens in its health care system and the overall health of its population
• lack of trust can lead to an even greater lack of trust
• US had seemingly learned next to nothing about how to deal with a pandemic
• did nothing to nudge corporate execs away from obsession with shareholder value
• hospitals in trouble
• cracks in globalization
• new risk — possibility of a turn toward strident nationalism
• misinformation might be tomorrow’s truth
• excess deaths remained surprisingly high
• student achievement plummeted during COVID
• certain percentage of students gave up on school
• mental health crisis for kids
• if you locked up everyone, merely delaying the disease, not eliminating it
• you openly and honestly discuss what went wrong without pointing fingers
• never make those mistakes again, which is what should happen
• Churchill: “Those that fail to learn from history are condemned to repeat it.”