Covid deaths in the US have passed 680,000. More than 2,000 lives are lost every day. The south and south-east are the new killing fields, intensive care units operate at near capacity, vaccination rates stall. In Florida, Republicans contemplate scrapping vaccine mandates for measles and mumps too. Talk about turning back the clock.Joe Biden’s declaration that “America is coming back together” looks like a “mission accomplished” moment. Zigzagging on booster shots has left the public scratching its head and Biden’s poll numbers sagging. With a third Covid winter looming, the president’s competence is very much an issue.Enter Scott Gottlieb, Donald Trump’s first commissioner at the Food and Drug Administration. Gottlieb left after less than two years with his reputation intact and even managed to pick a fight with the e-cigarette industry, to the delight of suburban moms and dads. By summer 2019, Pfizer’s shareholders had elected Gottlieb to its board – months before Covid placed the world in its grip.In his narrative of the most severe pandemic in a century, Gottlieb lets us know what he has seen, what may well come next and what we can do before the next pandemic arrives. The book is informative and well paced. At times it gets into the weeds – but it doesn’t stay snagged.According to Gottlieb, the Trump administration was poorly prepared, reacted badly and at times moved erratically and grudgingly.Gottlieb does not believe the pandemic was preventable. Rather, with better leadership and alignment, he contends, we could have “delayed its onset and reduced its scope and severity”. Structural deficiencies made the task tougher but so did a “sizeable enterprise devoted to manufacturing skepticism” about measures like masks and vaccines. Gottlieb confirms that hydroxychloroquine is no cure.Obviously, the search for a vaccine, Operation Warp Speed, was the notable exception to a series of missteps, “one of the greatest public health achievements in modern times”, according to Gottlieb. It “proved what government could accomplish when it functions well”.But he takes China to task for stonewalling, criticizes the World Health Organization for its failure to press Beijing, and argues that pandemic prevention is an essential component of national security.As for the virus’ origins, Gottlieb stresses that we may never know. He also makes clear that the Obama administration was not betting on a coronavirus walloping the US anytime soon – its public health measures were aimed elsewhere. Ron Klain, Biden’s chief of staff and Obama’s Ebola adviser, does not receive mention.Uncontrolled Spread acknowledges that during medical crises, both parochial national interests and international cooperation emerge. This time, many were surprised by the interest that prevailed.Transnational cooperation and domestic solidarity suffered under Covid.“Covid normalized the breakdowns in a global order that it was presumed, perhaps naively, would protect us, just as Covid pierced our own perception of domestic resiliency, cooperation, and fortitude,” Gottlieb writes.As for the social fabric at home, according to a recent poll those who heavily relied on Trump and the White House’s Covid taskforce in the early days are now among those “least likely to have been vaccinated against the virus”.Gottlieb attempts to navigate political and bureaucratic minefields. He stresses that government agencies must articulate clear rationales for decisions. In the same vein, he voices disapproval of the opacity about how 6ft became the accepted measure for social distancing.He also blasts the Centers for Disease Control and Prevention for its reaction to the pandemic. Its mishandled development of a Covid test receives particular notice. The test kit developed by the CDC turned out to be contaminated. Gottlieb tags the agency for “unclear process and decision making”, a failure he says helped Covid spin out of control. Early testing, Gottlieb believes, would have helped make a significant difference.Elsewhere, he posits that political pressure from the White House to hasten FDA approval of a vaccine may have backfired. Demands from the West Wing may have stiffened the resolve of the FDA to comply with markers and protocols.A look at how the FDA responded to Biden urging booster shots for everyone bolsters that hypothesis. This month, the FDA delivered less than what the 46th president asked for and what the public believed would be on its way.Gottlieb measures his words as he lambastes the Trump White House’s hydroxychloroquine fetish. He points a finger at segments of the investor community, “outside doctors who gained access to the Oval Office” and the rightwing echo chamber.The Fox News host Laura Ingraham “featured multiple segments about the medicine and emailed the White House about the drug”, Gottlieb writes. Lest anyone doubt her sway, Gottlieb observes that within days, “Trump made his first mention of hydroxychloroquine from the White House podium.”It didn’t end there.“During a single two-week period between 23 March and 6 April, hydroxychloroquine was mentioned on Fox News nearly 300 times.”Gottlieb is a regular contributor to Rupert Murdoch’s Wall Street Journal, a company related to Fox News. On 28 January 2020, Gottlieb and Luciana Borio wrote an op-ed: “How to Prevent an American Epidemic”.What needs to be done in the months and years ahead is now Gottlieb’s major priority. He urges expanding capacity for mass testing, large-scale production of a broad range of vaccines and antibody treatments, and a “no-regrets ethos when it comes to pandemic preparedness”.Such proposals appear essential, yet it is questionable if they could ever be enacted. Congress can’t even get infrastructure done. At a minimum, Uncontrolled Spread leaves us plenty to think about.