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Birx, who regularly appeared before the microphones with Anthony Fauci before being sidelined, was brought into the battle against Covid-19 as a result of her successful, ongoing work battling AIDS in Africa. Interviewed for the new job, she found herself having to explain to a resistant Trump that the virus was not just a bad flu. “He holds up his hand,” she writes. “He smiles that glib grimace of a smile. I stop speaking.” The interview was symptomatic of her treatment thereafter, her messaging often at odds with Trump’s, Mark Meadows’, and other White House figures’. She found a sympathetic, behind-the-curtain ally in Jared Kushner as well as unnamed members of the presidential communications staff, who found ways for her to get the word out. Yet her foes in the administration—particularly right-wing doctor Scott Atlas, “the worst purveyor of misinformation”—contradicted or stifled her warnings that masks, isolation, and mass vaccinations were needed, and she blames many of the hundreds of thousands of subsequent deaths on those insiders. Much of the narrative offers lessons for fighting the next pandemic, and there her writing can be—well, clinical. Still, her arguments are sound: Health agencies must be better coordinated, the CDC should be decentralized and its workers placed in underserved regions, and a single strong message about the risks and dangers of any given illness needs to be sent out. Readers will come to her book, though, not for her epidemiological prescriptions but instead for her anecdotes of battles against recalcitrant political appointees and assorted yes men as epitomized by Meadows, the object of an uncharacteristically sharp outburst from Birx: “This is the kind of unbelievable level of fuck-up that ends up killing people. We can’t keep doing this!” Yet keep doing it they did, and the death toll mounted.

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