Review: Scott Atlas’s A Plague Upon Our House

When President Trump declared COVID-19 a national emergency, the US arguably faced the most significant public health crisis since the Spanish Flu pandemic of 1918. A fearful America remained glued to their TVs, hoping for answers on how to combat the virus. As months under pandemic measures passed, paralyzing anxiety became polarizing skepticism.

Why were President Trump and Dr. Fauci seemingly always in disagreement? Why were hospitalizations and deaths increasing while most of the country was locked down? Why did the CDC and others’ advice on stopping COVID-19 from spreading seem inconsistent and contradictory?

Scott Atlas’s A Plague Upon Our House tackles these and other critical questions. Across 313 pages and 20 chapters, Dr. Atlas details his time spent advising COVID-19 measures, his frustrating interactions with prominent political figures, shocking bureaucratic incompetence, what the “facts” told us about how to address the pandemic, and how the US failed to act. The book reads like an academic text reviewing medical and policy research spliced with a tell-all expose of what happened behind closed doors in the White House.

Chapter 1 begins in February 2020. Dr. Atlas notes, “fear had seemingly displaced critical thinking about the data already at hand” well before COVID-19 was declared a public health emergency. Only a handful of health policy scholars (Jay Bhattacharya, John Ioannidis, and Sunetra Gupta) examined the data and empirical studies critically, while political authorities trusted and quoted doomsday model predictions. Even in the early stages of the pandemic, Dr. Atlas argued that lockdowns were causing more harm than good. Instead, he advocated targeted protective measures against known at-risk groups and improved testing for those groups.

Chapters Two and Three detail how Dr. Atlas left California for DC to meet with President Trump and Vice President Pence. He understands that “being associated with President Trump carried significant risk” and “they expected that I would be put out as disagreeing with Fauci and turned into a scapegoat for those who hated the president.” After reviewing the data and methods used by the COVID Task Force (led by the Vice President) to develop COVID-19 measures, he had the “first OMG moment” of his advising experience. “I knew the country was in really deep trouble,” he wrote. After a brief stint trying to advise the President from his California home, he returned to the White House to formally advise pandemic policy. It was an experience he would later liken to living in Alice in Wonderland.

Chapters Four through Nine specifically recount his interactions with Dr. Fauci and Dr. Birx (the Coronavirus Response Coordinator). After a few meetings, Atlas thought it naïve to try to convince either that their advice to Americans was mistaken. He notes that Dr. Birx was clearly unaware of the academic literature on COVID-19, and the methodological flaws in the studies she favorably cited (which aligned with her pro-lockdown views). Atlas also suspected that Dr. Fauci leaked details from their private conversations to the press on two separate occasions to cause him reputational damage.

At Task Force meetings, Vice President Pence was regularly briefed on pandemic-related updates by Dr. Birx, whose data, interpretations, and suggestions were never questioned by Task Force members (other than Dr. Atlas). Frustrated, he recounts, “there was virtually no disagreement among them. It was an amazing consistency… even though some of their statements were so patently simplistic or erroneous.” Atlas also highlights that the Task Force was run entirely by Vice President Pence, with President Trump never involved or present during their meetings. He attributes this to the disconnect between COVID-19 guidelines suggested by the President and Dr. Fauci.

Criticizing the mantra “test, test, test,” Dr. Atlas argued that widespread testing for the general population did little to protect the vulnerable. Rather, it often forced those at much lower risk of being hospitalized or dying in quarantine. He explains, “when a million tests per day are conducted, that interferes with timely results on priority groups.” Many top epidemiologists, President Trump, and much of the Task Force agreed with him. However, almost none of his recommendations become part of the CDC’s guidelines on testing. Defeated, Dr. Atlas admits, “while I didn’t want to believe it, I knew everything about the pandemic was political.”

These chapters also provide numerous displays of ignorance witnessed during Task Force meetings. Dr. Atlas specifically mentions numerous data-refinement errors used to make state-to-state comparisons, widespread unawareness of academic studies, misreported case numbers and death totals, repeatedly confusing correlation with causation, mispronounced medical terms, blaming rising COVID-19 cases on an unfearful public, insisting children could transmit COVID-19 to their parents despite evidence they seldom did. Ultimately, Atlas concludes that “nothing good would come of my being on the Task Force.”

Dr. Atlas also directly advised President Trump by verifying (and correcting) COVID-related statistics to convey during press briefings. He also attended press conferences to answer questions as needed. While hoping to help the President communicate that locking down the country would not eliminate or stamp out the virus, Dr. Atlas became a media target. He was slandered as a proponent of “herd immunity” and has his credibility minimized for not being an epidemiologist. Atlas humorously notes that neither Dr. Fauci nor Dr. Birx are epidemiologists or health policy experts either.

Chapters 10 and 11 provide more accounts of political authorities misleading the public. Dr. Robert Redfield (then Director of the Centers for Disease Control) declared, “if every one of us wore a mask, the pandemic would be over in 8 to 12 months,” and that “90 percent of the population was still susceptible to illness (nearly seven months after the pandemic began.” These statements prompted President Trump to ask Dr. Atlas bluntly, “Is Redfield stupid or just political?” Dr. Birx also continued to support mask mandates, school closures, and other policies to “stop all cases.” In a revealing passage, Alas writes:

Eventually I figured out the dynamic. Birx obviously was very knowledgeable about two things, regardless of her expertise on the pandemic itself. First, she knew that the VP had her back, often echoing her words. Clearly, he was conscious that the Task Force – which he directed – was the most visible evidence of his own work in the administration. That meant that its perceived positives must be protected – nothing about it that the public viewed as a positive would be minimized or criticized. Pence had zero intention of ‘rocking the boat’ with Birx or Fauci…Second, Birx, having been in Washington for decades, understood something else that I certainly did not – how politicians worked.

Chapters 12 through 14 review Atlas’s time working with the COVID Huddle team, which was responsible for handling the “political strategy” aspect of the Task Force’s guidelines. A significant part of the strategy was not to upset Dr. Birx and risk losing the election. Hoping to “communicate the truth to the American public,” Dr. Atlas developed more accurate charts to present to the Huddle and for the President to use during his press conferences. Afterward, several individuals told him privately that they agreed with his policy recommendations. Unfortunately, closeted agreements never resulted in questioning Dr. Birx and Dr. Fauci’s guidelines. Instead, there was a persistent “absence of independent thought. And that’s not science.”

In a final effort to promote questioning guidelines, Dr. Atlas invited several world-class medical researchers to the White House for a roundtable discussion. Vice President Pence canceled the first meeting because Dr. Birx was traveling at the scheduled time. After another attempted cancellation, Dr. Atlas and the others finally briefly met with President Trump and Vice President Pence. Future meetings were planned, but President Trump tested positive for COVID-19, and the looming election left little time for follow-up. After President Trump lost reelection, Dr. Atlas resigned from his role and returned home.

In Chapters 17 through 20, Dr. Atlas reviews the Trump Administration’s successes and failures. Although states determined COVID-19 measures independently, Dr. Atlas argues that mixed messages between the President’s message and the “lockdown message” portrayed by the media, Dr. Birx, and Dr. Fauci confused many of the governors and the American public. Further, he labels the lockdown approach as “likely the most egregious failure in the history of modern health policy.” He faults much of their popularity to the President for delegating the authority to communicate guidelines to “medical bureaucrats.”

Dr. Atlas makes a special exception for Florida, where Governor Ron DeSantis personally reached out to him early in the pandemic for advice. Unlike other states, Florida allocated considerable resources to testing residents of nursing homes, and emphasized focused protection while opening schools and removing mask mandates. Consequently, Florida outperformed most states in COVID deaths per capita, despite having a sizable elderly population.

Dr. Atlas praises the Trump administration for quickly stopping air travel from China, rapidly increasing hospital bed capacity, improving COVID-19 testing capacity, creating a national stockpile of pandemic goods, engineering economic recovery, and for the successes of Operation Warp Speed.

He concludes the book by reviewing peer-reviewed studies from early 2020 to demonstrate what we knew early on about COVID-19. He highlights that there is scarcely any evidence that children spread COVID to adults. Wild variability in COVID-19 prediction models made them unreliable for guiding policy. Only the elderly and individuals with some preexisting conditions are at an elevated risk of severe infections. Masks can prevent COVID-19 from spreading from droplets but cannot contain the virus otherwise. Lockdowns cause considerable harm to demographic groups that face the least risk of being hospitalized or dying from COVID-19. Consequently, lockdowns did not contain the virus, and most likely did not save lives on net, considering their disastrous consequences on overall well-being.

Dr. Atlas faced considerable professional and personal backlash for his efforts. He faced consistent personal attacks from the media, and from many of his Stanford colleagues. After his time in DC, he installed thousands of dollars of home security equipment and has a police car stationed outside his home. Dr. Atlas tirelessly fought for the truth “no matter what” despite these difficulties.

Dr. Atlas’ analysis of the US’s COVID-19 response is masterful. This book offers great explanations and evidence to clarify COVID-related misunderstandings and falsehoods. His accounts of working in DC are shocking and enlightening for readers skeptical about federal suggestions on combating the pandemic. These make his book an educational and entertaining read.

Although unintentional, Atlas’s book also illustrates fundamental public choice economics insights into political decision-making during the pandemic. While Dr. Atlas frequently expresses bewilderment that few seem interested in his advice or improving guidelines – these actions are easily explained. Even during a crisis, bureaucratic decision-making is sluggish because it lacks incentives to adapt. Public agencies succeed by acquiring more resources and influence. Dr. Atlas advises measures that would give them less of each. Developing effective guidelines to address COVID is essential, but less important than reelection. These realizations are unfortunate, but obvious from reading his frustrating interactions.

I have only minor criticisms of the book. Dr. Atlas repeats the same objections, struggles, and findings across multiple chapters, making the book unnecessarily long. I attribute most of his repetition to him trying to recount his experiences – which were repetitively being ignored accurately. I also think he was overly supportive of Operation Warp Speed, only recognizing its accomplishments and not mentioning its costs. However, since he left his advisory role in November 2020 (shortly before COVID vaccines were authorized), he likely did not have an opportunity to provide a balanced analysis of this effort.

When Dr. Atlas finished this book, Delta variant infections were minor, and there was no Biden Administration. Sadly, Dr. Atlas’s view that “we are turning a corner” while leaving the White House did not prove to be the case. Many of the policies he advised against persisted through new variants and a new administration. But this makes the information and message of his book still timely and important – even as COVID-19 becomes endemic.