Dr. Deborah Birx, the former White House Coronavirus Response Task Force Coordinator, says in her new book, published Tuesday, that problems with data collection and testing, slow communication, and interpersonal conflicts within the Trump administration hampered the initial response to the Covid-19 pandemic in the United States.

Throughout “Silent Invasion: The Untold Story of the Trump Administration, Covid-19, and Preventing the Next Pandemic Before It’s Too Late,” Birx describes her struggle to communicate with an administration unprepared for the pandemic, as well as President Trump, who quickly cooled on her dire predictions of the virus’s potential damage.

Birx levies critiques too against the US Centers for Disease Control and Prevention for its initial reaction to the illness as flu-like and lack of clear division of duties among agencies. Birx attributed some of this to CDC Director Dr. Robert Redfield’s status as a “political appointee” in the Trump administration.

“The rank and file would question everything that came from Bob and this White House,” she said of her difficulties getting CDC officials on board with acknowledging broad asymptomatic spread of the coronavirus.

Nonetheless, as political messages trumped public health messages, Birx and some of the doctors involved in the Covid-19 response struck a deal: If any of them were fired, Redfield, Dr. Anthony Fauci of the National Institute of Allergy and Infectious Diseases, and Dr. Stephen Hahn of the US Food and Drug Administration agreed to resign in protest.

Despite a “dysfunctional” White House, the US struggled to keep up with the fast-moving virus, according to Birx. She believes that addressing the issues raised by the Covid-19 pandemic will aid in the country’s recovery from the next pandemic.

Birx wrote that she thought US health officials were seeing data that she couldn’t see before joining the Covid-19 response. However, when Birx arrived in March 2020, it became clear to her that the country was “dangerously behind the eight ball” on data collection on the emerging coronavirus. Birx had previously worked on the President’s Emergency Plan for AIDS Relief.

She stated that the United States had nothing “a partial thirty-thousand-foot awareness that is static I shook my head and pressed the flats of my hands into my eyes. I had expected something completely different, but now I could see that not only were the data-reporting structures that had taken years to build in Africa absent from the US, but that we only had days to complete the same task.”

Birx wrote that she suspected asymptomatic spread was contributing to the rapid rise in Covid-19 even before joining the White House team, despite the lack of evidence.

A significant need for testing in the United States contributed to the lack of clear, granular data on Covid-19 and the misunderstanding of silent spread. Birx wrote that the CDC’s early test was flawed, putting the country weeks behind on testing. Even back then, public health laboratories lacked the capacity to respond quickly and efficiently to the Covid-19 crisis.

Birx wrote about a meeting with American Covid-19 testing manufacturers early in her tenure, describing it as a “worst-case scenario” after learning that the White House had dragged its feet on meeting with manufacturers, on top of limited tests and slow test processing.

Later, Trump’s rhetoric on testing shifted, implying that the United States had a high number of cases because it tested so many people, but Birx said the task force was working quickly to expand it, spending billions on tests and supplies and implementing serial testing in nursing homes and universities.

Birx’s book concludes with a list of “critical issues” in pandemic response and preparedness in the United States. It includes clarity on how responsibilities are divided between agencies, ramped-up testing and diagnosis, improvements to CDC data collection and “overarching” improvements for public health coordination.