As the world wakes from its pandemic-induced coma, Bloomberg rates the US as the best place to be. More than 150 million Americans have been vaccinated; little more than 4,100 have been hospitalized or have died as a result of breakthrough infection.

The vaccines worked – but too late to save more than 600,000 Americans who have died. More than 500,000 were on Donald Trump’s watch.

“This would have been hard regardless of who was president,” a senior administration official confided to Yasmeen Abutaleb and Damian Paletta. “With Donald Trump, it was impossible.”

Abutaleb is a health policy writer for the Washington Post. Paletta is its economics editor. Together, they supply a bird’s-eye narrative of a chaotic and combative response to a pandemic that has subsided but not disappeared in the west. Elsewhere, it still rages.

At almost 500 pages, Nightmare Scenario depicts an administration riven by turf wars, terrified of losing re-election and more concerned about the demands of Trump and his base than broader constituencies and realities. It was always “them” v “us”. Sadly, this is what we expected.

Under the subtitle “Inside the Trump Administration’s Response to the Pandemic that Changed History”, Abutaleb and Paletta confirm that life in the Trump White House was Stygian bleak. Trump was the star. Pain and insecurity were the coins of the realm.

Alex Azar, the secretary of health and human services, laboured in constant fear of Trump and competitors inside the government. After taking a hard line against flavoured e-cigarettes early on, to Trump’s dismay, Azar never recovered. The pandemic simply deepened his personal nightmare.

When Covid struck, he was all but a dead man walking. Then the White House Covid taskforce, headed by Mike Pence, neutered his authority. Think of it as a one-two punch. True to form, Trump told a taskforce member Azar was “in trouble” and that he, Trump, had “saved him”.

Azar was forced to take on Michael Caputo, an acolyte of Roger Stone, as spokesman. Eventually, Caputo posted a Facebook video in which he claimed “hit squads [were] being trained all over this country”, ready to mount an armed insurrection to stop a second Trump term. Caputo embarked on a two-month medical leave. His “mental health … definitely failed”.

Not surprisingly, Trump lost patience with Pence’s taskforce. It failed to deliver a magic bullet and he dismissed it as “that fucking council that Mike has”. For the record, in April 2020 Pence remarked: “Maybe I’m a glass half-full kind of guy, but I think the country is ready to reopen.” For all of his obsequiousness, Pence could never make Trump happy.

Instead, Peter Navarro, Scott Atlas and Stephen Moore emerged as Trump’s go-to guys. Predictably, mayhem ensued.

Navarro suggested his PhD in economics made him an expert in medicine as well. He jousted with Anthony Fauci, head of the National Institute of Allergy and Infectious Disease since 1984 – seemingly for giggles.

Atlas was a radiologist whose understanding of infectious diseases was tangential. As for Moore, he played emissary for a libertarian donor base distraught by shutdowns and mask mandates.

“Fauci is the villain here,” Moore intoned. “He has the Napoleon complex, and he thinks he is the dictator who could decide how to run the country.” Trump’s own authoritarian streak seems to have escaped him.

Moore also referred to Fauci as “Fucky”, and advised state-based “liberation” movements against public health measures that served as precursors and incubators to the invasion of the US Capitol on 6 January this year.

Going back to 2019, Moore was forced to withdraw from consideration for the board of the Federal Reserve after the Guardian reported on his bouts of alimony-dodging, contempt of court and tax delinquency.

With one major exception – financing and developing a vaccine – the Trump administration left Covid to the states.

Hydroxychloroquine never saved the day, though Ron DeSantis, Florida’s governor, ordered a bunch of it from India to sate Trump’s ego. Six days after the 2020 election, the National Institutes of Health issued a statement that insisted: “Hydroxychloroquine does not benefit adults hospitalized with Covid-19.”

Trump was callous and mendacious before the pandemic. Yet even as he embraced medical quackery, bleach injections and self-pity, he presided over unprecedented vaccine development, the medical equivalent of winning the space race and the cold war at once.

When Trump signed off on Operation Warp Speed in May 2020, “he thought vaccines were too pie in the sky”, Abutaleb and Paletta report. When Trump learned the first contract executed under the program was with AstraZeneca, from the UK, he growled: “This is terrible news. I’m going to get killed.”

Boris Johnson would “have a field day”, he said. Things didn’t work out that way.

Right now, countries that relied on Chinese vaccines are experiencing a death spike in the face of the Delta variant. In the Seychelles, almost seven in 10 are fully vaccinated – yet deaths per capita are currently running at the highest rate in the world.

Added to Chinese opacity surrounding its role in the outbreak, the limits of vaccine diplomacy and technology are apparent. From the looks of things, Trump has left multiple legacies, some more complex and alloyed than others. But things could have been worse.