As Ryan is left to represent the United States by himself, he must deal with multiple crises: reconstituting his own Cabinet, the House, the Senate, and the entire Supreme Court; a challenge to the legitimacy of his succession by former Vice President Ed Kealty, leading to press hazing; and a war brewing in the Middle East.

Meanwhile, CIA operatives John Clark and Domingo Chavez are tasked with investigating the origin of the virus in Africa, where they later discover Daryaei's involvement, connecting the puzzle of seemingly unrelated global crises.

The first part is a realistic portrait about being the President of the United States, with "a near fetishistic pleasure out of detailing the ways in which [the chief executive] is robbed of his private life every minute of the day", according to novelist Marc Cerasini's essay on the book.

The second part is about domestic critics and enemies — "venal politicos, fat cats, and corrupt media types", according to Publishers Weekly's review of the novel[2] — that cause problems for President Ryan as he tries to rebuild the entire U.S. government with his centre-right politics and his grassroots American values.

The third part features the United Islamic Republic's quest to become a superpower, which turns the novel into a "taut and harrowing" medical thriller that culminates in a military confrontation on land, sea, and air that is regarded as callback to Clancy's war novel Red Storm Rising (1986).

Publishers Weekly praised Clancy as "a war-gamer without peer, and his plotting here is masterful, as is his strumming of patriotic heartstrings"; they concluded: "This is heavyweight entertainment, and come pub date it's going to be the world champion of the bestseller lists.

"[6] The Washington Post hailed the novel as "compelling entertainment", explaining: "[it] shows that, despite the end of the Cold War and the temptation to coast that conventional success may bring, Clancy has lost none of his verve.