The past decade has witnessed a resurgence of patrimonial rule not only in the developing world but also, more surprisingly, in the developed West. This resurgence carries potentially dire consequences for responding to a range of pressing problems. Understanding the sources of contemporary patrimonialism is hindered by assimilating the phenomenon into the familiar democracy/autocracy typology or by assuming that it is a function of failed modernization. This article identifies the patrimonial phenomenon and explores the contemporary global diffusion of patrimonial rule from its origins in postcommunist Russia, with a focus on how patrimonialism has manifested itself in policy responses to the COVID-19 pandemic. Some signs indicate that reestablishing bureaucratic predictability and expertise may be much harder than demolishing it. In some respects, the task may be more daunting than the salvation of democracy itself.