The Premonition: a Pandemic Story by Michael Lewis is a must read

“You cannot wait for the smoke to clear: once you can see things clearly it is already too late. You can’t outrun an epidemic: by the time you start to run it is already upon you. Identify what is important and drop everything that is not. Figure out the equivalent of an escape fire.” 

“James,” she asked, “who exactly is in charge of this pandemic?” “Nobody,” he replied. “But, if you want to know who is sort of in charge, it’s sort of us.” from a conversation between two members of an informal cadre of doctors trying to get to the bottom of things that had no orders to do so from their bosses.

These quotes are from Michael Lewis excellent book on the COVID-19 pandemic called “The Premonition: a Pandemic Story.” Lewis has written another well-researched book breaking down complex topics into a story the reader can understand. He has written about the housing financial crisis in “The Big Short,” baseball’s embracing of data to change the paradigm in “Moneyball,’ how we make decisions in “The Undoing Project,” and how unprepared we were during the Trump presidency in “The Fifth Risk,” among others.

From the inside flap to the book, “For those who could read between the lines, the censored news out of China was terrifying. But, the president insisted there was nothing to worry about. Fortunately, we are still a nation of skeptics. Fortunately, there are those among us who study pandemics and are willing to look unflinchingly at worst case scenarios. Michael Lewis’ taut and brilliant nonfiction thriller pits a band of medical visionaries against the wall of ignorance that was the official response of the Trump administration to the outbreak of COVID-19.”

The book highlights an informal cadre of doctors, data scientists, and epidemiologists who dig deeper into news and data to realize we have an exponentially growing pandemic which is akin to a wildfire. If you do not act early and with strong interventions, it is hard to contain. These folks are acting without permission from their various jobs in governmental health care positions, but share communications regularly even when those communications could get them fired for going against stated public stances.

Several in the group came together at the behest of President George W. Bush after he read a book about the risks of a pandemic to a country like the United States. He formed a pandemic planning team that pulled together resources who had a reputation for solving problems in health care, breaking down preconceived notions. And, they wrote a pandemic response plan after doing much research about the failures and successes in fighting the Spanish Flu outbreak. They actually used data to turn that story on its ear.

While a few stayed around in the administration during the Obama years and were of benefit during other pandemics, they were long gone during the Trump administration who felt the greater risk was from a military or terrorist action. So, they went back to their health care related jobs. That was until they started to see reports out of China and dug deeper.

They saw global exposure and used previous exponential pandemic growth to ascertain that we could be looking at 350,000 US deaths. The key is they made this observation in mid-January, 2020. What they learned later is the exponential growth factor from COVID-19 was higher than that of other diseases. Carter Mecher, the informal head of this group who called themselves “The Wolverines” after a Patrick Swayze movie called “Red Dawn,” noted by the time the president closed incoming travel from China, it was too late as the pandemic had already reached our shores. By the time the US had its first reported death on February 26, it was masking the fact 200 others were already dying.

Acting quickly without all of the data is key as per the quote above. A key data driven lesson from the Spanish Flu response is social distancing, especially with children, is essential. The first thing they would have done is shut the schools down. Why? Kids average a distance apart of only three feet, while adults have wider distance. Kids will transmit any disease faster than adults. This practice was done in some cities during the Spanish Flu outbreak and the data showed it worked, whereas other cities who did not act like this, had worse pandemic responses.

This cadre started getting attention of others beneath the president and in governor’s offices, including Dr. Tony Fauci. So, their informal calls and email chains kept growing. They were the only folks who seemed to know what they were talking about. We also learned the CDC is not the best agency to manage a pandemic, as it is more of a research and report writing entity, not a nimble management group. One of the members of the informal team worked for the CDC and her bosses did not know she did, e.g. Yet, the CDC and White House administration staff would not go against the public positions of the president. Perception mattered more than fixing the problem, so needed change and actions could not get done. In fact, some of these officials encouraged them to keep going, even though they knew the president was not the kind of person who they could contradict without repercussions.

So, at a time when we needed to move quickly, people in positions of authority stood in the way of those who were begging with them to act quickly. A good example is in a public health official named Charity Dean in California, who was used to acting quickly when she saw potential outbreaks, often risking her job in so doing. Her boss came from the CDC and was towing that party line, yet Dean had been drafted into this informal group “The Wolverines.” While her boss disinvited her from internal pandemic meetings, she kept learning and sharing information with the group. Eventually, her boss could not make a press conference with Governor Newsom, and Dean spoke for 45 minutes of her concerns answering many questions. The press said this is the first time they have heard this. The governor acted quickly.

The book is a must read, in my view. It shows how important leadership is in welcoming information from reliable sources to make their decisions. It also shows how important courage is to tell leaders what they need to hear, not what they want to hear. As I read this book, I kept thinking how the former president craves being seen as a good leader, but at the time when we needed him to be one, he whiffed at the ball on the tee. A key to pandemic responses is to tell people the truth – only then will they act. When the so-called leader is telling them it will all go away soon on the same day the first US death is reported or that this is a Democrat hoax, then people hear that and act accordingly. The problem is those statements were far from the truth.

12 thoughts on “The Premonition: a Pandemic Story by Michael Lewis is a must read

  1. Note to Readers: The term I kept thinking of is “malevolent incompetence” as I read this book. To me, for the Trump White House to be so consumed with how things make him look, staff ignored signals and advice. Plus, he endangered his most ardent supporters by holding pep rallies without telling people they were in danger. Historians have noted that his poor handling of the pandemic and his seditious actions leading up to and including January 6, will be what Trump is remembered for.

  2. I love Michael Lewis’ books and I’ve read a number of them. I was kind of skeptical of this one but it totally bore out what he said in “The Fifth Risk,” 2018. The Fifth Risk is a critique of the Trump presidency with normal risks being things like natural disasters and international conflicts and the infrastructure including internet and climate change in general, but the 5 risk is that of “project management” and that, in Trump’s case, equalled incompetence. This is a startling book and although all of Lewis’ books are startling to a degree, this one borders on terrifying.

    The Premonition focuses on the incompetence aspect when a real pandemic came along. Imo, Trump not only fumbled, he dropped the ball and left it to bounce as governors were competing with each other for PPEs. – something which could have been easily accommodated by a knowledgable, focused and central agency which we already had in the CDC. The vaccines were developed asap using the system as it is but getting them fully utilized was/is a mess (surely there is a better way for next time?)

    The primary problem now isn’t what could we have learned but what we need to learn for next time – because there will be a next time.

    • And she should have managed to say thank you for the review and the reminder, Keith. It’s a good, good book -there’s a focus on the super-stars, the folks who went out of their way to make sure some jobs were done in spite of the problems in Washington. It points to places where we might very well learn for next time.

      • Becky, well said. I read “The Fifth Risk” and the fact Lewis read the briefing materials and met with people that the incoming Trump people (if there were some) did not do, speaks volumes. These folks knew of risks that the Trump administration chose not to have a clue about. As for “The Premonition,” this pandemic planning effort is the greatest thing George W. Bush did as president, but no one knows about it. As for COVID, I like to say the ball was on the tee for Trump to be the leader he wanted (and we needed for him) to be and he whiffed at the ball. Keith

  3. We had a strong sense of this when my spouse had retired from a provincial advisory and recommendation board that gathered national health data here in Canada and generated reports for the Minister of Health. The number of calls from previous colleagues asking my spouse for objective advice and direction and discussions of potential pitfalls working with politicians and Officers of Public Health at various levels grew in January 2020 and so I started commenting on various sites with information regarding the virus that was considered ‘good’ data… or data that had been sifted and interpreted and then shared as a working basis by respected virologists and epidemiologists. So I know it wasn’t just Trump that was very slow off the mark but a general distrust among many leaders at all levels of authority in many concerned sectors leery about creating a bigger problem and receiving criticism for political overreach.

    Strangely enough, most of the issues that paralyzed political leaders not just here in Canada but in some other NATO countries concerned with how to respond to the virus were of no concern to military leaders tasked with preparation for anything that could interfere with a ‘correct’ military response. I think because the military is so used to considering all kinds of potential problems and spends almost all of its time in times of peace planning and practicing a range of possible actions to possible scenarios, it was the military whose leadership voices tended to cut through the political noise and insisted on a clear civilian plan from the political leadership that the military could then incorporate. When these military voices were raised, everyone else involved with various considerations tended to pay attention to the questions they raised and then produced answers for them. In almost every case I can think of, these answers in the form of public health policy were then implemented all the way down the line… from who would head up announcements to creating chains of commend to produce daily briefings to who received what information when, how much manpower would be required to all the equipment that would be needed and so on. And the vaccine rollout, once direction was given for dose priorities from civilian leaders, was purely a military maneuver, headed up by a retired general and supplied by military chain in a remarkably efficient manner to those tasked to receive and distribute them.

    People outside the military rarely grasp the scope of involvement the military plays inside liberal democracies and this has certainly been true of the Canadian response. And thank goodness for that.

    I suspect the reason why the US has fared so poorly in comparison to other NATO members handling this pandemic has everything to do with Trump’s distrust of granting any authority to anyone about responding to the virus (pre-vaccination) that didn’t prioritize making him look good. And no response in his mind seemed to reach that bar. Once he decided it would be easier to not look up – to borrow the ‘don’t look up’ title from the Netflix disaster movie – then THAT became the official tribal message and all ‘good’ data became just more politicized noise. And just look how much trust and esteem the CDC has lost over handling this entire pandemic.

    • Thanks for sharing this perspective. Your wife might enjoy the book, as the heroism of those who could ferret out data and act, is illuminated. Good comment on the military needing to cut through the BS. And, your comment on Trump valuing loyalty over competence is dead-on accurate. Making him look good is mission one. The thought of letting good deeds do that job is foreign to him. Keith

  4. Try as they might wriggle and rant be they on the Left or Right those in denial cannot escape one of those rare salient Truths. We do not have the final say as to what goes on upon this World. We are but another species, vulnerable to the same tides and forces as any other.
    It was always ‘When’ not ‘If’.
    We were lucky this time Covid was in comparison a mild warning as to the potential threats.
    Well done to all those who forged on despite those in Denial.

    • Roger, it has been bad, but it could be worse. In any sporting event, those who play to look good tend to get beaten by those who play to win. In life, the same holds true. The second quote I used when members of the informal cadre realized no one was in charge, so it must be them is telling. The previous administration was more consumed with managing blame, so it failed miserably and still is at helping solve the problem. Ironically, Lewis’ book “The Fifth Risk” was concerned about a real problem the Trump administration may face knowing how unprepared they were. Keith

      • Roger, his is more the “buck stops over there” mindset. After several years of saying Obama was not both in the US, at Trump’s press conference to come clean, he blamed Hillary Clinton for his going on TV to discredit Trump. There are animal references that define this kind of behavior. Keith

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