“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.