Book Report: The Premonition

57. Michel Lewis, The Premonition: A Pandemic Story (2021) (11/14/21)

The other day on my daily walk I was listening to the podcast No Stupid Questions with Freakonomics' Stephen Dubner and psychologist Angela Duckworth, and they were talking about authors they admire. Stephen mentioned Michael Lewis as being something akin to a god for him. This I had to check out. When I searched for Lewis titles, I recognized a couple—not because I'd read them, but because I'd seen the movies: Moneyball, about professional baseball, and The Big Short, about the build-up to the 2008 credit and housing bubble collapse. He's written fourteen others besides. I decided to start with his most recent one.

Well, yeah. Lewis is quite a writer. He takes a complicated subject—in this case, pandemic preparedness—and gives it a human face and a story line. The main character in the book—the through-character, if you will, with all her flaws and all her strengths laid out—is Dr. Charity Dean, whom we first meet as the lead public-health officer of Santa Barbara County. She goes on to become the number-two health official in the state of California—in the midst of the Covid-19 pandemic. Which you'd think would be a position of power. But think again . . . 

Three other key players are Joe DiRisi, a University of California–San Francisco biochemist who is not only brilliant but also immensely creative; Carter Mecher, a Veteran’s Administration doctor known for designing fail-safe procedures to avoid fatal errors in ICUs, and with an uncanny understanding of pandemic mechanics; and Richard Hatchett, a poet turned ER doctor who after 9/11 called for the creation of a permanent medical reserve. These individuals form the core of a farflung, unofficial (and largely underground) group known as the Wolverines who, despite administrative disinterest, manage to get Covid testing and vaccines underway.

And there we see how ineffective—and ultimately, political (I do not mean that as a truism, but as an indictment)—government is. In the end, it's this small army of "L6's," individuals with expertise and passion, far removed from the top levels of power, who are in the trenches fighting the big battles, while such entities as, most notably, the CDC (Centers for Disease Control and Prevention) bumble along waiting for "the data" to come in, unwilling to make any difficult, unpopular decisions. (Lewis does give historical background to explain the CDC's decline from an active, responsive agency—it was at the center of eradicating smallpox in the 1960s—to a gutless, sycophantic bureaucracy. The cause lies in part in the shift from civil service advancement to the top leadership position, to presidential appointments.)

Here is a good in-depth review of the book, if you're interested in reading more.

Lewis employs some excellent metaphors. For example, layering slices of Swiss cheese until you can't see through any holes anymore: this is like having only partial understanding of exactly what a virus is doing, how it is spreading, and yet still needing to fight it with all the weapons available—vaccines, of course, but until those are developed, school closures and masks and lockdowns. Each of these responses is like a layer of cheese: use them all together, and you might have a fighting chance. Another is the Mann Gulch fire—which I keep bumping into: it's become a favorite metaphor for being confronted with something entirely unexpected and having to do something in response that is counterintuitive, indeed counter to all practices one has been schooled in. Carter heard a talk by a doctor that invoked this fire 

and thought: the Mann Gulch fire isn't about fire, or at least not only about fire. It's also about pandemics. In fire you could see lessons for fighting a raging disease. He jotted them down:

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 [a fire lit within the already raging forest fire to protect the firefighter].

The Mann Gulch fire captured the difficulty people had imagining exponential growth, even when their lives depended on it. "We are reactive and tend to only intervene when things are getting bad," wrote Carter. "And what we underestimate is the speed that what's bad moves."

This book is a great read, and now I'm interested in reading more of Lewis—and of checking out his podcast, Against the Rules.

I also wanted to mention that Lewis's explication of the public health "system" in this country (it is anything but "a system") made me, once again, shake my head at the ignorance of people who are protesting the overweening "powers" of public health officials in this country. So many people (especially those who've "done their research") have no idea what they're talking about. If only we had a system for fighting bad things. But we don't; we have nothing resembling a cohesive government response to much of anything anymore, or a national will to come together as one. It's tragic. Another reason we're considering moving to someplace that, we hope, does.