The Premonition by Michael Lewis

Yeah, Michael Lewis does it again. Reading his books is a total breeze as he is one of the best storytellers in the world, and in this one he turns the almost incomprehensible COVID-19 pandemic into a simplistic narrative about how it all went down, the people and players behind-the-scenes, how everything went badly wrong — and how the worst case scenario’s could have and should have been prevented. Lewis digs deep in The Premonition with the stories of a group of wonderful, talented, smart, sharp, and prescient group of doctors, scientists, public health officials, and government workers who spent years creating and formulating plans for COVID-like scenario’s, but were summarily ignored by the CDC, the Trump Administration, and other bureaucratic officials who couldn’t or didn’t want to make the necessary decisions to save lives. I had never heard of any of the major players in this book, and Lewis makes the case that had those in positions of power and influence understood exactly what these folks were doing, total calamity would have been avoided, lives would have been saved, and we as a society would not still be in the position of lacking faith and trust in our federal institutions. It’s really a remarkable tale that cannot be ignored — because if we choose to ignore this history we are absolutely bound to repeat it once again.

  • U.S. was the Texas Longhorns of pandemic preparedness — rich, special access to talent
  • book about the curious talents of society, how those talents are wasted if not led, how gaps open between a society’s reputation and its performance
  • Bob Glass helped her daughter build a science project of a pandemic for school — in the project they built a model where young people were given a vaccine, and then old people never got it
  • what they found was that there was no difference between giving a person a vaccine and removing him or her from the social network
  • in each case a person lost the ability to infect others
  • Charity Dean — big player in CA public health
  • all communicable diseases are infectious, but some infectious diseases are not communicable
  • communicable meant a person could give it to another person — you could get lyme disease, but you couldn’t give it to somebody else
  • communicable diseases were the diseases that created crises
  • most important part of a medical history isn’t the medical history, it’s the social history
  • simplest explanation is usually the best
  • if there is the faintest possibility of a catastrophic disease, you should treat it as being a lot more likely than it seems
  • when something doesn’t seem quite right about your diagnoses, respect the feeling, even if you can’t quite put your finger on why the diagnoses might be wrong
  • CDC has a fear of taking action for which they might later be blamed (meningitis outbreak in CA)
  • CDC wanted to observe something as if it was a science experiment on how meningitis moves through a college campus
  • Dean needed to make decisions without data — not enough time for data, decisions needed to be made
  • political risk for these types of outbreaks fall on a public health character without any social power — local health officer had to take risks and responsibility when no one else wanted to
  • U.S. more or less invented pandemic planning after George W. read John Barry’s The Great Influenza: The Story of the Deadliest Pandemic in History
  • Bush administration was also obsessed with the possibility that Saddam had preserved the smallpox virus
  • how do you slow the spread of a virus before you can produce a vaccine?
  • as communicable disease spreads through social networks, you had to find ways to disrupt those networks (Richard Hatchett)
  • Increasing Effective Social Distance as a Strategy, he called it
  • “When the systems depend on human vigilance, they will fail. Not bad people, bad systems.” (Carter Mecher) — worked for the VA
  • spending time and observing situations and patients made a difference — going back a second time to hospitals to let them know you were serious
  • best way to guard against error is to design systems with layered and overlapping defenses
  • “you can keep mistakes from happening if you can identify the almost mistakes”
  • people don’t learn what is imposed upon them but rather what they freely seek, out of desire or need
  • for people to learn, they need to want to learn
  • Bob Glass — closing borders does not work, shuts down all economic flows
  • the idea of isolating the ill, hustling to create and distribute vaccines and antiviral drugs and other ideas, including social interventions to keep people physically apart from one another had been tried in 1918 and hadn’t worked — leading experts agreed on this point
  • trick is to lower the disease’s reproductive rate — number of people each infected person in turn infected
  • mid 2000’s when experts got together to plan all this (Bush admin)
  • when you closed schools and put social distance between kids, flu-like disease fell off a cliff (based on a graphic model)
  • on an average day, school buses carried twice as many people as the entire U.S. transportation system — couldn’t design a better system for transmitting disease
  • Carter, Richard — Targeted Layered Containment (TLC)
  • mix and match strategies in response to the nature of the disease and the behavior of the population
  • R naught — how many people are infected, on average, by each infected person at the start of an epidemic, before any attempts have been made to intervene, either with drugs or social distancing
  • Effective R naught is the term for the reproductive rate at any moment in time
  • in 1918, Philadelphians closed schools and banned public gatherings and wore masks — suffered the highest death rate in the country; leaders were too slow to respond
  • they found that the earlier the restrictions imposed in any given outbreak, the fewer the deaths
  • folks wrote a paper based on 1918 called Public Health Interventions and Epidemic Intensity during the 1918 Influenza Pandemic — timing was vital
  • cities that intervened immediately after the arrival of the virus experienced far less disease and death
  • St. Louis in 1918 couldn’t keep interventions in place more than 6 weeks — people were not happy
  • American cities that caved to pressure from business interests to relax their social distancing rules experienced big second waves of disease — American cities that didn’t did not
  • people have a very hard time getting their minds around pandemics, paper concluded
  • whoever has the best narrative will win
  • school closings and social distancing of kids and bans on mass gatherings and other interventions would be central to the future pandemic strategy of the U.S.
  • Obama didn’t do much with the document on pandemic strategy
  • when swine flu came out, 12,469 people died, but it was mostly luck that it wasn’t more
  • Richard was still working for the White House — concluded how little government was able to do quickly
  • CDC was really good at figuring out what had happened, but by the time they’d done it, the fighting was over
  • Joe DeRisi — DeRisi lab — created a chip called the Vicrochip to see genetic sequences from every known virus
  • you could now approach a pathogen without any knowledge of preconception, and allow its genes to tell you what it was
  • all viruses on earth are genetically related because they’d evolved from common ancestor4s
  • first SARS outbreak had ended because those infected had been isolated quickly and preventing them from infecting others
  • problem for future use was that those people were very ill, easily identifiable, and there were few, if any, asymptomatic carriers
  • viruses have a natural edge on people as they deliberately make errors in their genetic code
  • “They evolved to make mistakes. And their mistakes give them an extraordinary flexibility that is unprecedented.” — DeRisi
  • science was just curiosity’s tool; progress often began when someone saw something they hadn’t expected to see and said, “Huh, that’s weird.”
  • proof in virology, Koch’s postulates: only way to prove a virus causes a disease is to isolate the virus and inject it into a healthy animal
  • last mile problem in medical science: corporations were only interested in stuff that made money
  • academics were interested in anything worthy of publication, but once they had their paper done, they tended to lose interest
  • Chan Zuckerberg Biohub; DeRisi ran it in 2020
  • the original pandemic plan created by the Bush White House spawned a program called Predict, which set out to test animals around the world to determine which contained viruses that might jump into people — Trump zeroed the program out
  • Carter and Richard had reinvented pandemic planning, reinterpreted 1918, resurrected an idea that a society could control a new disease by using social distancing in its various forms, and then somehow lead the CDC to the conclusion that the whole thing had been their idea
  • Trump White House lived by the Reagan era rule that the only serious threat to the American way of life came from other nation states
  • Mann Gulch fire: 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 its already upon you; identify what is important and drop everything that is not; figure out the equivalent of an escape fire
  • Americans from Wuhan were expatriated when the pandemic started, but the CDC wouldn’t let them get tested, even though they were in quarantine in Omaha; they spent 14 days there and left without knowing if they had the virus
  • according to the pandemic plan, the federal government should at least have been preparing the country from the full suite of interventions, which it was not
  • “Which decision, if you are wrong, will cause you the greatest regret?” — Carter Mecher
  • by January 2020, the CDC was only testing sparingly
  • none of the people who had been planning for the pandemic the past 15 years were part of the inner circle of Trump conversations — all “deep state”
  • pan = all, demic = all people
  • Carter Mecher was basically sitting in his bedroom in Atlanta creating a clearer picture of the pandemic than anyone in the government
  • at this point, all the major pandemic players were e-mailing and calling themselves “The Wolverines”
  • late 2018 — Charity Dean heard that Trump ICE workers would drive people into cities in the dead of night in CA and just leave them there, trying to create a disaster
  • Red Cross had no interest in helping because they didn’t want to antagonize their republican donors
  • she also found out that the Trump admin had been flying migrants in transport planes from Texas to CA so that they might create more stress on the system she had built and take advantage of it
  • Jan. 2020, she thought that the virus was already spreading in the U.S.
  • CDC = Centers for Disease Observation and Reporting … that’s what they do well
  • “Red Dawn” e-mail chain with Mecher, Hatchett and Dean — the guys who wrote the original paper, which stated that social interventions, if done early, could have huge effects on disease transmission; run the extreme they could contain it
  • she remarked to the group that based on her experience running public health in CA, there was no system, just a patchwork of state and local health officers, beholden to a greater or lesser degree to local elected officials
  • on TV, important people took insights and data generated by Mecher and repeated them as their own
  • Dean remarked on the idiocy of the CDC’s requirement that to qualify for a COVID test an American needed to be in an ICU, with a history of China travel
  • their group was basically in charge of the pandemic because no one else was
  • new virus was spreading much faster than swine flu
  • CDC lagged about 5 steps behind
  • they allowed people to believe they were the battlefield commanders, that they’d actually run the show in a pandemic
  • Pence’s office ordered the Department of Health and Human Services to not say anything that would alarm people
  • White House was listening in on Dean’s group’s phone calls
  • in any large organization, the solution to any crisis was usually found not in the officially important people on the top but in some obscure employee far down the chart
  • L6 = person buried under six layers or organization whose muzzled voice suddenly, urgently needed to be heard
  • Charity Dean was the L6
  • computer model advised Newsom to shut down CA — Mecher’s emails drove the decisions from the background — CDC and Trump didn’t have the nerve to make those decisions
  • Ohio and Maryland also paid close attention to the analysis — amongst the first to shut down
  • Dean wrote a plan for the country in secret (she was second in command in Public Health in CA, would have been fired, perhaps)
  • designations — hot, warm, cool, based on metrics
  • as scientists learned more about the virus, government would update the social interventions so that they remained as potent and targeted as possible
  • government had a role, but its role is to empower the grass roots by giving them data
  • the virus would enforce the plan
  • for it to work, it needed to be locally controlled
  • remove the feeling that government was imposing restrictions on people and re-instill the idea that people were imposing order on themselves, to fight a common enemy
  • single most important part of her plan was that it was NOT run by the CDC
  • plan was presented to Kushner by Andy Slavitt (former Obama staffer who ran Medicare and Medicaid and who spoke every so often to Kushner)
  • biggest problem of not having enough tests was not knowing where the virus was an where it was not
  • March 2020 — still no chemicals to test for COVID
  • Chan Zuckerberg had a Biohub with a new COVID lab, DeRisi’s team built an entire lab in two days whereas Quest Diagnostics and Labcorp would take two days to process a single test
  • Joe learned that private hospitals were either contractually obliged or habitually inclined to send tests to the for profit labs, and that the for profit labs had no incentive to move any faster than they were moving, as they got paid either way
  • their lab was doing testing for free, but no one was coming — hospitals couldn’t do free testing because it would come up as an error in the computer
  • also a lack of long nasal swabs, anywhere, not even in the Strategic National Stockpile
  • pattern continued: Trump admin would claim with fanfare that supplies were on the way to the states and leave it to the career civil servants whose job it was to interact with state officials to reap the humiliation when those supplies failed to arrive
  • absence of federal leadership had triggered a wild free for all in the market for pandemic supplies
  • symptoms of a failed state
  • COVID mutates, very reliably, every one or two times it transmits from person to person
  • small number of people were responsible for some big numbers of cases
  • genomic sequencing and information was not used well enough — U.S. was sequencing fewer of its genomes than any other industrialized country, and the only reason it was sequencing as many as it was is that a bunch of nonprofits had stepped in to do it, haphazardly, for free
  • in three months CA went from roughly last in the nation in COVID testing to roughly first
  • CDC somehow convinced the world that containment wasn’t possible
  • sequencing could empower local public health officers to use genetic connections between viruses to reveal the risky social relationship between people
  • CDC hadn’t done any of it, except for the purpose of publishing a paper
  • in the past, ability to refocus India from herd immunity to attacking the virus that allowed smallpox eradication to succeed
  • problems in CDC had reached a climax with Trump, but they hadn’t started there
  • under Reagan, the CDC head was converted from career civil servant position to presidential appointee — much easier to fire this person
  • the need to make hard decisions got pushed down to public health officials

I love books, I have a ton of them, and I take notes on all of them. I wanted to share all that I have learned and will continue to learn. I hope you enjoy.