Book Review: Premonition: A Pandemic Story, by Michael Lewis

 

This was a hard book for me to read, since so much of it is the story of government incompetence and the cowardice of our leaders, and the vast death and suffering those character flaws produced, but it is full of lessons for the future.

Michael Lewis is famous for his ability to put human faces on big stories and construct  coherent narratives.  Premonition tells the story of the efforts of a handful of visionary doctors and scientists to prepare for and cope with the great Pandemic of 2020-…

The first important politician to appreciate the threat was George W. Bush, maybe the last person I would have suspected.  Bush had read John Barry’s The Great Influenza: The Story of the Deadliest Pandemic in History during his summer vacation in 2005 and came back to the White House to ask Congress for money and created an office in the White House Staff.  Some of those recruited would play key roles in the rest of the book.

What happened when the Obama team took over exposed one of gaping cracks in the US governmental system. Some key people stayed on, but their computers and files were carted away.  WTF kind of way to run a government is that?  When a new President takes over thousands of positions for political appointees and their staffs need to be filled. This is absurd.  No more that three dozen of these positions need to be filled by political appointees.  The rest ought to go to the professional civil service.

The heroes of this story are mostly ordinary doctors and scientists who were dogged, determined, able to think outside the box, and see the big picture.  The most consistent villain is the Center for Disease Control (CDC), which is portrayed as ponderous, hypercautious, hidebound, bureaucratic and above all devoted to the Not Invented Here syndrome.

Each of the heroes in Lewis’s tale found themselves playing Cassandra.  In California Cassandra was Dr. Charity Dean, the Deputy State Health Officer, whom Governor Gavin Newsom had passed over for Chief Health Officer (“too blonde”) in favor of an unqualified affirmative action hire from the CDC, who demeaned Dean and would not listen to warnings of the oncoming pandemic, locking Dean out of the communication chain.

Another big villain is the US health care system, fragmented, for profit, and hopelessly lacking in the kind of central direction needed for response to a national crisis.  With authority hopelessly dispersed, and capability mostly confined to hospitals and testing services that cared only about profit, and nothing for efficiency or value delivered, the fundamental task of timely testing could not be executed.  A testing lab was set up and in operation at the Chan Zuckerberg Biohub by a group of molecular biologists in two days less than it took Lab Corps or Quest to process one test – and they could produce results in hours.

 They found few customers.  Why not? 

One clue came during a phone call between the Chan Zuckerberg Biohub and the recently renamed Zuckerberg San Francisco General Hospital. If there was a place where the Zuckerberg name would help rather than hurt, this was it.

“How much is it going to cost?” asked the woman at Zuckerberg General, after the team at Chan Zuckerberg had explained their new COVID-19 testing lab.

“It’s free,” said the Chan Zuckerberg person.

“There was this super-long pause,” said Joe, who was on the line. “We don’t know how to do no-cost,” said Zuckerberg.Lewis, Michael. The Premonition: A Pandemic Story (p. 248). W. W. Norton & Company. Kindle Edition.

Two reviews from professionals: Washington Post  and NY Times

The one from the WaPo strikes me as shallow, largely missing the point.