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"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's 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 characters you will meet in these pages are as fascinating as they are unexpected. A thirteen-year-old girl's science project on transmission of an airborne pathogen develops into a very grown-up model of disease control. A local public-health officer uses her worm's-eye view to see what the CDC misses, and reveals great truths about American society. A secret team of dissenting doctors, nicknamed the Wolverines, has everything necessary to fight the pandemic: brilliant backgrounds, world-class labs, prior experience with the pandemic scares of bird flu and swine flu...everything, that is, except official permission to implement their work. Michael Lewis is not shy about calling these people heroes for their refusal to follow directives that they know to be based on misinformation and bad science. Even the internet, as crucial as it is to their exchange of ideas, poses a risk to them. They never know for sure who else might be listening in"--… (more)
User reviews
“In February 2021, The Lancet published a long critique of the U.S. pandemic performance. By then 450,000 Americans had died. The Lancet pointed out that if the COVID death rate in the United States had simply tracked the average of the other six G7 nations, 180,000 of those people would still be alive.”
So what happened? Whose fault is that the American response was as ineffective and inefficient as it was? And most important of all, why did it happen?
According to Lewis, politicians (Republicans and Democrats, alike) share a large part of the blame for the country’s unfocused response to the coronavirus that probably hit our shores for the first time around December 2019. But the politicians, again according to Lewis’s reckoning, are not the primary villains here; that honor belongs instead to the Centers for Disease Control (CDC), the agency that Americans at one time could depend on to protect their health, not make things worse out of a fear to look bad. As Lewis puts it”
“The CDC did many things. It published learned papers on health crises, after the fact (emphasis mine). It managed, very carefully, public perception of itself. But when the shooting started, it leapt into the nearest hole, while others took fire.”
Perhaps the biggest — and thus, the most shocking — revelation that Lewis makes in The Premonition is that the CDC’s horrible leadership during the entirety of the COVID-19 pandemic stems all the way back to the agency’s politicization in the mid-1970s. That’s when politicians started appointing the chief of the CDC rather than allowing the best man or woman to rise to the top based on effectiveness and years of experience. That change, in effect, caused CDC leaders to worry more about their jobs and personal futures than about the diseases they were there to combat on behalf of the public.
The bulk of this 300-page book follows a small group of brave scientists willing to risk their reputations, many of whom had once worked in either the Obama or Trump White Houses, as they come to grips with the idea that if the virus is going to be contained, they are the ones who are going to have to come up with the plan to do it. So that’s what they do. But we will never know if their plan would have worked because no one in Washington D.C. or inside the CDC would even listen to their ideas. Instead, they were blown off until it was too late for their plan ever to work as well as it could have — and even today (May 23, 2021) just under 1,000 Americans per day are still dying from COVID-19.
Bottom Line: The Premonition is not the book I was hoping it was when I picked it up, so it is partially my fault that I find it disappointing. I want to know what happened in 2020 after the federal government put the burden on state governments to solve the problem for themselves. I want to know who did, and didn’t do, their jobs at all levels of government. That’s the book I want to read about COVID-19. Maybe it was just too soon to expect that one.
In "The Premonition," though, Lewis's choice of principal subject is very problematic, and, for me, ruins the book. Charity Dean should not have been part of the story. Dean is not trustworthy, she does not seem to have good judgement, and, now leading a startup company, she is also financially conflicted.
> It wasn’t easy to make even the most persuasive fake flowers seem real. [Dean] had to keep neighbors from getting too close, and invent excuses for keeping them off her porch. Instead of gardening she had to pretend to garden, which was even more difficult. She felt like an idiot waving to strangers while watering plastic flowers, but for months she went right on doing it. “It felt icky,” she said. “I just got sucked into it.” … She knew that her fraud was bound to be exposed, but she kept doubling down on it anyway.
When Lewis heard this story, shouldn't he have eaten his sunk costs and moved on to find a better source? He doesn't. Dean has a very high opinion of herself.
> The new story had gained focus after she’d taken the job as a local public-health officer. Its theme was bravery, and it compelled her to recognize those moments when she was doing, or failing to do, a thing out of fear. Coupled with her natural interests and abilities, it had turned her into an action hero. She believed that, in the bargain, her narrative had saved her life. Soon Charity’s purpose was clear, and not only to her but to anyone who watched her in action: she was put on earth to fight battles, and wars, against disease. To save lives and perhaps even an entire country.
Perhaps the "action hero" thing is Lewis's own exaggeration, and shouldn't be blamed on Dean. But still. The basic story here is that Dean was always right about everything, everybody else always wrong, but that Dean was afraid of saying anything, even though she thought she could save hundreds of thousands of lives, because she was afraid of losing her job.
> Three days later, a Sunday, Duane asked her to join them on a conference call. She hadn’t responded to the emails. Anything she wrote from her state email account might as well be made public, and she worried what might happen if anyone suspected that she had entered some back-channel conversation with the Trump administration. She’d learned, from other battles, that there was a fair chance that anything she said, even in private, would end up in the Los Angeles Times. She told Duane that she’d come onto his conference call but only to listen, not to speak. “I was nervous about being fired for even being on the call,” she said.
And yet, when the pandemic hits and California Governor Newsom is trying to put her in charge of the response, she decides to … quit her job. She is wowed by Facebook money, gets entirely behind a crazy idea to manage the pandemic by sequencing every virus sample to track its spread (an idea which Lewis accepts as brilliant without even considering the problems), and then quits to start her own company. "Action hero," indeed.
Despite this serious flaw, Lewis does throw in some other good stories, and even some (hopefully valid) insights.
> The CDC had lots of great people, but it was at heart a massive university. “A peacetime institution in a wartime environment,” Carter called it. Its people were good at figuring out precisely what had happened, but by the time they’d done it, the fighting was over
> “They really should just change the name,” she said. “It shouldn’t be the Centers for Disease Control. It should be the Centers for Disease Observation and Reporting. That’s what they do well.”
Other fragments from modern history:
> [George W.] Bush asked the U.S. Congress for $7.1 billion to spend on his three-part pandemic strategy, and Congress gave it to him. To staffers on the U.S. House Appropriations Committee, John Barry’s The Great Influenza became known as “the seven-billion-dollar book.”
> He now had a rule: if you visit a hospital to investigate some problem, visit more than once, as on the first visit the locals assume that you have come merely to find fault and assign blame rather than to enlist them as partners in the hunt for the flaw in the system. He’d learned that from some field anthropologists whom he had sought out. “They taught me how important it was to have a second visit when they visited villages,” said Carter. “The second visit made a statement to the villagers, and it usually wasn’t until the second visit that trust emerged.”
> The new [2009 H1N1] flu would turn out to be less lethal than it might have been. The CDC would report that somewhere between forty and eighty million Americans had been infected but only 12,469 had died. Their judgment had been vindicated, and President Obama’s decision had worked out, and everyone would soon move on and forget about the pandemic that wasn’t.
- Scientist Bob Glass: his
- Charity Dean: a California public health officer with a hero complex; I had a hard time truly understanding her character and her motivations under different circumstances. She also just didn't seem all that important to the story.
- Richard Hatchett: one of the first picks to work on a task force to produce a pandemic plan of action back in the George W. Bush administration; because President Bush had read a book (!) called THE GREAT INFLUENZA about the 1918 flu pandemic, and it scared him into wanting to craft a governmental plan of action to deal with pandemics. (Yes, the last Republican president whose initials were not DJT actually read books - those were the days!)
- Carter Mecher: kind of the main character, someone that Lewis obviously respects a great deal; a doctor at the Veterans Administration, and unofficial leader of the task force.
So the pandemic plan is written with its emphasis on social distancing and closing schools. During the Obama administration, there is the H1N1 scare, and the plan is considered; but they take a gamble and decide it's too intrusive into people's daily lives, and they don't use it. They dodge a bullet; I think there is a comment to the effect that it wasn't a bullet dodged, but rather that nature had chosen to spray us with buckshot. The pandemic response team is ultimately disbanded, and then we get Trump. There's also the politicization of the CDC; the CDC is not so much a villain in the story as a tragic anti-hero. They could have been so much better, done so much more. Instead, at first they minimized.. and then surrendered.
It took about half of the volume to finally get the narrative up to 2020 talking about COVID-19. Until then, I was chomping a bit at the bit - get to the good stuff already! These people are all relatively interesting but I didn't buy a book to read about a bunch of government scientists and doctors with some novel ideas. After all the backstory, things got very compelling indeed. I have long been a Michael Lewis fan and continue to be. Ugly cover, though.
Lewis draws the reader into his investigation by focusing on lives of people he presents as key players.
Some of the details of the development of the pandemic differ a bit from my recollection. There was already a
The book is well done and satisfying to read.
Such an approach makes it a riveting read. I found it instructive, and it gave me names, dates, details to research further to better understand how our country could have "done" the CoVid disaster - better.
Fortunately there were some very competent and smart people trying to save lives. Unfortunately these people had to overcome poor management and bureaucratic hurdles. Dr. Charity Dean, in particular, had to deal with stereotyping based on her age, looks and race to try to be taken seriously. Lewis also recounts the efforts of Bob Glass, Carter Mecher and others to collect needed data in order to make good decisions on how to control the spread of infection.
One of the surprises in the book was that George W. Bush was the president who took the threats of pandemics seriously and initiated studies to address them. Unsurprisingly, Donald Trump and his administration botched efforts to minimize the spread of pandemics. The Trump administration eliminated the scientific group inherited from the Obama administration who were in the midst of planning for pandemics. John Bolton was more concerned about military threats, not pandemic threats.
One of my personal takeaways from this book is how I could never trust any announcement or findings from the CDC. They are largely villains in this book.
While The Premonition does in fact invite us into the thinking of some brilliant outside-the-box thinkers, people who understood early on the threat we in the US faced - propelled by Lewis’ characteristic irresistible storytelling - it turns out that in the most meaningful sense, these accounts are the mere scaffolding for a far darker and more urgent revelation. Because if I knew by mid-January 2020 that we were facing no less than viral disaster, why was the country so ill-prepared? Where was the testing, the messaging, the preparation of the public for what would need to be done? Where was the truth-telling that would bring us together for the necessary NPIs - Non-pharmaceutical Interventions - that would buy time, slow the spread, and prevent hundreds of thousands of deaths that would otherwise occur before a vaccine could protect us?
That is real message of The Premonition. At multiple levels, the institutions and leaders who could have made a difference failed the people. The politicization and culture of the CDC - despite its continued capacity to produce world class academic research - meant suppression of the truth, no preparation for testing or necessary medical supplies, a craven obedience to an incompetent Administration primarily concerned with the next election, and not to put too fine a point on it, gross negligence. The shocking absence of a cohesive US public health system, which instead amounts to a balkanized set of sometimes dedicated but always local offices, waiting for advice from on high that either never came, or in other instances suppressed the truth that the virus was already spreading within the US. Federal and many state leaders calculated that keeping the public in the dark was a better policy than entrusting them with the information that might have enabled them to protect themselves. Those in the health system who knew found themselves silenced and shuttled to the side, or ignored. The protagonists in Lewis’ telling deserve a medal, but no doubt they would say they were just trying to do their jobs. This an eye-opening book. If we are to be better prepared for the next one, I can’t think of more powerful motivation than clarity about two things: what went wrong, and the perilous, regrettable condition of our public health institutions. Oh, and one more thing. The understanding that the next time may be even worse
Lewis could have been writing about the Pandemic, he could have been writing about an environmental disaster, a nuclear accident, an emergency response, or response to any social problem. The conclusions would have been the same. People on the coalface had a good understanding of what needed to be done; inefficieint, broken bureacracy, stopped it happening. In the book the CDC comes in for a good, seemingly deserved, kicking - which came as a surprise to me having known people who have worked there and who had praised its efficiency. In another disaster it would have been a different agency.
The saddest part is that, although the heros and heroines of Lewis' tale deserve to be lauded, the epidemiology they were promoting is neither hard to gasp nor, I thought, controversial, In most of Asia the principles of cutting as many social connection as possible (a "circuit breaker" as the Singapore PM put it) were understood and implemented quickly. But this is not really Lewis' point; nothing would work, as systems are mired in inertia and inefficiency
Every reader will have their own favourite jaw dropping moment; mine came at the point where the BIohub free testing facility discover why hospitals aren't sending sample for free, fast Covid testing; the hospital accounting systems have no way to process something that is free
Lewis is, as ever, an engaging storyteller. And in 30 years time this will be considered an important document of American decline. Unless of course, the structural fragility he outlines is addressed! But we all know, it won't be
Michael Lewis is implicitly saying that we should have performed NON-PHARMACEUTICAL INTERVENTIONS ("NPIs"). When I say "implicitly" he faults the CDC for not utilizing NPIs in threatened pandemics as early as swine flu (1976) on including the 2003 SARS and 2009 H1N1. NPIs are essentially lockdowns; closures of schools, businesses, places of assembly, mandating social distancing and restricting travel. The problem is obvious; society cannot function for lengthy periods or frequently in lockdown. Nowhere was the educational or social cost of the remedy discussed. The book's focus was purely on epidemiology.
Just because I think Michael Lewis is wrong does not mean The Premonition is not worth reading.
Quite the contrary. And despite my quibbles, the book appears to be a reasonably good discussion of recent events. I just don't think that Mr. Lewis's or the hero of the book, Dr. Charity Dean's nostrums would have worked much more than a rain dance.
Unfortunately, it is not fiction. I can only hope that people who read it will be appalled at the way in which politics and for-profit enterprises have weakened the ability of qualified, competent government employees to handle and solve problems for which they are trained and employed. As Richard Hatchett is quoted near the end of the book, "Government--and the value government provides--isn't just the whim of whoever happens to be elected at the moment...That government provides continuity across administrations and should be the repository of accumulated institutional experience and wisdom."
Health care decisions should not be made based on one's political views and should not be funded in order to make money for corporations.
The characters highlighted in this book vary from an evangelical-turned-public-health-official and a White House official/physician under George W. Bush to a grade-school student making a pandemic computer model for a science fair project and a CDC nurse dedicated to the public’s welfare. Their stories at first seem quite disconnected, but they come together in a beautiful way. This book puts to rest the popular myths that no one could have foreseen a pandemic and that no individuals could have mitigated its spread in America. These people did both. By putting their time, careers, and lives on the line, they courageously woke up to history’s call upon their lives while growing disillusioned with American political stagnation.
By way of criticism, Lewis’ story starts with a lot of “us versus them” sentiments, with “them” being the biomedical establishment personified especially by the CDC. In the first couple of chapters, he generally devalues academic research, even before the pandemic, as ineffectual. Yet much of the “wartime” pandemic response relied extensively upon this type of “peacetime” academic research. The problem wasn’t the research. Rather, in this crisis, there were no “generals” in power willing to leverage this knowledge towards practical aims.
Also, this story has a lot of effective buildup and can be cast as a history of science about current events, if that makes any sense. But as a weakness, it doesn’t have a particularly strong climax. The book was published in 2021, far before the end of the pandemic. That early date shows. I’m sure it gathered readers because of this timeliness, but I predict it’s not going to age particularly well. There’s a lot to the pandemic’s story that happened after publication, and the climax probably happened after the book went to market. That’s unfortunate.
Nonetheless, this book provides an interesting investigation into the events of the pandemic. It clearly shows how individuals still hold some power even when the government’s attention is absent. It also clearly reminds me how the value of my fellow Americans can be leveraged… if only leaders were willing to lead. I’m sure readers with public health interests will benefit from these personal investigations. It will inspire many about the power of the average, dutiful, but curious American.