Raghu Srinivasan

Book Reviews

The Premonition by Michael Lewis

One of my favorite authors, Michael Lewis, does not disappoint with this fantastic book! The Premonition is about a small group of government officials who thought about and planned for a pandemic response long before COVID-19 struck. They even came up with a playbook with clear recommendations. Unfortunately, their voices were unheard and their advice was not followed for various reasons. This book tells that back story to set the context to explain , at least in part, what happened in 2020.

In his unique style, the author brings to life characters and people no one had heard about before and their prescience about the pandemic. This is an eclectic group: from the father who helps his high school daughter with her science project that shows how pandemics spread exponentially to an obscure health officer in Santa Barbara to administrators in the Veterans Administration to officials inside the White House and the CDC. This is a group of people, codenamed the Wolverines, who lived through the 2003 SARS and the 2009 Swine Flu outbreaks.

Three people in this book stood out for me. The first is Charity Dean who rises from the health official of Santa Barbara county to becoming the #2 health officer in the state of California. She’s someone with a sixth sense for outbreaks - and the courage to act on her hunches. The second is Carter Mecher who comes off as a real national treasure for his low-key but high quality work. It is Mecher who digs through the data of the 1918 pandemic and realizes that school closures are among the biggest levers for reducing the spread of the virus. The third is Joe DeRisi, a biochemist at UCSF. In a memorable paragraph, Lewis shares how DeRisi’s lab tries to use snakes to track viral diseases - a process that involves injecting the virus into a snake’s heart and seeing if the snake gets sick. A small complication in this process is that unlike as in humans, a snake’s heart doesn’t stay put but travels up and down its body! As Lewis puts it: to inject a snake’s heart with a virus requires two post-docs and one full processor; one to hold the snake in a death grip, one to use a Doppler radar to find the snake’s heart, and a third to plug the needle into it.

The challenge with pandemics is that there is so much uncertainty in what might happen and how to react. Public health officials are caught between what can often be two extremes. One is doing too much and finding that nothing actually catches fire after all. This happened in 1976 when the CDC mobilized an effort in the US that vaccinated 40 million people only to have the disease vanish without a whimper or as a character puts it “nature shot at us but with a BB gun”. In such cases, the officials are blamed for overreacting, even panicking, especially given that that 1976 vaccine caused many deaths as a side effect. The other choice is to do too little and then be completely overwhelmed when things actually catch fire - this, unfortunately, is what happened with COVID-19. The counterfactual is very hard to argue.

Surprisingly and, in fact commendably, Lewis resists the temptation to lay the blame entirely at the Trump administration’s footsteps. Trump and his actions are described not as the leading cause of the huge death toll in the US but, in one of the most memorable phrases in the book, as “a comorbidity”. The system was already weakened and key posts already politicized. And with Trump at the head of the federal response, the tragic result according to Lewis was pretty much inevitable.

One surprise for me was the characterization of the CDC as an extremely academic institution - good for research after the fact but actually quite unfit for rousing the systems to action during an actual outbreak. Today the CDC is too risk averse - a transformation that began back with the 1976 event. The other surprise was California Governor Gavin Newsom (this book is told very much from a California-centric viewpoint) who seems to have listened and acted more actively than is generally known. Newsom declared a state of emergency on March 4th, 2020 and also issued the country's first statewide stay-at-home order on March 18th, 2020.

This book is in the initial batch of what will easily be hundreds of books to come on the pandemic and the US government’s response to it. It’s a great book and I highly recommend it. Lewis’ talent to take dense topics and bring them to life with incredible characters is on full display. This reads almost like a sequel to his 2018 book The Fifth Risk where he takes us on a deep dive into the federal bureaucracies of the departments of Agriculture, Commerce and Energy. If you haven’t read that one, I recommend it as well.

(Book cover courtesy of goodreads.com)

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