THE PREMONITION
A Pandemic Story
By Michael Lewis
We are almost halfway through “The Premonition,” Michael Lewis’s maddening account of America’s bungled response to the Covid pandemic, when an unsung health official in California, making her birthday resolutions, scrawls a foreboding note to herself: “It Has Started.” The official is Charity Dean, who sounds a little like the half-crazed scientist in a science fiction movie, suddenly realizing that the aliens are about to land.
It is December 2019. Dean, who will spend the next months trying and failing to prevent a national catastrophe, does not yet know what, exactly, has started. But we do. The coronavirus will spread from China to California, where Dean was then the state’s No. 2 public health official, and soon enough to everywhere else. As I write, Covid has killed more than three million people worldwide, including over half a million Americans, and is now burning ferociously anew through India.
We do not yet know how the movie ends. But Lewis, whose book is among the first wave of narrative accounts of the pandemic, is more interested in how it began. Believed to be the rich country best prepared for a pandemic, we ended up with almost a fifth of the world’s Covid deaths. Popular blame has centered, not undeservedly, on former President Donald Trump, who ignored his advisers’ warnings, publicly downplayed Covid’s dangers in the hopes of preserving his re-election chances and left states to fend for themselves. But Lewis has a different thesis. As one character puts it, “Trump was a comorbidity.” The rot ran deep through the American system of public health, and in particular the Centers for Disease Control and Prevention, once considered a crown jewel of American government.
We learn this in a looping, indirect way, through the intertwined back stories of Lewis’s half-dozen or so central characters. When Dean was a young county public health officer in Santa Barbara, her efforts to contain a 2013 meningitis outbreak taught her that the C.D.C. could be useless in a crisis — part of a system “designed to foist political risk” onto an institution that “had no social power.”
We meet Carter Mecher, a doctor and an autodidact working at the Department of Veterans Affairs who has a knack for seeing how systems fail. Drafted by the George W. Bush administration to help develop the United States’ first real pandemic response plan, Mecher learns that, as the C.D.C. saw things, there was little the country could do in a pandemic but isolate the sick and wait for a vaccine. There is Joe DeRisi, a genius biochemist in California whose hand-built gene analyzer helps identify the first SARS virus, but who is met “with boredom and blank stares” when he presents his technology to the C.D.C. As always, Lewis likes brilliant odd ducks — people who don’t have the usual credentials or the “right” ideas, but who turn out to be right. His subjects here are Cassandras: Blessed with uncanny foresight, doomed to be disbelieved.
In “The Premonition,” Lewis makes the most of his conceit, flashing backward and forward through the decades to show us how and when the warning signs flashed. The central lesson of his book is that beating a pandemic means acting before the danger is clear — a mind-set that politicians and bureaucracies are terrible at embracing. It is Mecher and his colleagues on the Bush task force who rediscover the idea of social distancing and, after studying the 1918 flu pandemic, draft a plan to shut down schools and encourage Americans to work from home in the case of a pandemic.
The C.D.C. at first resists such drastic measures, but in Lewis’s cinematic telling, Mecher and his co-conspirators essentially fool the bureaucrats into thinking that the new interventions were their idea. (At one point, Mecher sneaks into the office of a C.D.C. official and borrows a computer there to type out what would become the C.D.C.’s social-distancing policy.) Yet when the new protocol meets its first test, during the 2009 swine flu outbreak, politics overrides planning. Amid intense uncertainty about the new flu’s deadliness, President Obama decides against setting the pandemic plan in motion. When the virus proves less lethal than it first appeared, and the outbreak dissipates without widespread death, government learns the wrong lesson: that Obama was right not to overreact.
One big problem with pandemics, Lewis observes, is that human brains — and, by extension, human bureaucracies — are simply not wired to grasp exponential growth. If you take a penny and double it every day for 30 days, you’d end up with $5 million. “The same mental glitch that leads people to not realize the power of compound interest,” Lewis writes, “blinds them to the importance of intervening before a pathogen explodes.”
When the first Covid cases emerge in Wuhan, Mecher begins trading emails with his old comrades (nicknamed the Wolverines, after the scrappy American teenagers fighting off a Soviet invasion in the ’80s flick “Red Dawn”). Using back-of-the-envelope math — “redneck epidemiology,” Mecher calls it — the Wolverines realize that there are thousands more cases in China than acknowledged. Yet when the first American case is confirmed, Trump dismisses the danger, saying “It’s one person” and “We have it under control.” By then, the Wolverine email list includes people from all around the government who are supposed to be executing the United States’ pandemic response. But in those critical early weeks, C.D.C. officials repeatedly downplayed Covid. They wanted more data. They didn’t want to act until the danger was clear.
Some of this story has been told before, including in this newspaper. But Lewis brings a welcome gimlet eye to the Trump era, when government officials abused by Trump were instinctively deified by liberal Twitter and cable TV. When a C.D.C. official named Nancy Messonnier defied Trump and announced, last February, that the spread of the disease was inevitable, “people were soon saying how brave Messonnier had been to say that the virus could not be stopped.” The reality, Lewis argues, is that the C.D.C. did not even try.
But the lessons of the “The Premonition” apply to more than just the C.D.C. — they tell us why government bureaucracies fail. The problem wasn’t just in Washington, or with Trump. The bureaucratic disease of under-reaction, Lewis argues, runs deep in America’s fragmented, underfunded health system. After Charity Dean scrawled her prophecy in December 2019, the Covid virus broke out in Wuhan. Scanning Twitter and Chinese websites, Dean formed a picture of impending doom. She brought her urgent concerns to her new boss at California’s Department of Public Health, Sonia Angell, a former C.D.C. official who had little experience in infectious disease but a glittering résumé “righting racial injustice in health care,” as Lewis puts it.
According to Dean, Angell choked. She banned Dean from using the word “pandemic,” cut her out of meetings and yelled at her when Dean deliberately left a paper trail about the coming disaster. Angell insisted on deferring to the paralyzed C.D.C., where officials had by then flipped from claiming the virus was no big risk to insisting nothing could be done to stop it. (Angell would resign months later, her departure publicly attributed to a Covid-testing data screw-up.) Only with the help of a couple of Silicon Valley executives — who almost instantly realized Dean was right — did Dean persuade California’s governor, Gavin Newsom, to issue a stay-at-home order.
Not quickly enough. The aliens had landed. The virus was already among us. By the time it was politically convenient to act, the pandemic was already too late to stop.
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