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Book Review – The Premonition: A Pandemic Story

The Premonition cover

(W.W. Norton & Co.)

25 Oct. 2021. As the world struggles to overcome the Covid-19 pandemic, author Michael Lewis tells how the U.S. first struggled to identify and contain the virus. Lewis tells the story through the eyes of a few key public health officials who almost on their own and without official backing revealed the deadly scope of Covid-19.

In a sense, The Premonition is a continuation of Lewis’s previous book, The Fifth Risk, reviewed here in Feb. 2019. In The Fifth Risk, Lewis tells how several career U.S. government officials tackled their jobs of managing high and unpredictable risks to the country, particularly during the Obama – Trump transition period. The Premonition also highlights risk, but in this case the risk of infectious disease to public health, with Covid-19 representing the greatest such risk in a century. And the book likewise focuses on the work of a few individuals whose names were rarely seen in the media.

One of Lewis’s main characters is Charity Dean, described first as an activist public health officer in Santa Barbara, California, and later as California’s assistant public health director. In the U.S., public health functions are divided among federal, state, and local authorities, and as Covid-19 revealed, those functions become blurred and break down under stress. When those functions break down, it often falls on the local authorities to piece together solutions, often under difficult conditions. As Lewis describes Dean’s work in Santa Barbara (pp. 23-24) …

She’d pop over to the homeless shelter in downtown Santa Barbara for half a day every week, set herself up inside a tiny room, and treat whoever walked in the door. There were days when she would go straight from plucking maggots from the wounds of a homeless man to testifying on television in front of the board of supervisors. When the nurses asked her why she did that, she said, “When a doctor stops treating patients, they slowly start to forget. Seeing patients is how you develop a sixth sense.” She wasn’t simply doing good works, in other words. She was gathering intelligence.

Redneck epidemiologist

Another key player is Carter Mecher, a public health advisor to the U.S. Veterans Affairs department based in Atlanta. Mecher, a self-described redneck epidemiologist, had a knack of finding the real cause of problems in the veterans health system, the largest health system in the U.S., often lurking beneath the surface. Mecher became VA’s resident expert on using data and statistics, and was recruited by the George W. Bush administration to help write the government’s first pandemic response plan.

The George W. Bush administration had plenty of good reasons to fear a pandemic, suffering through the 9/11 attacks, hurricane Katrina, and a continued HIV-AIDS outbreak. Also recruited to write the pandemic plan was Richard Hatchett, a senior career official at the Health and Human Services department who led development of diagnostics and countermeasures against infectious diseases. The work of this team carried over into the Obama administration, and resulted in a pandemic response plan using statistical models to show the need for taking steps early on the prevent person-to-person transmission before development of vaccines. Among those steps were closing down schools and commerce, and social distancing.

The plan from Mecher, Hatchett, and colleagues helped rate the U.S. the leader in pandemic preparedness in November 2019, according to the Global Health Security Index and displayed in a Science & Enterprise infographic at the time. Less than two months later, the then-named “novel coronavirus” emerged as a global health threat and the Trump White House tried to minimize that threat, to aid his reelection chances.

Lewis tells how official Washington wanted to look the other way, but a group of public health experts formed to meet virtually and unofficially by email and Zoom to find ways of battling the quickly spreading pandemic. The unofficial collective called themselves the Wolverines, the same name of a fictional group of American teenagers fighting an invading North Korean army in the 2012 movie Red Dawn. Wolverines, in this case, included Mecher, Hatchett, and Dean, who by this time became California’s assistant chief health officer.

10-day waits for test results

Of all the characters in the Wolverines and book overall, Dean had the most hands-on action as a public health official. Lewis describes how Dean navigated the California state bureaucracy to circumvent an obstructionist chief health officer and deal directly with the governor Gavin Newsom. And the book recounts the painful early days of Covid-19 in the U.S., trying to learn the full dimensions of the pandemic, with 10-day waits for test results and shortages of nasal swabs and test reagents.

At several points in the book, Lewis also describes the U.S. Centers for Disease Control and Prevention, as a highly respected, yet often unresponsive agency when faced with the pandemic. The CDC’s struggles, according to Lewis, are more institutional, with officials more interested in protecting the agency’s respected scientific credentials than solving immediate problems. Those tensions were then aggravated during the Trump administration.

The name Richard Hatchett may be familiar to regular Science & Enterprise readers. We first met Hatchett in September 2016 as acting director of Biomedical Advanced Research and Development Authority, or BARDA, the agency in HHS developing countermeasures to biomedical threats. In 2017, Hatchett became CEO of CEPI, Coalition for Epidemic Preparedness Innovations, the group featured several times here that funded early R&D on the Moderna and other Covid-19 vaccines in use today.

The Premonition: A Pandemic Story
Michael Lewis
Publisher W. W. Norton & Company (May 4, 2021)
Hardcover 320 pages
ISBN-10 0393881555
ISBN-13 978-0393881554

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