The Premonition: a Pandemic Story

Michael Lewis (W.W. Norton, 2021)

 

   In 2003, a man named Bob Glass was working at Sandia Labs, playing with computer models, when his daughter Laura asked for his help using them to consider infectious disease. Her eighth grade project modeled the Black Plague; the next year, she introduced social networks to the model. She posited, for example, that children were something like twice as likely as adults to pass along a virus, because they spent more time in close contact with others. Her father coached and challenged Laura, and he did some of his own research, especially on the 1918 influenza pandemic.

 

    The Glasses are just the first of the self-taught plague experts Michael Lewis will introduce to us. They range from White House officials to county health officers; most are doctors or nurses, others are laymen like Bob and Laura Glass. They are experts because they're so interested in the problem, including what could actually be done to slow or stop the spread of dangerous illnesses. That's not exactly easy, but, in the context of this story, there's a larger problem: will they be allowed to do it?

 

   Charity Dean, as the chief health office of Santa Barbara county, has seen more than enough of this problem. She does her own research, including seeing patients in county clinics and homeless shelters; that's where hepatitis C and tuberculosis are likely to present themselves, and she wants to be the first to know when they do. Lewis describes the time in 2014 that Dean closed a clinic on suspicion that it was passing hepatitis from patient to patient. The Centers for Disease Control in Atlanta reacted with consternation: such a use of local authority struck them as radical and rash. "She'd grown used to the lack of material support. But...the total absence of moral and practical support from the state and federal government mystified her."

 

   It's a mystery, if you imagine that the CDC is intended to be working on controlling disease. Rather, Lewis says, "The CDC did many things. It published learned papers on health crises, after the fact. It managed, very carefully, public perception of itself. But when the shooting started, it leapt into the nearest hole, while others took fire." Charity Dean was a battlefield commander. She was General Grant, knee-deep in mud and blood, to the CDC's fastidious General McClellan. In that position, she had to make decisions on pitifully incomplete information; tests that would help will come back too late. Such decisions often involved asymmetrical risks: "Sins of commission got you fired. Sins of omission you could get away with, but they left people dead."

 

Carter Mecher is another real-life character who's acutely sensitive to that sort of problem. He found his sweet spot in the Veteran's Administration, as an expert in medical error. That is, he studied decisions made and delayed, and taught other doctors to make better ones. In 2005, he was invited to the White House to work on pandemic planning in a newly created interagency group. The official report the group produced went through the normal government bad-writing-ification process, but at least Mecher and the others had permission to think about the real problem, of what to do in an epidemic before vaccines can be produced.

 

Because weird things that happen sometimes happen for good, Bob Glass got his and Laura's research about disease transmission to Carter Mecher, who passed it to Richard Hatchett, a colleague who'd been looking for just such a model. Mecher and Hatchett put Glass to work testing ideas about how to slow disease transmission; the insight that children go to school in petri dishes felt like a big breakthrough.

 

 Later in the book, when a new coronavirus appears in China, we are equipped for premonitions of our own: The CDC collects information and never gives it back; decision-makers make things worse by waiting on data that will be ancient history by the time they get it; the people who do see what could be done have to work in unofficial networks and constantly buck the system. Michael Lewis, as always, tells a gripping story, and it may be as important a story as he's ever told.

 

 

 Published by email,

Any Good Books, December 1, 2021