The Premonition: A Pandemic Story

The Premonition: A Pandemic Story



The Pequod Review:

The most insightful part of The Premonition, Michael Lewis’s profile of the American response to the COVID-19 pandemic, comes near the end of the book. In 1976, a strain of swine flu appeared in over five hundred Americans and seemed to have the potential to turn into a widespread pandemic. The virus itself even had a structure similar to the Spanish Flu, all the more reason influenza experts feared a rerun of 1918. The Director of the CDC (David Senser) convened a meeting of public health officials and epidemiologists in the spring 1976 with the goal of figuring out what to do. It concluded with widespread consensus that a vaccination program should begin immediately. Senser wrote a memo summarizing his recommendation, which was quickly adopted and implemented by the Ford administration. But from there it all went wrong: 

Two weeks into the [vaccination] program, three elderly people in Pittsburgh died. They’d all been vaccinated at the same clinic. Their deaths made national television news. The vaccine fell under new suspicion, even after heart failure emerged as the cause of all three deaths. A month later, a recently vaccinated man in Minnesota was diagnosed with Guillain-Barre syndrome. Over the next few weeks more cases emerged, until the CDC had counted fifty-four, in ten states. The vaccine was pretty clearly responsible. That made national news again, as did cases of people who’d been vaccinated and became ill for reasons having nothing to do with the vaccine. The vaccine program went from controversial to unpopular to, on December 16, suspended. And the pandemic never came. The new strain of swine flu simply vanished. No one knew why. 

David Senser unfairly became the scapegoat, was fired from his job, and the position of CDC Director would later be changed from a career civil servant to presidential appointee. With this change, the Director of the CDC became a revolving door position from administration to administration, and one that served at the behest of the president with all of the political considerations that entails. The role would select for someone who pleased the president rather than someone who foresaw future risks and could make tough and unpopular decisions. 

As a result, it should be no surprise how the CDC behaved when it was presented with uncertain information in January 2020 about a novel coronavirus. A more intelligent book would have picked up on this thread by reviewing the internal structure of the CDC (a massive, 15,000-person agency) and its decision-making process during the COVID pandemic. It could have done the same for the Trump administration, National Institutes of Health (NIH), and even pharmaceutical companies and hospitals. Unfortunately, aside from some pointed criticism of the CDC’s decisions, the rest of Lewis’s books falls into his standard superhero narrative as it profiles a handful of individuals who mostly operated at the margins: a California public health officer (Charity Dean), a “redneck epidemiologist” who worked at the VA and briefly helped the Bush administration with pandemic planning (Carter Mecher), a biochemist who developed a rapid test in his own lab (Joe DeRisi), and the head of the Coalition for Epidemic Preparedness Innovations (Richard Hatchett).

Michael Lewis's profiles of these individuals nonetheless contain some interesting insights. We learn just how early on public health officials knew about the seriousness of the COVID threat; emails were circulating among members of the group (including individuals connected to the CDC and the Trump administration) in mid-January, eight weeks before the country would go into lockdown. There is also a good section describing Mecher's and Hatchett's original research reinterpreting the 1918 Spanish Flu to prove that cities that enacted social distancing (like St. Louis) had fewer infections than those that didn’t (like Philadelphia). Lewis furthermore shows how the near miss of the 2009 swine flu (when Obama was counseled by many to close schools and implement social distancing, but in the end decided to listen to the CDC which advised doing nothing) contributed to a complacency that became hard to shake when early information on COVID began trickling in:

The lesson many had taken away from the event was how smart it was not to have closed the schools, or taken the kind of aggressive action that was necessary at the start of a deadly outbreak, to prevent its explosion. “It’s like someone who looked down at their phone while driving and drifted onto the shoulder but didn’t hit anything,” [Carter Mecher] said. “The lessons aren’t as strong and defined. Had that person hit a mailbox or ended up in a ditch and wrecked his car, he would have learned a hard lesson. Had they hit and killed a pedestrian, they probably wouldn’t want to get into the driver’s seat again for a long, long time. In all cases, though, the lesson is really the same.”

People didn’t seem to get that. There was, Carter thought, a downside to experience. “Experience is making the same mistake over and over again, only with greater confidence,” he said. The line wasn’t his, but he liked it.

For all of its flaws, The Premonition is a thrilling read and Michael Lewis remains an astonishingly talented writer. But it is severely lacking in a rigorous analysis of the structural and institutional causes of our inadequate response to COVID.