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Book Review: The Premonition A Pandemic Story
JULY 2021 5 The Premonition: A Pandemic Story
BY PATRICIA SANDERS
The United States just experienced its most severe public health crisis in history (and it’s not over yet). The crisis exposed painful shortcomings in America’s public health system – if the response seemed to be slow, inconsistent, chaotic, confusing, and inadequate, you were noticing the effects of those shortcomings.
But into that vacuum of expertise and leadership, a few smart and courageous people came forward.
Out of passion for protecting public health and selfless concern for the welfare of people they’ve never met, they threw themselves into an effort to learn about the coronavirus, develop plans and guidance, and devise tests and analysis tools that made a difference in saving lives and reducing suffering. Their contribution is incalculable.
But part of the story is also that their efforts too often were ignored. Time after time, smart and dedicated people offered insights and solutions that went unheeded. Part of the story is the deep dysfunction in America’s health institutions, from local public health offices all the way up to the CDC and Washington DC. Too many people whose job it is to protect Americans’ health didn’t seem to care if they lived or died.
In a recent book, called The Premonition: A Pandemic Story, journalist Michael Lewis – the author of Moneyball, The Big Short, The Fifth Risk and other bestselling books about finance and sports – tells the story of the brokenness of our health system – the system that failed to offer clear guidance and assistance during the pandemic.
But mostly, he tells the stories of the courageous, serviceminded people who did all they could to help. It’s not an exaggeration to say that these people are true unsung American heroes, who deserve our gratitude and admiration. Charity Dean
The story begins with Charity Dean, who saw the pandemic coming through intuition and public-health savvy, long before it hit the news. Dean was assistant public health chief of California when the pandemic broke. She’d had experience tracking tuberculosis and meningitis outbreaks in California – so when the news started to come in from China, she knew what she was looking at.
Dean tried to raise the red flag, but her superiors in California’s public health department disregarded her warnings. It was only when she started speaking up in meetings where she’d been told to keep quiet, that others began to understand the threat and recognize her intelligence, insight, and commitment. Charity Dean prepared pandemic plans for California – and then for the rest of the country – that went to Jared Kushner, who briefed Trump, and the bones of her plan appeared in a White House memo. But obviously, a coordinated national response was never implemented.
Dean also developed a genomic tracking system that would have let public health officers understand how the virus was behaving so they could pinpoint strategies to fight it. That system, too, disappeared into the halls of the federal government and was never seen again.
Joe DeRisi
Joe DeRisi was a brilliant biochemist at the University of California in San Francisco who specialized in infectious brain diseases. When doctors had patients who were dying of some brain disease and they couldn’t identify the cause, they would call Joe on his “Red Phone” and he could often discover the culprit.
In March 2020, DeRisi realized that testing would be critical to the pandemic response – and that the country’s biggest testing labs, Labcorp and Quest, as well as the CDC, were taking up to ten days to turn around results. This would be no use at all.
So DeRisi converted his lab to a Covid testing lab. He asked for volunteers, and a small army of graduate students responded. Within two days, his lab was up and running. Joe offered testing for free and returned results within hours. His people could process 2,666 tests daily. This was a gamechanger: immediate testing meant the disease could be tracked in almost real time, and potentially stopped in its tracks with targeted interventions.
But in another tragic missed opportunity, Joe DeRisi’s lab went sorely underused. Partly due to shortages of testing supplies, but also because the healthcare system in the United States was so dysfunctional that they couldn’t – or wouldn’t – take advantage of what he was offering.
So DeRisi’s lab pivoted. They performed a genomic study of Covid transmission in a small area of San Francisco. Some of the most important early insights about how the Covid virus transmits – and therefore how to stop it – came from that study.
PHOTO: WIKICOMMONS Joe DeRisi, a biochemist, was one of a handful of people profiled in the book who ‘saw the smoke and acted.’
Richard Hatchett and Carter Mecher
In 2005, Richard Hatchett and Carter Mecher helped develop the first-ever national pandemic plan for George Bush – Bush had read a book about the 1918 flu pandemic and wanted to be sure America was prepared in case something similar happened on his watch. Hatchett was a doctor at the National Institutes of Health, and Mecher worked in the VA. Mecher had a way of going to the root cause of problems so that they could be solved efficiently and effectively. The two men worked together to develop the pandemic plan for Bush, and in the process essentially invented the concept of pandemic planning.
After that, they stayed in touch over the years and often tossed ideas back and forth. A group formed around them consisting of seven medical doctors, most of whom had seen combat in Iraq, and all of whom would be involved in a pandemic response if one should occur. The group had been dubbed the Wolverines. Every time the country faced a biological threat, such as MERS, Ebola, and Zika, the Wolverines put their heads together (via email) to study the problem and offer solutions.
Early in January 2020, the Wolverines began discussing the coronavirus outbreak. While the CDC, President Trump, and most members of the public health community were downplaying the severity of the coronavirus, the Wolverines were taking it very seriously, gathering information from Chinese sources, calculating the way it would spread, thinking about implications, and determining actions that needed to be taken and decisions that needed to be made. These men were, on their own hook, doing what the CDC and other agencies should have been doing.
Carter Mecher was the one who applied the lessons of the Mann Gulch Fire to pandemic response. In that tragedy, in 1949, 15 smokejumpers were moving toward a grass fire that they thought was small and located on the opposite side of a creek. When they came around a hill, they unexpectedly faced a 30-foot wall of fire moving toward them fast, with a 30 to 40-mph wind behind it. Twelve of the firefighters died. One survived because he did something that had never been done before – he created an escape fire and dove into it. The lessons Mecher took included:
Carter emphasized how quickly a problem – a fire or an epidemic – can explode and become extremely difficult to deal with.
Richard Hatchett was the one who got vaccine development underway before many Americans even knew that a problem existed. By the end of January, he had already contacted Moderna and AstraZeneca and arranged for funding to cover the initial clinical trials. At that time, only about five cases had been found in the United States.
Laura Glass
Laura Glass was in elementary school when she got interested in making computer models of disease spread. Her father, Bob Glass, was a scientist at Sandia National Labs and helped Laura with her science fair projects creating these models. Over time, her models became more and more sophisticated, and she came up with insights into ways to reduce the spread of disease that no one else had thought of – such as determining locations where spread was taking place and shutting down those places. In 2006, as a teenager, Laura built an analytic tool to understand the movement of disease through a population – a tool that decision makers could use to help stop an outbreak.
Bob Glass wrote an academic paper to contribute Laura’s work to the field. But no one was interested in publishing it, because he didn’t have the proper credentials. Eventually, he sent the paper to the Wolverines, and it became part of their thinking.
Laura and Bob’s work on disease modeling contributed to a new understanding that emerged around 2006 and 2007 about how to fight pandemics. Until then, everyone thought vaccines were the only solution, and that until a vaccine was ready, all you could do was isolate ill people and, beyond that, watch as the disease ravages the population. The Glass’s work showed that something could be done, and that a disease could even be completely thwarted through contact restrictions. All of that work and tools to put it into place were ready to go when the Covid pandemic struck.
As Carter Mecher explained, part of the problem with America’s pandemic response was the same as with fire: “We are reactive and tend to only intervene when things are getting bad. And what we underestimate is the speed of what’s bad moves.” u
ONE CHEF – TWO GREAT CONCEPTS ONE CHEF – TWO GREAT CONCEPTS ONE HAPPY FAMILY ONE HAPPY FAMILY
