SFMMS Book Review: "The Premonition A Pandemic Story" by Michael Lewis

THE PREMONITION: A PANDEMIC STORY

by Michael Lewis | WW Norton, May 2021

Michael Schrader, MD, PhD

Michael Lewis has written an insightful new book about the Covid pandemic.

This book is about the heroism and the failures of the US response to the Covid-19 pandemic. Given the current resurgence of Covid-19 as the Delta variant this story is ongoing.

As in many of his previous works the narrative is related through the personal stories of the heroes of this ongoing crisis. The heroes are physicians and scientists: Charity Dean, Carter Mecher, Richard Hatchet, Joe DeRisi (of UCSF). The narrative opens with the story of how a high school student’s science fair project became a seminal model for epidemiology. From then on things get ever more complicated and disturbing.

Lewis champions individual initiative and gumption over bureaucratic inertia. He characterizes the United States Centers for Disease Control and Prevention as inefficient and bureaucratic not in so many words but by repeated examples and descriptions of its failures to act decisively when the well-being of our citizens was at stake. He further points out that the CDC is not merely a United States institution but the preeminent institution of its kind in the world. Furthermore, the failings of the CDC predate the current crisis.

In typical Lewis style, he intersperses technical explanations with the personal narratives. He presents the science of epidemiology, R0 values, and logarithmic growth in simple metaphorical explanations. He returns to the technical aspects again and again, reinforcing through iteration.

Lewis addresses the political aspects of the pandemic response. He gives substantial credit to the administration of President George W. Bush. President Bush had read John Berry’s book, The Great Influenza, and had seen the potential threat. Through his impetus a pandemic planning task force was created and generously funded. This created a level of expertise in the Federal government headed by Drs. Mecher and Hatchett. They refined the pandemic model that had its roots in the school science fair project. They revisited the data from the 1918 influenza pandemic and affirmed the age-old practice of social distancing, and then were able to get it adopted by the CDC as policy. Lewis also focuses on the individual expertise and initiative of UCSF scientist Dr. Joe DeRisi. Dr. DeRisi pioneered a technology that identified the initial SARS virus in 2003. Dr. DeRisi was integral to the local response to Covid-19 and established a local lab that could DNA sequence SARSCoV2 samples to trace its origins. Lewis emphasizes the human hubris, arrogance, ignorance, and complacency that have exacerbated the crisis at every decision point. The CDC has failed both healthcare workers and the American public. The heroes of this book are the officials of public health departments who have done their best to shepherd us through this crisis.

Lewis builds to the larger points of the historical politicization of the CDC following the Swine flu immunization fiasco of 1976 and the lack of power and funding of local public health officials. He criticizes the fragmented nature of American healthcare with its shortsighted profit-driven goals. The final lesson: This has happened before, this will happen again, and it is still happening.

Dr. Schrader, an internist, is Chair of the SFMMS delegation to the CMA and PresidentElect of the SFMMS.