"The Premonition"

The Premonition: A Pandemic Story by Michael Lewis tells an interesting, and even a compelling story. But when I finished, I felt as if the story here was incomplete. The focus of this documentary book is on several people who began working in the early part of this century on epidemic and pandemic preparedness and on suggesting what should be done when an inevitable mutated virus began to spread throughout the world. Indeed, in late 2019 as we all know, the novel coronavirus that arose in Wuhan, China, was just such an organism. In the early days of 2020, the virus posed a severe threat to every human on the planet.

Lewis concentrates his narrative on a group of people who had been thinking hard for a number of years about the potential for such an event. Much of the book is about these people, including about the experiences they had in their childhood, youth, education (mostly in medical school and early years in medical practice), and their dealings with government bureaucracies. Quite a lot of the background is set in California, especially Santa Barbara where one physician named Charity Dean was in charge of Public Health. The author’s emphasis is on the extreme decentralization of public health policy and action, which was a terrible obstacle to a concerted effort against the pandemic.

All this background is very interesting. However, I was disappointed in the chapters about how these same people were called on, and then ignored in 2020, at the point when their plans could have reduced the enormous death toll from the coronavirus. Much information is also presented about the way that the administration in Washington, having fired many of the civil servants who would have taken charge of this emergency, failed to provide leadership or infrastructure to cope with a spreading infection and the overwhelmed medical system. I remember the squabbling between various agencies such as the NIH and CDC, and the fact that these once-neutral organizations had been politicized. I remember well how needed medical equipment such as ventilators was unavailable and the President (one of the big obstacles) said the states should do their own procurement. All this is covered in the context of the experiences of the individuals at the center of the book’s focus.

The author had a very close focus on these individuals and their nearly ineffective efforts to influence government policy or change the minds of stubborn and personally ambitious government bureaucrats, which is interesting. However, as I read about their struggle to reduce the impact of the catastrophe, I always felt as if I was missing some bigger picture of the crisis. Lots of very good material was in the book, but I still felt somewhat lost when I read it, especially when the author goes into a digression about the early life and traumas of one or another of the main characters. 

A lot of the book is really good and powerful, but it nevertheless left me frustrated and wishing for a more comprehensive viewpoint. I was especially frustrated by the extreme focus on Californians and how they coped, because the implication was that no other state had any reasonable response at all — and I don’t think that is true. In fact, for example, almost all the schools in the US were shut down in the spring of 2020, not only those in California. I note that the book was published in 2021, so perhaps the big picture couldn’t yet be grasped.

One message of the book is that the issue of future pandemic preparedness is critical. An article by Bill Gates in the New York Times on Sunday summarizes the way that the mistakes described in Premonition could be repeated if better political and practical measures aren’t taken:

“When the World Health Organization first described Covid-19 as a pandemic just over three years ago, it marked the culmination of a collective failure to prepare for pandemics despite many warnings. And I worry that we’re making ‌‌those same mistakes again. The world hasn’t done as much to get ready for the next pandemic as I’d hoped. But ‌‌it’s not too late to stop history from repeating itself. The world needs a well-funded system that is ready to spring into action at a moment’s notice when danger emerges. ‌We need a fire department for pandemics.” (Bill Gates writing in the New York Times this week)

My main fear for the future isn’t really in The Premonition at all: we have recently experienced the polarization of political sides in American life, with serious attacks on science and medical knowledge. My current “premonition” is that this situation is likely to derail any future efforts to deal with possible (or actual) coming pandemics. The author called out the authorities who in 2019 believed that immunization alone was the route to stopping the spread of disease. He made the case that many other measures, in general the need for social distancing, were also essential. How will this play out now, when a substantial minority have become convinced that medicine is a conspiracy against them. This minority oppose immunizations of any kind. Even wearing masks is politicized. Not to mention closing schools! What kind of a future does this foretell?

UPDATE: As one commenter says, an article this week in the New York Times has more updated material on the way the CDC was forced to act in dysfunctional ways in 2020. See this article:  “‘We Were Helpless’: Despair at the C.D.C. as the Pandemic Erupted.”

Blog post © 2023 mae sander.

I thank my friend Phyllis for recommending the book, 

and for thoughtful discussion of the issues.