Book notes: The Premonition by Michael Lewis

The Premonition is my new favorite Michael Lewis book. It’s about a collection of people working in public health who helped shape the response to COVID in 2020. I have liked several of Michael Lewis’s books, but in this one you get a winning combination of fascinating people, reliving the urgency days of the pandemic, and a peek behind the curtain of public health in the US. I read it on Kindle but I’m buying a paper copy to give it a place of honor in my bookshelves.

A few notes:

The idea of social distancing and closing schools

Bob Glass and his daughter start applying a software simulation to test responses to a pandemic before vaccines are available:

There was not enough vaccine to go around. So: Who should get it? United States government policy at the time was to administer the vaccine to those most at risk of dying: old people. Laura thought that wasn’t right. “She said, ‘It’s young people who have all these social interactions and are transmitting the disease,’ ” recalled her father. “ ‘What if you give it to them?’ ” They went to their model and gave the young people the vaccine, thereby eliminating the ability of young people to transmit the disease. Sure enough, the old people never got it. Bob Glass searched the literature for the infectious-disease specialist or epidemiologist who had already figured this out. “I can find only one paper that even suggested this,” he said.

(p. 8)

Carter Mecher and team reach a similar conclusion:

One intervention was not like the others, however: when you closed schools and put social distance between kids, the flu-like disease fell off a cliff. (The model defined “social distance” not as zero contact but as a 60 percent reduction in kids’ social interaction.) “I said, ‘Holy shit!’ ” said Carter. “Nothing big happens until you close the schools. It’s not like anything else. It’s like a phase change. It’s nonlinear. It’s like when water temperature goes from thirty-three to thirty-two. When it goes from thirty-four to thirty-three, it’s no big deal; one degree colder and it turns to ice.”

(pp. 86-87)

Carter and team debunk the existing narrative on the ineffectiveness of social distancing and masks, due to Philadelphia’s response to the 1918 flu pandemic:

It took just a few months for them to piece together what had actually happened in 1918. Their paper appeared in the May 2007 issue of the Proceedings of the National Academy of Sciences. A coauthor and friend, the Harvard epidemiologist Marc Lipsitch, did the statistical work and the other stuff that made it seem as if it were written by proper scholars.§ Titled “Public Health Interventions and Epidemic Intensity during the 1918 Influenza Pandemic,” the piece revealed, for the first time, the life-or-death importance of timing in the outcomes of 1918. Cities that intervened immediately after the arrival of the virus experienced far less disease and death. The first reported flu cases in Philadelphia had been on September 17. The first case wasn’t spotted in St. Louis until October 5—which also happened to be the day the United States surgeon general, Rupert Blue, finally acknowledged the severity of the disease and recommended that local leaders take action. The death rate in St. Louis was half that of Philadelphia because St. Louis’s leaders used the cover provided by the federal government to distance its citizens from one another.

(pp. 103-104)

Swine flu response

The Mexicans, interestingly, had taken the new pandemic strategy of the United States and run with it. They’d closed schools, and socially distanced the population in other ways that, studies would later show, shut down disease transmission. The CDC, by contrast, sent the message that each American school should make its own decision, which was a bit like telling a bunch of sixth graders that the homework was optional. A few schools closed, but the vast majority did not.

(p. 119)

COVID

My response is that a pandemic is not defined by what is happening in the US—it is defined by what is happening across the world (pan = all, demic = people, all people) . . . I know that this is not CDC’s intent but it is creating problems for bureaucrats who suffer from malignant obedience.”

(p. 183)

Charity Dean watches with frustration as the CDC is ineffective:

But she noticed when the CDC made a curious pivot, from downplaying the virus to behaving as if it never could have been contained. For the better part of two months, they’d repeated the same mantra: the risk to Americans is low, and there is no evidence of transmission inside the country. That fiction ended on February 25, when the CDC’s lab in Atlanta identified as positive for COVID-19 the patient inside the UC Davis Medical Center with no history of foreign travel. That day, the CDC’s Nancy Messonnier held a press conference to say that the spread of the disease was inevitable.

(pp. 224-225)

An order came from Vice President Mike Pence’s office saying that henceforth no one in the Department of Health and Human Services was allowed to say anything that might alarm the public.

(p. 225)

Joe DeRisi notes the clusterfuck around testing:

Joe studied them until the penny dropped: eyelash brushes. Some crafty soul had bought eyelash brushes, relabeled them as medical swabs, and sold them to the VC at a profit.

The absence of federal leadership had triggered a wild free-for-all in the market for pandemic supplies. In this market, Americans vied with Americans for stuff made mainly by the Chinese.

(p. 252)

And yet nearly a year into the pandemic, in February 2021, the number of genomes being sequenced in the United States was trivial—less than a third of 1 percent of the virus in people who tested positive. (The UK was by then sequencing 10 percent of its positives; Denmark had set a goal of sequencing all of them.) The United States was sequencing fewer of its genomes than any other industrialized country, and the only reason it was sequencing as many as it was is that a bunch of nonprofits had stepped in to do it, haphazardly, for free.

(p. 268)

No good deed will go unpunished

Local health officers across the country paid with their jobs and more in their attempts to control a disease without the help of the Centers for Disease Control. Sara Cody, the health officer in Santa Clara County, had issued the country’s first stay-at-home order, after finding the country’s first domestic transmission of COVID—and now Sara Cody needed round-the-clock police protection.

Nichole Quick, the health officer in Orange County, seeing the virus rampaging through her community, had issued a mask order only to have the CDC waffle about the need for masks. She’d been run out of her job and, finally, for fear of her safety, the state.

(p. 291)

Ioannidis predicted that no more than ten thousand Americans would die. He condemned social distancing policies as a hysterical overreaction. That was all that those who wished to deny the reality needed to be able to say, Look, we have experts, too. To say: See, all the experts are fake. Carter had received threats in the mail from such people, who had learned of his role in the strategy.

(p. 295)