The Premonition Book Review
30 Oct 2021
- David Baker
Tag:
books
I listen to Michael Lewis’s podcast Against The Rules, so when I heard he wrote a book on the pandemic called The Premonition I scooped it up on Audible. The book follows two public health experts, Charity Dean and Carter Mecher, as they navigate what would appear to be a tremendous amount of barriers put in place to prevent the country from an effective pandemic response. The book identifies something called “The L6” which is referring to an interesting observation that whenever something goes wrong in an organization, the people most likely to know the most about the problem are 6 layers deep from the top. Charity Dean and Carter Mecher are the L6.
The book really comes off to me as a tragedy of systemic failures. Even with infectious disease experts ready and willing to tackle the pandemic the system can work against them at every step.
- In the case of Charity Dean, she was blocked by her own boss from attending meetings, sending emails, and being proactive at all regarding the pandemic.
- There is no central pandemic response, so when local public health authorities stick their own necks out for effective disease control it comes at a huge risk to themselves professionally because they do not have the backing of state or federal agencies.
- The White House controlled the pandemic response optics, and they were firing anybody whose messaging did not align with theirs. Infectious disease experts had to meet in secret to form a response.
- The CDC is a bureaucratic nightmare incapable of effective leadership. They are a data-driven organization, but during the beginnings of a pandemic there is not going to be enough data leading to a lack of action. This method of handling potential outbreaks effectively makes them inevitable.
- Since Reagan times the CDC is run by White House appointees not by career experts, so the CDC leadership is entirely at the service of the White House. This is quite a clear conflict of interest if the White House political messaging doesn’t coincide with scientific consensus.
One of the more frustrating things about the book was that even with the misinformation from China and from the White House, the infectious disease experts who were meeting in secret from the White House still had a good idea of what was going on early in the pandemic just with their observational data. The fact that infectious disease experts could tell what was going on but nobody wanted to listen to them kind of makes the problem worse.
- They knew china was building 1000 bed hospitals while reporting only a few dozen cases.
- All infectious observational data was consistent with the infection rate of the 1918 flu.
- They were pushing for immediate testing but the CDC was refusing to even test people coming back from Wuhan.
- They quickly knew people were getting infected who hadn’t been to Wuhan, inferring it was already spreading.
- By the time Trump was tweeting that only 1 person had it and it was in control, they knew it was out of control.
- They already knew the background rate of flu-like symptoms in hospitals was above the yearly expected background rate before anybody was taking the pandemic response seriously.
The book failed to touch the successful parts of the pandemic response. The speed, safety, and efficacy of the vaccine development was not mentioned at all, and really deserves to be praised. Otherwise the book is just a reminder of how we are pretty much doomed to repeat all this again.