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4.3 AVERAGE
4.3 AVERAGE
FASCINATING. Reads like an action novel, but real, and of a wild time we remember.
Read this if you want to be disturbed and probably triggered by how the US handled the pandemic. Absolutely bananas….but overall really interesting. I can say I learned more from this book than I expected.
informative
medium-paced
In "The Fifth Risk" Michael Lewis argued that the United States government is filled with experts you never hear about who are working tirelessly to prevent disasters of all kinds, but their work is being systematically undermined by politics, to the detriment of millions. "The Premonition" is the companion piece to "The Fifth Risk". It's a chilling story of how the broken US health care system - especially the CDC - and the federal government failed to stop the COVID catastrophe, even though there were people who saw clearly what was happening and knew what to do.
I hesitated a little before picking this book up. Because I wasn't sure if I wanted to read a book about the COVID pandemic when we were only just emerging from two years of uncertainty, lockdowns, social distancing measures. There wasn't enough distance yet. But to date, I've never regretted reading a Michael Lewis book - the man can really tell a story. And The Premonition is a story about "the curious talents of a society, and how those talents are wasted if not led. It's also about how gaps open up between a society's reputation and its performance". In short, it's how the US had all the elements in place to demonstrate global leadership in successfully tackling COVID yet failed miserably.
This ensemble story features the following cast of characters:
- Laura Glass and her father, Sandia National Laboratories scientist Bob Glass, who developed an agent based model to show how a pathogen might spread through social networks (and how limiting social interactions amongst young people could stop transmission). This was in 2005.
- Dr Charity Dean, chief health officer for Santa Barbara County and subsequently, during the pandemic, the Asst Health Officer of California. Favourite bit about Dean, when she recounts the Santa Barbara coroner refusing to do an autopsy of a TB case and telling her if she wanted an autopsy, she had to do it herself (banking on the fact that she would back down). But Dean does the autopsy with the garden shears he gave her and Lewis writes:
"They had no idea of the things she had done, or what she was capable of. The coroner obviously hadn't even considered the possibility that she was a trained surgeon. "Men like that always underestimate me," she said. "They think my spirit animal is a bunny. And it's a fucking dragon.""
- Rajeev Venkayya, whom George Bush tasks with developing a strategy for tackling a pandemic after Bush reads John Barry's The Great Influenza in 2005. (Should I be comforted or alarmed that Venkayya knocks on the 12 page strategy in 6 hours on a Friday night at his parents' place? And by Venkayya's admission that "the 12 pages he'd written on his own amounted less to a plan than a plan to have a plan…. [being] written for an audience of one: the president…to get [him] off the ledge"? And the fact that all the cabinet secretaries signed off on it in 5 days to appease Bush and that Congress subsequently acceded to Bush's request for $7.1 billion to implement this strategy?). Venkayya subsequently received permission to hire seven people from the relevant federal agencies to help him implement the strategy. He gets people from the State Department, from the Justice Department, Department of Agriculture, Department of Homeland Security. The bureaucratic processes Lewis describes - drafting a chapter, sending it round to agencies for comments and approval, receiving multiple comments from multiple people (from the same agency) that the drafter is expected to reconcile and consolidate - would be familiar to most bureaucrats, even those outside the US, I reckon.
- Venkayya's team also includes Dr Richard Hatchett from the NIH and Dr Carter Mecher from the Department of Veterans Affairs. Mecher's talent is in fixing problems, doggedly investigating and delving into the details till he can diagnose the cause of the issue and set about resolving it. Favourite quote from Mecher: "[To Mecher, the nurses who made a fatal mistake] were victims, too. The environment in which they worked, and which they had been encouraged to trust, had failed them. "When you go into the details of the cases, you see it's not bad people…[i]t's bad systems. When the systems depend on human vigilance, they will fail." Second favourite bit: "The gist of it was that people don't learn what is imposed upon them but rather what they freely seek, out of desire or need. For people to learn, they need to want to learn…People in an organisation learn…They're learning all kinds of things. But they aren't learning what you are teaching them. You go to a formal meeting. The important conversation is not in the meeting. It's in the halls during the breaks. And usually what's important is taboo. And you can't say it in the formal meeting."
- Joe DeRisi, a superstar research biochemist based at UCSF, who develops a way to rapidly test for COVID-19. He also runs the Chan Zuckerberger Biohub, which gave him significant resources to work with. But notwithstanding DeRisi's lab developing a fast and accurate (and free!) test that trumped those provided by Labcorp and Quest Diagnostics, there were no takers for these tests. Because hospital computers would regard zero cost lab tests or nominal cost tests as an error. Because institutions (like prisons and hospitals) worried that using the Biohub testing services would put them in breach of their contracts with Quest. Because the US had a shortage of nasal swabs and the federal stockpile only had Q-tips in it. Because even if local health offices took DeRisi up on his offer, they were "so understaffed and under-equipped that they had trouble using the test kits…most were unable to receive the results electronically".
In The Premonition, Lewis lays out how, while in theory, the CDC sat atop the system of infectious disease management in the United States and indeed the world, in reality, the incentives were stacked against the CDC exercising bold leadership. Being staffed by people who regarded themselves as the world's authorities on disease control constrained the CDC's ability to think out of the box. It had no incentives to share information with other (viewed as lesser) players in the eco-system. Lewis paints a damning picture of an organisation which failed in its mandate to tackle the pandemic decisively, whose focus was instead on research and publication, managing public perception of itself, and not rocking the boat. Lewis describes the CDC as being "at its heart a massive university…[i]t's people were good at figuring out precisely what had happened, but by the time they'd done it, the fighting was over. They had no interest in or aptitude for the sort of clairvoyance that was needed t the start of the pandemic."
He lays out how any advances made in the US's fight against COVID were made despite the government; he credits instead the frantic and valiant efforts of the informal grouping working behind the scenes and who call themselves "the Wolverines" (whose members include Hatchett and Mecher, Matt Hepburn from DARPA who worked on rapid vaccine development), including Hatchett's decision to hand out more than a billion dollars to manufacturers including Moderna to speed up development of a vaccine. Lewis observes that there is "no system of public health in the US, just a patchwork of state and local health officers, beholden to a greater or lesser degree to local elected officials. Three thousand five hundred separate entities that had been starved of resources for the past forty years." Charity Dean would describe the government's pandemic response as "all optics".
A riveting, yet sobering, read.
This ensemble story features the following cast of characters:
- Laura Glass and her father, Sandia National Laboratories scientist Bob Glass, who developed an agent based model to show how a pathogen might spread through social networks (and how limiting social interactions amongst young people could stop transmission). This was in 2005.
- Dr Charity Dean, chief health officer for Santa Barbara County and subsequently, during the pandemic, the Asst Health Officer of California. Favourite bit about Dean, when she recounts the Santa Barbara coroner refusing to do an autopsy of a TB case and telling her if she wanted an autopsy, she had to do it herself (banking on the fact that she would back down). But Dean does the autopsy with the garden shears he gave her and Lewis writes:
"They had no idea of the things she had done, or what she was capable of. The coroner obviously hadn't even considered the possibility that she was a trained surgeon. "Men like that always underestimate me," she said. "They think my spirit animal is a bunny. And it's a fucking dragon.""
- Rajeev Venkayya, whom George Bush tasks with developing a strategy for tackling a pandemic after Bush reads John Barry's The Great Influenza in 2005. (Should I be comforted or alarmed that Venkayya knocks on the 12 page strategy in 6 hours on a Friday night at his parents' place? And by Venkayya's admission that "the 12 pages he'd written on his own amounted less to a plan than a plan to have a plan…. [being] written for an audience of one: the president…to get [him] off the ledge"? And the fact that all the cabinet secretaries signed off on it in 5 days to appease Bush and that Congress subsequently acceded to Bush's request for $7.1 billion to implement this strategy?). Venkayya subsequently received permission to hire seven people from the relevant federal agencies to help him implement the strategy. He gets people from the State Department, from the Justice Department, Department of Agriculture, Department of Homeland Security. The bureaucratic processes Lewis describes - drafting a chapter, sending it round to agencies for comments and approval, receiving multiple comments from multiple people (from the same agency) that the drafter is expected to reconcile and consolidate - would be familiar to most bureaucrats, even those outside the US, I reckon.
- Venkayya's team also includes Dr Richard Hatchett from the NIH and Dr Carter Mecher from the Department of Veterans Affairs. Mecher's talent is in fixing problems, doggedly investigating and delving into the details till he can diagnose the cause of the issue and set about resolving it. Favourite quote from Mecher: "[To Mecher, the nurses who made a fatal mistake] were victims, too. The environment in which they worked, and which they had been encouraged to trust, had failed them. "When you go into the details of the cases, you see it's not bad people…[i]t's bad systems. When the systems depend on human vigilance, they will fail." Second favourite bit: "The gist of it was that people don't learn what is imposed upon them but rather what they freely seek, out of desire or need. For people to learn, they need to want to learn…People in an organisation learn…They're learning all kinds of things. But they aren't learning what you are teaching them. You go to a formal meeting. The important conversation is not in the meeting. It's in the halls during the breaks. And usually what's important is taboo. And you can't say it in the formal meeting."
- Joe DeRisi, a superstar research biochemist based at UCSF, who develops a way to rapidly test for COVID-19. He also runs the Chan Zuckerberger Biohub, which gave him significant resources to work with. But notwithstanding DeRisi's lab developing a fast and accurate (and free!) test that trumped those provided by Labcorp and Quest Diagnostics, there were no takers for these tests. Because hospital computers would regard zero cost lab tests or nominal cost tests as an error. Because institutions (like prisons and hospitals) worried that using the Biohub testing services would put them in breach of their contracts with Quest. Because the US had a shortage of nasal swabs and the federal stockpile only had Q-tips in it. Because even if local health offices took DeRisi up on his offer, they were "so understaffed and under-equipped that they had trouble using the test kits…most were unable to receive the results electronically".
In The Premonition, Lewis lays out how, while in theory, the CDC sat atop the system of infectious disease management in the United States and indeed the world, in reality, the incentives were stacked against the CDC exercising bold leadership. Being staffed by people who regarded themselves as the world's authorities on disease control constrained the CDC's ability to think out of the box. It had no incentives to share information with other (viewed as lesser) players in the eco-system. Lewis paints a damning picture of an organisation which failed in its mandate to tackle the pandemic decisively, whose focus was instead on research and publication, managing public perception of itself, and not rocking the boat. Lewis describes the CDC as being "at its heart a massive university…[i]t's people were good at figuring out precisely what had happened, but by the time they'd done it, the fighting was over. They had no interest in or aptitude for the sort of clairvoyance that was needed t the start of the pandemic."
He lays out how any advances made in the US's fight against COVID were made despite the government; he credits instead the frantic and valiant efforts of the informal grouping working behind the scenes and who call themselves "the Wolverines" (whose members include Hatchett and Mecher, Matt Hepburn from DARPA who worked on rapid vaccine development), including Hatchett's decision to hand out more than a billion dollars to manufacturers including Moderna to speed up development of a vaccine. Lewis observes that there is "no system of public health in the US, just a patchwork of state and local health officers, beholden to a greater or lesser degree to local elected officials. Three thousand five hundred separate entities that had been starved of resources for the past forty years." Charity Dean would describe the government's pandemic response as "all optics".
A riveting, yet sobering, read.
A story of bureaucracy, of courage, and of political baloney. An interesting read, though I'd be curious to read a similar story except from _inside_ the CDC rather than just an entire book lambasting it.
Excellent read that documents all the ways in which the US pandemic response failed. I think what is troubling is the fact that it was likely to fail no matter who was in power.
3.75 stars. An interesting look into those who saw the pandemic coming before the first case even occurred.
Also, a big takeaway: that the CDC is an organization that completely lost its way, and time will tell if it will ever recover.
Also, a big takeaway: that the CDC is an organization that completely lost its way, and time will tell if it will ever recover.
"We are the bad example for the world."
Fascinating, disheartening book about some of the smartest people in America putting together a comprehensive pandemic plan and then having it not implemented, leading to the avoidable deaths of hundreds of thousands. A fascinating, disheartening look at how the politicization of the CDC leadership, beginning under Reagan and continuing through at least the Trump years, caused the agency to do more to hamper pandemic response than to implement it. A fascinating, disheartening look at how this country's lack of a national public health system left local public health officers to make the decisions in fighting the pandemic.
The next pandemic is just waiting to happen. One hopes lessons will be learned - and learned quickly - from this one. If they are Michael Lewis will be due some of the credit.
Fascinating, disheartening book about some of the smartest people in America putting together a comprehensive pandemic plan and then having it not implemented, leading to the avoidable deaths of hundreds of thousands. A fascinating, disheartening look at how the politicization of the CDC leadership, beginning under Reagan and continuing through at least the Trump years, caused the agency to do more to hamper pandemic response than to implement it. A fascinating, disheartening look at how this country's lack of a national public health system left local public health officers to make the decisions in fighting the pandemic.
The next pandemic is just waiting to happen. One hopes lessons will be learned - and learned quickly - from this one. If they are Michael Lewis will be due some of the credit.