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julieparsonnet 's review for:
The Premonition: A Pandemic Story
by Michael Lewis
I started The Premonition but couldn't get past the second chapter. It began like an error-filled screed filled with unlikeable (waaa! no one is listening to me!) protagonists Why go further?
There are MANY reasons to criticize the US response to COVID but, starting in the first chapter, Mr. Lewis takes everything told to him at face value without any critical evaluation. Nothing that the Santa Barbara health officer did was subject to any scrutiny; her negative comments about CDC are just taken at face value. And it seems many of the things that she did could, in fact, have been wrong. Going down the list: what was the reason for the autopsy? They seem to already have the diagnosis and the isolate and they could have just done contact tracing. As an infectious diseases epidemiologist myself, I found it perplexing and, yes, potentially unnecessarily risky. For meningococcus and hepatitis C, county health officers typically go through the state health department, they don't go right to the CDC . These are bread and butter problems. More specifically, there is not just one case of group B meningococcus every four years as Lewis states, there are a few hundred annually in the US.
Tried and true, published protocol, written by the CDC, detail how to manage transmission. That's why there are so few cases. The health officer wanted to try something new (the then unapproved meningococcus B vaccine) but, as the CDC recommended, it should have been done within a clinical trial since the standard of care is already outstanding with little to no transmission As for the hepatitis C episode, that is the life of a health officer. A "nice" outbreak with a good resolution. Yet Lewis uses the episode to harangue the CDC and the State Medical Board. With respect to the mudslide, there is no risk for vibrio cholera in California and it never causes a rash. Either the author or the health officer confused it with Vibrio vulnificus. And although I'm not sure about whether she did the right thing about evacuating the nursing home, the county of 7 deaths makes me suspect that she did not or that there were better ways to have managed the situation.
So who was right here? And who was arrogant? It is notable that the CDC responded each time she called, with multiple people (a weird complaint that there were too many people on the phone). The chief complaint seems to be that they didn't uniformly back her approach. Well, maybe the health officer was actually wrong. How about looking into that, Mr Lewis? Are there not two sides?
Lewis makes it sound like the CA state health officers are dottering retirees. In fact, the health officers in the highly populated counties and many of the others are mid-career and outstanding public health leaders.
In the first two chapters, Mr. Lewis makes the CDC sound like overbearing overlords of public health. That may well be true and it certainly has been stated by others at local and state health departments. Although they have had many triumphs, during COVID, CDC was arrogant, too certain about things that were incorrect, and lumbering in their responses. It appeared bloated, insular and tone-deaf. As I waded into chapter three, I saw a similar, poorly substantiated, yellow-journalistic approach to DHS and HHS. I couldn't go on. How much of the failed response to COVID was politics vs. poor leadership vs. intrinsic flaws in the system is unknown. It would make a great book. Just not this one.
There are MANY reasons to criticize the US response to COVID but, starting in the first chapter, Mr. Lewis takes everything told to him at face value without any critical evaluation. Nothing that the Santa Barbara health officer did was subject to any scrutiny; her negative comments about CDC are just taken at face value. And it seems many of the things that she did could, in fact, have been wrong. Going down the list: what was the reason for the autopsy? They seem to already have the diagnosis and the isolate and they could have just done contact tracing. As an infectious diseases epidemiologist myself, I found it perplexing and, yes, potentially unnecessarily risky. For meningococcus and hepatitis C, county health officers typically go through the state health department, they don't go right to the CDC . These are bread and butter problems. More specifically, there is not just one case of group B meningococcus every four years as Lewis states, there are a few hundred annually in the US.
Tried and true, published protocol, written by the CDC, detail how to manage transmission. That's why there are so few cases. The health officer wanted to try something new (the then unapproved meningococcus B vaccine) but, as the CDC recommended, it should have been done within a clinical trial since the standard of care is already outstanding with little to no transmission As for the hepatitis C episode, that is the life of a health officer. A "nice" outbreak with a good resolution. Yet Lewis uses the episode to harangue the CDC and the State Medical Board. With respect to the mudslide, there is no risk for vibrio cholera in California and it never causes a rash. Either the author or the health officer confused it with Vibrio vulnificus. And although I'm not sure about whether she did the right thing about evacuating the nursing home, the county of 7 deaths makes me suspect that she did not or that there were better ways to have managed the situation.
So who was right here? And who was arrogant? It is notable that the CDC responded each time she called, with multiple people (a weird complaint that there were too many people on the phone). The chief complaint seems to be that they didn't uniformly back her approach. Well, maybe the health officer was actually wrong. How about looking into that, Mr Lewis? Are there not two sides?
Lewis makes it sound like the CA state health officers are dottering retirees. In fact, the health officers in the highly populated counties and many of the others are mid-career and outstanding public health leaders.
In the first two chapters, Mr. Lewis makes the CDC sound like overbearing overlords of public health. That may well be true and it certainly has been stated by others at local and state health departments. Although they have had many triumphs, during COVID, CDC was arrogant, too certain about things that were incorrect, and lumbering in their responses. It appeared bloated, insular and tone-deaf. As I waded into chapter three, I saw a similar, poorly substantiated, yellow-journalistic approach to DHS and HHS. I couldn't go on. How much of the failed response to COVID was politics vs. poor leadership vs. intrinsic flaws in the system is unknown. It would make a great book. Just not this one.