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Premonition: A Pandemic Story – Michael Lewis

by Venky
The Premonition: A Pandemic Story

Michael Lewis has this gifted and almost uncanny propensity to select seemingly complex and sacrilegious topics and present them for the consumption of his readers in a breezy and mind numbing manner that would put even the best fictional thriller to utter shame. His latest “Premonition” is no exception to this unique norm. The book details the valiant exploits of an iconoclastic band of medical experts who tried to goad a hapless and haphazard United States administration to take decisive and pre-emptive steps to combat the COVID-19 pandemic when it was still in its nascent phase. A former White House colleague in the George Bush administration even termed this intrepid band, the “Wolverines.” Michael Lewis calls them “a rogue group of patriots working behind the scenes to save the country.”

The genesis behind the evolution of the Wolverines was a seminal book on the 1918 influenza pandemic, “The Great Influenza: The Story of the Deadliest Pandemic in History” by John Barry. After reading the book, Bush realised that the United States was dearly lacking an effective plan for pandemic prevention. He tasked Rajeev Venkayya, a physician heading the Biodefense Directorate to come up with a ‘pandemic preparation plan.’ Venkayya assembled a band of unique and unconventional experts to aid him in this endeavour. He deliberately left the premier institution the Centres for Disease Control and Prevention (“CDC”) from this exercise, having accurately assessed its probable intransigence. Driving the entire exercise was an odd couple pairing of Richard Hatchett and Carter Mecher. Richard Hatchett was a doctor with a penchant for poems that caught the eye of eminent poets such as Donald Davie and Mark Jarman. He also worked the emergency rooms Memorial Sloan Kettering Cancer Centre, and also the pioneer who extrapolated the concept of “Social Distancing” as an effective strategy to combat communicable diseases. Carter Mecher on the other hand, was an incorrigible son of the soil. A genius in thinking out of the box, he was also a maverick when it came to offering ingenious solutions to seemingly intractable problems. Carter fixed many problems ailing the Veteran Administration and made it into a smoothly and reliably functional health unit.

Ken Staley, who worked in Venkayya’ s bioterrorism unit, called them, “the odd couple.” “Richard played chess and quoted Borges; Carter took apart pickup trucks and put them back together. Much of what Richard loved doing could be done in a white linen suit. Much of what Carter loved doing left his hands black. Richard liked to borrow a phrase, Carter a tool. Richard was top-down—he conversed easily with the fancy academics and important policy people, and they with him. Carter was bottom-up—there was no fact, and no person, trivial enough to evade his curiosity. Richard left every classroom he entered at or near the top; Carter often just left the classroom. Carter poked fun at the way Richard walked around saying important-sounding things, like “All models are wrong; some of them are useful,” but he felt the alchemy in their interactions.”

Another Wolverine or “Wolverette”, being the only woman in the team, Charity Dean was the  former deputy director of California’s Department of Public Health. A daredevil with an uncompromising degree of integrity, Charity Dean always found herself bucking the ‘establishment’ trend. From being forced to perform an autopsy herself with a pair of garden shears instead of a saw when the official coroner backed out of fear since the deceased was a patient suffering from a virulent strain of tuberculosis, to being shut out of meetings and calls by her obdurate boss for mentioning the word “pandemic”, Dean’s professional career proceeded from one wrangle to the next.

This motley crew taking invaluable cues from the 1918 Spanish flu pandemic, where Philadelphia, having instituted Non Pharmaceutical Intervention measures just a week prior to the peak level of transmission, suffered twice the number of fatalities that afflicted St. Louis, which managed to get social distancing measures in place far earlier in the game, devised certain key “social distancing” measures. For instance, Mecher showed how an early closure of schools could make all the difference in the event a pandemic struck the country in future. Children enjoyed a far greater proportion of intimate, unstructured, and spontaneous social encounters than adults, and those interactions were triggers and breeding grounds for outbreaks. 

The task force faced its first challenge not during the Bush tenure but during the Presidency of Barack Obama. The year 2009 witnessed an outbreak of swine flu. Due to their previous involvement in pandemic management, Mecher and Hatchett are brought back to the White House to offer their suggestions. However the duo’s proposal of a school shutdown is rejected by a preternaturally conventional and risk averse CDC. Obama ultimately consents to the CDC. Thankfully from a crisis perspective, the outbreak turns out to be much less volatile and severe, but from a future pandemic prevention perspective, sets a very negative and discouraging trend. In Dean’s words, “the CDC — they do mental masturbation and  talk in circles for an hour and reach no decision.”

The failings and foibles of a health care system teetering on the brink of inefficiency and incompetence is highlighted in eviscerating manner by Michael Lewis. Joe DeRisi an absolute genius when it came to decoding the genome sequencing of infectious disease and a recipient of the highly touted “MacAthur Grant”, bore the full condescension of the health care system. An integral part of the Chan Zuckerberg Biohub, DeRisi and his team at the nonprofit lab offered hospitals COVID-19 tests for free and in a rapid manner. The hospitals refused to avail of this offer by quoting the ludicrous reason of their incapability to code their systems for a $0 test! The people manning the nonprofit lab also ordered a shipment of nasal swabs from the Strategic National Stockpile only to find to their utter chagrin that the containers all contained Q-Tips! An altruistic venture capitalist was left carrying a con can when in offering hep he procured ‘nasal swabs’, which turned out to be eyelash brushes. “There was something deeply dysfunctional about how the government worked that I never fully grasped,” De Risi said later expressing his utter exasperation. “There’s no one driving the bus. God knows what the hell is wrong with them.”

“Premonition” is a compelling David v Goliath paradigm, that centres on the inadequacies and inchoateness of public health care institutions that keeps failing the citizens repeatedly and a band of indefatigable individuals who have made it their avowed objective to right a ship that is threatening to keel over. The essence of the books is captured by a marvelous letter penned by Bill Foege, the former Director of the CDC, and a legendary figure in humanity’s combat against infectious diseases. On the 23rd of September 2020, the eighty-four year old Foege addressed the current CDC Director Robert Redfield, “I start each day thinking about the terrible burden you bear. I don’t know what I would actually do, if in your position, but I do know what I wish I would do. The first thing would be to face the truth. You and I both know that: 1) Despite the White House spin attempts, this will go down as a colossal failure of the public health system of this country. The biggest challenge in a century and we let the country down. The public health texts of the future will use this as a lesson on how not to handle an infectious disease pandemic.”…. You could upfront, acknowledge the tragedy of responding poorly,” he wrote, “apologize for what has happened and your role in acquiescing, set a course for how CDC would now lead the country if there was no political interference, give them the ability to report such interference to a neutral ombudsman, and assure them that you will defend their attempts to save this country. Don’t shy away from the fact this has been an unacceptable toll on our country. It is a slaughter and not just a political dispute . . . The White House will, of course, respond with fury. But you will have right on your side. Like Martin Luther, you can say, ‘Here I stand, I cannot do otherwise.’ ”Suffice it to say neither Redfield nor the Trump administration decided to behave with dignity for its accountability to the severely affected public.

“Premonition”: Not just a book for the dystopian times that humanity is going through, but a lesson for the ages.

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