Christina Amanpour interviews author Michael Lewis May 6, 2021 about his new book “The Premonition.” 

In his book, Michael Lewis followed three characters involved in the public health system and tells their stories.  The stories carry lessons for pandemic response in the past and the future.

As Amanpour notes, Lewis had already written about the hollowing out of creative professionals in the ranks of government.  This hollowing out left a bureaucracy afraid of creativity and afraid of risk.  When COVID hit, the CDC which should have been the leader, was afraid to act. 

As Ezra Klein noted in his article about  Lewis’ book in the New York Times (May 2021), the CDC was “too passive, too unwilling to act on uncertain information, too afraid of making  mistakes, too interested in its public image.”

According to Lewis, the hollowing out of the CDC, the loss of their reputation, happened long before Trump.  I was interested to hear this since during the COVID crisis I kept wondering how Trump could eviscerate the CDC so rapidly.  Turns out he didn’t. 

According to Lewis, by 2012 the CDC had become an academic institution reluctant to take on any action aside from studying problems.  It had, according to Lewis, become a “disease observation and reporting” institution, not a disease control center.

Lewis tells the stories of several people involved in the public health system and their experiences dealing with the CDC. One, Charity Dean, was a public health official on the ground, locally.  When she tried to get assistance from the CDC for public health problems, she found none.  In fact, she found active hostility.  When she called on the CDC to help her they actually obstructed her investigations. 

Lewis commented that if the three people whose stories he told were asked whether the CDC would act as the battlefield commander in the event of a pandemic, they would have answer no.  The Centers for Disease Control had ceased to function to control disease.

It was obvious to some people, people who were actively trying to develop strategies for a future pandemic, that a battlefield commander was going to be needed.  But, the CDC wasn’t listening.

As Lewis tells tells the story, after 9/11 and Katrina, George Bush was primed to be concerned about any unexpected threat.  Sometime in 2005, he was handed the book “The Great Influenza.”  He supposedly read it and asked about the plan for dealing with a future pandemic.  The answer was that there wasn’t any.

Surprisingly, the Bush administration acted quickly and within weeks had Congress appropriate money to study the issue and devise a strategy.  Lewis notes how this back story illustrates just what can be done quickly when the President focuses on an issue and decides to get something done.

And, also surprisingly, the individuals brought in from various federal agencies were nominated because of their reputation for creative thinking.  That in-and-of itself is extraordinary.  In a country that spends untold amounts of money creating commissions and investigations filled with dignitaries and political donors, this body was staffed by people who were creative.  Go figure.

These folks Bush appointed to the commission, created a testing, tracking and social distancing strategy and convinced the rest of the world that it could be effective.  This strategy was designed to decrease mortality during the period between the onset of a pandemic and the development of vaccines.

The kicker was that after convincing a skeptical world that this public health strategy could work, the country that developed it failed to adequately put it into effect when a read pandemic occurred.

Lewis noted that this was because the strategy was widely considered to be a theoretical idea not an implementable public health measure.   Similarly, a pandemic was considered to be a theoretical threat, not a real possibility.

But, people on the ground, people like Charity Dean, one of the people in Lewis’ book, were looking at factors like the increasing worldwide transmission of viruses from animals to humans.  What they were looking at wasn’t a theoretical possibility.  When they looked at the evidence, the outbreak of a dangerous pandemic was a matter of when not if.

But, as Charity Dean told Lewis, people like her felt like Moses, building the ark.  Everyone around them accused them of lunacy.  So, there were people who knew a dangerous pandemic was coming.  When Trump went on national TV and claimed that the COVID virus outbreak was a total shock to the world, he was (as usual) lying.

By 2011 people like Charity Dean, people on the local level of public health, knew not only that a pandemic was coming, but that the country was unprepared.  The population, however, (as usual) was being told that we were the most prepared country in the world. 

Studies ranking preparedness, listed the U.K. an the U.S. as the most prepared countries in the world.  They were wrong.  They made people feel good.  They made people complacent, but they were wrong. 

As Lewis noted, the U.S. with 4% of population would up with 20% of the deaths.  Somehow, sometime, Americans are going to have to stop creating and repeating and believing their own propaganda. 

Crisis response is not about having the most resources or the most labs or the most prestigious boards at the CDC.  Lewis detailed some of the problems that are part of the structure of the society, features that make crisis response (whether it’s to a war or a pandemic) almost impossible.

Lewis and doctors at the WHO, talked about the endemic fear of failure.  As one of the doctors at the WHO put it, in March of 2020, fear of failure, fear of making a mistake has become paralyzing. “If you need to be right before you move, you will never win.”

Lewis noted that the culture has been primed to punish viciously crimes of commission, but to forget crimes of omission.  It doesn’t take much to predict which crimes will be the most prevalent. 

Many of the researchers who understood and warned about the coming pandemic believe that this is not the serious pandemic they are concerned about.  They believe that this is only a dry run.  The real pandemic has yet to happen.  We all need to put that in our pipes and smoke.   

TOMORROW: How the For-Profit Health Care System Crippled the pandemic Response.