Michael Lewis on the Unlikely Trio That Defeated the Pandemic
The saga of local public health officials tasked with fighting epidemic disease, and their clashes with national health authorities who didn’t care, was a perfect recipe for putting readers to sleep. But Michael Lewis made it into high drama.
I couldn’t put it down. That’s about the worst opening for a book review that I can think of, but I did read Lewis’s The Premonition: A Pandemic Story in one sitting – despite my having gobbled up reams of literature about COVID-19 in the last year and a third.
This is the second of Michael Lewis’s books about the micro-functioning of government. It is a sequel to his 2018 book, The Fifth Risk, which was about the Departments of Energy, Agriculture, and Commerce under the Trump administration. In that volume, Lewis coaxed us into appreciating the diligent work done by experts several layers down from the top, working in agencies that we know little about. (The first four risks are not specific threats but categories: severe and mild consequences, plotted against low and high likelihood. The fifth one is project management, as unlikely a topic for a page-turner as has ever been chosen.2)
While The Fifth Risk chronicled the work of federal government employees, The Premonition focuses on the local ones who interact daily with the people they’re sworn to protect. Of course, in a pandemic, local issues quickly become national and global ones, but it’s at the level of homes, schools, and hospitals where the peculiar characteristics of a disease and the habits of the people who contract it are first noted. Only then does information filter through to the familiar national authorities.
The heroine and the heroes
The heroine of the book is Dr. Charity Dean, who started out in Santa Barbara, California’s public health department, became assistant public health director for the state, and is now an entrepreneur and professor at the University of Southern California. In a 60 Minutes interview, Lewis recalled, “Charity…thinks she's all alone, all alone in the world, aware in January that this pandemic [will] sweep through the United States and nobody's doing anything about it, including her state government.”3
Soon, she is introduced to a renegade group of doctors called the Wolverines, named after a team of high-school guerrilla warriors in the 1984 movie Red Dawn (you can’t make this up). As the team takes shape, her concerns begin to filter upward, but only after encountering roadblocks at the highest levels of government.
The book, like many of Lewis’, is built around an individual toiling in relative obscurity to achieve something good: think of Leigh Anne Touhy, who raises a very unusual son in The Blind Side, and Brad Katsuyama, who builds a system for defeating greedy high-frequency stock traders in Flash Boys. Accounts of ordinary people who turn out to be extraordinary are appealing – and Lewis is a master of the genre. Charity Dean is the key figure, but two Wolverines also play central roles in The Premonition.
Unlike Dean, Dr. Carter Mecher resided within the belly of the beast. A senior medical adviser at the U.S. Department of Veterans Affairs, Mecher wrote on January 28, 2020 that “WHO and CDC [were] behind the curve.” On February 20 he warned that the outbreak of COVID on cruise ships was, “a preview of what will happen when this virus makes its way to the U.S. healthcare system [and especially] … nursing homes. I’m not sure that folks understand what is just over the horizon.”4
Both Dean and Mecher had already studied virus contagion in detail. Dean observed that schoolchildren socialize in much closer quarters than adults do. She believed that closing schools would be the most valuable action to take in a flu pandemic. (Unlike COVID, flu is serious in children and is easily transmitted by them.) Mecher was part of a federal group that performed battle-plan pandemic simulations using the Bush administration’s template. The group, he said, “concluded they would soon need to move toward aggressive social distancing, even at the risk of severe disruption to the nation’s economy and the daily lives of millions of Americans.”5
If this policy had been adopted when Mecher and his colleagues recommended it, the virus might have been stopped early in 2020; that is, R0, the transmission rate, might have fallen below 1. The endless lockdown and ensuing economic catastrophe might have been avoided.6
Joe DeRisi is the third musketeer. You knew there would be a tech genius in this story somewhere. He is a biochemist and biophysicist at the University of California San Francisco who invented “the Virochip – a…chip with DNA sequences from every virus ever discovered,” writes Steve Vasallo at Forbes.7 “With this technology, Joe’s UCSF lab can test blood or spinal fluid against every known infection, offering new hope for cases previously dismissed as undiagnosable.” Not just every virus that affects humans, but viruses across the animal kingdom that have the potential to make the jump to people.
Put together Mecher, the government doctor; DeRisi, the virus hunter and inventor; and Dean, the battlefield commander – and you just might beat the virus, despite opposition from higher-ups, including the then-president, who didn’t seem focused or aware of the danger. But this battle in the eternal war between humans and viruses would not be won right away. Hundreds of thousands of deaths and a devastating economic lockdown would intervene.
Pandemics that were and weren’t
One lesson that these experienced pandemic fighters had learned from their past battles was that pandemics are not all equal. The devastating 1918 Spanish Flu, which killed 600,000 Americans and perhaps 50 million people worldwide, spread at a wild pace among the young. As already noted, Dean observed that closing the schools resulted in rapid control of the contagion.
Mecher compared the COVID virus to the more recent (2003) SARS epidemic, which was contained almost immediately:
The original SARS had infected only eight thousand people, killing eight hundred, before it was contained.8 This new SARS [that is, SARS-CoV-2, the virus that causes COVID] had similar official stats, but he saw signs that the stats were misleading. The new SARS was spreading much more quickly from country to country…[and] was also eliciting very different [much more aggressive] behavior from the Chinese government.
Piecing together evidence like a movie detective and
practicing what some derided as “redneck epidemiology,” Mecher looked at details like Wuhan death notices – there were too many to be consistent with the official story – and the sudden appearance in Wuhan of a 1,000-bed quarantine hospital built in five days by the Chinese military. He also noted that about half of COVID cases were transmitted by people who had the virus but weren’t sick. This fact made COVID incomparably worse than diseases where only the sick were contagious. You couldn’t just remove sick people from the population and protect everyone else.
The disease was living among us and spreading fast.
SARS and MERS are under control. Ebola (not a coronavirus) ravaged three West African countries but did not spread. The difference between those threatened pandemics and the 1918 Spanish flu, it turns out, was in the social not the medical response. We don’t have antiviral drugs (cures) for any of these diseases. Until the appearance of the COVID vaccine, all we had was behavioral protocols. The hated social distancing protocol was supported by a study, not just of the 1918 flu, but of the pandemics that weren’t, where transmission was stopped by decisive early action.
The Wolverines’ and Charity Dean’s horrifying conclusion was that COVID-19 was not a repeat of the 1957 or 1968 flu pandemics or the SARS or MERS coronaviruses. COVID was 1918.9
Young men and fire
Part of Lewis’ genius, as with any great writer, is in making unexpected connections. In the case of the deadly Mann Gulch fire in Montana in 1949, Mecher made the connection for him. Mecher “had fire on the brain,” Lewis writes. “Fire was his favorite metaphor to convey how hard it was for people to wake up to a threat that grew exponentially.” The Mann Gulch fire, initially thought to be “small and simple,” turned into a nightmare that suddenly climbed a 76% slope and moved at 30 to 40 miles per hour. Only three of the 15 elite Forest Service smokejumpers there to fight it survived.
In a move that made the other firemen think he was crazy, the lead smokejumper (who survived) intentionally lit an “escape fire” that burned the grass in front of him. He safely trudged through the small fire and “felt the main fire passing by on either side of him, leaving him unscathed.” This is now standard procedure.
The writer and University of Chicago professor Norman Maclean, best known for his short book, A River Runs Through It, also chronicled the Mann Gulch fire.10 His book about it, Young Men and Fire, is also a classic…but not just because of its lessons for firefighters. Mecher heard a talk about the book and thought, “The Mann Gulch fire isn’t about fire… It’s also about pandemics,” writes Lewis. Mecher jotted down lessons for fighting a raging pandemic including, “Figure out the equivalent of an escape fire.”
Dean’s escape fire
The escape fire materialized not in the brain of Mecher, but in an unrelated story Dean was telling herself about her own traumatic past experiences. (This plot twist was a little hard to follow, the only flaw I found in Lewis’s narrative.) A trauma survivor – Dean’s traumas appear to be sexual although we are never quite told –
she [saw] the fire, growing exponentially, coming straight for her. In response she created an escape fire. Her escape fire was a story. In this new story she told herself about herself, she was never simply a victim. For whatever had happened she bore some responsibility.
[The story] had turned her into an action hero…[s]he was put on earth to fight battles, and wars, against disease.
The newly minted action hero quit her county job and moved to the state health department in Sacramento. She then proceeded on a rapid upward path that ended in the White House, advising and conferring with Dr. Duane Caneva, the chief medical officer of the Department of Homeland Security. Caneva was, “a sometime antagonist [of Dean’s] from her first days…as the number two public-health officer for California.” She perceived Caneva as an agent of the Trump administration, caging child migrants from Mexico, and didn’t at first realize that, in Lewis’ words:
there was this other Duane, who…belonged to this small, informal, almost secret group of…doctors who had once worked in the White House under Bush or Obama and were…now working, without the White House’s permission, to coordinate some kind of national pandemic response… Duane Canova wasn’t a storm trooper for Donald Trump. He was part of the resistance.
She had been introduced to the Wolverines. She called it a “break glass group.” In case of fire, break glass.
The surfer dude with a genius grant
Because Lewis pieces together a story that results in the eventual collision of three minds working at different times and in different places, some jumping around in time is required. Let’s look at how the coronavirus that causes COVID was discovered.
In 2003, at the age of 33 with the look and manner of a surfer, the microbiologist Joe DeRisi was the first to identify SARS. Regarded as a genius, with that rubric confirmed by a MacArthur Foundation “genius grant,” Lewis writes that,
… he’d been handpicked by UCSF’s faculty to skip the usual postdoc stage of formal scientific training and been given his own lab – because they didn’t want to waste a moment of his mind. “It’s a mind without boundaries,” said Don Ganem, a USCF microbiologist…who had pushed for DeRisi’s hire. “It’s a mind that is interested in everything and afraid of nothing. It’s a bandwidth that is hard for most people to fathom.”
The magic chip
DeRisi’s invention, the ViroChip, made it possible to label the mystery illness arriving from China in late 2019 as a novel coronavirus. The chip, actually a glass microscope slide, holds genetic sequences from all 22,000 known viruses. When one passes unidentified genetic material from a virus over the slide, some of the material sticks. Whatever sticks is a match to the known viral material on the slide.
If it sounds like magic, it’s pretty close.
Some of the genetic material from the mystery virus stuck to existing cow, bird, and human coronaviruses but was not an exact match to any of them. DeRisi concluded that it was a novel coronavirus, named SARS-CoV-2 by whoever gives official names to the nonliving (yet frantically evolving) bits of DNA or RNA, smaller than the shortest wavelength of visible light, that we call viruses.
The pop-up microbiology lab
By 2020, DeRisi ran not only his UCSF lab but also an outfit called the Chan Zuckerberg Biohub, created with a $600 million gift from the well-known tech couple. It was founded with the absurd goal of eradicating all diseases by 2100. (Diseases are not that stupid, and we are not that smart. We won’t win. But maybe it’s a way to get attention and attract the best people.) Chan Zuckerberg specialized in testing.
Once it got past the hurdle of not being trusted because it did not charge for its services and was funded by a disliked billionaire, the Chan Zuckerberg Biohub blew away the hospital/lab/regulatory agency combine. Lewis writes, “On March 18, just eight days after the idea was born, the…Biohub’s new COVID lab opened for business. It had taken Joe’s new team two days less to build an entire lab than it was taking Quest Diagnostics and Labcorp to process a single test.”11 Efficient COVID testing had begun.
Into the Mann Gulch fire
On March 6, 2020, California governor Gavin Newsom convened a large group of experts. Dean was one, and she noted that when you have a virus that is spreading exponentially, there are no tests, and people with no symptoms can spread it,
The only clear signal you get from the virus is death… [When] you realize that only half of 1 percent of the people who get [it] die, you can surmise that for every death, there are 199 people already walking around with it. That first death – which California had already experienced – was telling you that you had 200 cases a month earlier.
Assuming a reproduction rate of 3, Dean did the math and projected that
seven weeks from today you’d have 11,809,900 cases. As much as 10 percent or so of those people, more than a million Californian, would need a hospital bed. Half of 1 percent, or a bit more than 59,000 people, would die.
This forecast assumed no mitigation – that nobody would do anything to stop the virus. There is always mitigation, if not imposed from above then by people making their own decisions about what risks to take. The forecast was, unfortunately, uncannily accurate despite the extensive mitigation (masks, lockdowns, and so forth) that took place. As of May 27, 2021, 63,214 Californians had died of COVID, consistent with Dean’s estimate. More than 600,000 have died so far in the United States, and roughly 3.5 million in the world.12
Government versus government
A lesser writer could have more starkly framed the story as underdogs versus the establishment, and that has a whiff of truth to it. A fairer interpretation, however, is that there are two establishments, one that is careerist and obstructionist, and the other consisting of diligent public servants, mostly at lower levels in various governments (local, state, and federal) and in universities and private industry, who not only know and care about their fields of expertise but also are able to occasionally persuade the top brass that they are right.
Lewis is not fond of the way that the top levels of government function. The CDC comes across particularly poorly in The Premonition. In a CFA Institute-sponsored interview, he said,
We have an enterprise called the Centers for Disease Control, that actually isn’t set up to control disease. This is putting it a little harshly, but if you had asked the [CDC] to maximize illness in America because of COVID, they might not have behaved all that differently from what they did.13
Other agencies are just as bad. Yet Lewis does not blame the individuals working at CDC. It’s the institutional structure of government – the perverse incentives, the short tenure of political appointees, the many-layered bureaucracy, the redundant and competing agencies, the ever-present risk of being fired – that keeps government agencies from doing their job. We have much to learn from Lewis’s micro-analysis of these structures.
“When someone convinces me that I am wrong, I change my mind. What do you do?”
During the pandemic, I thought that the delegation of disease-fighting authority to the states was a risky but promising experiment in data gathering. Different approaches to disease containment would yield differing results, and we’d quickly be able to figure out what was working and what was not. Also, state and local public health workers could make decisions based on what they were observing on the ground, right in front of them, rather than in a faraway place where they were getting information second- or thirdhand.
While we did get some worthwhile data out of the experiment, The Premonition convinced me that I was wrong. (That’s why I titled this section with Keynes’ famous wisecrack.) The U.S. is such an open society, with state boundaries so porous by design, that a national pandemic strategy would have been preferable – if real experts, not the careerist stick-in-the-muds who block their every move (and who appear as villains in Lewis’s story) were in charge and had real power. Based on the parallels between COVID and 1918, social distancing and lockdowns should have been started much earlier. They would have also ended much earlier, with many fewer deaths and probably an open economy by summer 2020.
Everything including a disease that has killed one American in 500 has an upside we can learn from. Lewis writes that a year into the pandemic Charity Dean thought of COVID as:
Mother Nature’s gift to the country. The hardest part, to a public-health officer trying to control a communicable disease, was that you were always looking in the rearview mirror. COVID had given the country a glimpse of what Charity had always thought might be coming – a pathogen that might move through the population with the aid of asymptomatic spreaders, and which had a talent for floating on air. Now that we knew how badly we responded to such a threat, we could begin to prepare for it. “Mother Nature,” [she said], “has…tipped the odds in our favor.”
This is too sanguine a conclusion because it has cost between 600,000 and 900,000 lives, in the United States alone, just to get this view out the front windshield. (It is like saying that we learn from losing a war. We do but we still lost.) We had some idea what was coming as far back as the Bush and Obama administrations, and should have been much better prepared. Unfortunately, several “pandemics that weren’t” made us complacent. But now we’re not. Dean is right that we will be much better prepared for the next pandemic.
But the gift that Dean didn’t mention, one even more valuable than logistical preparation, is mRNA technology. It existed before COVID, but we didn’t know much about applying it. Now that we’ve had to sequence a rapidly mutating virus and develop an effective vaccine for it in a hurry, we know a lot.
Disease prevention using mRNA is, in fact, a general-purpose technology, adaptable to many viruses including those we don’t know about yet – perhaps all viruses. David Adler wrote, “the Warp Speed people told me that the end of pandemics, or even infectious diseases, is now in sight, as are new cancer treatments. But then they dialed down their comments a bit.”14
Even a fraction of that kind of success would be, in Neil Armstrong’s unforgettable phrase, a giant leap for mankind.
Laurence B. Siegel is the Gary P. Brinson Director of Research at the CFA Institute Research Foundation, the author of Fewer, Richer, Greener: Prospects for Humanity in an Age of Abundance, and an independent consultant. He may be reached at [email protected]. His web site is http://www.larrysiegel.org.
1 The author thanks David Adler for his contributions.
2 Elsewhere in The Fifth Risk, the risks are enumerated as: (1) missing nuclear weapons and materials, (2) North Korea, (3) Iran’s nuclear program, (4) a cyberattack on the electrical grid, and (5) project management.
4 As reported by Adler, David, 2021, “Inside Operation Warp Speed: A New Model for Industrial Policy,” American Affairs, Volume V, Number 2 (Summer). Plagiarism of a few words in this article is intended to be a compliment to Mr. Adler and is the result of me trying to write clearly, without quotes inside quotes.
5 As reported by Lipton, Eric, et al., 2020, “He Could Have Seen What Was Coming: Behind Trump’s Failure on the Virus,” New York Times (April 11).
6 This was, in fact, the original plan: “Two weeks to flatten the curve.” Of course, they were the wrong two weeks; in late January 2020 the plan might have worked. However, there was never any guarantee that it would. We are now seeing that countries that seemed to have beaten COVID through early behavioral intervention, such as Taiwan, are now experiencing surges. It is possible that almost everyone in the world will eventually be exposed, with those protected early in the pandemic becoming vulnerable later, so that near-universal vaccination is the only answer. Fortunately, that is now possible.
My use of the word “catastrophe” is justified. At present, we are so far into the V-shaped recovery that it is hard to remember the severity of the COVID economic collapse. U.S. GDP contracted by 9.5% (not annualized) in one quarter, much faster than in any quarter of the Great Depression or any other historical depression. While GDP was not calculated in these old depressions, proxy measures show that the worst one-quarter decline was much less than that experienced in the second quarter of 2020.
7 Vasallo, Steve. 2021. “Missionary Misfits: Meet Joe DeRisi, A Real-Life Virus Hunter.” Forbes (March 8). Vasallo called it a computer chip but it is a glass microscope slide.
8 That is a very high fatality rate, but a tiny infected population. The containment was successful.
9 Fortunately, the parallel is inexact. The 1918 Spanish flu pandemic attacked the young, while COVID principally affected the old and infirm. And, despite the matching numbers – approximately 600,000 Americans having died in each episode – our population today is three times what it was 102 years ago, so the per capita death rate is much lower.
10 Maclean’s A River Runs Through It (1976) was made into one of the finest movies of all time (directed by Robert Redford, 1992).
11 My emphasis.
12 California data from the New York Times, https://www.nytimes.com/interactive/2021/us/california-covid-cases.html; U.S. and world data from http://www.worldometers.info. I ignore the controversy about having died of COVID (that is, as a direct result); dying with COVID (along with other direct causes of death); and dying because of COVID (including unrelated medical conditions that were overlooked or not treated, and so forth).
13 Emphasis mine. Lewis’s interview, entitled “Looking Back to Look Forward: A Conversation with Michael Lewis,” was conducted at the CFA Institute Alpha Summit, virtual conference, May 18, 2021.
14 Personal communication, May 20, 2021.