| THE PREMONITION A Pandemic Story Michael Lewis New York: W. W. Norton & Company, May 2021 |
Rating: 5.0 High |
|||
| ISBN-13 978-0-393-88155-4 | ||||
| ISBN-10 0-393-88155-5 | 304pp. | HC | $30.00 | |
As the author did in his previous book, he focuses here on individuals, probing their specific circumstances and letting their words and their track records vouch for them. They are a diverse bunch. But all share the dedication to mission over money that distinguished the heroes of The Fifth Risk.1
As in the previous book, the people we meet in these pages are not household names. As I noted, they are mission-driven people. All are heroes who by insight and persistence have overcome formidable obstacles in order to do the right thing for the nation. But the one who stands out in my view is Charity Dean. Raised in a fundamentalist household, she went on to medical school and became chief health officer for Santa Barbara County in California. In that role she had, among a long list of responsibilities, the duty of controlling communicable diseases in the county. One, tuberculosis, gave her many problems. Far from being the idyllic paradise for the wealthy it seemed to outsiders, Santa Barbara County was notorious among health professionals for its tuberculosis cases. Another was hepatitis C, found in a woman who had come to a hospital to donate blood. A frequent blood donor, she clearly had contracted hep-C recently. Dr. Dean found she'd had an improbable number of possible exposures, and sent a nurse to check them out. Only one made the nurse uneasy: the clinic of Dr. Thomashefsky. To cut to the chase, Dr. Thomashefsky slacked off on good medical practice generally, including changing needles but using the same syringe for different patients — and four more of his patients had hep-C. Charity shut his clinic down. Eventually, the state of California pulled his medical license and he was asked to close his clinic in Oregon.
By then Charity Dean knew that, in her quest to stop the spread of disease, she was more or less on her own. She had her friends and allies. The public-health nurses, for example, who were among the more impressive human beings she had ever known. She was also growing to adore Santa Barbara's chief counsel, who kept handing her enough rope to hang herself, by confirming that, yes, the law allowed her to do whatever the hell she thought needed doing to protect the public. She felt a deep connection to the fifty-seven other California county health officers—though they were, she had to admit, a mixed bag. Some were ancient doctors who viewed the job as a sinecure; some were part-timers who didn't even seem all that interested in the job. "There's no defined career path to becoming a public-health officer, and that's a problem," she said. "You get the retired anesthesiologist who is spending most of his time as a professional dog breeder." But some of her fellow local health officers, like Charity herself, were so deeply committed to the job that they experienced it more as a mission. These people she loved best. But their needs and issues were too diverse for them to function as a single, powerful unit. And they weren't in a position to have her back in a crisis. The larger apparatus of American public health was very different on the inside from how Charity had imagined it from the outside. The Centers for Disease Control, the apex authority, wasn't of much practical use to her. The distance they had put between themselves and her when she had closed Thomashefsky's clinic was of a piece with their general behavior. She'd repeatedly seen the tendency to flee when conflict arose. – Pages 35-36 |
The case that really drives this home is described near the end of this chapter (pp. 36-42.) A UCSB student athlete was in hospital in shock, his legs a mottled purple. Meningitis B was suspected — but the lab test was negative. This disease hits young people and can kill within hours. Dr. Dean wanted to close down fraternities and sororities and intramural athletics at the university and administer a vaccine approved in Europe but not in the U.S. The CDC was having none of it. But these measures were taken, and there were no more cases of meningitis B in Santa Barbara County. The young athlete, however, lost his legs.
The other heroes of this story demonstrated the same insight, courage, and persistence shown by Dr. Dean. There was teenager Laura Glass, who with her father developed a software model used to predict the spread of the coronavirus. There was Carter Mecher, who delved into John Barry's book The Great Influenza on the 1918 flu pandemic2 and showed that social measures could work to blunt the spread of the disease. There was Joe DeRisi at UCSF, who was able to build a genetics test lab for coronavirus in eight days and offer to do 2,666 tests per day — for free.3 There was Lisa Koonin at the CDC who worked with Carter, risking her career. There were Heidi Avery and Rajeev Venkayya and Richard Hatchett. And there were others whose names I didn't take time to winkle out of the text. All these collaborated in a multiyear effort to prepare for, and then get a handle on, the 2019 pandemic. They faced formidable institutional opposition, some of which readers of this book will have witnessed first-hand on television and Twitter.
Charity Dean had been offered the job of deputy public health officer for the state of California, and had accepted in late 2018. She assumed that when the former officer Dr. Karen Smith stepped down, she would step up. That was in fact why Dr. Smith had brought her on board, and when Dr. Smith stepped down in June 2019 she became acting health officer. But Gavin Newsome instead picked someone from the CDC with no experience in communicable disease: Sonia Angell. And Sonia Angell turned out to be Priscilla Safenest.4
Charity Dean had begun as acting health officer by walking around and getting to know the department's employees — until someone, meaning well, advised her she was making people uncomfortable. From the moment Dr. Angell took over, she was at odds with Charity Dean.
The first thing Karen Smith had asked Charity to do was to resolve a crisis on the U.S.-Mexico border. The first thing Sonia Angell asked her to do was to figure out how to set the clock on her desk phone. – Page 193 |
When she learned of the situation in Wuhan, Charity began tracking events there and calculating the likely spread of the virus. But Dr. Angell didn't want to hear what she was doing, cutting her off with "If this is a real thing, the CDC will tell us." (Page 196)
Dr. Angell resigned abruptly in August 2020, after reports emerged of computer systems undercounting the COVID cases in California. Accepting her resignation, Gavin Newsom was not entirely clear on his reasons. She had been serving as both Director of the Public Health Department and public health officer. Those positions were subsequently filled by Sandra Shewry and Dr. Erica Pan. In December 2020 Gov. Newsom announced Dr. Tomás Aragón would again fill both positions.
Donald John Trump was part of that opposition, of course — but not the most important part. Michael Lewis explains that it was rather the standard sort of entrenched bureaucracy in the federal government, and in many state agencies, that formed the main impediment to progress. It has long been known that bureaucrats will avoid making decisions for which they might be blamed in the future.
"Charity, like Joe, would later say that their interaction was the last time she felt a flicker of hope that the virus would get anything like the response it required. In late March 2020, when she first announced her intention to resign, she'd made a note in her journal: "one million excess deaths by May 31, 2021." It was a prediction: the number of Americans who would die either directly from COVID or indirectly because of, say, lack of access to an overwhelmed health care system. Nothing had happened to change her view by the time she finally submitted her resignation in June. Walking out the door, she carried with her a list of unanswered questions. Maybe the biggest was: Why doesn't the United States have the institutions it needs to save itself?" – Page 279 |
A large part of the explanation for the CDC's poor performance during the recent pandemic lies in a cautionary tale the author relates on pages 281-289. The tale has two parts.
David Sencer was running the CDC in March 1976 when five soldiers at Fort Dix became seriously ill. One died. The CDC determined the cause was a new variant of swine flu related to the one that caused the 1918 pandemic. Dr. Sencer convened a meeting of experts; all agreed that a vaccine should be developed before the disease returned in the fall. The only question was whether to administer the vaccine ASAP or to store it until it was needed. Waiting was politically safer, but Dr. Sencer took the responsibility of recommending immediate vaccinations. The program began on 1 October 1976 and reached 43 million Americans. But 3 died (of heart attacks, it turned out) and 54 contracted Guillain-Barre syndrome, clearly due to the vaccine. These cases made news, as did other deaths unrelated to the vaccine. When, for reasons unknown, no pandemic occurred, the vaccination campaign became very unpopular. Joseph Califano, the new Carter administration's HEW secretary, fired Dr. Sencer, and the former CDC head was widely vilified for having exceeded his authority.
Cut to 1983. Ronald Reagan is president, and the CDC is headed by Bill Foege. CDC researchers have found a connection between aspirin and Reye's syndrome in children. When children suffering from the flu or measles are given aspirin, their livers or brains might swell. In rare cases death can occur. Aspirin manufacturers petitioned the White House, which ordered the CDC to do a new study. Bill Foege resigned, prompting the White House to change his position from career civil servant to a presidential appointment.
These two events illuminate the different ways Robert Redfield5 and Tony Fauci performed during the Trump administration. As Michael Lewis explains in a footnote:
"If Donald Trump had gotten up and said, "Fauci, you're fired," nothing would have happened, which is likely why he never did it. The person with the authority to fire Tony Fauci was Francis Collins, the head of the National Institutes of Health. To do it, however, he would have needed to show cause—which is why Fauci was always less likely to be fired than to be reassigned to, say, the Indian Health Service. Even then Fauci could have appealed the decision, to something called the Merit Systems Protection Board. The Merit Systems Protection Board would not have been able to process his complaint, as it lacked a quorum: Trump never staffed it. But you get the idea. To fire a competent civil servant is a pain in the ass. To fire a competent presidential appointee is as easy as tweeting. – Page 290 |
And these events show us precisely what has been going wrong with America since the Reagan era: The gradual rewriting of the rules to let those in power pretend they can have their own facts — Daniel Patrick Moynihan and common sense be damned. Couple it with the large numbers of citizens who want to be told what to think, and you have the nation on a slow drift to disaster.
Michael Lewis seems to be on a mission to show us the way back. We can start by respecting the people who aren't afraid to make tough decisions.
This book has the same defect as The Fifth Risk: it lacks an Index. It does its job of telling stories of courage equally well, however, and I consider it just as much of a must-read.
To contact Chris Winter, send email to this address.