Nursing Book Club

The Premonition: A Pandemic Story by Michael Lewis

How America ignored the warnings of public health experts

In 2019, the Global Health Security Index ranked the U.S. first in overall pandemic readiness. Two years later, we lead the world in both total cases and total deaths due to COVID-19. In his recent book, The Premonition: A Pandemic Story, author Michael Lewis tries to get to the bottom of what went wrong.

This sprawling account follows the stories of a number of public health data experts — knowledgeable people who are able to look at the numbers and predict trends — whose vital information and urgent warnings were largely ignored in a political climate that ran the gamut from disinterest to outright hostility.

Crying Wolf?

Lewis begins his account in 2005, when then-President George W. Bush read John M. Barry’s book The Great Influenza: The Story of the Deadliest Pandemic in History. Realizing that with today’s much greater U.S. population, we now stood to have an even higher death toll than in 1918, Bush ordered his staff to begin preparing contingency plans for any mass outbreak.

From there, political enthusiasm for pandemic preparedness waxed and waned. If there’s no immediate threat on the horizon, budgets gradually shrink, and experts who project worst-case scenarios are treated like the boy who cried wolf.

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In 2018, when John Bolton was appointed national security advisor, Lewis says, he “demoted or fired everyone in the biological threat department.” This official disinterest wasn’t just at the federal level.

One of the people the book follows is Charity Dean, M.D., MPH, a public health veteran and the former assistant director of the California Department of Public Health.

In late 2019, Dean became concerned by the news coming out of Wuhan, China. She ran the numbers and was alarmed by the implications. However, despite Dean’s expertise, her boss, California Public Health Director Sonia Angell, M.D., was reluctant to even consider the possibility of a U.S. pandemic.

Dean eventually left her position in frustration. (Angell herself resigned in August 2020, after less than a year on the job.)

Public Health Agencies Drop the Ball

Lewis presents a detailed timeline of the emergence of SARS-CoV-2, highlighting the many points at which closer official attention should have been paid and more decisive action should have been taken.

By late January 2020, no one was being allowed to enter or leave Wuhan and construction had begun there on a new 1,300-bed hospital. Yet, no one in the U.S., even travelers reentering the country from China, could be tested for the virus except under very strict guidance from the Centers for Disease Control. It might not have mattered, since we didn’t have the labs, personnel or supplies to do the job anyway.

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The Premonition is full of sharp criticism for the CDC’s slow response and lukewarm guidance to local health departments. Those too come in for their share of blame: a disorganized network of 3,500 separate agencies across the country, most with woefully inadequate funding, and often led by political appointees reluctant to rock the boat.

This is a vast book that goes in many directions at the same time. Even having recently lived through the events described, it’s sometimes dizzying, particularly when we start to get a look at the big numbers: cases, deaths, costs.

Paying the Price

Towards the beginning of this book, one of the data experts Lewis follows does some “back of the envelope” extrapolation of the transmission and mortality rates coming out of China. He predicts that if nothing is done, the U.S. will face between 800,000 and 1.8 million deaths. At press time, the official death toll had already topped 650,000, and the pandemic is still far from over.

Clearly, our slow response has had an impact, and our inability to effectively fight a biological threat is evident. The Premonition tells us who was raising the alarm — the question now is whether we’ll listen to them the next time.

The Premonition: A Pandemic Story by Michael Lewis (W.W. Norton & Company, 2021)

CHRISTINE CONTILLO, RN, BSN, PHN, is a public health nurse with more than 40 years of experience, ranging from infants to geriatrics. She enjoys volunteering for medical missions.

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