The Covid-19 pandemic has laid bare many fault lines in American society, from the savage inequalities of our health care system to the collapse of federal governance into a quagmire of blame-shifting and conspiracy-mongering during much of the crisis. For longtime financial journalist Michael Lewis, though, the effort to comprehend and contain the spread of Covid-19 mostly represents a tragic parable of unheeded expertise and thwarted procedural efficiency.
Lewis’s new book on the Covid debacle, The Premonition, is a companion study of sorts to his 2018 book The Fifth Risk, which sought to document the heroic resistance to the raw dictates of Trumpism mounted by conscientious civil servants ensconced in the federal bureaucracy. As in that book, The Premonition renders the crisis of the moment as a long-gestating case study in the misallocation of policy imagination. In this case, the challenge of the pandemic summons a corps of policy entrepreneurs, both within and without the public sector, to act as an ad hoc sort of Justice League, managing by force of invention and stubborn will to steer the errant machinery of governmental power back toward the path of sane public health planning and long-term Covid containment. If only their counsel had commanded brisk assent in the early phases of the pandemic, the great narrative moral of The Premonition has it, untold thousands of lives would be saved.
As a diagnostic saga, the narrative of The Premonition makes for compelling reading, as Lewis’s corps of lead administrators and investigators stumble into the vanguard of American pandemic planning and doggedly thrash out and refine their new, prevention-driven model of containment and (eventual) treatment. Lewis writes of the quest for an improved public health response to such devastating crises as an extended set piece in fearless and iconoclastic scientific inquiry, calling to mind the tense, high-stakes storyline of a Michael Crichton thriller or an episode of House.
But for all the genuinely heroic determination and bold thinking displayed by the lead characters in The Premonition, the American Covid catastrophe has proved to be something more than a lesson in the superior brief of policy innovation and enlightened data science. Many of the failures of our country’s Covid response ultimately stemmed from the dogmatic refusal to believe that government can and should envision and carry out a comprehensive plan to preserve our public health in the first place. Yet rather than confronting the ideological proportions of the crisis, the otherwise restless, skeptical corps of lead characters in The Premonition leap into the same privatizing logic that has wreaked so much harm in American health care.
Going back to his landmark first book on Wall Street’s characteristic 1980s excesses, Liar’s Poker, Lewis is a lively narrator of the folkways and unintended consequences of elite systems management and has a knack for chronicling the struggles of heterodox thinkers seeking to muscle their way into the center of the action. This was the morality play that propelled his best-known work, Moneyball (2003), which chronicled the data-analytics revolution in Major League Baseball, and it also fuels nearly all the central conflicts in The Premonition. As the title suggests, a scattered company of data and policy visionaries stumble upon the challenge of plotting out future pandemic scenarios and discover that American leaders have done astonishingly little to think through the basic demands of crisis management during such emergencies, or to prepare for the sacrifices entailed by effective pandemic containment strategies.
These figures start out on discrete paths through various, dubiously hospitable thickets of institutional groupthink toward their eventual shared mission. Back in 2004, Bob Glass, a scientist at Sandia National Laboratories in New Mexico, was drawn into the exercise of data-modeling a new pandemic’s patterns of social transmission through a science-fair project his daughter completed at her Albuquerque middle school; eventually he enlisted a computer whiz at Sandia to help flesh it out. Charity Dean, who worked as a public health officer in Santa Barbara, California, from 2011 to 2018, confronted local outbreaks of tuberculosis and meningitis B—together with the gruesome, disease-ridden detritus of a major fire and mudslide—before moving into the number two spot in the state public health administration in Sacramento. Lisa Koonin, a registered nurse and policy hand in the sprawling headquarters of the Centers for Disease Control and Prevention in Atlanta, became a roving pandemic ambassador-without-portfolio there, often directly at odds with the CDC’s terminally cautious and ass-covering senior brass. Richard Hatchett was a New York emergency room physician (who’d also been a patrician man of letters in his college days at Vanderbilt); he landed in the ambit of Vice President Dick Cheney’s vast national security empire-within-an-empire thanks to a blistering memo he drafted after pulling emergency duty at the Ground Zero site of the September 11 terror attacks. In that document, he called for the institution of a permanent reserve medical corps. Carter Mecher, a senior medical administrator in the Veterans Administration, did pioneering work to design fail-safe systems to reduce the incidence of fatal medical error in intensive care units.
The origin story that launches the unlikely network of collaboration among these far-flung policy entrepreneurs hinges on a random occurrence all but tailor-made for a Michael Lewis narrative: In 2005, President George W. Bush, still reeling from his administration’s obscenely incompetent handling of Hurricane Katrina’s aftermath in New Orleans, sat down and read John Barry’s chronicle of the lethal 1918 outbreak of the Spanish flu, The Great Influenza: The Story of the Deadliest Pandemic in History. Bush realized that the country had no effective plan in place to contain and overcome a latter-day pandemic and so deputized Rajeev Venkayya, a physician then detailed to head the Biodefense Directorate, deep in the bowels of the recently launched Department of Homeland Security, to start putting one together.
In turn, Venkayya assembled a team to assess the many harrowing risks created by a pandemic outbreak and the most effective measures, absent a preexisting vaccine, of containing its spread. At the center of this effort were Hatchett and Mecher, who soon developed an intense odd-couple rapport on the job that is also catnip to Lewis, as he crafts another wry-and-folksy account of how otherwise bland and impersonal workplaces and institutional redoubts become suddenly creative and counter-hierarchical: “Richard liked to borrow a phrase, Carter a tool. Richard was top-down … 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.”
Together, this band of intrepid misfits discovers a key plank of coherent pandemic planning: that an early and aggressive campaign of social distancing can effectively slow and contain a pandemic’s spread without a vaccine in play. In the 1918 flu pandemic, for example, Philadelphia, which instituted such 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. Mecher also intuited early on that closing schools would probably be a crucial time-and-life-saving device in a future pandemic: Children had a far greater number of intimate, unstructured social encounters worked into their average days than adults did, and those interactions looked to be prime breeding grounds for future pandemic outbreaks.
On a parallel course, Bob Glass had sought to get the findings of his pandemic-modeling experiments published in a scientific journal—not so much out of professional vanity, since they didn’t really relate to his day-job duties at Sandia, but because his immersion in the worst-case scenarios of pandemic transmission had scared him shitless, which made publication feel like a public service to the nation at large. Eventually, Hatchett and Mecher got wind of his work and set about adapting his computer simulations to their own disaster scenarios in the making. Again, the core teachings of the social distancing gospel were confirmed—and thanks to Lisa Koonin’s dedicated missionary work in Atlanta, the CDC itself was converted, albeit in its typically halting, lumbering way. In time, the Bush White House’s ad hoc pandemic task force could claim it had fulfilled its core mission, by getting the federal public health colossus to start thinking differently, and more inventively, about the sort of far-reaching prevention-minded social measures that the new pandemic age mandated.
When the new planning model met its first real-world challenge—a 2009 outbreak of swine flu, which evidently migrated north from Mexico—the federal response was mixed. Mecher—the only member of the team who stayed on in the Obama years—had Hatchett dispatched back to the White House to help navigate the new administration’s health bureaucracy. The two men argued for a school shutdown in order to contain the spread of a new disease in its critical early phase, just as their own pandemic playbook had counseled. But this time the CDC, ever-mindful of potential damage to its public image and chronically risk-averse, dissented—and Obama and Education Secretary Arne Duncan eventually sided with the CDC. As the crisis played out, it turned out that the new flu strain was far less lethal than the White House planning corps originally reckoned—with total American infections running somewhere between 40 and 80 million, 12,469 swine flu patients died.
The less-grim-than-expected outcome of the swine flu scare doubtless helped supply the rationale for the Trump White House’s now-notorious decision to shelve the detailed and ambitious pandemic blueprint drafted and refined by the two prior presidential administrations. And in 2018, when Trump’s newly hired national security adviser John Bolton promptly fired homeland security adviser Tom Bossert—a rare holdover from the George W. Bush years who’d endorsed the Hatchett-Mecher plan and pledged to call on both men the instant a new pandemic scare surfaced—the disease-prevention arm of the national security complex went along with him. “Bolton redesigned the White House to focus on hostile foreign countries rather than, say, national disasters and diseases,” Lewis writes. “Bad people, rather than bad events.”
In this foreshortened landscape of risk, the world-historic bad event known as Covid-19 took hold in early 2020, and the United States proved a fertile breeding ground for the pandemic. The balance of The Premonition covers the sickeningly familiar story of the nation’s descent into Covid paralysis and mass death, as Lewis’s ragtag corps of formerly plugged-in pandemic fighters tries, and mostly fails, to get a hearing at the senior levels of the terminally feckless and paranoid Trump White House. “None of the people who had been involved in the last fifteen years of thinking about pandemics were in the conversation,” Bossert recalled. “They were deep state.” But unlike the deep state of right-wing lore, these advisers were almost all on the outside of the nexus of federal power, looking in, thanks to the myopic and disastrous decision-making of the Trump White House.
When news of a new virus sweeping China broke, in January 2020, the old network of Bush-era pandemic planners took to a running email thread to weigh the scale of the risks ahead and to workshop what an optimal federal response might be. (In homage to their own maverick status and sensibility, they had dubbed themselves “the Wolverines,” after the insurgent resistance forces in the 1980s movie about a Soviet invasion of the U.S. So much, it seems, for the deep state.) As the Covid speculations proliferated on the thread, the Wolverines gathered new recruits along the way, including some panicked members of the Trump policy world. (When the network started having weekly conference phone calls, Trump administration figures would lurk silently in the background—until some hapless physician and scientist found herself, without advance notice, speaking to, say, Deputy Homeland Security Director Ken Cuccinelli.) Facing up to the epic leadership and policy failures of the White House, the group decided to enlist a senior state-level health official to advance an exemplary program of comprehensive shutdowns and social distancing measures, per the original pandemic playbook: Charity Dean, who’d been marooned in California’s highly politicized and inertia-prone public health establishment, was clearly the woman for the job.
Like Lewis’s other pandemic heroes, Dean is a stubbornly empirical, unsentimental bureaucratic outsider, and a woman of swift and decisive action. An introductory vignette about her tenure in Santa Barbara has her cutting open the chest of a woman who’d recently died of tuberculosis with a pair of gardening shears on a picnic table, after the local coroner refused to extract his own sample from the cadaver’s lungs to determine how far the infection had spread. After newly elected California Governor Gavin Newsom passed her over in 2019 for her expected promotion to lead the state public health administration, Dean developed a strong foreboding that a major health crisis was coming. (It’s this episode that apparently furnishes the book’s title; Lewis reports that Dean “felt this premonition. It resembled the feeling she sometimes had at the start of an outbreak back in Santa Barbara County.”) And in early 2020, as she grew more vocal about the imminent, deadly risks of Covid-19, she was routinely exiled from upper-level confabs about the state’s still-evolving Covid containment strategies. She was, in short, an eager recruit to the Hatchett-Mecher team, eventually conscripted by them to draft an alternate Covid containment plan not only for California but for the country at large, in the glaring absence of any such initiative from the expected channels of federal power.
Her draft plan was a social distancing regimen, heavily reliant on data-savvy tracking applications that would indicate when residents of a given zip code had graduated out of a stringent lockdown regime into a moderately looser one. The model she had in mind, like that of many of Lewis’s pandemic heroes, was a mobilization of collective will and self-sacrifice of the sort that one normally sees in wartime. As she neared the end of her draft plan, she exhorted Americans “to rise collectively in the spirit of patriotism with the same vigor and stubborn resolve that our grandparents’ generation rose to meet the moment of WW2.” In this scheme of things, she later explained to Lewis, “government has a role, but its role is to empower the grass roots by giving them data.”
The trouble here is not so much that California and the nation bypassed many of Dean’s recommendations in favor of a far more shambolic and erratic response to the Covid epidemic; rather, it’s that this eminently sound model of pandemic health care can get no meaningful traction in our country’s patchwork, profit-driven, and unequal system of health care provision. Like other ideal-type presumptions of liberal policy wonkery—such as the notion that education alone is the all-purpose engine of upward social mobility—it presumes an efficient and equitable system of access where nothing remotely close to such a thing exists. That’s why the countries that have achieved exemplary success in Covid containment, such as Taiwan, have been able to test, track, and vaccinate via a single-payer model of universal health coverage. (Taiwan also has taken strict measures to ensure that all the social data the government collects to track the spread of Covid is destroyed within 28 days—a basic civic precaution that is again unimaginable in America’s proprietary system of surveillance capitalism, jointly administered by government and tech monopolies.) In other words, for Dean’s grassroots model of Covid tracking and testing to work, an entirely different system of health care—together with a trustworthy and transparent system of government oversight—would need to be in place first.
Nor is it the case that the experience of the Covid lockdown has unambiguously borne out the counsel of the Hatchett-Mecher team. Even after California adopted a good portion of Charity Dean’s action plan, via an emergency task force appointed by Newsom, with an accelerated testing-and-tracing regime, the results were equivocal over the longer term. At the time—the early spring of 2020—the California plan was “a triumph,” Lewis writes. Paul Markovich, CEO of Blue Shield of California, who joined Dean and venture capitalist Bob Kocher on the task force, remarked that “I don’t think we repelled aliens who were trying to invade the earth, but it kind of felt like it.” Now, however, California, like the rest of the country, is racing to get enough of its residents vaccinated to reach something close to herd immunity before a deadly fourth Covid wave crashes across the state.
None of this is to discredit the genuinely brave and heroic efforts of Dean, Hatchett, Mecher, and the other policy entrepreneurs in the bureaucratic morality play of The Premonition; science is by definition an experimental, provisional, trial-and-error endeavor, and it’s to be expected that the apostles of scientific inquiry will make mistakes and miscalculations, and correct subsequent plans and models accordingly. But it is to question whether the moral of Lewis’s science-triumphing-over-politics set piece is as pat and tidy as Lewis makes it seem. For one thing, the federal health bureaucracy is almost exclusively represented in the pages of Lewis’s book by the CDC—even though the agency played no role in drafting the Bush-era pandemic strategy. (That said, of course, the CDC’s forays into policy during the early days of the Covid pandemic were indeed exasperatingly confused, contradictory, and harmful, as anyone who remembers its senseless early resistance to mask-wearing can readily confirm.)
In a book seeking to lay bare the government myopia that’s thwarted the effective adoption of pandemic prevention measures, it’s exceedingly strange that Dr. Anthony Fauci, head of the U.S. National Institute of Allergy and Infectious Diseases, and the culture hero of many liberal detractors of the Trumpian mishandling of the Covid crisis, merits but a single passing cameo appearance. Deborah Birx, the Trump administration’s decidedly more compromised—but still undeniably influential—White House coronavirus-response coordinator, doesn’t rate a mention at all. Even the signature villains of the hideously botched Trump Covid initiative—Vice President Mike Pence and presidential son-in-law Jared Kushner—barely put in an appearance, while Trump himself, with his surreal press conference diagnostics and crackpot racist outbursts about the pandemic’s origins, is a remote and muffled presence, the policy equivalent of the madwoman in the attic in a Victorian gothic romance.
The main action, Lewis insists throughout, concerns the efforts of the insurgent pandemic policy entrepreneurs to gain the attention and interest of the hidebound, risk-averse, and image-conscious CDC, pursuing its own terminally opaque institutional agenda down in Atlanta. It’s an account of an account of what is at bottom a political power struggle—over how to redefine public health, how to assess society-wide risk, how to deliver equitable as well as briskly provided health care resources and treatment—with much of the actual politics written out of the picture.
It’s not hard to surmise the thinking behind this narrative choice. Without the messy and chaotic battle for power and influence both within the Trump White House and on the broader public health bureaucracy, The Premonition can deliver the same blandly reassuring moral that The Fifth Risk and Moneyball did: With a bold embrace of more innovative and data-driven fixes, the public health bureaucracy, like the civil service and the twenty-first-century model of baseball management, can play the starring role in an edifying parable of efficiency. Like those studies, The Premonition evokes a fundamentally frictionless world of nimbly-executed solutionism—a vision of a perennially improving civitas produced by just the right complement of innovative disruption, planning protocols, and data inputs. In his introduction, Lewis writes, “I think this particular story is about the curious talents of a society, and how those talents are wasted if not led.”
Sure enough, Lewis preaches on the plague of public-sector stodginess and inefficiency throughout The Premonition. Again and again, his dramatis personae report that they’re “mystified” by the federal government’s flagrant misallocation of resources and talent, noting “in particular the way some people were able to use their own inefficiency to create a seeming need for more funding.” True, the brutal logic of market-driven health care has produced plenty a perverse incentive of its own, erecting “a U.S. medical-industrial complex that lurched between lethargy and avarice”—but at least these excesses, in Lewis’s telling, are theoretically remediable via the networks of meritocratic savvy he sees on the ascendant. Government dysfunction, by contrast, is deep-seated and congenital, as he argues when he contrasts the Hatchett-Mecher crusade with the Moneyball revolution: “The market forces that punish ignorance were far more intense in pro sports than they were in disease control; the mistakes made by epidemiologists didn’t cause their teams to lose and their bosses to waste tens of millions of dollars.”
Leaving aside the obvious bankruptcy of this comparison—not only are the real-world stakes of epidemiology-related error far higher than the embarrassment of a losing season, but pro sports owners are absurdly insulated from actual “market forces,” as Major League Baseball’s century-old antitrust exemption, and no end of municipal stadium tax breaks, make all too clear—there’s a universe of ahistorical presumption lurking just beyond the scope of this little market parable. Some of the most devastating debacles of modern American governance—from the Vietnam War to the savings and loan meltdown to the 2003 invasion of Iraq to the 2008 financial collapse—occurred at the behest of just the sort of executive-level knowledge elites that Lewis lionizes in the pages of The Premonition. To contend that yet another corps of strategically placed, data-savvy technocrats holds the key to our collective salvation is to disregard the bulk of modern American political history.
The Premonition isn’t detained by any such downbeat reflections as it cruises to what feels like its inevitable climax. Even after her boss at the California Department of Public Health was finally forced to decamp, and Charity Dean was all but assured that she’d take the reins, she elects to bail out of government work entirely. “Once she’d become a public-health officer,” Lewis writes,
she’d imagined an entire career in public service. Now she did not believe that the American government, at this moment in its history, would ever do what needed doing.… From the point of view of American culture, the trouble with disease prevention was that there was no money in it. She needed to find a way to make it pay.
So
she does. A year into the pandemic, she founds something called the Public
Health Company, bankrolled by a venture capitalist named Todd Park, who’d
worked as chief technology officer in the Obama White House, who now captains a
major billing fiefdom in the vast empire of for-profit health care. At first,
Dean reports, it was awkward to interest prospective investors in the selling
points of a health care startup seeking to render the myriad dysfunctions of
our public health infrastructure somewhat workable again. “Five smart people
have replied with confusion when I said the company was to save the world and
protect our country,” Dean recalled. “Then when I said, ‘We’re going to do
private government operations, like Blackwater,’ their eyes lit up and they
said, ‘Oh wow, you could take over the world.’”
Again, a glum, politically minded naysayer might well have pointed out that the Blackwater model of taking over the world involves an ugly combination of indifferently punished war crimes, mercenary domestic spying, and rampant plutocratic corruption and fraud. But why spoil the stirring spectacle of human talent being properly led, at long last? Charity Dean is playing Moneyball, and all is right in Michael Lewis’s world.