Michael Lewis's new book The Premonition: A Pandemic Story is not satisfying reading but it's sure as hell informative and interesting-- it's not satisfying because there's no end to this story in sight, and our country was ill-prepared, ill-informed, and barely organized in its response to the COVID pandemic; you'll learn why certain things went the way they did and you'll also learn that there isn't a "cabal of people at the top controlling this entire thing"-- which is what an old guy at a wake told me last Sunday-- because all the decisions came from the bottom up-- often from state and county employees referred to as "L6" because apparently, the answer to big problems doesn't come from top administrators-- you've got to go six levels down until anyone knows how to actually do anything . . . one piece of logic I learned was that when that first person died of COVID at the end of February, it was all over . . . because COVID kills about a helf of one percent of people and it takes a while to die from it, so that meant that 200 people had COVID 3-4 weeks before that person died-- so the genie was way out of the bottle, there was no reason to close the borders, the virus was rampant, no one had been contact traced and the rest was history . . . if this isn't enough, Sam Harris just did a major take on the lessons of the pandemic, and here are some highlights from the book:
The CDC was avoiding controversy
Charity could see that the CDC’s strategy was politically shrewd. People were far less likely to blame a health officer for what she didn’t do than what she did. Sins of commission got you fired. Sins of omission you could get away with, but they left people dead.
In a pandemic, you've got to utilize utilitarian thinking
Ahead on the tracks, you spot five people. Do nothing and the train will run them over and kill them. But you have an option! You can flip a switch and send the train onto a siding, on which, unfortunately, there stands a man named Carl. Do nothing and you kill five people; flip the switch and you kill Carl. Most college freshmen elect to kill Carl and then, wham, th professor hits them with the follow-up. Carl has five healthy organs that can be harvested and used to save the lives of five people in need of them. All you need to do is shoot Carl in the back of the head. Would you do that, too? If not, explain the contradiction . . .
All Thinking is Flawed
He found a book called Human Error, by a British psychologist aptly named James Reason. “It was like reading the owner’s manual of the human mind,”
Carter poked fun at the way Richard walked around saying important-sounding things, like “All models are wrong; some of them are useful,” but he felt the alchemy in their interactions.
Richard viewed models as a check on human judgment and as an aid to the human imagination. Carter viewed them more as flashlights. They allowed him to see what was inside a room that, until now, had been pitch-black.
My Job is a Hot Zone
“I couldn’t design a system better for transmitting disease than our school system,” he said after his visit. To illustrate this point he created a picture, of a 2,600-square-foot home, but with the same population density as an American school, then turned it into a slide. “The Spacing of People, If Homes Were Like Schools,” read the top. The inside of the typical American single-family home suddenly looked a lot like a refugee prison, or the DMV on a bad day. “There is nowhere, anywhere, as socially dense as school classrooms, school hallways, school buses,” said Carter.
You Need to React Quickly
“Public Health Interventions and Epidemic Intensity during the 1918 Influenza Pandemic,” the piece revealed, for the first time, the life-or-death importance of timing in the outcomes of 1918.
Cities that intervened immediately after the arrival of the virus experienced far less disease and death.
Charity Dean Came From Another Planet: rural Oregon
They told me I should be at the fiftieth percentile of my class. No better.” After the next semester, when her grades remained high, the church elders sent her a letter instructing her to drop out of medical school and return to Junction City.
It Could Have Been Worse
So little about it was known that a trained pathologist had stared at a picture of it and mistaken it for human immune cells. It had been detected only a few dozen times since its discovery—once in a dead four-year-old girl. No one knew what it ate when it wasn’t eating the brains of mandrills or humans. Asked to explain what he’d found, Joe would only say, “Balamuthia is an amoeba and it eats your brain, and there is no cure.”
Politics Played a Role
But then, on April 9, 2018, Trump hired John Bolton as his national security adviser, and the next day, Bolton fired Tom Bossert, and demoted or fired everyone on the biological threat team. From that moment on, the Trump White House lived by the tacit rule last observed by the Reagan administration: the only serious threat to the American way of life came from other nation-states. The Bush and Obama administrations’ concern with other kinds of threats was banished to the basement.
Sometimes You've Got to Light a Fire to Escape
“Escape fire,” was what they’d call it. The event so captivated the writer Norman Maclean, best known for his only other book, A River Runs Through It,
In fire you could see lessons for fighting a raging disease. He jotted them down:
You cannot wait for the smoke to clear: once you can see things clearly it is already too late. You can’t outrun an epidemic: by the time you start to run it is already upon you. Identify what is important and drop everything that is not. Figure out the equivalent of an escape fire.
It Wasn't Just in Italy
On March 1, it announced that the United States would screen people arriving from other countries for symptoms of the virus. “I wouldn’t waste a moment of time on travel restrictions or travel screening,” Carter wrote. “We have nearly as much disease here in the US as the countries in Europe.”
Most of Us (Including Me) Had No Clue
Ken Cuccinelli, the acting deputy secretary of homeland security and a member of Trump’s coronavirus task force. “He said, ‘Charity, you need to push these things through. You’re the only one who can do this.’ ” She was taken aback by his insistence. “He wasn’t pleading with me to do the right thing. He was yelling at me. He was basically implying that the White House is not going to do the right thing. The White House is not going to protect the country. So California needs to take the lead.”
Charity Dean realized just how lost and desperate the people at the top were.
half of 1 percent of the people who get the disease die, you can surmise that for every death, there are 199 people already walking around with it. That first death—which California already had experienced—was telling you that you had two hundred cases a month earlier.
In Park’s time with the federal government, he’d dealt with one technology crisis after another. He’d noticed a pattern that he’d first identified in the private sector: in any large organization, the solution to any crisis was usually found not in the officially important people at the top but in some obscure employee far down the organization’s chart. It told you something about big organizations, and the L6s buried inside them, that they were able to turn Charity Dean into a person in need of excavation.
Sometimes You Need the Government to Take the Lead
Far more often than not, some promising avenue of research would die as a failed company. He hated that; he hated the way financial ambition interfered with science and progress.
The absence of federal leadership had triggered a wild free-for-all in the market for pandemic supplies. In this market, Americans vied with Americans for stuff made mainly by the Chinese. Marc Benioff, the CEO of Salesforce, flew in a planeload of materials from China to the UCSFmedical center with boxes of functional, though less than ideal, nasal swabs on board.
American government, circa April 2020, was just how different appearances on the outside could be from the understanding on the inside. Inside California state government, inside even the Trump administration, there was some logic to everything that happened;
“The greatest trick the CDC ever pulled was convincing the world containment wasn’t possible,” she said. “Our dignity was lost in not even trying to contain it.” She wondered if perhaps they had undergone a process similar to her own—a descent, which
You have this burden of maintaining optics. It’s all optics.”
He finally more or less gave up on the state. “There was something deeply dysfunctional about how the government worked that I never fully grasped,” Joe would later say. “There’s no one driving the bus.” And the CDC—well, the CDC was its own mystery.
Her conclusion had pained her some. Once she’d become a public-health officer, 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. Disease prevention was a public good, but the public wasn’t going to provide anything like enough of it. 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.
