Medical research

An event as large and devastating as the Covid pandemic was always going to attract a rush of authors seeking to uncover the story behind the decade’s biggest story. Leading the pack – not for the first time – is Michael Lewis, the man with an unerring knack for finding narrative gold in the most well-mined territories.He did it with notable success in the financial crisis of 2008, by smartly identifying the people who made money from the banking collapse, those who bet against the collateralised debt obligation bubble. That was The Big Short, a bestseller that was turned, like a previous book, Moneyball, into a successful Oscar-nominated Hollywood film.And one can imagine that the film rights will be quickly snapped up for The Premonition, Lewis’s pacy exploration of America’s response to the pandemic. There are many approaches that could be taken with such a far-reaching crisis but Lewis has opted for a similar counterintuitive approach to the one he took in The Big Short. Instead of following those whose lack of foresight has had such damaging effect on life and prosperity in America, he has focused on a group of health officials whose warnings were ignored.“The working title for most of the time I was working on it was The Ones Who Knew,” he tells me on a Zoom call from his office in Berkeley, California. He decided against that title because he was worried that it would place his subjects in a harsh spotlight, by suggesting – incorrectly – that they were negligent with their knowledge. He opted for The Premonition because, he explains, “to control a virus you have to see around corners”. What he means by that is that if you wait for sufficient evidence to establish that a pandemic is under way, it’s already too late to stop it.In the pandemic prevention business, you need to see the future before it arrives and, as it turns out, there were a number of people who had anticipated precisely where things were heading. One of them was the deputy public health officer for the state of California. A woman with the wonderful name of Charity Dean, she is such a remarkable character that it would have been a tragedy had she not found her way, at some point of her life, into a Michael Lewis book.Each December, Dean would write her new year resolutions on the back of a photograph of her grandmother. On 20 December 2019, she wrote down two things. “1) Stay sober. 2) It has started.” She had a kind of sixth sense that the viral pandemic she had long been expecting had begun. By coincidence, and rather oddly, at about the same time, Lewis put forward the idea, in a conversation with the Observer, that the only thing that could wake America up to Donald Trump’s governmental negligence was a pandemic.He now plays down his clairvoyance, explaining that he gave that example simply because it was a situation that would affect everybody. “Rich white people would be scared too,” he says. In the event, many Americans followed Trump’s lead in denying the danger of Covid-19 and the virus has remained a highly divisive and contested subject. “If it had killed twice as many people and killed kids,” says Lewis, “you wouldn’t be seeing these revolts in Oklahoma. You’d be seeing the New Deal.”As it is, the virus has killed nearly 570,000 Americans, one of the highest death rates in the world, though not quite as high as the UK’s in relative terms. The irony, as Lewis notes, is that in a pre-pandemic assessment of those nations best prepared to deal with a global contagion, the US was ranked top and the UK second.The way Lewis tells it, the US practically invented pandemic planning, after George W Bush read a book in the summer of 2005 about the 1918-19 Spanish flu pandemic. Written by John Barry, The Great Influenza: The Story of the Deadliest Pandemic in History so affected the then president that he asked a unit of the homeland security department to develop a new pandemic strategy. At the time, the only documented plans were to speed up vaccine production and stockpile antiviral drugs.Lewis details the recruitment of a group of medical mavericks, led by a couple of southern doctors, one a poet-administrator named Richard Hatchett and the other Carter Mecher, a sublimely focused problem-solver with highly evolved people skills (Tom Hanks would have to play him in a movie). They were charged with breaking away from received thinking and looking at radical ways of dealing with a pandemic.Three years earlier, a 13-year-old girl called Laura had entered a school science fair in Albuquerque with a project she’d been working on: a computer model to predict the spread of a virus. She was helped by her scientist father, Bob Glass. The senior Glass soon became obsessed by the project, long after his daughter moved on to other interests, and he tried without success to engage the attention of the academic science world with his findings. No one was interested. But eventually Hatchett and Mecher were and they used his model, first developed with his daughter, to come up with a comprehensive plan for limiting the spread of a virus: closing down schools and colleges, social distancing, mask wearing.“It’s a novella,” Lewis says of the Bob and Laura Glass story. “It could be written as fiction. I went and saw Bob Glass in Albuquerque. He reminded me of me. He’s much smarter than I am but his feelings about his daughter’s science projects are exactly the feelings I have about my daughters’ softball careers.”Drawing on Glass’s work, Hatchett, Mecher and several others were brought into the White House in the Bush years and some stayed on during the Obama administration. But when it really mattered, they found themselves outside the decision-making process, unable to get through to those in power. The book follows the pioneering strides made in federal pandemic planning and then the gradual and then abrupt dismantling of their work.For all Hatchett’s and Mecher’s painstaking efforts, perhaps the real hero or heroine of the book is Dean. As deputy public health officer of California, her warnings were ignored by her boss and the state governor’s administration. When she protested, she was frozen out of meetings and silenced. But rather than buckle, she fought back, finding any way she could to get the message out, until finally the state administration, reeling from the virus, was compelled to backtrack and adopt Dean’s plan, although without publicly recognising her input.We see her first as the public health officer for Santa Barbara, where she gained a fierce reputation for battling a tuberculosis outbreak. In a scene that must surely feature in any prospective film, Dean is forced to conduct a postmortem in a mortuary car park with a pair of garden shears because the local coroner is too scared to extract a lung that might be infected with TB.“Men like that always underestimate me,” she tells Lewis. “They think my spirit animal is a bunny. And it’s a fucking dragon.”Any author would kill for that kind of dialogue. As is often the case with Lewis’s books, I wonder how he manages to find people who speak in such gloriously vivid language. Is it a factor of America culture, steeped as it is in cinematic ways of talking, or is he just lucky?“There are two secrets,” he says. “One is I’m picking characters. They’re not randomly selected. But if you ask Charity Dean how much time I spent with her, she will say, ‘He spent more time with me than any human being in my life has ever spent’. She would say I know her better than either of her ex-husbands. I’m also culling. But having said that, all three major characters in the book were really unfiltered. They weren’t thinking, how’s this going to sound?”If Dean and Mecher are the good guys, there are no shortage of baddies. Chief among these, perhaps surprisingly, is the Centers for Disease Control and Prevention, better known as the CDC. It’s an American federal institution with an international reputation. As Lewis himself admits, he’d always thought of the CDC as “one of the places in the government that America can be proud of”. This, he adds, is because he didn’t know what they were doing.In the book, they are mostly not doing very much and a lot of their energy seems to go into preventing others from doing anything either. Back in the 1970s, the then head of the CDC, David Sencer, called for nationwide vaccination after a swine flu outbreak. Two hundred million doses of vaccine were ordered and 45m administered, only for the outbreak not to materialise. Sencer was blamed for overreacting and sacked. Henceforth, the CDC tended to err on the side of cautious inaction. “I think the CDC had virtues but it was not battlefield command. It had become a place where the generals had no experience fighting a war,” says Lewis.He is impressed by what the Biden administration has achieved in a short time. “I feel like there’s an intelligent entity all of a sudden,” he says. Nor is he in any doubt how ill-suited Trump was to being the man in charge during a pandemic. Yet, although he charts Trump’s incompetence, he doesn’t really target the former president as the arch-villain of the piece, partly because it’s a handy simplification that Lewis wants to avoid. “There is a national institutional desire to sort of bury what just happened and say, ‘Oh it was all Donald Trump’. And I don’t think anyone who’s close to the thing believes that,” he says.The official within the Trump administration whom he does identify as a major culprit is the former national security adviser John Bolton, who now does the media rounds as a voluble Trump critic. The day after he was appointed to the position in April 2018, Bolton sacked Tom Bossert, a veteran of the Bush administration. Bossert was the homeland security adviser who oversaw the biological threat team that was even then still influenced by the Hatchet and Mecher pandemic plan.“From that moment on,” Lewis writes, “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.” So ingrained was this perspective within the administration that when he finally began to acknowledge the danger that Covid presented to America, Trump could only speak of it in nationalistic or xenophobic terms, continually referring to the “China virus”. Yet Lewis believes there was an opportunity for Trump to have been seen as the saviour of the day.Bossert told Lewis that had he survived he thinks he would have been able to persuade Trump to give him a chance of implementing the pandemic plan, on the basis that if it didn’t work, he could fire and blame him and, if it did work, he could take all the credit.“Trump would have loved that,” says Lewis. “All it would have taken is a couple of months with the United States doing well in relation to other people. That could have got Trump re-elected. The fact that Bolton cut that tie – that probably cost hundreds of thousands of lives. It prevented all the knowledge that had been accumulated from ever getting into the response. There’s an alternative history there. Maybe John Bolton is the reason Donald Trump didn’t get elected.”For many observers, not only did the Trump administration fail the United States, it also vacated its long-established position as world leader. Had the US set the kind of example seen in Japan and South Korea, it’s not hard to imagine that the UK and the EU would have been more inclined to follow suit.Lewis says it’s another element of the story that reminds him of the financial crisis. “With The Big Short, I remember wandering Europe and thinking, no one will ever listen to us again on the subject of finance and banking. We were the world’s leader on this. We had a moral authority and we lost it. We’ve just embarrassed ourselves all over again. The fact that Britain has done worse than the US doesn’t excuse the American response and there’s a tendency to use that excuse here [in America].”If The Premonition is an avowedly character-driven book, it also seeks to cast a critical light on the workings of America’s mammoth industrial-medical complex. One point that repeatedly emerges is that lacking any kind of national coordination, it is fundamentally ill-prepared to deal with national crises. That said, the UK does have a national health service, but it didn’t stop us from being among the nations with the highest per capita death rate from Covid. “The existence of an actual national system is not a sufficient solution,” acknowledges Lewis, “but it’s necessary. There’s no way you can run a coordinated response without a system.”On a more profound level, the book also examines the backward priorities in health, how we are geared up to treat illness rather than to stop it from occurring. The paradox of medical science is that the better you are at avoiding a problem, the less likely that anyone will notice your efforts. And if they do, it will probably be to complain of a needless overreaction.“There is no incentive to prevent things,” he says. “If you look at what our two societies have in common, we’ve given ourselves over to markets in a way that’s pretty extreme. Which is to say, we strongly encourage things that pay and we give correspondingly less attention to things that don’t pay. Prevention does not pay. Disease pays. It pays when Covid is all over society and corporations get to make a lot of money testing for it. It doesn’t pay just to shut it down up front. And if there’s food for thought, it’s that we were essentially incentivised to have a bad pandemic response.”The lesson of the book is that there are people who spend their lives readying those in power for bad outcomes. Rather than being treated as tiresome Cassandras, simply because bad outcomes more often than not don’t occur, they ought to be involved at the centre of decision-making, not just for strategic purposes but economic ones. Most of the damage done to the economies of the US and UK was due to the fact that neither country acted early enough. Each saw themselves as the so well prepared that they had no need to worry about it. And so they didn’t.Or, as Lewis, ever the sports fan, neatly puts it: “Our players aren’t our problem. But we are what our record says we are.” The Premonition is published by Allen Lane (£25). To support the Guardian order your copy at guardianbookshop.com. Delivery charges may apply More