The Premonition: A Pandemic Story

by Michael Lewis

The federal government had a well-earned reputation for moving slowly. Rajeev marveled at just how fast it could move—when the president was pissed. He returned from his parents’ house on October 23, 2005. Five days later, all of the cabinet secretaries had signed off on his twelve-page document. Four days after that, on November 1, Bush gave a speech at the National Institutes of Health, announcing the new strategy. It had three parts to it: to detect outbreaks overseas so they might remain there; to stockpile vaccines and antiviral drugs; and, finally, to “be ready to respond at the federal, state and local levels in the event that a pandemic reaches our shores.” Whatever that meant. Bush did not elaborate much, because Rajeev hadn’t, either. The twelve pages he’d written on his own amounted less to a plan than a plan to have a plan. “It was written for an audience of one: the president,” said Rajeev. “To get the president off the ledge.”

“Experience is making the same mistake over and over again, only with greater confidence,”

There was an analogy with his earlier life as a doctor in an intensive care unit. “The patient is fading right there in front of your eyes,” he said. “You cannot run out of options. Because what do you do when you run out of options? You panic. Having something in front of you, a map, a plan, a list of treatments, even if it isn’t completely right, is better than nothing.”

By the end of January, when she walked into the building and took the elevator to the seventh floor, she was asking the universe a question: “Why won’t you let me do my job?” A bitterness she thought she’d banished had returned. She felt a despair she had not felt in a decade. “I was the lone person in state public health who was saying this is a pandemic,” she said. “I wasn’t talking to anyone else. I had no validation that I wasn’t a crazy person.”

“One could think of the interventions like a fire extinguisher,” he wrote. “It will be effective if the fire is caught early (say only a grease fire on the top of a stove). But once the fire has spread and half the house is ablaze, you can empty the fire extinguisher, but it won’t do much (probably as effective as just throwing it through a window). The problem with implementing (the social interventions) too late is you get all the downsides and little benefit, so speed is critical. The challenge is that they need to be implemented before things get bad.” By the time people realized that their house was on fire, they needed more than a fire extinguisher. The trick was to learn how to smell smoke.