The Premonition: A Pandemic Story

by Michael Lewis

The model he’d built with his daughter showed that there was no difference between giving a person a vaccine and removing him or her from the social network: in each case, a person lost the ability to infect others. Yet all the expert talk was about how to speed the production and distribution of vaccines. No one seemed to be exploring the most efficient and least disruptive ways to remove people from social networks.

She knew that her obsession with pandemic disease was unusual, even off-putting. “I learned not to talk about it,” she said, “because when I talked about it, people thought I was crazy.” But the fact remained that, from a very young age, when she was feeling low, she had cheered herself up by reading books on bubonic plague. The ones with the grisly drawings she liked best.

She had, in theory, incredible legal powers to prevent disease. She soon realized how few people, in practice, knew the law. Most of the citizens of Santa Barbara, including nearly all of the public officials by whose pleasure she served, didn’t even really understand what a public-health officer was supposed to do.

The law’s words felt strong, but their spirit felt weak. By her second year on the job, she found herself quoting the law so often that she asked her assistant to laminate a copy of that one passage, so that she might carry it with her in her briefcase. “I’m in a meeting trying to explain to people that I actually do have the authority to do something I need to do,” she said. “I really tried hard not to whip it out. But I pulled it out once a week.”

By the time she got the call about the young woman with tuberculosis in her brain, she’d read that one sentence aloud more than just about any other in her life.

“Any disease!” she’d cry, and then parse the adjectives. “ ‘Contagious’ isn’t really a medical term, so ignore that—they just tossed in the kitchen sink there—but you really need to understand the distinction between ‘infectious’ and ‘communicable.’ ” All communicable diseases were infectious, but some infectious diseases were not communicable. Communicable meant a person could give it to another person. You could get Lyme disease, for instance, but you couldn’t give it to somebody else. Communicable diseases were the diseases that created

. . . shall take measures as may be necessary to prevent the spread of the disease or occurrence of additional cases. “ ‘Shall’!” she’d exclaim. “Not a may. A shall. Not think about it. Not consider it. Not maybe get around to it one day if you feel like it. It’s your duty. If you suspect disease, you can do whatever the hell you want.”

The sheriff couldn’t simply ignore a legal order. He phoned up the chief counsel for the board of supervisors to confirm his belief that a legal order issued by a local public-health officer carried no authority. Santa Barbara’s chief counsel looked into it and, to his surprise, discovered that the sheriff was mistaken. The woman was right: the only person whose authority trumped the health officer’s, in cases involving disease, was the governor of California. And then only if the governor had declared a state of emergency.

Not for the first time she wondered what would happen in Santa Barbara County if there was ever a serious outbreak of communicable disease. “They won’t even do an autopsy because they are worried about aerosolized TB,” she said. “What the fuck are they going to do if it’s aerosolized Ebola?”

To staffers on the U.S. House Appropriations Committee, John Barry’s The Great Influenza became known as “the seven-billion-dollar book.”* But the book offered no advice about what to do with the seven billion dollars. The book, truth be told, left the reader feeling that there was little that might have been done to prevent all those people from dying.

When asked why, instead of pursuing a career as a poet, he had gone to medical school, Richard would say simply, “Writing is too hard.”

“Social distance” had been used by anthropologists to describe kinship, but he didn’t know that at the time, and so he thought he was giving birth to a phrase. (“But I don’t think I turned it into a gerund,” he’d later say.)

“When you go into the details of the cases, you see it’s not bad people,” he said. “It’s bad systems. When the systems depend on human vigilance, they will fail.”

“I couldn’t design a system better for transmitting disease than our school system,” he said after his visit. Until that moment, no one had really seen what was unusual about schools, at least from the point of view of the pandemic strategist.

“We’re reading the newspapers in St. Louis,” said Richard, “and they know for a fact that they are having a better experience than other cities, and they still couldn’t keep their interventions in place for more than four to six weeks.” The paper analyzed the effects of that inability, and showed that American cities that caved to pressure from business interests to relax their social distancing rules experienced big second waves of disease. American cities that didn’t did not.

The CDC recommended that schools close, for instance, only when some new communicable disease was projected to kill more than 450,000 Americans.

The Mexicans, interestingly, had taken the new pandemic strategy of the United States and run with it. They’d closed schools, and socially distanced the population in other ways that, studies would later show, shut down disease transmission. The CDC, by contrast, sent the message that each American school should make its own decision, which was a bit like telling a bunch of sixth graders that the homework was optional. A few schools closed, but the vast majority did not. The local public-health officials with the power to close the schools had no political cover to do what needed doing.

The two epidemiologists had gathered the data from the Mexican outbreak. They estimated the attack rate—the percentage of the population likely to be infected—at somewhere between 20 and 30 percent, and the so-called case fatality rate at between 0.1 and 1.8 percent. That was the difference between a slightly worse than usual flu season and more than one million dead Americans, some large number of them children. With that little information, decisions had to be made.

At a very young age, she sensed that she was being trained, as a dog might be trained, to grow up to be a woman with no ambition other than to bear children.

The sample resided in a chunk of lung, taken from a person who’d died of the new disease. To Joe’s surprise, the CDC shipped the lung in an ordinary FedEx box. Weekend delivery. Until a new pathogen is formally identified, the CDC explained, it remains classified as just another benign packet of genetic material.

The Mann Gulch fire captured the difficulty people had imagining exponential growth, even when their lives depended on it. “We are reactive and tend to only intervene when things are getting bad,” wrote Carter. “And what we underestimate is the speed that what’s bad moves.”

When space in the migrant shelters ran out, ICE workers would drive these people into cities in the dead of night and just leave them there. “I’d heard that Trump was trying to create a crisis,” said Charity. “Trying to turn people against immigrants. It was just a rumor. But when I get there I find this is all true. They’re just dumping families on street corners at two in the morning. They were trying to create a disaster.”

She never stopped worrying about chicken pox and measles. Measles had a spectacular R naught of somewhere between 12 and 18—which is to say that each person who got it on average gave it to between a dozen and eighteen others.

Then she found a clinic in San Ysidro that was willing to accept the seriously ill. Then Jewish Family Service stepped in to help—and she was struck by how private American forces of mercy were straining to offset America’s public agents of cruelty.

“They went from wanting a crisis to ‘Oh shit, we need to keep kids from dying,’ ” said Charity. By then she knew that the Trump administration had been flying migrants in transport planes from Texas to California, so that they might create more stress on the system she had built and, at the same time, take advantage of it.

In the end they found what they needed. By early April, the Biohub was able not only to run 2,666 coronavirus tests a day but to supply test kits to anyone who needed them. Late each night, lines of PhDs formed on the basketball court to assemble the kits for the resource-starved departments of public health.

Another member of Joe’s small public-health team, David Dynerman, also a mathematician, arrived with a different perspective. He’d been born in Poland and moved to the United States as a child. He had memories of Poland as a communist regime, and of the total breakdown of the government’s ability to be useful to its citizens. What he saw in the local U.S. public-health offices remined him of public services in Poland, but before the collapse of communism. “Poland now is not like this,” said David, after seeing the inside of a U.S. public-health office. “Poland now is more functional. Eastern Europeans are tough and kind of not shocked by a failed state. But these are the symptoms of a failed state.”

The expression “what doesn’t kill you makes you stronger” actually isn’t usually true for human beings. It is for bacteria, however.

After trying and failing to confine Agustin Zeferino to a hospital handcuffed to a bed, she secured from a judge permission to strap a GPS monitor to his ankle—which was why, of an evening, she was able to track Agustin as he left his motel room and strolled down the street to a strip club named the Spearmint Rhino. “Note to self,” said Charity. “Don’t put the isolation motel next to a strip club.”

Her role, it seemed, was to do stuff the state’s chief health officer was meant to do, while not being seen doing it, as that might raise questions about why the chief health officer wasn’t.

And the need to make hard decisions in public health didn’t just go away. It got pushed down in the system, onto local health officers. They had little social status and were thus highly vulnerable, but they also had little choice, if they hoped to save lives. Local health officers across the country paid with their jobs and more in their attempts to control a disease

Sara Cody, the health officer in Santa Clara County, had issued the country’s first stay-at-home order, after finding the country’s first domestic transmission of COVID—and now Sara Cody needed round-the-clock police protection.

Nichole Quick, the health officer in Orange County, seeing the virus rampaging through her community, had issued a mask order only to have the CDC waffle about the need for masks. She’d been run out of h...