The Premonition: A Pandemic Story

by Michael Lewis

As the legendary football coach Bill Parcells once said, “You are what your record says you are.”

I think this particular story is about the curious talents of a society, and how those talents are wasted if not led.

There is no shortcut to courage. Courage is a muscle memory. The tallest oak in the forest was once just a little nut that held its ground.

“Mental masturbation is actually an important concept. It’s when you talk in circles for an hour and reach no decision.

The root of the CDC’s behavior was simple: fear. They didn’t want to take any action for which they might later be blamed.

The job of the public-health officer—or at least her job as the public-health officer—was a series of intense firefights. There was no standard operating procedure for many of the situations in which she found herself: usually, they were sufficiently different from anything that had ever before happened. If she waited until she had enough evidence to publish in a scientific journal, the battle would be over, and she’d have lost. Kids would lose limbs, or die. The decisions she was forced to make were less like, say, those made by a card counter at a blackjack table, and more like the ones made by a platoon leader in combat. She never had all the data she wanted or needed when making her decisions—enough so that afterward she could defend them by saying, “I just did what the numbers told me to do.”

The hard truth was that there was never time to wait for more data. The moment an infectious disease appeared, decisions cried out to be made. The longer you waited, the more likely it was that people would die waiting for you to decide—or waiting for you to gather the data you needed to cover your ass if your decisions proved wrong.

In theory, the CDC sat atop the system of infectious-disease management in the United States. In practice, the system had configured itself to foist the political risk onto a character who had no social power. It required a local health officer to take the risk and responsibility, as no one else wanted to.

‘Stop waiting for someone to come and save you. Because no one is coming to save you.’

‘You’re going to make a mistake,’ ” said Carter. “The sin is making the same mistake twice. The best is to learn from other people’s mistakes.”

The gist of it was that people don’t learn what is imposed upon them but rather what they freely seek, out of desire or need. For people to learn, they need to want to learn.

If models could improve predictions about some basketball player’s value in a game, there was no reason they couldn’t do the same for the value of some new strategy in a pandemic.

If you took a penny and doubled it every day for thirty days, you’d have more than five million dollars: people couldn’t imagine disease spread any better than they could imagine a penny growing like that. “I think it’s because of the way our brains are wired,” said Carter. “Take a piece of paper and fold it in half, then fold it in half again, for a total of 50 times folding it in half. If a piece of paper is 0.004 inches thick to begin with, by the time you fold it 50 times, it is more than 70 million miles thick.” Again, it feels impossible. The same mental glitch that leads people to not realize the power of compound interest blinds them to the importance of intervening before a pathogen explodes.

There was, Carter thought, a downside to experience. “Experience is making the same mistake over and over again, only with greater confidence,”

“You cannot run out of options. Because what do you do when you run out of options? You panic.

Managing a pandemic was like driving a weird car that only accelerated, or braked, fifteen seconds after you hit the pedal.

The CDC had lots of great people, but it was at heart a massive university. “A peacetime institution in a wartime environment,” Carter called it. Its people were good at figuring out precisely what had happened, but by the time they’d done it, the fighting was over. They had no interest in or aptitude for the sort of clairvoyance that was needed at the start of a pandemic.

David had always been her favorite character in the Bible. As a boy, David had terrifying encounters with lions and bears, but they left him with skills. Courage was one of those skills; and Charity very much considered courage a skill. She was grateful for the fears that life had forced her to face up to in the way that she thought David should have been grateful to the bears, for preparing him to fight Goliath. “That list of twenty things I’ve overcome is the reason I’m a good health officer,” she said. “Those are my bears and lions.”

The human mind was simply no match for nature’s variety. Nature was full of surprises that no scientist, however smart, could predict. “You start looking only for things that you are trained to expect,” said Joe. “And you miss what’s there.”

He also thought that people who looked at stuff without any preconception of what they might find were the ones who saw the things that no one had seen before.

Science was just curiosity’s tool. Progress often began when someone saw something they hadn’t expected to see and said, “Huh, that’s weird.”

was Joe’s big takeaway from the story: what he called the last mile problem in medical science. Corporations were interested only in stuff that made money. Academics were interested in anything worthy of publication, but once they had their paper done, they tended to lose interest. The government was meant to fill in the blanks, but the United States government by now mystified Joe.

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. Bolton redesigned the White House to focus on hostile foreign countries rather than, say, natural disasters or disease. Bad people, rather than bad events.

But once you got past the necessary imprecision, you arrived at a better place—a place where the critically ill patient might not just be studied but treated. That was the place the Wolverines needed to be. A place where you could say to yourself that you were more or less right, even if you were a little bit wrong. But a place that you had gotten to fast, so that you might act.

Maybe disease outbreaks need a warning like the one on your car mirror—things are much larger than they appear.”

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.

“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.”

According to the pandemic plan, the federal government should at least have been preparing the country for the full suite of interventions. It wasn’t. So far as Carter could tell, it wasn’t even working all that hard to keep track of the virus.

Carter already had a view about these kinds of decisions. He thought that they should be approached the way an ICU doctor treated a patient clinging to life. Play forward whatever you are thinking about doing, or not doing, and ask yourself: Which decision, if you are wrong, will cause you the greatest regret?

But this is like the misdirection of a magician—we aren’t seeing what we cannot see because we aren’t looking for it.

He and Richard and others had spent years creating and selling the ideas that would, if quickly seized upon, prevent a lot of Americans from dying. Those ideas were useful, and yet no one in authority seemed willing to use them.

If the United States government wasn’t even going to try to save the American people from the virus, the states would need to do it.

she was struck by how private American forces of mercy were straining to offset America’s public agents of cruelty.

she’d never have the data she’d need to act—or, rather, that by the time she had that data, it would be too late to act.

What the humans would do, she felt certain, is what they were led to do, if only they were well led.

There was no system of public health in the United States, just a patchwork of state and local health officers, beholden to a greater or lesser degree to local elected officials.

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.

The American authorities were either unable or unwilling to smell the smoke. A lot of people seemed to be viewing events in Wuhan as just one of those bizarre things that happened in China.

He had the right mental model for the virus. The glitch was in his mental model of his own country, and its leadership. Every day brought him more evidence of their unwillingness to act on what he’d seen.

Trump had simply declared, “It’s going to disappear. One day—it’s like a miracle—it will disappear.”

The CDC had allowed people to believe that they were battlefield commanders—that, in a pandemic, they’d actually run the show.

“I was basically encouraging them to go rogue, because the state’s chief health officer is team CDC,” she said.

number of countries had set out to contain the new virus. Charity admired them for that. She thought that the United States should have had the good sense to emulate them.

“I thought that people could handle the bad news so long as you’re straight with them. What they don’t like is uncertainty. Say ‘here’s where we are and everyone needs to understand that this is going to get really bad.’ You tell them what is going to happen. So they can emotionally prepare for it.”

Donald Trump had said that it was every state for itself. In that one phone call, the Newsom administration had signaled to the local health officers that it was every county for itself, too. They would learn the lesson Charity had been forced to learn during her time as a local health officer: No one’s coming to save you.

The simple truth that the formula captured: the more transmissible the disease, the more people needed to be infected before the herd was theoretically safe.

The computer model gave the governor little choice but to shut down the entire state, and take responsibility for what should have been a national decision, because neither the Centers for Disease Control nor the president of the United States had the nerve to make it.

The virus would enforce the plan. If the citizens in certain zip codes still insisted on some fiction, the virus would expose the lie, and they would soon find themselves isolated and unwelcome in other parts of the country, where businesses had reopened and a semblance of ordinary daily life had resumed. It wasn’t just the effects of the virus that needed to be mitigated. The effects of the culture did, too.

The one shot America had at behaving well, and thus saving itself, was to remove the feeling that “the government” was imposing restrictions on people and re-instill the idea that people were imposing order on themselves, to fight a common enemy.

The absence of federal leadership, combined with the fragmented nature of the American health care system, meant that tests for the virus either weren’t available or were being processed too slowly to be of any use.