The Premonition: A Pandemic Story

by Michael Lewis

My book asked: What happens when the people in charge of managing these risks, along with the experts who understand them, have no interest in them?

For the better part of three years, the Trump administration got lucky. That luck ran out in late 2019, as a freshly mutated virus in China made its way toward the United States.

it became clear that Trump’s approach to government management was only a part of the story, and maybe not even the bigger part. As one of my characters put it, “Trump was a comorbidity.”

in October 2019—

a collection of very smart people had gathered to rank all the countries in the world, in order of their readiness for a pandemic. A group called the Nuclear Threat Initiative partnered with Johns Hopkins and The Economist Intelligence Unit to create what amounted to a preseason college football ranking for one hundred ninety-five countries.

The Global Health Security Index, it was called.

They ranked the United States first. Number 1. (The United Kingdom was Number

At last count the United States, with a bit more than 4 percent of the world’s population, had a bit more than 20 percent of its COVID-19 deaths.

In February 2021, The Lancet published a long critique of the U.S. pandemic performance. By then 450,000 Americans had died. The Lancet pointed out that if the COVID death rate in the United States had simply tracked the average of the other six G7 nations, 180,000 of those

people would still ...

After a catastrophic season, management always huddles up to figure out what needs to be changed. If this story speaks to that management in any way, I hope it is to say: There are actually some things to be

proud of. Our players aren’t our problem. But we are what our record says we are.

Laura Glass was thirteen years old and entering the eighth grade at Jefferson Middle School in Albuquerque, New Mexico,

Bob Glass was a scientist at Sandia National Laboratories, created in the mid-1940s to figure out everything that needed to be figured out about nuclear weapons, apart from the creation of the plutonium and uranium inside them. It was Sandia’s engineers who’d calculated how to drop a hydrogen bomb from a plane without killing the pilot, for instance.

she noticed that a few of the dots were not green but red—and when a red dot bumped into a green dot, the green dot turned red. It was what was called an “agent-based model,” her father explained.

One of the things Bob Glass liked about this type of modeling was how easy it was to explain. Models were abstractions, but what this model was abstracting from was familiar: a single entity, which you could describe as a person, a piece of information, or any number of other things. As the green dots turned red, you could be watching gossip travel, a traffic jam, a riot start, or a species go extinct. “When you start talking about it this way, everyone can understand it immediately,” he said.

She asked her father: Could you use this model to study how a disease spreads? He hadn’t considered using his model to study disease.

Soon they were deep into a new science fair project. That first year, the model was crude. The disease was the Black Death,

She was the only kid at the fair who had done epidemiology.

“She came to me,” recalled Bob Glass, “and said, ‘Dad, it’s not so great that they just pass each other and they get sick. Dad, another thing, people don’t just walk around like this. They have social networks. I need to have social networks in here.’ ”

Through 2004, Bob watched as his now fourteen-year-old child designed a survey and administered it to hundreds and hundreds of people in her school district:

“At first it was going to my peers and asking them questions,” said Laura. “How often did they hug and kiss? How many people? How many different people did they sit next to? How many minutes did they spend sitting next to them? Then I went from them to their parents.” She mapped their social networks and their movements, and then mapped the interactions among the different social networks.

The most gifted computer programmer Bob Glass had ever met was a guy at Sandia National Labs, Walt Beyeler.

Asking him to help with a child’s science fair project felt a bit like pulling LeBron James in to play on your pickup basketball team. Walt was game.

it felt less like a science project than an engineering one. Once you understood the way a disease moved through a community, you might find ways to slow it, and maybe even stop it. But how?

in the fall of 2004, that because a single vaccine-making factory in Liverpool, England, became contaminated, the United States had lost half of its supply of flu vaccine. There was not enough vaccine to go around. So: Who should get it? United States government policy at the time was

to administer the vaccine to those most at risk of dying: old people. Laura thought that wasn’t right. “She said, ‘It’s young people who have all these social interactions and are transmitting the disease,’ ” recalled her father. “ ‘What if you give it to them?’ ” They went to their model and gave the young people the vaccine, thereby eliminating the ability of young people to transmit the disease. Sure enough, the old people never got it.

“I can find only one paper that even suggested this,” he said.

Her big white foam boards now focused tightly on a question. “Flu strains mutate all the time,” she’d written on them. “What would we do if we didn’t have the right vaccine in time?”

The disease in 1918 that had killed fifty million people had sprung from a handful of mutations in the virus inside some bird. By 2005, the seasonal flu had already achieved a few of these mutations. “We had a looming life-or-death problem of global proportions,” he wrote

Yet all the experts basically assumed that, in the first months after some killer mutation, little could be done to save lives, apart from isolating the ill and praying for a vaccine.

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 f...

Dr. Charity Dean was the newly appointed chief health officer for Santa Barbara County.

To move from one person to another, however, TB needed to invade the lungs. The young woman in the Santa Barbara county hospital had been diagnosed with tuberculosis of the brain, and, had the bacteria confined itself to her brain, it would have threatened no one. If it had found its way into her lungs, it had the power to kill. And 30 percent of the people who had TB in their brain had it also in their lungs.

The young woman who’d just died in the county hospital illustrated the point: no one had any idea she even had tuberculosis until she was on her deathbed. She’d had a husband and children; she’d lived in a crowded neighborhood; she’d worked inside a massive open-plan office, alongside three hundred other people. If the TB had reached her lungs, anyone she’d been anywhere near was now in mortal danger. That was Charity Dean’s immediate problem: to figure out who, if anyone, might be infected.

If the test came out positive, she’d need to call the company that employed the young woman and shut it down for long enough to test all three hundred of its employees, along with anyone they might have infected, along with anyone they might have infected—and on and on.

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.

the fine print in the binder describing the role

One sentence st...

Each health officer knowing or having reason to believe that any case of the diseases made reportable by regulation of the department, or any other contagious, infectious or communicable disease exists, or has recently existed, within the territory under his or her jurisdiction, shall take measures as may be...

To minimize horrific death, and to chase disease, the state of California had bestowed upon local public-health off...

She had, in theory, incredible legal powers to prevent disease. She soon realized how few people, in practice, knew the law.

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.”

Each health officer knowing or having reason to believe . . . “What does that mean??!!” she’d cry, and point her finger in the air. “It means suspicion! You only need to suspect!”

that any case of the diseases made reportable by regulation of the department, or any other contagious, infectious or communicable disease exists, or has recently existed, within the territory under his or her jurisdiction . . .

“Any dis...

All communicable diseases were infectious, but some infectious diseases were not communicable. Communicable meant a person could give it to another person.

Communicable diseases were the diseases that created crises.

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.”

then called the coroner to ask him to send her a sample of the lung tissue.