The Premonition: A Pandemic Story

by Michael Lewis

he explained to her why he wouldn’t.

She hung up and called the sheriff.

The sheriff didn’t know the law, either, it seemed, as he said he wouldn’t interfere with the coroner’s authority.

She wrote out a legal order and delivered it to the sheriff in person. “Then I waited for the phones to blow up.”

Seven people were waiting for her outside the morgue, all men. The coroner, the sheriff, and a bunch of his deputies. They’d clearly come for the show. She’d driven straight from cleaning up the mess under the tree, and so she wasn’t in her usual battle armor of Talbots suit, pencil skirt, and grandma heels. Just a tacky Christmas sweater and blue jeans.

The coroner was now just angry. He explained all over again that the entire operation was unsafe and he was not going to risk opening up the body indoors.

why he hadn’t even brought his bone saw with him, as the one known case of a surgeon becoming infected with TB by a corpse had involved a bone saw.

Instead of the bone saw, he’d brought along a pair of garden shears. Now he offered t...

“I had thought I was just there to watch,” said Charity. “And he turned it into a game of chicken.”

her office and home bedroom were plastered with Post-it notes on which she had scribbled the mantras by which she hoped to live,

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.

Like most everyone else, she needed reminding. Unlike most everyone else, she reminded herself.

they don’t think I’m going to go through with this. Then another: they don’t think I will do it, because I don’t look like a person who would do it.

She’d created a rule for herself: when entering a meeting with a certain kind of male, allow a thirty-second recovery period before attempting to convey information upon which that male might need to act.

as she reached into the woman with the garden shears, the coroner reached in, too. He wanted to . . . help. “Should we look in her belly?” he asked gently. Right, she thought. If it was in her belly, then it was in her blood, and if it was in the blood, it was probably on her lung.

It was as if her nerve had changed his view of the situation.

she held the young woman’s lungs in her hands. This Jell-O. Outside the human body, lung tissue didn’t hold its form. And now she could see just how sure the coroner had been that none of this would ever happen: he had nowhere to put them. The only container in sight was an orange plastic bucket from Home Depot. She grabbed the woman’s lungs and placed them into it, then tossed the bucket into the car and drove away.

To the men she left behind, the entire scene would remain a vivid memory; to her it was almost just another day in her life as the local health officer. They had no idea of the things she had done, or what she was capable of. The coroner obviously hadn’t even considered the possibility that she was a trained surgeon. “Men like that always undere...

Paige Batson had been a nurse in the Santa Barbara County Public Health Department for more than a decade when Dr. Charity Dean was named the new deputy health officer.

Right from the start, Dr. Dean did stuff no other health officers had done. She spent huge amounts of time with the public-health nurses, for instance, and treated them not as subordinates but as teachers.

There were days when she would go straight from plucking maggots from the wounds of a homeless man to testifying on television in front of the board of supervisors.

the most curious thing about Dr. Dean was the sheer number of strange events that occurred whenever she was around. “Things exploded the minute she came,” said Paige. After Dr. Dean was promoted from deputy to chief, in early 2014, the pattern became even more pronounced. At one point Paige turned to her boss and blurted out, “You know, since you’ve been here, we’ve had the weirdest cases. It’s been weird case after weird case.”

Later she realized that the weird cases didn’t simply happen to Dr. Dean. They happened because of Dr. Dean.

A woman had turned up at a hospital to donate blood and tested posi...

By 2016, hep C was killing more Americans than all the other infectious diseases put together, according to the Centers for Disease Control and Prevention, but it never made the list of diseases that required a swift response from the local health officer. It was blood-borne, which made it harder to contract, and easier to ignore.

this local woman who’d caught hep C was an unusual case. She happened to be a regular blood donor, and had given blood just a few months earlier, which meant that just a few months ago she did not have hepatitis C. Dr. Dean asked Paige to call the woman and ask her where she had been the past few months. It emerged that in that brief period, the infected woman had treated herself to an astonishing number of possibly infectious procedures. An improbable number of manicures and pedicures. Botox treatments. Dental work. Some kind of stem cell procedure. By the time Paige got off the phone, she had a list of ten places where a virus might have entered the woman’s bloodstream. Dr. Dean asked her to go have a look around the places and report back.

a doctor named Stephen Hosea. Dr. Hosea was a poor boy from Kentucky who had trained at Harvard in the 1960s and then spent a decade researching disease at the National Institutes of Health (alongside a young researcher named Tony Fauci) before coming to California to treat infectious disease.

“He said you should always put your hands on the patient,” said Charity.

Soon the patients would be babbling on about their travels, their love lives, their workplaces, their extended families. It could seem like a natural conversation, but it never was. “The patients were all like, ‘Oh, he wants to know all about me,’ ” said Charity. “But not really. He was digging into the parts that helped to inform his differential diagnosis.”

Over and over again, Charity watched the older doctor tease out possibilities missed by the younger doctors, just by getting patients to talk about the relevant parts of their lives. Or, as Dr. Hosea put it, “What have you been doing that I haven’t been doing that puts you at risk for whatever the hell you’ve got?”

He wouldn’t tell you what the diagnosis was. He’d just lead you to it with the questions he asked the patient.”

Steve Hosea burned into my mind that the most important part of the medical history isn’t the medical history. It’s the social history.”

Charity had taken away other lessons from Dr. Hosea.

The simplest explanation is usual...

If there is the faintest possibility of a catastrophic disease, you should treat it as being a lot more likely than it seems. If your differential diagnosis leads to a list of ten possibilities, for instance, and the tenth and least likely thing on the list is Ebola, you should treat the patient as if she has Ebola, because the consequences of not doing so can be calamitous.

When something doesn’t quite seem right about your diagnosis, respect the feeling, even if you can’t quite put your finger on why the diagnosis might be wrong.

A doctor needed to be a detective for the patient: that was Dr. Hosea’s big message.

Preventing infection was all about creating barriers: between patients; between dirty needles and clean ones; between work spaces and life spaces. That’s why all the rules existed, but the doctor was following none of them.

“I thought, Oh my God, he may have been infecting people for thirty years,” said Charity. “I thought, If these are the things I am seeing when they knew I was coming, what are the things I’m not seeing? At that moment I wasn’t worried about hep C. Hep C was the least of my worries. I was worried about HIV.”

Dr. Dean called the chief counsel of Santa Barbara County to let him know what she had just done—and that he should maybe expect a shitstorm from the doctor’s important patients.

even after the CDC people conceded her authority, they refused to condone how she’d used it. “They told me that if I’m wrong I’m going to get fired,” she said.

As Kat DeBurgh, head of the Health Officers Association of California, put it, “To do the job of local public-health officer, you basically always need to be willing to lose your job.”

Apart from the uninsured poor she treated in the clinics and homeless shelters, few citizens had any clue what Charity did—until she did something that infuriated them.

The illness you prevented, and the lives you saved, went unnoticed by the people sitting on top of society. That’s why her role was, every year, less well funded than the year before. The fax machine was the new tech in the office that still kept its records on paper and filed the paper in red manila envelopes. “If I wanted to send a letter, I needed to fill out a form, and the form had to be approved—all to use a county-funded stamp,” said Charity. “I was the county health officer, and I wasn’t allowed to use a stamp. But that’s okay! I learned to live within the system.”

That system was the front line of defense against disease, not just in the county but in the whole country. Seventy percent of Santa Barbara’s cases of communicable disease came through one of its five public-health clinics, overseen by the health officer.

But because people who had health insurance thought it had nothing to do with them—that it was just government—the society h...

“I learned the way to make the argument to elected officials for money for disease control was not ‘It is the right thing to do to take care of the most vulnerable in our community,’ ” she said. “Rather, make the case

of the dollar return on investment to prevent the disease from spilling over into the rest of the community.”

even then—even after she showed a return—the investment ...

“The cost of a single TB case is between thirty and a hundred thousand dollars,” she said. “Higher if it is drug-resistant TB. So why are we haggling over a seventy-two-thousand-dollar machine?”