The Premonition: A Pandemic Story

by Michael Lewis

All communicable diseases were infectious, but some infectious diseases were not communicable.

The simplest explanation is usually the best.

the best way to guard against error is to design systems with layered and overlapping defenses.

“You can keep mistakes from happening if

you can identify the almost mistakes.

For people to learn, they need to want to learn.

Targeted Layered Containment

If you took a penny and doubled it every day for thirty days, you’d have more than five million dollars:

rather than try to change people’s minds, they ought to try changing people’s hearts.

the way to change minds was by first changing hearts.

stopped making an argument and began to tell a story.

Instead of “Targeted Layered Containment (TLC),” the CDC wanted to call the new strategy “Community Mitigation Guidance.” “Carter could give a shit about the name,” said Staley. “He let them change it so it becomes their idea.”

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

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 ...

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

A River Runs Through It,

Identify what is important and drop everything that is not.

fifty-seven Americans spent fourteen days quarantined in Omaha, then left without having any idea of whether they’d been infected, or might still infect others.

The plan that he and Richard had created and passed off to the CDC back in 2006 classified pandemics, in a way that made them sound like hurricanes, by how many Americans they were projected to kill if left unchecked.

A Cat 5 (more than 1.8 million Americans) or a Cat 4 (900,000 or more dead Americans) required the CDC to call for all available measures: isolate the ill, cancel all public gatherings, encourage telework, enforce social distancing, and close schools for up to twelve weeks.

focus on foreign travelers was a pointless distraction.

“None of the people who had been involved in the last fifteen years of thinking about pandemics were in the conversation. They were deep state.”

(pan = all, demic = people, all people)

Trump administration had busted it up and sent pieces of it to other places, and entirely neglected other pieces.

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

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

I wouldn’t waste a moment of time on travel restrictions or travel screening,

A system was groping toward a solution, but the solution required someone in it to be brave, and the system didn’t reward bravery.

the number of infections required to achieve herd immunity could be calculated, as it was a simple function of the reproductive rate. (The formula was 1 − 1/R0, where R0 was the reproduction number.)

The first was for the president to announce a stay-at-home order for the entire country until it was able to test as much as was needed. As he did this, he would explain the second feature, the rules for reopening. Each community would receive one of three designations

hot, warm, cool—based on a few simple metrics: the number of cases per capita, the percentage of its COVID-19 tests that came in positive, the percentage of its hospital beds that were occupied.

it needed to be locally controlled. Each zip code would be able to see what it needed to do if it wanted to relax restrictions. And each zip code would have its own leaders, who would know the best ways to encourage good behavior.

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.

One measure of poverty is how little you have. Another is how difficult you find it to take advantage of what others try to give you.

“Deciding on a swine flu program is like placing a bet without knowing the odds,

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.

We are the bad example for the rest of the world,” said Carter. “That’s what is so embarrassing.”

To fire a competent civil servant is a pain in the ass. To fire a competent presidential appointee is as easy as tweeting.

Airborne and Asymptomatic. Now that we knew how badly we responded to such a threat, we could begin to prepare for it. “Mother Nature has given us a fighting chance,” she said. “She’s tipped the odds in our favor.”