The Premonition: Part 1 Discussion

[Kyli]

In Part 1 of The Premonition, featured background information about the characters we’ll follow throughout the rest of the book, a discussion of the H1N1 pandemic in 2009, and an overview of how the US pandemic response strategy was drafted. Please feel free to respond to any of the discussion questions below. We look forward to an engaging discussion with you all!

1. What were your overall thoughts about Part 1 of the book? Did anything surprise you? What stood out most to you?

2. Which character or story from Part 1 did you find the most interesting and why?

3. There is a debate in healthcare ethics regarding vaccine prioritization: should we vaccinate the oldest/most at-risk groups (usually called “sickest first”) or vaccinate younger/healthier people to slow the spread? What are your thoughts about these strategies and what moral challenges exist?

4. How has the COVID-19 pandemic positively or negatively affected public perceptions of the role of public health leaders and their authority to implement mitigation strategies?

5. Lewis shares in Part 1 that after reading a novel about the 1918 flu pandemic, President George W. Bush grew passionate about pandemic preparation. President Bush brought his concerns to an Oval Office meeting, where he was disappointed to learn that the United States did not have a comprehensive pandemic response strategy. Within a month of that meeting, a three-part pandemic strategy - written by Dr. Rajeev Venkayya - was passed by Bush's cabinet members and $7.1 billion was awarded to it by Congress. Did it shock you to learn how quickly the US pandemic response strategy memo was developed, passed, and funded?

6. What were your thoughts about the Targeted Layered Containment (TLC) strategy proposed by Carter and Richard where multiple semi-effective strategies are used together (also known as the "Swiss cheese" model)? Do you think it is an effective method for mitigating pathogen spread?

[Kenni]

2- I really enjoyed reading about Carter's story. His unorthodox introduction into the team was fun to read about. A good reminder that the best option might not be the most obvious one.
His experience working for the Bush and then Obama administrations highlighted one of the problems that exists in our federal government -- the notion that if one party created it, it can't be of use to me.
4- I think the COVID-19 pandemic drastically negatively affected the general public's perception of public health. People were seeing, in real time, how decisions are made and then altered and modified because new evidence supports a new direction. The mass media took these changes as "evidence" that no one knew what was happening and all public health authorities were trying to do was trick the public. The level of mistrust that has developed out of this pandemic is disheartening. I am worried about the next public health crisis that appears because it will take a lot to convince the general public to trust decisions that are being made, no matter how important they are.

I really enjoyed reading part I and I'm excited to continue to read and learn more!

[Kristy]

2. I particularly enjoyed learning about Bob and Laura Glass and how her scientific curiosity in middle school resulted in a comprehensive pandemic model that helped guide Bob through this project. It made me think of the various interactive models that circulated in the early pandemic to help the general public understand R0 values, herd immunity, etc. (like this: https://sph-umich.shinyapps.io/RoandH...).

5. I was very surprised to learn that the pandemic response strategy was created essentially on a whim after Bush read a book, and was also surprised at how quickly it was funded and developed. I think it all tracks with the mood at the time though—afraid of everything after 9/11 and wanting to plan for all potential worst-case-scenarios.

6. I'm a big fan of the "Swiss cheese" model, particularly since no single strategy will ever be fully effective. Layering mitigations not only allows for more chances at slowing spread, but it also allows for imperfections within populations—not everyone is going to social distance, or wear a mask, or get vaccinated, but perhaps everyone will take part in some combination.

[Kyli]

Kenni - thanks for your insightful comments! I absolutely agree that the changing strategies during the beginning of the pandemic negatively affected perception of public health. I hope that when the next public health crisis emerges there is open dialogue about why guidance may change by owning up to the fact that there is limited data/evidence and things may change as we learn more.

[Kyli]

Kristy - I am also a big fan of the "Swiss cheese" model! I saw it being used later in the COVID-19 pandemic after vaccines were widely available and many public health experts were still suggesting masking & social distancing despite mandates dropping. I think your view that everyone will take part in some combination is a great way to look at public health interventions. By providing many different tools that are semi-effective and sharing ways to layer those tools, people would maintain their autonomy to choose which tools to use.

[Gabe]

1/2 - I really enjoyed the story of Charity Dean because it was so sassy. she was right once, wrong once, and might have have prevented a disaster another time but there was no way to know for sure. I thought it was raw and honest. It shows how hard decision making can be. I know throughout the pandemic answering hotline calls I heard valid concerns and tragic stories from both sides. Her approach was particularly refreshing because I know firsthand how frustrating it can be to work with governmental public health agencies - even as someone working in the system myself. I think many of us feel this way. You really shouldn't be called 'brave' for going against the status quo. I always feel like creative great thinkers always leave for a multitude of reasons but it really is a shame. Good for her for taking her job seriously while also realizing that it is a great responsibility. Getting out in the field is important. I also loved Carter's story. I wish sending long rambling e-mails in the middle of the night was more commonplace. Also the story about the snakes was just bizarre I had no idea. I have a phobia of snakes but have always been intensely fascinated by both snakes and pandemics.

3- I think the idea to vaccinate younger people really makes a lot of sense although it depends on the disease to some degree. I l remember writing a two sided paper on this regarding hpv vaccination. a different situation but it still highlights how important early vaccination can be while also needing to being sensitive about what it means for kids and parents when thinking about autonomy. Coming back to something like COVID it's all about personal vs public protection. I think people really like to see evidence and it's hard when something is new and even harder when it's a disease that isn't particularly dangerous for children. I think considering children's access to high risk groups is reasonable as well. We know vaccination is the best to but I think offering alternatives like sex ed and safe spaces promotes trust, understanding of risk, and hopefully informed decisions. I think people forget risk exists on a spectrum can be conditional.

4- I took a course in public health ethics that was required in my MPH and it was really important. I think the key is to recognize that working on behalf of groups or while populations comes with unique responsibilities and considerations. Trust during this pandemic was an issue and I think listening and responding to constituents always increases situational awareness and promotes trust. it allows us to come up with solutions that address concerns and explain why decisions are being made.