Why the U.S. failed to avert the pandemic (1)

Michael Lewis’s The Premonition tells stories of Americans who foresaw the danger of a pandemic and created workable plans and technologies to fight it, but in the end were brushed aside.

He throws light on U.S. unpreparedness to deal with pandemic disease and how COVID-19 was allowed to take hold when it could have been eradicated.

The stories of his heroes are oddly inspirational, even though they mostly failed in the end.  Their plans and inventions were usually not tried, or tried too late.  They were like Winston Churchill’s in a world in which he was never called to power and World War Two ended in stalemate.

Lewis’s book leaves off in the spring of 2020 when it became plain that a pandemic was not going to be averted.  Andy Slavitt’s Preventable takes up the story at that point. 

Slavitt’s provided a good overview of the Trump administration’s failures, but I learned little that was new to me.  Lewis’s book is more fragmentary, but his insights are deeper and his writing is much more readable.

The back stories of Lewis’s heroes are as illuminating as their responses to the pandemic.  I’ll just give the highlights of one of them.

Charity Dean was public health officer for Santa Barbara County, California.  In 2013. she was alerted that a student at the University of California at Santa Barbara had symptoms of meningitis B, a rare infectious disease that attacked healthy young people and could kill them in hours.  The test for the disease was inconclusive.

She asked the Centers for Disease Control what to do.  The CDC advised her to do nothing.  She didn’t have enough data.  She ordered the university medical authorities to test any student with a low-grade fever four the disease.  Three tested positive.  The CDC still advised her to do nothing.

Instead she ordered lockdowns of the fraternities and sororities and to gave the 1,200 students a prophylactic (preventive medicine).  Over the objections of the CDC, she thinned out the dormitories by sending some students into hotel rooms, shut down intramural sports and administered a vaccine that had been approved in Europe, but not by the U.S. Food and Drug Administration.

There were no more cases.  Two years later, the CDC drew up a plan for best practices for an outbreak of meningitis B, which included most of the things Dr. Dean had done.

Another time she was faced with the decision as to what to do about a home for the elderly, which was within the path of a possible mudslide that would kill them all. 

Meteorologists said there was a 20 percent chance of such a mudslide.  The medical director of the home said that maybe 5 percent of the 100 residents were so frail to they would die if they were moved.

Based on those figures, she ordered the evacuation.  Seven of the old people died.  There was no mudslide.

A short time later, Karen Smith, public health director for the state of California, asked Dean to become deputy state public health director. 

Dean asked, Why me?  Smith answered, Because you make decisions.

In 2019, Smith stepped down.  Dean had expected to be her successor, but Gavin Newsom, the new governor of California, instead named Sonia Angell, a former CDC employee who was a stranger to California and had no experience in contagious disease.  Angell is Hispanic, and Newsom reportedly hoped she could reduce racial injustice in administration of health care.

In January of 2020, Dean was alarmed by images on social media that appeared to show Chinese medical authorities welding apartment doors shut to keep residents indoors.  She started monitoring Chinese videos on the Internet, running the captions through Google Translate.

Dean’s hunch was that international travel into California’s major airports meant the COVID-19 virus was already circulating in her state.  Neither the CDC nor Dean’s boss expressed concern.

The CDC was supervising the return of Americans from China, including Wuhan, but, according to Lewis, it didn’t test them or even take down their home addresses. The initial line from the CDC was the virus was nothing to worry about.

Dean did what she called “dirty math” on a whiteboard, plotting what the virus might do to California in the coming weeks. 

She guessed there might be 100 undetected cases of COVID-19 in California in February.  She extrapolated that, unless the state government took action, 20 million Californians, half of California’s population, would be infected within by June.  That would mean 2 million would be sick enough to be hospitalized, and 100,000 would die.

Angell saw no reason to question the CDC.   She ordered Dean to wipe the white board clean and to stop using the word “pandemic.”  She cut her off from meetings and e-mails concerning COVID-19.  “You’re scaring people,” she said.

Dr. Charity Dean. Source: CBS.

But on Feb. 6, Dean got a call from Duane Caneva, the chief medical officer for the Department of Homeland Security.  He put her in touch with a group of seven physicians who called themselves the Wolverines, and had an e-mail distribution list called Red Dawn.

They had written a plan in 2005, at the call of President George W. Bush, on how to prevent a repeat of the 1918 influenza pandemic, and they’d worked together ever since to prepare to stop a new pandemic.  Many high officials read their e-mails and listened in on their conference calls.

Early in March, Dean got a call from Ken Cuccineilli, the deputy director of Homeland Security.  He said the only hope of stopping the pandemic would be for some important state, such as California, to take the lead.  The implication was that there was no hope at all of leadership from the White House.

On March 6, Gov. Newsom called a meeting of top state officials to discuss the coronavirus.  At the last minute, Angell called in sick and asked Dean to stand in for her.  She spoke for 20 minutes, and answered questions for another 45 minutes.  After that she was in the loop.

Newsom’s economic adviser asked Todd Park, a technology entrepreneur, and DJ Patel, a data scientist, to help figure out a COVID strategy.  The two quickly found Charity Dean, and created a computer model incorporating her research and suggestions.

“Our only job was to make it possible for Charity to talk through a model,” Park said.  “Our job was to take everything in her brain, and get it to the governor.”

Park and Patel presented their model to Newsom on March 18.  On March 19, the Governor issued a statewide shutdown order, the first U.S. governor to do so.  The total number of cases in California so far is 3.7 million, far fewer than Dean feared, and 63,000 reportedly have died.

Of course the disease had already established itself by the time he acted.  Action in January might have squelched the disease completely with much less economic hardship.

Charity Dean was just one hero of the pandemic. You’ll have to read the book to learn about the rest, including the Wolverines.

***

Here are my main takeaways from Michael Lewis’s fine book.

The way to fight a pandemic is to stop it before it starts. Carter Mecher, the unofficial leader of the Wolverines, said that contact tracing, quarantines, lockdowns and travel restrictions can be highly effective in the early days of the disease, but they do little good by the time an epidemic or pandemic is recognized as an epidemic or pandemic.  A fire extinguisher can easily put out a grease fire on a stove, but is virtually useless by the time the fire has spread to half the house.

The United States lacks a national health system.  We have 50 state systems and thousands of county systems. Public health officers have great authority, but they serve at the pleasure of elected officials.  Their careers can end if they exercise their authority and make a wrong decision, or even if they make a correct by unpopular decision.  Coordinated action is very hard, even with good will.

The Centers for Disease Control is a major obstacle to action in pandemics.  The tendency is to authorize no action that is not backed up by rigorous scientific data, whereas emergencies require quick decisions based on incomplete information.  The CDC does good work on disease studies, but it is a vortex of negativism when it comes to disease control emergencies.

LINKS

Interviews of Michael Lewis, Charity Dean and Carter Mecher by John Dickerson for CBS News’ 60 Minutes.

A review of The Premonition by Mark O’Connell for The Guardian.

The Premonition, a review by Alex Tabbarok for Marginal Revolution.

We’re Not Ready for Another Pandemic by Olga Khazan for The Atlantic.

The Spread of New Covid Variants by Ian Welsh.

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2 Responses to “Why the U.S. failed to avert the pandemic (1)”

  1. davidgmarkham Says:

    Great review and essay! Thank you very much.

    I have not read Premonition but intend to. I did read Lewis’s previous book, The Fifth Risk, which is also very good in which he predicts the fiasco of the Trump administration because of its incompetence which is after nuclear devastation, shut down of the electrical grid, climate change, and economic melt down, the fifth risk. We have seen that play out.

    The loss of faith in social institutions in our fast changing world is warranted. Institutions function for stability and maintaining the status quo. They do not like fast or what many would consider disruptive change. It is the nature of the beast. Institutions function for maintaining the status quo and in times of rapid change individual expert decision making is often superior to institutional management.

    Thus, the loss of faith in institutions by the public is somewhat warranted but institutions should not be abandoned. There is a need for stable, reasoned management but also a time for thinking outside the box and turning to expert leadership. Our challenge is find a good balance between the assets of both management systems.

    Like

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