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The Hot Book about the Pandemic Poses Its Own Danger

‘The Premonition’ by Michael Lewis undercuts faith in what public health can accomplish.

Crawford Kilian 18 May

Tyee contributing editor Crawford Kilian blogs about the pandemic.

This will be the hot pandemic book of the spring and summer. It’s readable, informative, funny, shocking, maddening and very one-sided.

In earlier books like Moneyball and The Big Short, Michael Lewis focused on bloody-minded individuals who knew they were right and proved it by making a lot of money despite the skeptics around them. He sticks to that formula here, except the key characters don’t get rich — just vindicated. Many readers will feel vindicated too, because Lewis confirms their worst suspicions about the incompetence of the U.S. public health system in dealing with COVID-19. As his central character, public-health officer Dr. Charity Dean, observes, “The United States doesn’t really have a public-health system. It has 5,000 dots, and each one of those dots serves at the will of an elected official.”

Lewis is an excellent storyteller, and here he adopts the plot of Akira Kurosawa’s Seven Samurai (later remade as the western The Magnificent Seven): the slow gathering of a band of outsider-heroes, almost by chance, to rescue a community from bandits.

Lewis’s twist is that the bandits win anyway. His samurai (who call themselves the Wolverines after a bad 1980s movie) are a small group of scientists and public-health experts who’ve taken their jobs seriously. The bandits are the bureaucrats who obey their political masters.

And politicians hadn’t cared about pandemics in decades. Doctors have an old saying: “You know public health is working when nothing happens,” and non-disasters are politically boring. That changed, a little, when an aide got president George W. Bush to read John Barry’s book on the Spanish flu pandemic of 1918–19. It scared Bush into convening a planning group to prepare for a new flu pandemic.

The first warning sign was bureaucratic apathy toward the whole idea of pandemic preparedness. Health agencies like the Centers for Disease Control had been fatally politicized since the mid-1970s after an abortive “swine flu” scare. After that, presidents started appointing political friends, not medical experts, to run the CDC — friends who understood that their key function was to avoid embarrassing the government of the day.

But if “the president was pissed” about something, government would spring into action, and Bush was certainly pissed about lack of pandemic preparedness. A minor functionary, who became one of the Wolverines, slapped something together on a Friday night and it was policy within days.

Now the plan had to evolve into a real plan, so the first Wolverine began to recruit helpers. They included some very smart people, including a Veterans Affairs doctor named Carter Mecher, who would become the mentor of the team that emerged years later when COVID-19 hit.

By coincidence, Mecher heard from Bob Glass, a scientist but no health expert, who was trying to find someone to take an interest in his daughter Laura’s model of a flu pandemic — created for a student science fair. When Mecher saw it, his reaction was “holy shit!” It was far ahead of CDC thought, which boiled down to “develop a vaccine, stockpile antiviral drugs, and be ready to take casualties.”

Laura Glass’s model offered more choices. “When you closed schools and put social distance between kids,” Lewis writes, “the flu-like disease fell off a cliff.”

Back in the 2000s, then, a handful of people foresaw 2020. Social distancing, especially school closures, would buy time while vaccines were developed and distributed. Carter Mecher foresaw the implications as well: “The majority of Americans employed by state and local governments were employed in education.” He learned that there were more than 100,000 kindergarten to Grade 12 schools in the country, with 50 million children in them. Many of them rode in 500,000 crowded school buses from home to school and back again.

Mecher and the other Wolverines understood the likelihood of exponential spread of a pandemic through the kids in such a system, and the political consequences of putting hundreds of thousands of teachers and school staff out of work.

With hindsight, we’re quietly appalled by Mecher’s foresight. But when he presented the Wolverines’ plan to the CDC, “They just beat the shit out of him,” one samurai recalled.

Pandemic planning based on models made no sense to the CDC experts. The Wolverines were reduced to publishing articles on cities that had locked down in 1918–19, and cities that hadn’t. As one of them observed, “they were in a war of competing narratives, and... whoever had the best narrative would win.”

The Wolverines won a temporary victory in a 2006 meeting that persuaded the CDC to endorse social distancing in a new pandemic. But they then scattered to new or former jobs. The H1N1 “swine flu” emerged in 2009 and briefly scared the world. But the public reaction was like the old Charles Addams cartoon, in which a patent attorney, standing at his office window with a ray gun in his hands pointed at people below, sneers at the inventor: “Death ray, fiddlesticks! Why, it doesn’t even slow them up.”

The CDC responded to H1N1 swine flu by offloading responsibility to individual American schools, while the Mexicans successfully used the Wolverines’ plan to shut down transmission of H1N1. The Obama administration responded sensibly to the West African Ebola outbreak, and developed its own pandemic plan, but it would be ditched the moment Donald Trump became president.

Lewis has meanwhile given us glimpses of a young doctor named Charity Dean, formerly married to a rich Santa Barbara surgeon, who takes on the job of public health officer. She’s a remarkable woman, brutally honest, who once opened a tuberculosis victim’s rib cage with garden shears, in a parking lot, when the local coroner was afraid to do so. By 2019, her success had taken her all the way to serving as the acting public health officer of California under Gov. Gavin Newsom. Then Newsom hired someone else for the job — Dr. Sonia Angell, a New York expert in chronic conditions with no experience in communicable diseases.

On Dec. 31, 2019, the world heard about the unidentified pneumonia in Wuhan, and the Wolverines began swapping email again — much as Dr. Li Wenliang did with his Wuhan colleagues, which got him in trouble with the local cops. (He would be dead of COVID-19 on Feb. 7.)

The Wolverines seemed better prepared for the pandemic than the Chinese. By the time five Americans had been diagnosed with COVID-19, Carter Mecher was scribbling numbers to project that failure to intervene in the outbreak would result in 900,000 to 1.8 million American deaths.

Early in 2020, the Wolverines contacted Charity Dean. They were hoping that she could set up a state response in California that the rest of the country could follow. But she was already battling her boss Angell about even the use of the word “pandemic.” Dean told them the CDC and California Public Health wouldn’t do anything; at best, some local public-health officers would start testing for COVID-19 and find a lot of it.

That shocked the Wolverines, who recruited her, listened to her, and began transmitting her views through back channels to the CDC. As she later told Lewis: “I didn’t want to manage it. I wanted to beat it.”

But the CDC didn’t accept the idea of beating the virus; it preferred mitigation, as did Canada and many other countries. New Zealand, Taiwan and Vietnam chose virus-beating, shut their schools, and have suffered far fewer cases and deaths.

The rest of the book describes how the Wolverines helped to battle COVID-19 while also dealing with Trump’s refusal to battle it at all on the federal level. It makes exciting reading, and it teaches us a lot about what went on inside the U.S. response. But Lewis wraps up with an unpersuasive conclusion: that the CDC is too much a political creature ever to mount an effective response to a major threat.

Worse yet, he shows us the pandemic strictly as the Wolverines saw it. He seems not to have talked to Sonia Angell or anyone in the CDC who may have questioned the Wolverines’ warnings. The Wolverines are vivid, quirky, real people; the bureaucrats are faceless careerists who get no chance to defend themselves — or even to admit that they screwed up. This is a serious flaw in Lewis’s argument.

Perhaps the 1976 swine-flu debacle led to the politicization of the CDC, just as the 2009 H1N1 pandemic led the Harper government to create the Public Health Agency of Canada — which was soon run by political appointees, not health scientists. But that wasn’t because a federal health agency was intrinsically incapable of dealing with a pandemic. It was because politicians saw public health as a political theatre, not as a way to save lives.

Wiser politicians, making wiser policy and appointments, could have made the CDC and PHAC into formidable disease fighters. Neither the U.S. nor Canada has had such politicians in the past 40 years. Since the 1970s, both countries (and many others) have ignored public health and encouraged us to look after ourselves as well as we can afford to. We Canadians brag about medicare, but the pandemic has exposed its shortcomings and inequities.

But Lewis and his Wolverines seem to have given up on public institutions, very much as Donald Trump did. Charity Dean resigned from her state job last summer. Lewis describes how she then set up the Public Health Co., a private firm hoping to persuade corporations to do what government could not: “I’m going to create a data-based tool for disease prevention that companies can use to secure their supply chains.”

The message of The Premonition, then, is that we are incapable of saving ourselves as citizens working through our democratic institutions. Instead we must persuade our billionaires into seeing that their road to still greater wealth lies in keeping us healthy as their employees.

Michael Lewis’s book is very much worth reading, but reserve your judgment until equally persuasive advocates for public health have answered it.  [Tyee]

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