Book Review: The Premonition: A Pandemic Story (2021). Michael Lewis.

On the back cover of Michael Lewis’s latest non-fiction book, The Premonition, there is a single quote of praise for the author from reviewer John Williams of the New York Times Book Review. The quote says, “I would read an 800-page history of the stapler if he wrote it.”

That is high praise, but an apt description of the quality of Lewis’s story-telling and his books, which among others include The Fifth Risk, which I previously reviewed; The Big Short, his insightful and scathing story of Wall Street and the financial and political shenanigans that caused the 2008 financial crisis; and also Moneyball, his fascinating account of how a gifted young statistician and Billy Beane, the unconventional general manager of the 2002 Oakland Athletics, upended Major League Baseball's traditional player evaluation process and built a winning baseball team of young “dark horse” players on a limited budget. Moneyball was also later made into a popular sports drama movie starring Brad Pitt.

The Premonition takes a look at a topic you’d think none of us would ever want to read another word about, the 2020 onset of the COVID-19 pandemic. It brings to light a gripping story behind the stories we’ve all heard, and it's a story most of us knew nothing about, despite the endless media coverage of the pandemic and how it's been handled here in the U.S.

At the center of his narrative is a small group of unheralded experts in the field of public health, including a 13-year old girl whose school science project turned into a key tool for modeling disease spread within social networks; a California doctor and public health officer whose relentless drive to save lives by taking action based on scientific knowledge constantly ran afoul of political actors and their self-serving agendas; and a small group of epidemiology policy outsiders across the U.S., heavily steeped in the research and history of the 1918 Flu epidemic, who recognized the pandemic’s potential danger almost the moment it first appeared in Wuhan, but had to fight against medical and political establishments in Washington D.C., in the states and at the CDC to make their voices heard, and to come up with effective means for combating the pandemic’s spread.

In the course of telling this inspirational yet depressing story of how the U.S. bungled its early response to the COVID-19 pandemic, Lewis demolishes the image of the CDC as an effective instrument of pandemic response and management. He paints it as it ultimately was seen by this small group of outside experts, as a stuffy and self-serving academic bureaucracy, reluctant to make recommendations or take action that might not succeed, and reflexively protective of its data and knowledge in service to its production of academic research papers rather than the sort of rapid “break the glass” action required in the face of a public health emergency.

Lewis also goes into some fascinating detail about the impact of rapid genomic testing for the first time in this pandemic, and how our ability to quickly read the genetic code of the disease as it mutated from person to person created at least a theoretical means to map the spread of the disease, and better understand what people and events were the “super-spreaders” that needed to be isolated to slow the disease’s spread. This little understood capability was not used very effectively, due to the lack of interest in resourcing widespread testing early on.

The book is a riveting story of private insights and urgency, contrasted with public delay, inertia, inaction and incompetence. In addition to these little known public health and epidemiological heroes behind the scenes, who ultimately ended up providing much of the most effective public health advice for fighting the pandemic, we see a few political figures who did listen, and acted relatively promptly upon the science-based advice coming from these experts, including Governor Gavin Newsom in California, as well as a few senior figures in the Trump administration and at the CDC, who had to operate anonymously and stay “below the radar” to try to steer the federal government toward an effective response.

For all of us who followed the news throughout the pandemic, and were trying to make sense of how the government and the CDC could seem to be so slow, so disorganized, and so lacking in preparedness for a pandemic like COVID-19, The Premonition provides much needed clarity.  It highlights many of the reasons for our national failures in responding to the pandemic quickly and effectively, and puts a spotlight on the small group of people who ultimately had the right answers, but were often thwarted in being able to get federal, state and local governments to follow their advice, and swiftly take the necessary steps to stop the spread of the disease.

It's a powerful, intriguing and illuminating account of the early days of the COVID-19 pandemic, and some of the previously unknown human dramas and events behind the scenes that played out as our health system and society struggled to find answers to the emerging public health crisis. Very highly recommended.