The Premonition by Michael Lewis has all the makings of a good thriller: a small group of rogue superheroes — scientists and doctors — who have never worked together join forces to fight a supervillain, the malevolent force of institutional rigidity and arrogance. Tragically, this book is not a novel. Instead, in this non-fiction account, Lewis portrays the American government and public health systems as incredibly vast and insufficiently centralized, with “no one driving the bus.” In fact, Lewis asserts, information about COVID-19 was known and ignored, and evidence about what public measures should have been taken while awaiting the arrival of a vaccine existed well before April 2020. In this account of COVID-19, institutional malaise contributed to the spread of the pandemic.
The main characters in The Premonition come from assorted backgrounds: Bob Glass, a father who helped his daughter create an infectivity model for a 2003 science fair project; Joe DeRisi, a biochemist who developed a useful technology for rapid viral testing; Charity Dean, a public health officer in California who began tracing transmission of resistant tuberculosis in her county; Carter Mecher, an epidemiologist with an almost clairvoyant mind, and Richard Hatchett, who plotted a national response to a deadly virus — in 2006. These unlikely collaborators somehow coalesce over time, banging their collective heads against institutional brick walls in their attempts to stop the spread of COVID. The institutional rigidity is mind-boggling, but perhaps not surprising.
The Centers for Disease Control and Prevention (CDC) emerges as the main antagonist. As America’s public health agency, the CDC is, as its name suggests, technically responsible for preventing the spread of disease. But the book presents a damning portrayal of an organization in which no one is willing to risk getting fired by making a wrong move and in which an institutional abundance of caution amounts to a form of recklessness. The CDC pretended that the virus wasn’t important until it was too late and, as a result, tens of thousands of Americans lost their lives. Even more mind-boggling is the complete absence of any coordination or integration of the public health system, with every county bumbling along on its own, making it so dysfunctional that one wonders whether there is a public health system at all.
Lewis focuses on the political conditions that existed before the pandemic and even before Donald Trump. The tragedy that became the American coronavirus pandemic was the perfect storm: the timing of the virus, the responses of then-President Donald Trump, the long history of politicization of the CDC, and the lack of a responsive and integrated public health care system.
The Premonition shows the damage done by institutional and bureaucratic malaise and rigidity to the lives of the US population in 2020. Could the same type of institutional, governmental, and bureaucratic rigidity inhibit physicians and physician leaders in overhauling what needs to be transformed urgently in the Canadian health care system?
Johny Van Aerde, MD, PhD, FRCPC, is co-editor-in-chief of the Canadian Journal of Physician Leadership and executive medical director of the Canadian Society of Physician Leaders.