The Premonition

Lewis builds the book, as he did The Big Short, around a small cast of people who were right early: Charity Dean, a county public health officer in Santa Barbara who rose to a senior post in California's health department; Carter Mecher, Richard Hatchett and the informal group of pandemic planners who had worked on influenza strategy under George W. Bush; and Joe DeRisi, a UCSF biochemist who stands up a Covid testing lab in a matter of days.

Lewis, the author of Liar's Poker, Moneyball and The Big Short, uses the same narrative tools he brought to Wall Street: underdog experts, clear explanations of models and a target institution. Here the target is the Centers for Disease Control and Prevention, which he portrays as cautious, politicized and more interested in studying outbreaks than stopping them.

Kirkus called it an urgent and highly readable contribution to the politics of disease. Others were less convinced: some critics said Lewis portrays his heroes favorably without scrutinizing them, and the CDC indictment is one-sided by design.

Finance readers will recognize the problem of warnings from inside an institution that cannot act on them, and the costs of waiting for certainty during an exponential process.

1. Act before the data is complete. In an exponential process, waiting for certainty means acting too late. Mecher and his colleagues argued that early intervention was worth the cost of being wrong.
2. Preparedness rankings can mislead. The United States looked strong on paper and still performed poorly, a reminder that capacity and execution are different things, in public health as in risk management.
3. Institutions can punish being right. Lewis shows warnings stalling because careers rewarded caution and avoiding blame, the same dynamic that silences dissenting risk officers inside banks.
4. Informal networks fill gaps. Much of the useful work happened through private email chains and personal relationships rather than official channels.
5. Models start simple. Some of the most influential thinking about social distancing began with a basic simulation of how contacts spread disease through a school, a point about the value of clear, simple models.

The book is in three parts, opening with a prologue on a father and daughter's school-science model of disease spread and closing with an epilogue, and it moves from pandemic planning in the 2000s to the failures of early 2020.

1. The planners. Lewis goes back to the Bush administration's push for a pandemic strategy in the mid-2000s, when Mecher, Hatchett and their colleagues argued that early, layered measures such as closing schools could slow a new disease before vaccines were available, building on modeling work that started with a science-fair project.
2. The health officer. Charity Dean's rise from deputy health officer in Santa Barbara County to a senior job in the state health department shows how much of the system rests on overstretched local officials with few resources.
3. The scientist. Joe DeRisi's work on pathogen detection, and his push to build large-scale Covid testing in San Francisco, shows what outsiders could do quickly when official channels lagged.
4. The outbreak. As the virus spreads from China in early 2020, the cast tries to warn officials, trades information through a private email chain and urges state and federal action while the CDC and the White House delay.
5. The bug in the system. The final part argues that the US public health system was built to avoid blame rather than act decisively, and that the people who were right had little formal power.

For those who could read between the lines, the censored news out of China was terrifying. But the president insisted there was nothing to worry about. Fortunately, we are still a nation of skeptics. Fortunately, there are those among us who study pandemics and are willing to look unflinchingly at worst-case scenarios. Michael Lewis’s taut and brilliant nonfiction thriller pits a band of medical visionaries against the wall of ignorance that was the official response of the Trump administration to the outbreak of COVID-19. The characters you will meet in these pages are as fascinating as they are unexpected. A thirteen-year-old girl’s science project on transmission of an airborne pathogen develops into a very grown-up model of disease control. A local public-health officer uses her worm’s-eye view to see what the CDC misses, and reveals great truths about American society. A secret team of dissenting doctors, nicknamed the Wolverines, has everything necessary to fight the pandemic: brilliant backgrounds, world-class labs, prior experience with the pandemic scares of bird flu and swine flu…everything, that is, except official permission to implement their work. Michael Lewis is not shy about calling these people heroes for their refusal to follow directives that they know to be based on misinformation and bad science. Even the internet, as crucial as it is to their exchange of ideas, poses a risk to them. They never know for sure who else might be listening in.