Michael Lewis’s “The Premonition: A Pandemic Story” is an excellent read for those with an interest in systems, especially dysfunctional service systems and institutions that fail to adequately protect the people they are designed to serve. The book is also an excellent read from the perspective of understanding the human-side of service systems, as Lewis does his usual masterful job of bringing colorful people to life in these pages (e.g., Money Ball is also by Lewis, and well known among the general public, sports enthusiasts, and data scientists).

The book is important for systems thinkers, to understand system failure, especially of public trust in institutions like the CDC. The COVID-19 global pandemic has so far killed an estimated 4 million people world wide, and over 600K in the USA alone. The head of the CDC (as of January 2021 is Rochelle Wilensky, and previously Robert Redfield) transitioned from a career civil servant role (David Senser – “the enemy is the virus, and its ability to mutate rapidly and randomly”, William Foege – famous for eradication of small pox) to a presidential (political) appointed role during the Reagan era (James O. Mason), and a great deal of the book deals with the spiraling down of the CDC as an institution equipped to protect US citizens from a disease during a crisis. The first line of active engagement with a killer virus is the county health officer, of which there are about 3000 across the USA (see NAACHO).

A key hero of the book is Charity Dean, who has great experience as the head of Santa Barbara County Health System, later as assistant director of California Department of Health (helping to move California from last to first in COVID testing with the help of others in a three month period), and in the epilogue CEO of The Public Health Company. Some of the other key heroic people in the book are Richard Hatchett and Carter Mecher who lead the charge about the best way to save lives as a pandemic is taking hold, and before a vaccine is available. Lisa Koonin of the CDC worked with Richard and Carter and is one of a short list of helpful CDC figures in the book. They all seem to be systems thinkers to me. For the breakthrough present, as well as the future of health and tracking viruses is represented well in the book by the work of Joe DeRisi. The future is also better simulations, and the aspect of the book was highlighted well in the person of Bob Glass of Sandia National Labs (“the scientists who simulate the end of the world”). They all seem level-headed, and more interested in saving lives through better systems (e.g., service systems for people and organizations to co-create value), rather than working in silos concerned with political optics and who takes credit.

Some snippets below to get a sense of the book:

Prologue: “But not for him. “This is the crux of science,” he’d say with enthusiasm. “All science is modeling. In all science you are abstracting from nature. The question is: is it a useful abstraction.” Useful to Bob Glass, meant: Does it help solve a problem.”

“With her dad, science was this tool for finding cool new questions, to ask and answer. Exactly what questions didn’t matter: her father had no respect for the boundaries between subjects and thought of all sciences as one and the same.”

“He began to read whatever he could about disease, and the history of epidemics. He picked up The Great Influenza a book by the historian John Barry about the 1918 flu pandemic.”

Chapter 1 – Dragon: “Then she saw the phrase ‘Communicable Disease Controller.’ It was an official state role. Played by local health officers. Her mind lit up…. To minimize horrific death, and to chase disease, the state of California had bestowed upon local public health officers extraordinary legal powers.”

Chapter 2 – The Making of a Public Health Officer: “In theory, the CDC sat atop the system of infectious-disease management in the United States. In practice, the system had configured itself to foist the political risk onto a character who had no social power. It required a local health officer to take the risk and responsibility, as no one else wanted to… ‘What scares me the most and what I think about most,’ said Charity, ‘is our ability to respond to a new pathogen, like influenza that’s just mutated. The H1N1 pandemic of 1918 was over a hundred years ago now. The world is overdue for a pandemic like that, whether it is influenza or something else. And in public health, we known that we have to be prepared for that.'”

Chapter 3 – The Pandemic Thinker: “Like Rajeev [Venkayya], Richard [Hatchett] thought the United States government was paying too much attention to threats posed by people and too little to those posed by nature. Like Rajeev, he believed that some new strain of flu, or some similar respiratory virus, was an accident waiting to happen. And so when he heard Rajeev’s offer to create a pandemic plan for the country, he was all in…. The task at hand was so unusual that he also asked for people who could ‘think about the box.’ … The VA sent not a policy person, not a Washington person, not a person who knew anything about pandemics, not a person who looked all that happy wearing a suit and tie, but a doctor from Atlanta named Carter Mecher. As it turned out, he would make all the difference.”

“‘That was when I started to see the world differently. To see systems… When you go into the details of the cases, you see it’s not bad people,’ he [Carter Mecher] said. ‘It’s bad systems. When the systems depend on human vigilance, they will fail.'”

Chapter 4 – Stopping the Unstoppable: “Richard had become obsessed with the idea of using models to shape the pandemic strategy, and so Carter had forwarded him the whole package – the VA guy’s email, together will all the stuff Bob Glass had attached… Richard believed that if the country were suddenly overwhelmed by some strain of flu for which there was no vaccine, there nonetheless existed strategies to prevent illness and death. He also wanted to believe that the benefits of these strategies could exceed their costs. He even thought it might be possible to eradicate a new virus without a vaccine. The trick would be to lower the diseases reproductive rate; the number of people each infected person in turn infected. Drive that number below 1, and a disease would flicker and die. But as few disease control experts believed any of these things, and so would not explore possible strategies in a real-life pandemic, he needed the models, to explore the strategies in artificial worlds.”

See their publication, “Public Health Interventions and Epidemic Intensity during the 1918 Influenza Pandemic.“

“The paper analyzed the effects of that inability, and showed that American cities that caved to pressure from business interests to relax social distancing rules experienced big second waves of disease.”

“This bothered Lisa. If one day in some future pandemic the new strategy saved millions of lives, no one would no would ever known where it came from. She thought they should know. And so, on the cover of the CDC’s official publication, in print so tiny it needed to be magnified many times before it was visible, she stenciled TLC.”

Chapter 5 – Clairvoyance: “American society had no ability to deal with what she felt was coming.”

Chapter 6 – The Red Phone: “The Virochip, as it was called, was actually a glass microscope slide. Its surface help genetic sequences from every known virus. These sequences, along with the genetic information of living creatures, were stored in a federally funded database called GenBank, inside the National Institutes of Health…. The DeRisi Lab had grabbed from GenBank the full or partial genetic puzzle pictures of twenty-two thousand viruses and transferred them onto a single glass slide.”

Chapter 7 – The Redneck Epidemiologist: “For more than a decade the seven doctors had come together each time a new biological threat presented itself. MERS, Ebola, Zika: they’d all been involved in each of those outbreaks, one way or another, behind the scenes.”

“Richard agreed, and never looked back. CEPI wound up handing out more than a billion dollars to various manufacturers to speed the development of a vaccine.”

Chapter 8 – In Mann Gulch: “She called the Red Cross, only to find out the Red Cross had no interest in helping, either. (She learned later that they didn’t want to offend their Republican donors.)”

Chapter 9 – The L6: “The Japanese were not dismissing it, though. The Japanese were alert.”

“A system was groping toward a solution, but the solution required someone in it to be brave, and the system didn’t reward bravery. It was stuck in an infinite loop of first realizing that it was in need of courage and then remembering courage didn’t pay.”

“‘Six layers down from the people in charge we found two contractors who actually understand what is broken.'”

“On March 18, Park and Patil presented the model’s output to Governor Newsom’s senior advisers… The next day, Governor Newsom issued the country’s first statewide stay at home order.”

Chapter 10 – The Bug in the System: “The thing to do, Joe decided, was to transform the Biohub into a COVID-19 testing center as quickly as possible – and publish a paper to show others how to do it.”

Chapter 11 – Plastic Flowers: “In three months California went from roughly last in the nation in COVID testing to roughly first, depending on how you counted.”

“Where once they had been a bunch of poorly connected dots on the map there would grow a tight web. A system. ‘It’s the future of disease control,’ said Charity.”

“Walking with her out the door, she carried with her a list of unanswered questions. Maybe the biggest was: Why doesn’t the United States have the institutions it needs to save itself?”

Epilogue – The Sin of Omission: “Even before she quit her job she had that odd thought, that the country didn’t have the institutions that it needed to survive. In particular, it did not have what it needed to battle a pathogen.”