Read this Book!
Most of us have many questions about the ongoing Covid pandemic. This book provides the context for most of those questions and raises a few questions of its own; particularly about the Centers for Disease Control and how they saw their roles and responsibilities.
Just as Americans were being repatriated from Wuhan, the government decided to only test those who were running a fever, even though other countries including Japan had already proved that a certain percentage of those infected did not manifest any fever: "Did they want to avoid finding cases to avoid displeasing Donald Trump? Were they concerned that, if they tested people without symptoms and they found the virus, they’d make a mockery of their current requirement that only people with symptoms be tested? Were they embarrassed or concerned that someone other than the CDC was doing the testing? If so, then why didn’t they just perform the tests themselves?" Thus, all Americans returning from Wuhan and were isolated, if they had no fever, were not tested before being released.
Here's how Lewis frames his focus: "During the first half of the Trump administration I’d written a book, The Fifth Risk, that framed the federal government as a manager of a portfolio of existential risks: natural disasters, nuclear weapons, financial panics, hostile foreigners, energy security, food security, and on and on and on. The federal government wasn’t just this faceless gray mass of two million people. Nor was it some well-coordinated deep state seeking to subvert the will of the people. It was a collection of experts, among them some real heroes, whom we neglected and abused at our peril. Yet we’d been neglecting and abusing them for more than a generation."
Some writers of non-fiction have a special gift of serving you an immense bowl of ideas and facts without making you gag on all of it. Tracy Kidder and John Krakauer are two of my favorites and Michael Lewis fits in nicely with them. Here, he acquaints readers with some of the people that you never heard about, but whose efforts were key to understanding and responding to this pandemic. I have to give this book my highest recommendation. 5*
Some of my favorite insights from this book:
"In February 2021, The Lancet published a long critique of the U.S. pandemic performance. By then 450,000 Americans had died. The Lancet pointed out that if the COVID death rate in the United States had simply tracked the average of the other six G7 nations, 180,000 of those people would still be alive. “Missing Americans,” they called them. But why stop there? Before the pandemic, a panel of public-health experts had judged the United States to be more prepared for a pandemic than other G7 nations. In a war with a virus, we were not expected merely to fare as well as other rich countries. We were expected to win."
Some of that blame was not due to political machinations but to governmental structure. Lewis calls out the Center for Disease Control (CDC) and its view of own role: "The CDC had lots of great people, but it was at heart a massive university. “A peacetime institution in a wartime environment,” Carter called it. Its people were good at figuring out precisely what had happened, but by the time they’d done it, the fighting was over. They had no interest in or aptitude for the sort of clairvoyance that was needed at the start of a pandemic."
"“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?"
"“The cost of a single TB case is between thirty and a hundred thousand dollars,” she said. “Higher if it is drug-resistant TB. So why are we haggling over a seventy-two-thousand-dollar machine?”"
"The decisions she was forced to make were less like, say, those made by a card counter at a blackjack table, and more like the ones made by a platoon leader in combat. She never had all the data she wanted or needed when making her decisions—enough so that afterward she could defend them by saying, “I just did what the numbers told me to do.”"
"If models could improve predictions about some basketball player’s value in a game, there was no reason they couldn’t do the same for the value of some new strategy in a pandemic."
"He didn’t ask his superiors at Sandia National Labs for permission, because he already knew the answer. “They kill people for doing that,” he said. “They would flip and put people in between me and them, and I wouldn’t be able to do anything.”"
"Richard couldn’t understand his certainty, or the weird conventional wisdom that had coalesced. “One thing that’s inarguably true is that if you got everyone and locked each of them in their own room and didn’t let them talk to anyone, you would not have any disease,” he said. “The question was can you do anything in the real world.” The new models of disease, slow and unwieldy though they were, gave Richard hope. D.A. Henderson, and the people at the CDC, along with pretty much everyone else in the public-health sector, thought that the models had nothing to offer; but they were missing the point. They, too, used models. They, too, depended on abstractions to inform their judgments. Those abstractions just happened to be inside their heads. Experts took the models in their minds as the essence of reality, but the biggest difference between their models and the ones inside the computer was that their models were less explicit and harder to check. Experts made all sorts of assumptions about the world, just as computer models did, but those assumptions were invisible. And there was every day fresh evidence that the models inside the minds of experts could be seriously flawed."
"The more Carter and Richard learned, the more excited they became. “Imagine if we could affect the weather,” Carter wrote, in one of his long memos. “Imagine if we had the capability to reduce a category 5 storm to a category 2 or a 1 . . . Now although the Federal Government is not at the threshold of significantly reducing the potency of a hurricane, it is at the threshold of doing just this to another natural disaster—pandemic influenza.”"
"He’d visited the CDC to explain the new genomic technology, only to be met with boredom and blank stares. In the Food and Drug Administration there was one woman—a single human being—trying to curate the academic literature so that doctors and patients could easily access new knowledge. She’d taken it upon herself; no one had asked her to do it. “It’s often individuals who pick up the baton, and they’re not even doing it as part of their day job description,” said Joe. “Scattered throughout those organizations there are these people, but they aren’t organized, trying to compensate for the deficiencies in the system.” The Red Phone could save your life if you called it in time. The system had configured itself in such a way that, more often than not, you didn’t."
"To inject a virus into an African python took some trouble. Snakes don’t have injectable veins. They do, perhaps surprisingly, have hearts, and that’s where the virus must be injected. Snake hearts don’t stay put, like human hearts, but travel up and down the snake’s body. To inject a snake’s heart with a virus requires two postdocs and one full professor: one to hold the snake in a death grip, one to use a Doppler radar to find the snake’s heart, and a third to plunge the needle into it."
"All of which was part of a bigger problem that he wanted to tackle: how any big government agency allocates its resources."