This is not just another pandemic book. When Michael Lewis takes on a subject (Moneyball, The Big Short), it is because he has discovered interesting people who have a uniquely different perspective, who are closer to the nub of the issue, and can frame it in a different light. You won’t hear what you already know; you’ll get an entirely different, illuminating point-of-view. Charity Dean, Carter Mecher, and Joe DeRisi— three smart doctors who understand the story data can tell, the warnings it can issue to those willing to examine it closely— as well as a careful re-examination of John Barry’s book, “The Great Influenza: the Story of the Deadliest Pandemic in History”, and a more careful study of Barry’s source material— lead these three lives to intersect and raise the alarm when our government was sleeping at the wheel in 2020.

Lewis provides evidence for two key indictments that, if go uncorrected, we may not survive next time pandemic hits. One is the politicization and academic culture of the Centers for Disease Control. It’s in the name—disease control— that led everyone from federal government officials, to state and local officials, down to citizens, to assume that when a health crisis hit our nation, the CDC would lead the charge, snap into action with a plan and a strategy. The CDC evolved into a culture of data collecting, careful study and research, and publication, like a university culture, not an organization ready to mobilize the nation for a war. Everyone waited, losing precious time, for CDC to lead the charge, which they never did. It took forever for them to issue a Covid test, while states and private entities developed their own in desperation. Remember their contrary mask advice? Since the director of the CDC is a political appointee, they are simply a voice of the administration, not of a scientific approach. If this virus had more lethality, we would have been cooked.

The second indictment relates to our network of public health officers. To call it a network is absurd, since there was little communication or coordination between local and state health officers. Much depends upon their role, yet they have been defunded over the years to near oblivion. Often physicians on the glide path to retirement take these jobs, not investing much energy into the work. Charity Dean felt a calling to fight infectious disease, and took her role as local public health officer for Santa Barbara County very seriously. She responded proactively and effectively, rising to second in command for the State of California. Unfortunately, the lead health officer was a politically appointed doctor with no knowledge of infectious disease, and only interested in the optics of her role— not someone to lead the charge when preemptive action is required.

The problem with heading off a pandemic is you never know the deadliness of the virus until it is too late. You cannot sit back and collect data on the death rate, doing nothing, until you are certain it is serious and warrants action. Once you know that, it is too late, and the virus is widespread. It is like smoking causing death—the consequences follow too far after the behavior to alert the public to the need for action. The CDC and politically appointed public health officers don’t want to call for public action if the virus winds up to be little worse than a common cold. The three subjects of this book understood that, intervention is not done for glory or public acclaim, it is done to save lives. The balance is between a high rate of transmission, combined with a high level of lethality— this is not knowable until a virus has permeated the population, and people start dying. Containment has to happen at the very start to have a chance of being effective, then actions are adjusted as more information is garnered about the virus. To the public, this appears arbitrary and ill informed— not the optics desired by politicians or by extension, political appointees.

Nothing appears to have changed since the current pandemic started over a year ago. When the next one arrives, as it absolutely will, we may not be so lucky. Lewis has a knack for good storytelling, for understanding the personal level up to the macro level. Great reading experience.