The Premonition: A Pandemic Story

One of the duties of leaders is to make quick decisions that shape or change policy—even in a crisis. In The Premonition, Lewis highlights the disastrous effects of leaders’ hesitation to make such decisions. Leaders—and experts—are the ones that the public defers to. They’re the only ones who can with expediency implement policy changes and mandates for things like masks.

Like Carter Mecher, the other members of the Wolverines make decisions based on what they’ll most regret—and what will cause the most real damage (to citizens)—if they’re wrong. They don’t think in terms of political capital or prioritize public image. Having unselfish motivations frees them to think objectively about problems, without an agenda beyond solving problems and saving lives.

The “wait and see” approach doesn’t work during a pandemic. Carter notes,

You cannot wait for the smoke to clear: once you can see things clearly it is already too late. You can’t outrun an epidemic: by the time you start to run it is already upon you. Identify what is important and drop everything that is not. Figure out the equivalent of an escape fire (172).

In another section, he expands on this idea, saying that people must be able to recognize the smell of smoke; that could prevent more fires than fire extinguishers.

Charity Dean agrees with him in one of her remarks about the CDC: “The CDC does not know how to pull the fire alarm. In fact, there is no fire alarm in this country” (196). If leaders fail to agree on clear warning signals before a pandemic starts, expecting a sense of urgency in the preliminary stages of a spreading disease is naive.

One takeaway from The Premonition is that we’ve already had enough pandemics to learn from. Each one serves as a potential dress rehearsal for something worse. The public record shows that pathogens punish hesitancy and that decisive action can save lives. This principle is clear from the H1N1 pandemic of 1918, the early-2000s SARS outbreak in China, and COVID, among others. The nature of COVID—from the uncertainty about its origin, to the varying intensity of symptoms that people experience, to the virus’s many mutations and variations—produces confusion. A person whose neighborhood, or town, is unscathed during the pandemic may view the global panic as extreme or confusing.

In the 2019 Nuclear Threat Initiative’s Global Health Security Index, the US ranks first in overall preparedness but last in many metrics for more specific critical preparedness metrics. In The Premonition, once Charity Dean, Carter Mecher, and the others realize that the pandemic is inevitable and won’t go away on its own, they give the government recommendations based on their experience.

Unfortunately, nothing happens fast, and sometimes nothing happens at all. Promising ideas often receive support and then vanish in the bureaucracy. Dean never learns why her ideas about genomic analysis aren’t put into practice despite their obvious efficacy. In Chapter 10, DeRisi’s staff change the Biohub into a testing facility when it becomes clear that the CDC won’t offer immediate solutions: “It had taken Joe’s new team two days less to build an entire lab than it was taking for Quest Diagnostics and Labcorp to process a single test” (247). The government’s slowness is maddening for Carter and the Wolverines, who know that people will die unnecessarily because of the government’s fumbled response.

What makes DeRisi and his staff, the Wolverines, and Dean so much more efficient than the US government is partly that they don’t run for office and aren’t the heads of corporations. The government doesn’t reward efficiency. The need to appease constituencies, prepare for the next election cycle, and keep good relationships with corporations is not conducive to expediency.

Lewis spends Part 1 introducing the major characters and their bodies of work. Dean, Carter, and the others work tirelessly to lay the groundwork for future pandemics. However, no one can find a use for them most of the time. After Carter leaves the White House at the end of the Obama administration, he’s shocked by the ensuing display of inefficiency. Thousands of the files that his team worked on disappeared as if they’d never existed. People at the White House ignore a great deal of foundational work that would be useful as a roadmap for future pandemics. Decision makers and political influencers hesitate to act to avert crisis because they’re less likely to focus on the potential gravity or anecdotal evidence than those who have direct experience with the symptoms or other indicators—and the potential death toll. However, when decision makers hesitate to make necessary policy changes, the tragic cost of that hesitation may be human life.

Like the other Wolverines, Carter’s primary interest is in solving problems. However, he rarely gets the chance to work on problems without first removing obstacles like inefficiency from the equation. The government’s inefficiency often results from indifference or distorted priorities. Other times, it’s purely the result of old technology, like the California state computer system that won’t allow free help because its computers can’t enter zero as the payment for a procedure.