Michael Lewis on the Mirage That Is America's Public Health System

Michael Lewis on the Mirage That Is America's Public Health System

; Michael Lewis, MS

Disclosures

June 04, 2021

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This transcript has been edited for clarity.

Eric J. Topol, MD: Hello. This is Eric Topol for Medscape. It's my incredible privilege today to speak one-on-one with Michael Lewis, the storyteller of our era, about his new book, The Premonition: A Pandemic Story. Michael, welcome.

Michael Lewis, MS: Thanks, Eric. Good to be back.

Topol: You've taken us to another level with this book. It's quite extraordinary. What I found especially fascinating is the pre-pandemic warmup that went on for almost 15 years here in the United States. It includes a 13-year-old girl, Laura Glass, and her father, Bob, in Albuquerque, in 2004; the incredible public health physician in Santa Barbara, Charity Dean; the "Wolverine Group" of seven doctors; and Joe DeRisi, from UCSF. How did you find these people?

Lewis: I was looking for people through whose eyes I wanted to see this event, people who could teach me things I didn't know. They landed in my lap in various ways.

Joe DeRisi was the easiest find. Five years ago I published a book called Flash Boys and ended up at dinner with a San Francisco money manager who wanted to talk to me about the book. And he said, "I have a character for your next book. His name is Joe DeRisi and he's opening this institution called the Chan Zuckerberg Biohub. When you meet him, you'll be smitten."

People do this to me a lot and I nod politely and take their business cards. And then I go hide. But he was so insistent that I went and had a sandwich with DeRisi. He is a virus hunter — a sort of freelance rogue virus hunter attached to UCSF. He's a really interesting man and a nut. When I met him, he'd already hunted down pandemics in snakes and in exotic birds. He invented a genomic sequencing technology to identify unidentified encephalitis. You know, it was one thing after another.

Topol: He cracked the case for SARS in 2003 and he sequenced the genome.

Lewis: He made the sequence quickly, like in hours. When I met him I thought, I don't deserve this character. My characters have earned rights. But what right do I have to write about this? I got a D in biology my sophomore year in high school and placed out of my science requirement in college by taking something called Physics for Poets. It felt almost inappropriate, almost obscene for me to use him as a character, even though he was so interesting. I thought, Some good science writer will pick up on him. But I made a folder about him and put it in my desk.

And when the pandemic was in early stages in March 2020, I called him up. No one had found him. He was still kind of virgin territory. I said, "What are you doing?" And he said, "Well, the Centers for Disease Control and Prevention (CDC) has a test that doesn't work. And so we've turned the Biohub into a COVID testing lab and we're going hunting for the virus." So that was case number one.

For each of characters, there's a story a bit like that of someone saying to me, "You've got to talk to this person." In the case of Charity Dean, five different people said it. In the case of the Wolverines, it was people who had helped me indirectly with The Fifth Risk, the book I wrote about the federal government as a manager of existential risk. Anyone near the pandemic space knew these guys because two of them had created the country's pandemic strategy and all seven had spent time working in the White House. They were an odd collection.

The whole notion of doctors in public policy was odd. When you go to Washington and start talking to people about public policy, you inevitably will be talking to some lawyer. And even if they're talking about science, they are quick studies and not subject matter specialists. But these were real, hands-on doctors who had wandered into the creation of a public policy and found in each other companionship, inspiration, teammates. They had been together for the better part of 15 years and whenever there was an outbreak anywhere in the world — MERS or SARS or Ebola — they were close to it either in the federal government or in prominent positions where they could have some effect on disease management. I thought that was riveting.

It was clear to me when I started this thing that we weren't going to get to the pandemic until halfway through the book, because what happened before told you so much about what was going to happen during.

Topol: Each of these four people or groups are protagonists and had their own premonition path. On the cover of the book, you have dots. Are the dots the Laura Glass model, or are they the 5000 public health people who respond to nobody?

A Science Fair Project Goes to the White House

Lewis: If you look at the cover, one dot becomes two and then creeping around the edge are other dots. It's exponential growth. It's the way a virus replicates.

The Laura Glass story is an example of the quality of the material I was working with. Bob Glass was kind of an all-purpose scientist at Sandia Labs. He's a very smart man who was working with a computer model he had created, an agent-based model, and his daughter Laura was watching him play with his model. On the screen were all these green dots and one red dot, and they moved, he explained, according to rules that he wrote for them. He was trying to show the way gossip spread or the way an angry person became a mob, or how a panicked person in the financial markets became a financial crash — the way information kind of cascades through a society.

Laura was looking at it and thinking, oh crap, another year rolling around and Dad's going to require me to enter the science fair again. She actually loved doing it, I think. But Bob Glass was like a Little League dad, but instead of baseball, it was science fair. Laura looked at the model and she said, "That could be the science fair project because that reminds me of the way disease spreads." She had been learning about bubonic plague. So she set about modeling disease spread.

It started out as a sweet little project, and then it spun completely out of control. It went on for several years. Bob Glass roped in the smartest programmer he knew at Sandia. (It was like hiring LeBron James and Steph Curry to play in your pick-up basketball game.) The model they created is very stylized but quite interesting because Laura does all this research about how people interact in their communities: how many face-to-face interactions, how close are they, how many people do they see in a day, where do they see them. And they built rules for the citizens in the community to move around.

Then they started to predict where people would be infected, how they would be infected, and how fast they would be infected. They move from plague to flu as the disease. And they start to see that you can do things in this community to jam up disease transmission. In particular, given the rules, closing schools has a huge effect. Bob Glass is looking at the epidemiologic literature in 2006 and the playbook says wait for a vaccine. The so-called nonpharmaceutical interventions were supposedly discredited back in 1918.

At the same time, two doctors in the White House, Richard Hatchett and Carter Mecher, are trying to answer the question, what do you do when a pathogen is loose in society? Before you get a vaccine, how do you slow it; how do you prevent illness and death? They had very fancy people turning up with early disease models, like Neil Ferguson from Imperial College in London, people who end up being giants in their fields. But Carter Mecher said these models were so complicated, they couldn't really use them to experiment with, they couldn't ask questions like what happens if you ban large gatherings?

So Carter Mecher knows somebody who used to date Bob Glass's sister, who knows about this kid's science project and sends him the model in the mail. Bob Glass had spent the better part of a year banging on the doors of epidemiologists saying, "Please, can you look at this," and no one is answering the door. Now the White House calls and says, "This model seems really cool. Can you get on a plane and come to the White House?" This model is one of the tools they used to design the pandemic strategy that ends up saving a lot of lives in other countries, because the plan is exported. And the punch line to it all is, Laura Glass doesn't win the science fair.

Two Cities, One Paper, and Social Distancing

Topol: I was surprised that it was the Bush administration that wanted a pandemic preparatory plan and Bush brings in Rajeev Venkayya. Then Venkayya brings in the two doctors you just mentioned, Richard Hatchett and Carter Mecher. Carter is known as Rain Man because he's all about the data. Rajeev writes the pandemic plan; he ghostwrites it for the CDC in 6 hours. And Carter ghostwrites the CDC social distancing plan.

In the book, you get into their 2007 PNAS (Proceedings of the National Academy of Sciences) paper that compares outcomes in the 1918 pandemic in St. Louis vs Philly. Up until this time, that is one of the most cited papers during the pandemic because of masks and social distancing.

Lewis: It's an amazing story of people pursuing a solution to the ends of the earth. They are involved with a very skeptical public health community. They've got this toy model that is part of some girl's science fair project, and the public health community is not totally persuaded by the model. The models are not in vogue at that time. Carter and Richard are looking at the evidence the other side is offering, which is that people did this in 1918 and nothing happened. It didn't work.

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