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Tuesday, May 4, 2021

The Covid-19 Premonition

Michael Lewis

The Missing Americans

This book began with an unholy mix of obligation and opportunism. 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. That behavior climaxed with the Trump administration. My book asked: What happens when the people in charge of managing these risks, along with the experts who understand them, have no interest in them?

I had no clue what was going to happen next. I assumed something was bound to happen. But it didn’t—not really. For the better part of three years, the Trump administration got lucky. That luck ran out in late 2019, as a freshly mutated virus in China made its way toward the United States. This was just the sort of management test I’d imagined when writing The Fifth Risk. How could I not write about it? But as I got into it, and found these wonderful characters to tell the story through, it became clear that Trump’s approach to government management was only a part of the story, and maybe not even the bigger part. As one of my characters put it, “Trump was a comorbidity.”

Back in October 2019—nearly three years into the Trump administration, and before anyone involved was aware of the novel coronavirus—a collection of very smart people had gathered to rank all the countries in the world, in order of their readiness for a pandemic. A group called the Nuclear Threat Initiative partnered with Johns Hopkins and The Economist Intelligence Unit to create what amounted to a preseason college football ranking for one hundred ninety-five countries. The Global Health Security Index, it was called. It was a massive undertaking involving millions of dollars and hundreds of researchers. They created stats and polled the experts. They ranked the United States first. Number 1. (The United Kingdom was Number 2.)…

Critics quibbled with the rankings. The complaints weren’t all that different from the complaints you hear before every college football season. For years the University of Texas football team, with its vast resources and sway with voters, always seemed ranked more highly at the start of the season than at the end. The United States was the Longhorns of pandemic preparedness. It was rich. It had special access to talent. It enjoyed special relationships with the experts whose votes determined the rankings.

Then the game was played. The preseason rankings no longer mattered. Neither, really, did the excuses and blame-casting and rationalizations. As the legendary football coach Bill Parcells once said, “You are what your record says you are.” At last count the United States, with a bit more than 4 percent of the world’s population, had a bit more than 20 percent of its COVID-19 deaths. 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…

Lewis, Michael. The Premonition: A Pandemic Story (pp. xii-xv). W. W. Norton & Company. Kindle Edition.

I have long eagerly devoured everything Michael Lewis has written and published, all the way back to his Wall Street time. Hie latest book has just been published. 

Thia was all that Donald Trump saw and heard. He thought he was gonna ride the Dow-S&P-NASDAQ limo to a second term as Acting President. Everything else was irrelevant.
Cited Michael's book The Fifth Risk here.

Stay tuned. Just downloaded The Premonition.

Finished the book in a day and a half. Great story, compellingly written. Michael Lewis rocks. NY Times book reviewer wrote "I would read an 800 page history of the stapler if he wrote it."

Me too.

The CDC does not come off well in this book (nor do a number of other entities), in part for reasons long pre-dating the derelictions of the absurd Donald Trump.
Bring on the screenplay. Erin Brockovich, make room for
Dr, Dean resigned her California public heath position to co-found The Public Health Company (PHC).
Even before she’d quit her job she’d 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. The pandemic had given America’s enemies a clear view of the country’s weakness: its inability to respond to a COVID-like threat. On her calls with the Wolverines, she’d ask: “What does the country need?” She was really asking herself, as no one had the answer. Her conclusion had pained her some. Once she’d become a public-health officer, she’d imagined an entire career in public service. Now she did not believe that the American government, at this moment in its history, would ever do what needed doing. Disease prevention was a public good, but the public wasn’t going to provide anything like enough of it. From the point of view of American culture, the trouble with disease prevention was that there was no money in it. She needed to find a way to make it pay.

The problem was a crazy problem. It wasn’t going to have a non-crazy solution. Still, she’d sort of shocked herself. She’d never had the slightest interest in business. But if she wanted to save the country, she’d need to become an entrepreneur, and create a company—though in business, she quickly learned, she couldn’t talk like that. When she said she wanted to build a tool “to save the country,” people just smiled and thought she was goofy in the head. But when she said things like “I’m going to create a data-based tool for disease prevention that companies can use to secure their supply chains,” serious business types nodded. “Five smart people have replied with confusion when I said the company was to save the world and protect our country,” said Charity, after her first attempts to explain her vague idea. “Then when I said, ‘We’re going to do private government operations, like Blackwater,’ their eyes lit up and they said, ‘Oh wow, you could take over the world.’ ”
[Lewis, pp. 298-299]
They've come out of the blocks hot. to wit,
The Future of U.S. Public Health


COVID-19 demonstrated a single pathogen’s ability to wreak havoc at global scale. Though organisms with this capacity strike sparingly, their impact nevertheless remains palpable for years to follow. Anticipating such biological threats has been historically difficult. As evidenced by the recent pandemic, our responses are often reactive, rather than proactive, and the consequences unforgiving…

This white paper outlines our framework for the future of U.S. public health as it relates to communicable diseases and public-private partnerships...

Closing remarks

Failing to address the fragmented and antiquated structure of our underlying U.S. public health system will continue to come at the unnecessary expense of lost human lives, shuttered businesses, and worsened divisions in our economic and health outcome chasm.
Much of this devastation is preventable but requires early detection, rapid response, and frictionless coordination. The public health system of the future gives private entities and local public health jurisdictions access to real-time information at their fingertips. A robust bio-surveillance and total infection control support system powered by science and technology results in rapid, tactical guidance and avoidance of deadly outbreaks. As pandemics increase in frequency and severity, the U.S. must stand ready with an infrastructure capable of protecting humanity against impending biological threats. We must break through existing structural forces and build a modernized system that has greater reliance on technology (including both genomics and dissemination of expertise via networked hub-and-spoke models) and empowered private sector leaders. As pandemics will certainly increase in frequency and severity, the U.S. stands at the precipice of a critical inflection point: continue with business as usual or use the COVID-19 pandemic as a turning point to reimagine our public health infrastructure.
They are Loaded for Bear, flush with significant VC funding.
When I was covering the healthcare startup space, I saw a lot of "Silicon Valley HBO" SMH stuff. PHC is immeasurably different. Totally substantive. As serious as a heart attack (read the white papers). I wish them well.
"Bears" watching.
The only thing I'd recommend goes to my recent study of Davarian Baldwin's "In the Shadow of the Ivory Tower." PHC lists its prospective business lines as encompassing "Business, Government, and Healthcare" sectors. What about "Academia?" See Dr.Baldwin's riffs on "Meds and Eds"—
Indeed, urban universities and their medical centers—the “meds and eds”—stand as one of the most central yet least examined social forces shaping today’s cities. In today’s knowledge economy, universities have become the new companies, and our major cities serve as their company towns. But unlike Amazon, Microsoft, and other info-tech industries, higher education claims responsibility for our public good. It’s time we investigated that promise, asking whether a school’s increased for-profit ambitions can undermine the interests of the public. In fact, the presumption that higher education is a public good has for too long distracted critics and urban residents from getting to the heart of the matter: what makes universities good for our cities? We need fewer assumptions and more analysis...

Baldwin, Davarian L. In the Shadow of the Ivory Tower (p. 6). PublicAffairs. Kindle Edition.
If your cardinal goals iinclude communicable disease prevention and mitigation, the urban environs comprise the fish in the barrels. Leverage academia.


Although it is difficult to predict when the next ‘big one’ will happen, it will likely be similar to something we have seen before. The pandemics of the last century have all been caused by influenza. The COVID-19 pandemic was caused by a pathogen related to a seasonal coronavirus that causes colds and the SARS epidemic in 2003. Thus, the next pandemic will likely be caused by another airborne pathogen, probably in the influenza and coronavirus families, with a period of pre-symptomatic transmission able to disseminate quickly and widely due to global air travel and crowding.

However, a global pandemic is not the only biothreat the U.S. should prepare for. Epidemics that spread across parts of the country or across a single continent can still have grave repercussions for healthcare systems and economies. Dengue, Zika, and Ebola epidemics have increased in frequency in recent years despite being caused by pathogens that have been known for many decades, and they will likely return to U.S. shores once global travel resumes. Furthermore, pathogens (whether released intentionally or accidentally) present a less likely but far more catastrophic biosecurity risk that could cause large outbreaks in the U.S. due to extremely high case fatality or transmission rates.

While fortifying healthcare and technology infrastructure is needed for pandemic preparedness,
we also need to safeguard the parts of the system that have protected us over the last year: public health officers, epidemiologists, public health nurses, doctors, nurses, scientists, janitorial staff, and delivery services.

There are hundreds of pathogens that could cause outbreaks in the U.S. spread through any of the transmission routes described in this white paper. Improving infrastructure to better prevent, detect, and contain these smaller but more frequent threats will help us prepare for the next ‘big one.’ These improvements are further detailed in another white paper, ‘The Future of U.S. Public Health.’

Click the screengrab.


It's not over.

PHC issued a new White Paper

In the COVID era, public health jurisdictions around the world have used SARS-CoV-2 genomic data in their pandemic response at unprecedented scale. As of April 23, 2021, over 1.2 million viral genomes have been sequenced for public health purposes. These data have enabled policy decisions (e.g., Denmark increasing interventions despite falling cases in response to detecting the UK variant), cluster investigations (e.g., uncovering transmission clusters across healthcare facilities that share staff), diagnostic test and vaccine development (e.g., establish diagnostic assays to detect the UK variant), and more.
A good read. As is Michael Lewis's new book The Premonition, which got me down this path.




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