The Premonition: A Pandemic Story

The end of The Premonition drives home the big problem with our current public health system. In the mid-1970s the US public health authorities anticipated a deadly swine flu outbreak. They chose to institute a max vaccination campaign. Unfortunately, the local health infrastructure was not up to the task and was only able to vaccinate a fraction of the population. Some of those vaccinated died. Even though many of the deaths were not related to the vaccine, the presence of deaths together with the no-show of the deadly outbreak lead to a piloring of the health officials. Today, public health policy tends to be led in a cautious manner. People are concerned more about protecting their image. Government appointments are often made with regard to "optics" rather than expertise. Altogether, this leads to slow and inadequate reactions. Actions that avoid a deadly epidemic will be judged harshly if a few people had died. Meanwhile, positive improvement after a deadly epidemic are more likely to be praised.

The book traces the experience of a few key "behind-the-scenes" people that are doing the work to protect us. One person had worked as an administrator for the veterans administration. His hospital suffered greatly in the realm of public opinion because some of the patients had died. He later helped drive planning for pandemic response. Another key player worked as a public health official in Santa Barbara County, California. There she welded great power with limited resources. Then she accepted a state position where she was stuck behind bureaucracy when the covid pandemic played out. The third prong of the story focuses on research labs that have done work to identify and trace disease. They offered free, fast covid testing - yet bureaucracy slowed the uptake. (There were a variety of reasons - some places had relations with other vendors or could not bill $0). The lab also had the ability to rapidly identify different contagions. They even used this to identify drugs that could help cure things. Alas, these skills were often used. The government would even recommend a non-working treatment rather than the one that worked.

We do have great skill for responding to public health crises. We just can't necessarily take advantage of it.