The Premonition was the most impactful book I read in 2021. Michael Lewis writes a compelling narrative outlining the challenges with the healthcare infrastructure of the United States, and he illustrates the overarching difficulties for institutions to make decisions during the COVID-19 pandemic. I appreciated the book for its ability to tell a reasonably balanced story of the pandemic, and it gave context to some of the impossible decisions faced by government officials. 

My main takeaways:

• The CDC is a research institution, and it is not designed or equipped to make real time decisions. It covers its ass before making any decision. 
• “Redneck epidemiologists” built the plans for the country because there is no singular fix. 
• There was an absence of federal leadership that created a vacuum for decision making.
• Local public officials were forced to make impossible decisions for their areas, and many faced strong criticism because there is no way to illustrate a successful pandemic policy because it is preventative. 

Quotes

“The hard truth was that there was never time to wait for more data . The moment an infectious disease appeared , decisions cried out to be made.”

“The longer you waited , the more likely it was that people would die waiting for you to decide — or waiting for you to gather the data you needed to cover your ass if your decisions proved wrong .”

“A case fatality rate of 1 percent implied a terrifying pandemic . It also implied that , at the critical decision – making moment , only one person in the entire city of one hundred thousand people would have died . Might not even have died yet , but was merely lying in some ICU bed , about to die . It would take extraordinary leadership to look at that situation and say , “ Shut it all down . ”

“Because what do you do when you run out of options ? You panic . Having something in front of you , a map , a plan , a list of treatments , even if it isn’t completely right , is better than nothing . ”

“ The CDC does not know how to pull the fire alarm. In fact , there is no fire alarm in this country . ”

“It shouldn’t be the Centers for Disease Control. It should be the Centers for Disease Observation and Reporting. That’s what they do well.” 

“The pattern continued right through the pandemic : the Trump administration would claim with fanfare that supplies were on their way to the states and leave it to the career civil servants whose job was to interact with state officials to reap the humiliation when those supplies failed to arrive .” 

“The absence of federal leadership had triggered a wild free – for – all in the market for pandemic supplies . In this market , Americans vied with Americans for stuff made mainly by the Chinese.”