The transcript from this week’s, MiB: Michael Lewis on Pandemic Planning, is below.
BARRY RITHOLTZ, HOST, MASTERS IN BUSINESS: This week on the podcast, boy, do I have an extra special guest. Michael Lewis, author of such books as “The Big Short,” “Liar’s Poker,” “The Blind Side,” “Flash Boys,” “Moneyball.” It just goes on and on. “The Undoing Project.”
He’s here to talk about his new book, his latest book which is out this week called, “The Premonition: A Pandemic Story.” And man, let me tell you, I plow through this book in two days, it’s just astonishing. This is the Moneyball for epidemiology, the Big Short for how to screw up a pandemic response. It’s all of your favorite Michael Lewis characters. The brilliant but quirky outsider, the people who were not quite dead center of the institution but are aware the institution is collapsing.
And it’s just a fascinating tale. If I haven’t lived through this for the past year, I would’ve read this and said this couldn’t happen. This is impossible.
But having lived through it, it’s like, oh my God, I remember that. How’d — that’s how that happened. Holy cow. The whole thing is just astonishing.
Every time Michael Lewis releases a new book, it’s an event and this one is no different. So, with that, I will just shut up and say my conversation with Michael Lewis.
VOICEOVER: This is Masters in Business with Barry Ritholtz on Bloomberg Radio.
RITHOLTZ: My extra special guest this week is Michael Lewis. He is our returning champion and I think this is our third or fourth interview. His latest book is “Premonition: A Pandemic Story.” Think of it as the Moneyball version of epidemiology and it’s absolutely fascinating.
You know Michael Lewis’s work. Everything from “Liar’s Poker” to “Moneyball” to “The Big Short” to the undoing project. This is very much along the same lines. And I think you will really enjoy it.
Let’s jump right into this and I have to start, Michael, by asking you wrote a series of dispatches from America in the age of COVID-19. When did you recognize that, hey, this is a book here?
MICHAEL LEWIS, AUTHOR: Yes. The dispatches were already services of the book that I was — couple things happened. One was, I’d written the previous book, the “The Fifth Risk” which is just kind of an argument that we’re all in trouble if the administration isn’t all that interested in managing the federal government because the federal government manages this portfolio of risks.
Many of them existential risks including the risks of the pandemic. And that book’s our post question-like what happens if something really bad happens? And so, I was sort, in a way, poised for this. It was like what is the bad thing going to be and it was this.
The other thing that happened, very early on in the pandemic, like March, late March, is I stumbled into characters who clearly were book characters. That they had the dimensions, the breadth of the best book characters I’ve had. And so — and the p in particular, there were — it sounds preposterous but I can’t think of another way to put, a kind of secret group of doctors who were — who would — some had worked in the White House, actually most had worked in the White House, they were placed all over kind of the institutions that might have something to do with pandemic response who had been — who had been kind of together for about 15 years, who were kind of trying to shadow manage the pandemic.
And one of those characters was so interesting to me, I thought, man I don’t know how I’m going to do this, but he — he’s a book. Carter Mecher was his name and he — we can get in to him. But he basically invented the idea of pandemic response.
And so, I wrote some things for Bloomberg which were on the side of the book and it was a way to get me around and out and reporting in the field and giving me a license to go ask people questions. But the book was there first and it took shape differently than they usually do.
Your question is good, because normally what I would write is I find a bunch of magazine stuff and it just builds and builds and builds and all of a sudden, I’ve got a book. But in this case, what I had was not the — that stuff I had characters and I just thought I’m going to follow this people wherever they go.
RITHOLTZ: And there are at least three characters, it’s not more in the book, that each of them could be a main character in the book. We’ll come back to them later.
One of the things you write about, you do pick up where “The Fifth Risk” left off and you write, hey, for three years, despite all sorts of global threats and risks and potential crises, the Trump administration, it had gotten pretty lucky and then suddenly their luck ran out. Tell us about that.
LEWIS: Well, there wasn’t anything that big to manage and there wasn’t — they didn’t need to really be able to understand and wield the instruments of the federal government and the way they would have to do in a pandemic.
But what was ironic about this was, though, I think probably going in, I thought my book would have a lot to do with the Trump administration because I at least used the Trump administration’s transition indifference way back when as a — as a book to explain what these instruments were inside the federal government and how important they were.
I think I would — I thought in the begging, that Trump and the administration were going to be really important in this story and I was surprised that they — they kind of — as you read it, they kind of fade into the background of the problems …
LEWIS: … Trump ends up as one of the — as one of the characters said is a comorbidity. He’s like another thing you died of, but it — it wasn’t that — it wasn’t the thing that really killed you, it was — that we had — our problems — our problematic response to a pandemic was baked into our system.
RITHOLTZ: it predated the Trump administration, not that they made it any better but there were problems leading right up to 2017.
LEWIS: Yes. You — that I think at least two of my three main characters would have predicted this is going to be a total mess well before Trump because of their interactions — because of their knowledge of the public health system which isn’t a system at all. It’s several thousand local public health officers not really stitched together and — with plenty of legal authority but not a lot of social power.
And on top of it, an institution the CDC that has steadily become less capable it at kind of battlefield command. And though …
RITHOLTZ: We’re going to come back to the CDC because they are a major character in this and a major failure. Before we leave sort of the set up, I have to ask you, George Bush George W. Bush is kind of an unlikely hero in the book. After 9/11, he reads about — reads a book about the 1918 pandemic and immediately recognizes, I guess, a parallel to terrorism and says, hey, we need an early warning system for predicting emerging pathogens.
Tell us a little bit about what Bush did.
LEWIS: Well, you have to — you have to kind of rewind tape and imagine the state of mind George Bush is in when he picks up John Barry’s “The Great Influenza” which is a book about the 1918 pandemic. He’s not only has he been provided over 9/11, he — Katrina’s just happened.
And he’s got a sort of like what’s the next bad thing and he reads about exactly how bad it could be if a new pathogen whips through the population and he asked somebody what’s the plan? And the somebody says, there isn’t one. There’s this narrow thing, but not really a pandemic plan.
And Bush turns — there are a few people in the room when the conversations are having — are being had, but there’s a fairly young doctor who has turned — who has become more interested in public policy named Rajeev Venkayya. It’s kind of a great story, actually.
So, Rajeev is like the young guy in the room and at the end of a meeting were Bush is furious that the nation doesn’t have a plan for a pandemic, everyone kind of turns to Rajeev and says, go write it. And he kind of picked people’s brains for a week and try to figure out — and he ended up going back to his parents’ home in the Xenia, Ohio, locking himself in a basement for two days and writing essentially a plan for a plan.
And comes back and says what we need to do is bring in people from seven or eight federal agencies who would be involved in responding and preparing for a pandemic and think about what the plan should look like. And that’s the beginning of the creation of the plan.
So, he’s — so two — one of the main characters or kind of two of the main characters, there are kind of four main characters, get pulled in to that effort and that’s the beginning. And it sort of like — they’re told — they’re told to do lots of things like figure out how to streamline, make our vaccine production capacities more robust and figure out how to, I don’t know, prevent disease from leaping from chickens and to people. That would be Department of Agriculture.
And they’re like lots and lots of little things they scheme about. But the center of it is this question and the question is what do you do with people, with the population before you have a vaccine and that sounds like a question that you would have thought had been answered at that point. In fact, this is the thing that was — this is really interesting to them and to me, was that he received wisdom from the 1918 pandemic was that social interventions, they go by various names, nonpharmaceutical intervention, social distancing, whatever you want to call it.
The closing of schools and bars and churches and all that and keeping six feet apart, all that was — it was concluded that didn’t work in 1918. And so, the elites in public health thought they’ll do any of that. It just doesn’t work.
And so, they had a question on their hands. What do we do? We just sit around and wait until we figure out the vaccine and hope not too many people die? That’s the beginning of their — of really their investigation.
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RITHOLTZ: I’m going to come back to the wrong takeaways from the 1918 pandemic in a little bit. I just have to ask you for a followup. So, the Bush administration pandemic response, that’s three administrations ago, almost 20 years ago. What happened with that group? Did they ever managed to get a plan together? And what did the most recent administration do with what they had created?
LEWIS: It’s the most remarkable story. Not only do they get a plan together, they do — they perform extraordinary feats, like going back and completely reinvestigating 1918 and determining that, actually, the social distancing did work, they just didn’t understand how it worked because they didn’t understand.
For example, Philadelphia had death rates that were multiples of the death rates of St. Louis. At the time that the — the wisdom — received wisdom was that was just kind of accidental. And in fact, what it was the social distancing policies were implemented in St. Louis earlier in relation to the arrival of the virus than they were in Philadelphia.
And they go — there’s like — it’s an incredible kind of story of how they figured this stuff out but they — they write a plan and they write a plan without — this is the couple of critical component, this — one is Rajeev Venkayya, the young doctor who’s put in charge of sort of assembling the people to write the plan, leaves the CDC out of it and he leaves the CDC out of it because already back then, there is suspicion that the CDC is an entrenched kind of bureaucracy defending its own turf and what’s required here is some new kind of thinking and they’re very invested in the all kind of thinking and you don’t want them at the table which tells you something, right?
We’re at 2006 and people are already feeling this way about the CDC. And so, after they get — they create the plan, there is the trick of selling the CDC and the entire public health community on the plan which is in itself a story. It’s a two-year story of 300 meetings.
And in the end, Carter Mecher, one of my main characters, who has — he always — all my characters have these superpowers. Carter’s superpower is invisibility. His ability to walk into the CDC which no one does and write a plan for them that they then took on as their own.
RITHOLTZ: They changed the headline and — that’s all they did was change the title of it and that was enough to give them ownership.
LEWIS: Yes. They — he physically kind of slipped in and writes this thing with — and makes them feel like they’re doing it and they are left with the impression this was the CDC’s plan. And this is very important because the CDC, at that moment, is the world’s great health organization, public health organization.
And whatever its relationship to the American people is, its relationship to the rest of the world is extremely powerful. And it goes out in itself, this plan, all over the world, explains how, for example, social distancing works and how you would implement it.
And the — and so the plan takes root in lots of places and it takes root in theory in the United States. But there’s thing, your point is well taken. This is three administrations ago. Carter Mecher, my character, who is in the Bush White House, is amazed when Bush leaves and Obama comes in.
What happens in the federal government as a rule when administrations change? They come into his office. They take all his computers, all his hard drives. They remove all of his papers. They take every piece of work he’s done and just whisk it away. Where it goes, he never knows.
And it’s like the memory of the previous administration is erased and all that’s left is whatever human beings are around and what they have in their head. Now, he’s a human who’s designated to stick — to hold over from Bush to Obama and he’s only meant to stay there for about six months in case something happens kind of thing.
And something happens, right? There’s a faux pandemic. There is a pandemic. There swine flu pandemic of 2009. But as one of my characters puts it, it wasn’t — it wasn’t that — that we dodged a bullet. It’s that nature shot us with a BB gun. It was …
LEWIS: It was — and a lot of people got that virus, it just wasn’t as lethal as initially feared.
RITHOLTZ: Right. Got very — very lucky. To the point you just made, you described the real tragedy about government waste. Is that one box? You described the government as a series of boxes, little turfs where people have their own knowledge and talent and expertise, and they create a culture and the big tragedy is that people in one box might have the solution to a problem that’s one or two boxes over but they never meet, there’s no interaction, none of the knowledge, none of the human wisdom gets to spread throughout the government.
LEWIS: So, my story — that’s true. And my story partly dramatizes what happens if you break down those boxes a little bit because Rajeev Venkayya did. He brought these people together, hauled this doctor out of obscurity from the Veterans Administration who proved to be a savant in pandemic who never would’ve been found.
But once the thing — the thing that’s so shocking is that we create — we invent, thanks to George W. Bush. We invent pandemic planning. We invent — we create the plan. It has sort of becomes the playbook for most of the world.
LEWIS: And we, ourselves, start to forget why and we — and forget what it is and forget it’s important. To forget — as the arguments that led everybody to agree, this is what you do.
And the Obama administration sort of have to have to learn it all over again and they are lucky, well, and smart because they kept Carter around and Carter kind of teaches them stuff and they — one of the central lessons that they all had kind of internalized was that you need — if you’re going to — if you’re going to face a pandemic, you have to do it from the White House. That you can’t — you can’t just leave it to the CDC.
There’s a whole bunch of agencies involved. The CDC will have its own skewed take on things. You use the CDC but you — you run at the battlefield command it out of the White House. And the Obama administration, that’s the kind of — will learn that all over again and Carter sort of is part of the reason they — they learned it.
But the bigger point is the way — the way our government does create things and throws enormous resources into creating them and that does not preserve what’s created in the way you would wish it would. And because there is this very strange notion of a new administration being — having a clean slate or being a clean slate.
Now, smart presidents — Obama was a smart president, lean very heavily on Bush and try to keep people around and he had a bunch of crises he was dealing with at the time, you remember. But so there are reasons to keep people around.
He wasn’t hostile to learning from the outgoing, but the outgoing, still, outgoing to too great a degree. Four thousand something people who were president — presidential appointees flee the place when the new administration comes in and those people were running the place.
Now, what — what kind of company like could function if every four years you whacked off the heads of all the managers instead of bringing some new ones and the new ones, they have a choice, they can either kind of have a conversation with the old ones and they can just go make it up all over again. But that’s basically how we run our government.
RITHOLTZ: Quite fascinating. Let’s talk a little bit about why people have such a hard time getting their minds around a pandemic including some of the worst tragedies in American history? Why is the human brain so bad at comprehending the way contagion spread? We can intuit arithmetic growth but our intuition fails when we try and comprehend exponential growth. Why is that?
LEWIS: Well, first, it is an observation that’s a really important observation. And it’s the observation that is — if one of the observations is that the center of the story and at the core of the thinking of the main characters. They all realize that when you are facing a pandemic, a virus that’s spreading, you got this — this invisible enemy that’s growing exponentially and before you have signs of it in the form of illness and then death, to be able to kind of take its measure, it has — it has progressed greatly.
And you — you will be — if you think you’re looking at an arithmetic problem — process you’ll be overwhelmed before you respond. And the — this is why that’s partly the reason for the title of the book. They all realize that in the beginning of a pandemic, that you have to — you got to imagine that you’ve got to look around corners. You’ve got to — you’ve got to kind of — you got to see the thing before it can be seen.
And Carter Mecher, I mean, they’re always groping for metaphors or analogies to try to get people to understand how hard it is to deal with a — with a pandemic virus. And fire was Carter’s favorite and the story he loved was the story of — that Norman McLean told in his book, “Young Men and Fire” of the Mann Gulch fire where you have — you have a dozen or so very healthy young man walking down a Gulch and they see what looks — they see a fire — when they see a fire coming at them and they start to run away, and like you know a minute later, they’re all incinerated.
And to the point where some of them didn’t even bother to drop their packs and their axes. And they were kind of judging the movement of the fire by how it was moving when they first saw it. But by the time it gets them, it’s moving two or three times faster. It’s spreading — because the fire move — grows exponentially.
And a virus is like that. And it’s — so why is it that we don’t — have trouble with exponential processes? I don’t know.
When we were in the savanna, how often do we see it? It’s like one of those things that — it exists. We encounter it every now and then but why is it people have trouble with compound interest?
LEWIS: It’s same sort of thing, right?
LEWIS: People give us all kinds of crosswise with compound interest because they don’t understand the power of it.
RITHOLTZ: We don’t see it often enough for to have an evolutionary impact on who passes along that gene or not. It’s so rare …
LEWIS: Yes, something like that.
LEWIS: Now, maybe that’s changing. But it’s — but, yes. And it creates a big problem for people who are trying to save the society because — because there — we have these — the mechanisms of government are so slow grinding and nobody wants to — the phrase that drove my characters crazy was don’t get ahead of the data.
LEWIS: Sort of like we’re going to wait for the data. By the time you have the data, you’re dead.
LEWIS: By the time you know that there are — that the virus is spreading internally in the United States and there’s one death. You know that you can go back and say, well, that one death is a result of an infection that caused — that occurred a month ago and the virus is spreading in such and such a rate, so probably have like 1,000 cases monthly — a month ago that are multiplying exponentially.
You’ve already lost your ability to contain them. So, you got to — you got to jump out in front of that. You’ve got to — you’ve got to act before you have visible evidence to act on.
RITHOLTZ: You used the metaphor that deaths and hospitalizations in the pandemic is like starlight. You’re looking at something that starlight could be for or hundreds or millions of years old. By the time you see it, if you wait for that data, you’re already way too late. In fact, the current data is already lagging in a few weeks behind.
LEWIS: Correct. And — or it’s like driving just by looking in the rearview mirror. I mean, it has — there is — any — but the bigger point is what is it, what problem does this create for any authority that’s trying to manage the problem? You — and it’s a big problem in a society that doesn’t trust the authority because the authority is going to be saying things for which there is no visible evidence.
They’re going to be saying you’ve got to trust me but if we act now, we’ll cut it off and be able contain it but were going to have to do some things before you even see — before you see the fire coming at you. We see smoke. We know that — we are inferring because we have expertise in the subject that that smoke suggests this fire is going to be all over us in two weeks.
But if we go and throw water on the smoke right now, at some expense, we may never see the fire. And but it — but who does — in which society does that work? It works in a society where that person, that authority who’s speaking is widely trusted and that was one of our problems.
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RITHOLTZ: Speaking of widely trusted, you hardly reference Anthony Fauci of the National Institute of Health, who I believe is one of the most widely trusted people in America. How do you tell the whole pandemic story and not bring in Fauci very much? He really wasn’t a key part of this story, was he?
LEWIS: He wasn’t a key part of my story. I had great admiration for him, but it’s — how do I put this? I think Fauci learned a lot from my characters rather than the reverse.
So, Carter Mecher, the VA doctor who is at the at the heart of the invention of the pandemic plan, in early January, is writing emails to his small group of doctors and it — and the emails end up attracting a huge following about what’s going on in Wuhan. And Carter Mecher in — on January 20th has said this is — this is a five-alarm fire. This is just — this is beyond — this is beyond shocking. And this is what’s going to happen.
And he was just about dead right. And at that point, Fauci was saying there wasn’t anything to worry about, that there was — they’re watching it, but it wasn’t — and Carter is saying, at this point, this when you can’t be just watching it.
LEWIS: And so, I think that that the expertise of responding to the pandemic was located in — more in my characters that in in Anthony Fauci. He was really good at public communication.
LEWIS: He’s, I’m sure, great at what he does, but my guys invented this and go — to go one step further was just my guys, the main character of the book is a woman, and one of very peculiar dimension to this whole — whole U.S. pandemic was that on the ground battlefield disease commanders, local public health officers who had spent their careers fighting — fighting communicable disease, other communicable diseases whether TB or hepatitis C or measles or whatever it is, some of them quite lethal, we’re not front and center in the pandemic response.
That they — they understood like how you — the hand-to-hand combat side of this. And in ways that even Anthony Fauci wouldn’t because he had never done that.
So, I mean, what do I — it’s funny. Your audience may appreciate this analogy, but when I was thinking about what this — what other book of mine this is kinda like, you mentioned Moneyball. But I thought …
RITHOLTZ: The Big Short.
LEWIS: … Big Short.
RITHOLTZ: Yes. Absolutely.
LEWIS: And it’s ‘The Big Short ” because you got this a system problem and the system’s gotten so screwed up that the people who are at the heart of the system or who seemed to be running the system don’t understand the system as well as people who are — seem to be kind of on the fringes of the system.
In this case, the people on the fringes of pandemic response seem to be were the ones who actually knew what to do and who were able to kind of diagnose the problems of the system. And our problem was the wrong people at the center (ph).
So, I thought to myself, as I thought with “The Big Short,” I want to really read a book or write a book about the people at the heart of the system who didn’t understand the system. I want to write a book about people who actually did understand the system wherever they happen to be.
And I want to — a kind of assemble a cast of characters who actually knew what was going on and can describe it to the reader and that took me outside the Trump administration.
LEWIS: Outside to some extent, the federal government. I mean, Carter Mecher’s in the federal government but he’s — he basically — he’s working out of his house for the VA and the VA doesn’t even know they employ him. They — it’s — it was very strange and disturbing where the expertise was in the story just like it was very strange and disturbing where the expertise was in the financial crisis in the subprime mortgage crisis.
RITHOLTZ: So, I’m glad you brought up “The Big Short.” You’re forcing me to jump ahead to a question that I have to ask and it’s what’s the archetype Michael Lewis book? And with all due respect to your friend, Malcolm Gladwell, I don’t find biblical analogies work and referencing.
But here’s how I see your archetype, and it’s — there’s a big important institution that at one point was a key preventer of existential disaster and overtime, it begins to calcify and starts to fail slowly, sometimes years, sometimes decades. The entrenched powers fail to see it. They can’t see the forest for the trees and there’s always this scrappy band of outsiders. They are always intelligent, often quirky, sometimes misfits. they see it early, they warn about it, sometimes to various effect, sometimes warnings or ignored, fortunes are made and lost, lives are lost, catastrophe is either averted or not, that’s my archetype Michael Lewis book. Fair or not?
LEWIS: Well, it doesn’t — you describe a few other books with that. You missed “The Undoing Project,” you missed …
LEWIS: You capture “Flash Boys,” you capture “The Big Short,” you …
LEWIS: You don’t really capture “Liar’s Poker.”
LEWIS: Moneyball, I don’t know. I bet — I guess you could argue that baseball was …
LEWIS: … a sclerotic enterprise.
RITHOLTZ: Right. Well, look how — look how Moneyball changed baseball, it changed basketball, it’s changed all sorts of sports and I would even argue with you the author as much as I’m loath to do that, that “The Undoing Project” are about two outsiders from the world of finance and economics who essentially turn the whole concept of incentives on its head.
LEWIS: Yes, that’s a very fair way to look at it. So, it’s true — it is true that I’m attracted to that story.
RITHOLTZ: Yes. And you tell it better than anybody else does.
LEWIS: But the world has sort of handed me those stories, too. I mean, I think we’re having — we’re living it through a time where — to put it very broadly, the character of the entrepreneur is extremely important. The entrepreneur, very broadly defined. The person who is coming in and undertaking something new from outside that it’s going to — it’s going to turn the system on its head or it will expose the flaws or weaknesses in the system.
So, there’s a fluidity to especially American life and this is = this is another example of that. It’s — it’s — but when it come — when you find it at the level of the federal government which is the — an extremely important institution, whatever you think about it, you got to go and stop and go learn about it if the — if you don’t understand its importance that — that if it doesn’t do the things — that nothing else is going to do, well, it doesn’t keep us safe in the ways it’s uniquely designed to keep us safe, we are doomed.
And so, when you find the sclerosis that that enables the characters that I’m drawn to to play a role, to seek to identify the problem to try to fix the problems to attack it from the outside, that — that it’s — it’s troubling. And in this case, it’s — what’s so peculiar is that unlike “The Big Short” where the main characters were all people who were pretty fringy their whole careers until the financial crisis.
I mean, yes, they had little hedge funds and so on and so forth, they were not running Goldman Sachs or they weren’t running the biggest hedge fund. And these people were — were people who were on the inside in some ways. I mean, they — they could completely — it was — it’s as if — I don’t know.
RITHOLTZ: Outer ring of the bull’s eye. They weren’t dead center. They we’re in one of the third …
LEWIS: That’s exactly right. That’s exactly right.
RITHOLTZ: And they would have said to you, like Charity Dean would’ve said to you, local public health officer in Santa Barbara County who becomes number two in the State of California and who has the single most vivid on-the-ground view of what is going on with communicable disease in the country. It’s her little fight for the country but you can just replicate it thousands of times.
LEWIS: That she would say that from the moment she started that job back in whatever 2011, that she had a better view than the CDC of what was going on and it shocked her. She thought the CDC sort of ran things and she really comes to learn that they don’t really run things. And that you know a year or two years in, she realizes, hell, no one’s coming to save me. I am on my own.
I am on my own if there’s an Ebola outbreak in Santa Barbara County, that it’s — so they are — they are — they’re not coming from that far away, the main — these main characters.
RITHOLTZ: Quite interesting observations. So, one of your main characters, Carter Meacham (ph) says, quote, “I could not design a system better for transmitting disease than our school system.” And you go on to describe the desks, the buses, what makes schools such a vector for transmission of airborne disease?
LEWIS: You got to just stop and realize how cool this is. This guy is in the White House, he’s been told to write a pandemic plan. He has done that and unsatisfied with the degree to which he’s going to save the American people. He won, goes back and figured out that social distancing, closing things and all the rest had huge effects back in 1918.
For the first time in history, he does this kind of historical work. And he’s a doctor. He’s not a historian. And he does it with his colleague Richard Hatchett. But — and then second, they get — they get this very crude models and that’s a whole other story where the models come from.
And they see in simulations, in these models of disease transmission something really peculiar happens when you close schools. And he does — they don’t know whether to believe the model, the models are abstractions from reality. It seems like a really smart abstraction for reality that they working with, but no one is really ever paid much attention to models for disease transmission. So, they’re a little — they’re a little skeptical.
And he — Carter asked. Like, what is it about schools? And that this guy who’s in the White House calls his wife and says we’re going to school. I want — next time they give us an opportunity to go to one of the kid’s schools, I want to go with a tape measure and start looking at how these kids interact.
And he starts to measure the physical space between children. And also observed very closely how kids interact with each other and how they don’t observe space. They don’t kind of give each other space in the way adults do on the bus stops, in the classroom, in the hallways. And its — and he says, why — why are people missing just how — how sort of built for transmitting a communicable disease in school is and they’re thinking about what we do if there is one.
And he says it’s because people forget what it was like to be a kid. But it’s — they designed the busses to the seats have 39 inches across because they assume hip width of a child is 13 inches and they could put three on a seat. I mean, he does all this research.
And it’s — so the — she realizes that the closing of schools have to be an important aspect of any kind of response to whether they’re dealing with pandemic flu, which is much more lethal in children, so but — but even COVID, it’s — I think he would say one of the unexplored subjects in COVID is the role kids have played because they are — they can get it, they can transmit it, but they don’t get sick and they often don’t even have symptoms.
So, that it’s — you can point to a lot of anecdotal evidence where the start of an outbreak was quite likely a school and you just didn’t see at the school. You didn’t see it until the kid interacted with some older person. But it’s the — just the idea that he is wandering around schools with tape measures and figuring out why this model that was built to analyze disease transmission is saying what it’s saying.
And that — they then embed in the CDC’s plan like the minute it looks like this is a big deal, you got to close schools first. And then, if you — if you see what happened in this pandemic, go to — I don’t know. Pick a country. Cambodia, a country that contained the virus but there are a bunch of countries that contained the virus.
What’s the first thing they did? They closed the schools. It all — it goes back to Carter Mecher and his a tape measure in Atlanta public school figuring out how kids interact and how close they were to each other.
So, let’s talk a little bit about that. So, the Group of Seven male doctors led by Carter Meacham (ph) that put together the pandemic plan originally for George W. Bush, they’re holding is as we go through 2020, they’re holding these, for lack of a better word, conference phone calls and Zoom calls and more and more people start listening in from various aspects of government.
This is — they’re unofficially doing this. They’re not — the Trump White House didn’t say go do this and that sort of spreads from county to county, state to state, eventually the White House is listening in on it, how influential is Carter Meacham (ph) and his band of merry doctors that are setting policy because nobody else was? It was a giant vacuum.
LEWIS: So, it was only two of the seven from the Bush White House team that ended up becoming so obsessed that they became sort of the pandemic guys, Richard Hatchett and Carter Mecher and those two are the hub of a group of doctors and their — these doctors are in unusual positions.
Matt Hepburn is the Head of Vaccine Development for Operation Warp Speed. James Lawler runs an infectious disease unit of the federal government that’s in Omaha where you’re — you’re likely to be sent if you get — if you have blood coming out of your eyes and no one knows why, that it’s like for highly — for really, really alarming cases of disease, to treat and understand.
So, he’s on the frontlines there. Dave Marcozzi, another doctor, is in — ends up being essentially advising the governor of Maryland. Rajeev Venkayya who was the doctor who assembled the original pandemic planning team in the Bush administration, who’s now head of a big pharma — works at a big pharmaceutical in Japan, has social connections with the governor of Ohio.
And so, what happens is, you can sort map the U.S.S — because the Trump administration basically said you’re on your own to the governors, you’re going to do — and we had 50 different pandemic responses, which of course is never to work because …
LEWIS: … unless you close the borders between states.
The — you can map the urgency with which a state responded on to the — on to the interactions that these doctors had with particular people in the States so they had …
RITHOLTZ: So, which states got it right? Which ones got it wrong?
LEWIS: Well, the — in the beginning — so it changed overtime. But in the beginning, the ones who jumped to as they should have were Maryland, Ohio, and California. And it was — entirely a result of them kind of listening to what these are largely a result of, of listening to what these guys had to say about what was about to happen.
Now, there is — there — the email chain, they had a group that calls themselves The Wolverines, the doctors, and it was kind of a joke, but their email chain was the red dawn chain and the red dawn chain, all kinds of people ended up on this thing. And it’s a little hard to see.
I mean, like in the Trump administration, what effect it had because you had, I don’t know, Ken Cuccinelli who was the Deputy Homeland — I don’t know what exactly his title was. I this he’s number two in Homeland Security who is on conference calls with these guys, just listening in.
And the — indirectly, because of this, Charity Dean, the lead character of the book, the public health officer who is number two in California who’s being, at the time, ignored by Gavin Newsom, has a plan solicited from her from — that goes to Jared Kushner and she never finds out what actually happens with this plan. They don’t actually enact it, but these guys were the ones who were sounding alarm bells and people were listening to it, to the extent they were listening.
The problem was the incoherence, right? Just to show you how accidental our response was, when Trump came in to office, his head of Homeland security with a guy named Tom Bossert and Bossert was a bit of an odd character in that he had been in the Bush administration and for Trump, mostly, the Bush people and the Obama people were off-limits because they’d all been could rude about him. And he didn’t — he wanted just loyalists.
But Bossert somehow stuck and among the first things Tom Bossert did back when Trump entered the White House was get in touch with Carter Mecher and Richard Hatchett, the two guys who had cooked up the pandemic response plan, and said if we ever have a pandemic, you guys are here and I’m almost like the bad you in now, so we don’t have to worry about that when it happens.
And flash forward two years, and John Bolton comes into the White House to run the Head of National Security and he — the first thing he does is fire Tom Bossert. And at that moment, the link between the Trump White House and the expertise that could have saved us is severed.
And so, the expertise is just kind of rattling around the United States, not organized in any way, not accessed by the government, but it might have been. And if you talk to Bossert, he says this is as accidental as if Bolton had not been brought in and I was still there, he says, I think — he really believed, I think I could’ve persuaded Trump to do the things these guys were saying to do, to be very draconian upfront because he would — and he would — I would have said to him that you just fire me if it doesn’t work. Blame it all on me but you get all the credit.
And if it does work and give it — just give it six weeks two months and all of a sudden, we will be a model in how — in the world of how to respond to this thing and everybody will be singing your praises.
Think about that. Think about that decision. Is there a chance that if that — it Bossert’s right and that had happened, Trump would be president now.
RITHOLTZ: Right. Right. And less than 550,000 Americans would be dead.
LEWIS: And plus, you get — Trump will be president plus you have hundreds of thousands of American alive and who were not alive. Is it — but that we are — that we are at the mercy of such serendipitous events. It’s terrifying. I mean, it just speaks to a badly organized society.
And the thing — the thing that’s attracting me to this book so much, the story, my main characters are just their superheroes. You read it. They’re unbelievable characters. They’re unbelievably …
RITHOLTZ: No, no. Each one more fascinating than the next.
LEWIS: And they’re not …
RITHOLTZ: You want to hang with these guys.
LEWIS: It is not people who — who you would have a hard time figuring out, have something special about them.
LEWIS: And are incredibly useful. And the fact that our society is so disorganized, they can’t put them in the place they need to be, that I have to come along and write a book to put them into place they need to be. That’s the problem.
RITHOLTZ: So, Michael I want to discuss the failures of the CDC and the WHO, but first I have to ask you about brain-eating amoebas and to get there, we have to talk about Joe DeRisi and the Biohub. How did you go from hearing about the DeRisi to writing about him?
LEWIS: He’s my other main character and he was — it was a funny thing. Way back when “Flash Boys” came out, five years ago, I had a dinner and the purpose of the dinner was to introduce me to a money manager out here in California named call Carl Kawaja. And Carl — because Carl came with his conviction that I needed to meet this guy at UCSF, this biochemist, named Joe DeRisi.
He said, he’s a — he’s like a character out of one of your books. And people say this to me every now and then, like he’s like — I try to polite, but no, I’m not really believing you. And he was so insistent that I said, Christ, all right. I’ll go have a sandwich with him.
And I went over. And at the time, he was just moving partly — he was out of his office at UCSF to run this really weird institution called the Chan Zuckerberg Biohub. It’s Priscilla Chan and Mark Zuckerberg’s money, hundreds of millions of dollars, gone to create this institution whose purpose, stated purpose, is to eliminate disease by the end of the 21st century which just seems preposterous.
LEWIS: But Priscilla Chan had watched this guy, Joe DeRisi, lecture back when she was a medical student and she said I know a guy who might actually be able to do this and DeRisi is what’s — what’s so — and it was true, when I met him and had a sandwich with him, I thought, oh, my God, he’s like the most interesting man on the planet.
He does have — he was — he was able to convey science to moron like me and he was able to show me the stakes and he was a at the time, setting — starting to set up a system of essentially tripwires around the world where using genomic technology.
So, let me just simplify this. So, if you’re in — if a child walks into a medical clinic in Cambodia with a fever and some odd symptoms, you don’t just like treat it like flu. You run it through one of Joe DeRisi’s gene machines and you see — and you sequence — you sequence whatever the thing is that’s infecting the child and you see if it’s something new that has never infected people before
That you do that in a lot of places around the planet and you, all of a sudden, have kind of an early warning system for new pathogens. That — that was one of the — one of the things he wanted to do. And he was interested in this because he was one of the early, kind of creators of the machinery of the of the genomic machinery, the technology to — it’s kind of mind-blowing …
RITHOLTZ: It is. It really is.
LEWIS: If you get sick and nobody knows what it is, Joe was among the first to say, look, hand me his DNA. Just get me something out of his body.
My machine will eliminate all the stuff that’s human in his body. I will know all the stuff that’s supposed to be there. And then we’ll analyze all the stuff in there that shouldn’t be there and try to match it against the database of every known pathogen of the genomes of every known pathogen that we have, and there are thousands of them. And including brain-eating amoebas. And …
RITHOLTZ: By the way, the hospital where the poor guy died from the brain-eating amoeba spent over $1 million trying to cure him, tell us what stops brain-eating amoebas?
LEWIS: I have to go back in my book to get the name of chemical.
LEWIS: Was it penicillin?
RITHOLTZ: It was penicillin.
LEWIS: No, no, no. Penicillin was the boy. He saved the boy. The poor Chinese woman who had Balamuthia, it was — it was — there was something else.
RITHOLTZ: Are you sure? I just read this last night …
LEWIS: All right. You may be — all right. I will go back and look.
RITHOLTZ: I’m scrolling right now. I’m not seeing it.
LEWIS: But the bigger point — yes, the bigger point is …
RITHOLTZ: I could be wrong. I read it so quickly.
LEWIS: Yes. A Chinese woman is being studied for the better part of a month and a half as her brain is vanishing and they can’t figure out what’s going on in their brain. They can’t even see that — it’s a brain-eating amoeba. They don’t know what it is.
LEWIS: They think it’s her immune system that’s — that’s over reacting to something but they don’t know what the something is. And the — it gets classified as many situations do as unidentified encephalitis. It’s just a description. It’s not a diagnosis. They don’t know.
And someone happens to know Joe DeRisi, one of the doctors. They — he says give me — just give me, like a sample out of her and let me see what it is. And he identifies Balamuthia. Balamuthia is a brain-eating amoeba, first, I think, identified in a mandrill in the San Diego zoo back in the 1980s.
And it’s — it’s sufficiently rare that it just doesn’t — the pharmaceutical companies have no interest in figuring out how to cure it because there’s just not enough people who get it. And but — and you get it — it seems like stuffing dirt up your nose is not a good idea.
But it’s — it’s a little hard — but the case — there have been several cases where he has been able to intercede. What he did was once he figured out what it was, he set his postdocs to work on …
RITHOLTZ: That’s right.
LEWIS: … the various drugs on the things he would …
RITHOLTZ: That’s right. You’re correct. It was an existing drug that was off-label. It wasn’t penicillin.
RITHOLTZ: So, yes, you are correct. I’m wrong.
LEWIS: No, what you’re remembering is another story where he happens to know a doctor who in — who’s in Wisconsin, who have — the doctor happens to know him who’s got a 17- or 18-year-old boy who is, as they say, swirling the drain. He’s about to die.
And they can’t figure out what’s wrong with him. And they send him a sample of his DNA of what’s inside him, to Joe, and Joe figured out what it is and penicillin cures that.
LEWIS: And the boy, two weeks later, walks out and sends Joe a video saying thanks for saving my life.
RITHOLTZ: That’s right.
LEWIS: But here’s — there is a larger point here that mirrors the pandemic response and the larger point is that Joe — he’s this little lab all by himself and his postdocs, figuring out both what ails people and how to cure it and there is no mechanism to get that out to the broader medical system.
LEWIS: As he says, like, there’s one woman in her spare time at the FDA who is trying to keep track of the academic literature and curated but it’s insufficient. So, it’s like the left hand doesn’t know what the right hand is doing. We have this unbelievably sophisticated medical industrial research complex that is generating new information, new knowledge, but it’s not actually getting into the hands of the people who need it when they need.
And it’s like an organizational problem. And it explains why — way before the pandemic — way before the pandemic, middle of 2019, there was a study done by an enterprise called the nuclear threat initiative where they brought together like hundreds of experts to try to do a sort of a league table, a college football ranking, right of who is best prepared for a pandemic.
And they ranked number — United States number one and they did because we have people like Joe DeRisi in here, that we have all of this — we have all these potentially sophisticated response to a disease that the market and the government is not organizing properly. This is like life-and-death stuff.
RITHOLTZ: Right. You specifically point out incentives inside the medical industrial complex or such that corporations are only interested in what makes money. Academia is only interested in publishing research. And in between is where people live and die but the system fails.
RITHOLTZ: Well, it’d better be. You wrote it.
LEWIS: Joe DeRisi — it’s very well put. And Joe DeRisi sits there in a position to watch this happen in lots of little instances, just like Charity Dean sits there in a position to watch disease spread in the community without anybody but her able to stop it in lots of little instances.
And they’re able, in their minds, to sort of extrapolate and think, well, if this happens in a little instances, what’s going to happen if there’s a big instance? And they both live through the big instance in the pandemic and they realize that everything they saw leading up to it was a — was a premonition. It was a hint of how we were going to fail when we were struck by the big one.
RITHOLTZ: So, let’s triangulate on those three characters. Carter Meacham (ph) …
LEWIS: Mecher. Carter Mecher. Yes.
RITHOLTZ: Carter Mecher is the 30,000-foot philosopher looking down at everything and figuring all sorts of stuff out. Joe DeRisi, he is doing this incredible genomics research, figuring out whether it’s sharks that are going crazy or all these obscure tiny diseases that industry has no incentive to cure because it’s so small, he’s — he’s got the red hotline that people call and then Charity Dean is on the front lines, actually dealing with this. Are those really the three main points? The three main characters of the book?
LEWIS: Yes. You can think of them as — if you think of it as a James Bond movie, Charity Dean is James Bond, Joe DeRisi is Q, he’s supplying all the kind of new weaponry, how you fight a virus, and how you track a virus and you could think of Carter as M. He has the plans, like this is the mission.
And but they are — they are the different — they’re the three stools to a pandemic response. It’s like big strategy which is what Carter Mecher and Richard Hatchett dreamed of, it’s like developing new tools, new weapons, to stay ahead of the virus and that’s what Joe DeRisi does, and the big thing, the thing that — it just has been completely lost in our response is the — on the ground on the ground hand-to-hand combat because disease is fought locally, that it is — it’s thousands of county health officers, making their county safe, spotting the outbreak early, getting at in front of it, stopping it from infecting other people.
RITHOLTZ: So, I only have you for a minute or two left. What does the United States need to do to not be the counterfactual bad example for the rest the world, what do we need to do to prevent the next pandemic from being as bad as this one?
LEWIS: We need to create a public health system. We don’t have one. We pretend like we have one. It’s not a system.
So, more broadly, we need to learn how to govern ourselves. It’s childish. But the — specifically, you need to wire together the 3,000 public health officers in a network where they have each other’s information, where the network can respond as a whole to anyone instance of anything happening, so they all know that, oh my God, this new pathogen just arrived in Dallas or in Atlanta. Everybody be on alert for this thing.
And that — and that in this network, information spreads not only bubbles up instantly, it’s like from the ground, but spreads down instantly from the top so they know how to deal with what’s happening. Now, there’s a cultural thing that has to happen and the cultural thing is, the country needs to understand the importance of these characters.
Like their social status needs to be higher. Their social power needs to be higher. And if — if you ask me one of the points in my book is an important point of the book, I’d have to say you need to understand how important Charity Dean is. You missed it. You missed it just like you missed how important Michael Burry was in “The Big Short.”
LEWIS: That you — it’s this character who knows how to save our lives. And so, I think if you create the network, if you create the system, you’ll also start to solve the problems of social power and social status, but it’s a system that needs to be built that we don’t have.
RITHOLTZ: Thanks, Mike, for being so generous with your time. We have been speaking with author, Michael Lewis, about his newest book, “The Premonition: A Pandemic Story.”
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