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transcript
Michael Lewis Is Asking the Right Question
Why did America’s pandemic response fail so miserably?
[MUSIC PLAYING]
- ezra klein
I’m Ezra Klein, and this is “The Ezra Klein Show.” [MUSIC PLAYING]
All right. Before we get into it today, a job announcement. We’re looking for a senior editor for the show. Someone who really understands the show, and the space it occupies, and the kinds of ideas and people that it focuses on. Someone who is really good, loves shaping and editing episodes. This is an editor role. And who will work with me to manage a team and to chart the future of the show. This is, as the title suggests, a senior role — a senior editor. So you need seven years at least of editing experience. It doesn’t all need to be in audio, but some of it should be. And at least two years of management experience. I’ll put the link to the job listing in the show description or you can find it by going to nyt.co.com/careers. But to the episode today — I have to tell you I struggled with Michael Lewis’s new book “The Premonition.” Not the reading it, of course. It’s a joy to read, like everything Michael Lewis does. But I did struggle with its central argument. This book is asking exactly the right question and one we we’re not asking enough in America. How could we have stopped coronavirus from becoming a pandemic here in the first place? Because once you have a pandemic, everything you might do to stop it is either going to be draconian or it’s going to be not enough. So you need to do is not let it become a pandemic in the first place. And there were people who had that plan. Michael Lewis’ book — he’s following characters who saw this coming early and were trying to raise the alarms on it. Carter Mecher, a pandemic expert from the George W. Bush administration, who helped design the government’s pandemic playbook. And he saw really clearly, really early, and was trying to tell others what this was going to be. Charity Dean, a public health official in California, who was fighting her own bureaucracy, her own state, to get them to take this as seriously as the world-shaking event it would later prove to be. And there are villains in this book. And I would say one in particular. It’s the Centers for Disease Control and Prevention. And I don’t want there to be any doubt on my position on this or simply the reality of this. They screwed up in a profound way. First and foremost, by insisting on making their own test and then failing to make a useful test, costing us unbelievably crucial time and information right at the beginning of the pandemic. There is blood on their hands. And yet, for that, I am not sure that the kind of pandemic response Lewis is lionizing here was possible in America ever, because to do this, to have the kind of aggressive public health lock-downs he’s talking about, or his characters are talking about, it wouldn’t just be for this pandemic. We’d be locking down every few years, because every few years we see diseases that could become the next pandemic. And we never know which one it will be. So what would happen if regulators tried to lock us down each time? Would people listen to that? You look around at the way this country has fought shutting down, has fought school closures, fought masks, even when thousands of people were dying each day. You look at how many people won’t take a vaccine even now. And you ask, could we have really done what Lewis’ characters are saying we could have. What are the actual constraints of the public — the constraints the public imposes on public health. So the question then it’s not just what the right playbook would have said we should have done, but realistic, what could we do? And what’s the optimal strategy given what we’ve learned about people and politics in this pandemic? And then maybe what are the new strategies that have emerged now that people understand how bad a pandemic could be? So that’s what this conversation is about. I think it’s one of the most important policy questions we need to answer. As always, my email is ezrakleinshow@nytimes.com. Here’s Michael Lewis. [MUSIC PLAYING]
This is a book that is centered around the failures of the CDC and why they happened. But before we get into the why, tell me the what. What were the CDC’s key failures in your view?
- michael lewis
Key failure number one, not facing up to the severity of what was going on in Wuhan as early as you could have done it. I would say January 20, when my characters have a real bead on what the transmissibility and the lethality of it is. And they had connections within the CDC. They’re talking. They’re trying to get them to pay attention. The “head-in-the-sandness,” kind of, of it. Two, being proprietary about COVID testing so that they created in our government a single point of failure. So that when their test didn’t work, we had no test. And that’s not just the CDC. That’s the FDA, because the FDA was insisting that people use the CDC’s test. We have more microbiology labs than any other country on Earth. They could all have whipped up COVID tests and some of them did. We could have done it a completely different way. Not just that the tests failed, but instead of responding to the failure by saying, this isn’t working, we got to find a different way, clinging to the authority to create a test. That would be two. Three, in the midst of all this, not being able to stand up to Donald Trump and say, what you’re saying about this is false. You’d lose your job maybe. But there was a public information role that they failed repeatedly with. And they failed in both directions. It’s interesting. Saying that masks didn’t do anything, because they didn’t have masks. But also, remember early on there was an obsession with fomites. You can get this thing off of surfaces. And you were cleaning your newspaper before you got it off your front porch if you got —
- ezra klein
Yeah, people were Lysoling their groceries.
- michael lewis
All that. Think about the expense that the whole society has gone to because the CDC only like last week said, actually, that’s not that big a deal. They could have said that last May. So the guidance has been bizarre.
- ezra klein
You root a lot of these failures in a risk-averse culture at the CDC. So let’s ground this conversation in history there. Tell me about the 1976 flu outbreak and the fallout to the CDC’s response.
- michael lewis
Yeah, because that’s the moment where the CDC starts to change. Fort Dix, New Jersey, end of the flu season in ‘76. Some soldiers become ill. One dies. Scientists isolate a new strain of the swine flu. To the best of everybody’s knowledge, they’d never seen a new strain of a flu that was so transmissible and lethal that didn’t result eventually in a pandemic. And so instantly there’s a crisis. The CDC gathers all relevant experts to talk about what to do. It’s presided over by the — and career public servant, David Sencer, who’s the head of the CDC. And there’s a consensus that they should go as fast as possible to vaccinate the American population against this thing, because in the fall it’s coming kind of thing. Sencer, who’s presiding over the meeting, drafts a memo with just his name on it to the then Ford administration saying that this is what we think you should do. And the Ford administration feels, I think, backed into a corner. But also, this is what the experts are saying, so they go and do it. Flash forward to the fall and the vaccine is administered to — I don’t know, I can’t remember — but many millions of Americans. And first, some people get sick. The illness is actually unrelated to the vaccine. Random chance alone some people are going to get sick after they get the vaccine. But the vaccine is blamed on the evening news. Walter Cronkite actually apologizes for that report. And then after that, people actually get sick because of the vaccine. So some people die because of the vaccine. And the swine flu doesn’t come. So overnight, David Sencer goes from trusted leader of the Centers for Disease Control to scapegoat. And the Carter administration has arrived. And they fire him and then commission a book. It demonizes Sencer. And it actually ignores the whole process that led to the decision, which was actually a good process. It was decision-making with a lot of ambiguity and conditions of uncertainty. No one has ever seen a highly transmissible and lethal new strain of the virus not result in a pandemic. The American people had no immunity to it. Everybody basically agreed that’s what you should do is vaccinate them. And if you don’t vaccinate and it happens, you’re going to have a lot of death on your hands. It’s the first step in what then happens over the next six to seven years in the CDC of the politicization of the CDC. Flash forward a few years later and the Reagan administration is starting to insist the CDC do things that are alien to them. I mean, shut down research programs because it angers aspirin manufacturers. That kind of thing. And the Reagan administration decides to change the job of running the CDC. It’s no longer a career civil servant who is basically bubbled up with the approval of his peers. It’s going to be a presidential appointee. That’s a moment where the culture changed. And you can see why, because it goes from being a place that’s run by someone who might run for 10 or 15 years, and who is not beholden to any particular president or White House, and who’s been selected largely because his field finds him highly competent, to someone who’s selected from a smaller pool of possibly very competent people, but who happen to please politically who happens — whoever happens to be in the White House. And that director is going to serve for on average a couple of years. And so it’s like giving a house to a renter instead of a homeowner. They’re just going to behave differently. Their concerns are going to be different. The decision-making is going to be on a shorter political leash. So this is at the end of the book, not the beginning. But it was my attempt to figure out how this institution, the Centers for Disease Control, had acquired this illustrious reputation for controlling disease and why it was so different from that reputation.
- ezra klein
But I start with it, because it seems to me to frame the question of the book really well. Which is, how much do regulators and public authorities — public health authorities — have to worry about the public? And how much can they do things that the public may not want them to do? So I want to do one more historical story before we get into this pandemic, which is H1N1. Talk a bit about what almost happened during H1N1, which is a more modern precursor to coronavirus.
- michael lewis
Right. That’s 2009. That’s an actual pandemic.
- ezra klein
Actual pandemic.
- michael lewis
An incredible number of Americans were infected with that strain of swine flu. The problem early on — and again, in the beginning of a pandemic, it’s very hard to tell what’s going on, which seems strange. You would think, oh, it’s easy to tell what’s going on. But waves of death inside an ICU in Mexico, gruesome reports coming out of Argentina. It looks like it’s really lethal and you just don’t know. And in the Obama White House sat one of my main characters, Carter Mecher, who had been a holdover from the Bush White House and who had essentially created the U.S. pandemic response. The Bush administration had invented the idea of pandemic strategy. Crafted one in the form of a booklet inside the CDC. And then left it to the Obama administration. And he was just supposed to be there for six months. And then when he trained up his successors, he would leave. But he’s there and he happens to be a pandemic savant. But he knew that he didn’t know what was going on. But he thought in an abundance of caution, we need to treat this thing like it’s lethal. And the CDC actually disagreed. The CDC — its advice was don’t rush to vaccinate. We want to wait and see and gather more data. That’s kind of the thing.
- ezra klein
And he wants to close schools, right? He wants to do the whole thing.
- michael lewis
In the very beginning, yes, until they know what they’re dealing with. And the problem generally with waiting to have more data is that by that time you have data, it’s over. The war is over. When you’re looking at disease in the society, you’re looking at star light, as Carter would say, or you’re driving by looking in the rear-view mirror. A death today is an infection from five or six weeks ago with a virus that’s multiplying exponentially. And so if you’ve got one death, you’ve got thousands of cases, kind of thing. And so he was trying to explain to the Obama White House that, yeah, there’s no evidence here that it’s lethal yet, but we don’t know. So Obama decided, rightly as it turned out, not to listen to him. The CDC’s advice to wait until they had certainty ended up being the smart advice. However, one of my other main characters, Richard Hatchett, another doctor who was in the Bush White House, was brought back in to help Carter Mecher manage this thing. He kept a journal through that time. And Hatchett, in the course of the journal, you see him realizing that, yeah, they created this pandemic plan, but had the swine flu actually been lethal, it would have been catastrophic given the response. And he tells Obama, it’s not that we dodged a bullet, it’s that nature shot us with a BB gun and we got lucky. And to his credit, the Obama White House learns a lesson from this. And the lesson is actually you’re not going to manage a pandemic out of the CDC. You’re going to get a particular point of view out of the CDC that is going to be afraid to stick its neck out, insisting on certainty. Whereas, if you wait until you have certainty, it’s too late. And so the Obama administration actually from then on elects to manage pandemics out of the White House. They put a pandemic manager onto the National Security Council, who is directly talking to the president and coordinating the various federal agencies. It’s a position Trump ends up getting rid of. But they learn all over again what the Bush administration learned on its own, which was that the Centers for Disease Control is not really equipped to control disease. [MUSIC PLAYING]
- ezra klein
So I’m going to try to take the side of the CDC for some of this conversation, because this is a very critical of the CDC book. And I agree with a lot of the criticisms. I’ll be clear on this. But the weakness of them, I think, is that I am not sure an agency could do what these characters — your renegade epidemiologists — want to do. And that’s the part of this I want to push on. So we’ve watched during this pandemic that even when the virus is out there killing your friends and neighbors, there are people who will not mask. There are people who will not take a vaccine. There are people who will not socially distance. Kids will go to parties on colleges. The key argument made by a lot of your players — and it’s completely true. I mean, on the facts it is completely true. It is that when you do not know how bad this can be, that is the time to stop it. Lock things down.
- michael lewis
You could contain it.
- ezra klein
You can contain it. You can actually beat the virus. You don’t —
- michael lewis
Australia did this.
- ezra klein
Yeah, you don’t have to wait till the fire is raging out of control.
- michael lewis
Right.
- ezra klein
At the same time, a lot of these come up. I mean, H1N1 being another example. SARS was a possibility. We could have done a lot more here about Ebola and some people were arguing for that. A lot of things come up that you might implement the hard core pandemic playbook to stop and then they fizzle. And if you do that five or six times, the worry of the politicians, of the CDC is that you can’t take the public out of public health. And that there’s going to be a backlash. You’ll lose your seat. You’ll lose the government. The CDC will get neutered the way it was in the ‘80s under Reagan. And so they are not free to take this advice. And so this is my question for you, having talked to these people, do you think it would have been possible to do what they had wanted to do when they had wanted to do it? Do you think a different agency, a different presidential administration could have gotten Americans to go into that kind of lockdown before we knew how bad this was, when there was just a cruise ship docked, I think not that many miles from where we are now.
- michael lewis
You mean, would we have to be a different society in order to pull this off?
- ezra klein
Yes.
- michael lewis
How different are we from Australia? You would have to pull it off for a matter of a couple of months before everybody saw the wisdom of what you’ve done, because you’d be looking at other countries where there was raging disease.
- ezra klein
But that’s this time.
- michael lewis
Yeah.
- ezra klein
If you had done this three or four times —
- michael lewis
I thought we were talking about this time.
- ezra klein
But I’m talking about all of them, because you would have — in a world where we listen to these folks who would have done it for H1N1, we might have done it for Ebola.
- michael lewis
I think you’re imagining a response that even they’re not imagining. They’re not thinking shut down the society. Closing schools is a particular thing. One of the things that Carter Mecher and the inventors of pandemic response figure out is just how central schools are to disease transmission. So that’s a peculiar thing. And it’s not shutting schools for months. It’s shutting them for a couple of weeks. I could imagine a world where we build in as a society a kind of rapid response to a virus that is minimal. It’s like the least you have to do that doesn’t involve closing businesses, for example. That may involve some hesitation about mass gatherings in schools. So this is a matter of public education. I mean, I don’t think that you can be fatalistic about this. And I mean the leadership we had made it impossible. And it wasn’t just the leadership. Even if we had taken the action that these people would have liked to have taken, it has no purpose if you don’t have COVID testing. And we wouldn’t have had testing. But as a society, could we create a mechanism to respond more intelligently than we have in the past? Yes, totally. But you can’t just do it. You have to explain it. You have to say, look, this is going to happen again. It’s like a hurricane. Think about hurricane response. When I was growing up in New Orleans, nobody evacuated. And if you told people they would have to evacuate, they’d say, no, you could never pull that off. You’re not going to get everybody to leave New Orleans. Katrina happens. The meteorologists say it’s time to get in your car. People get in their car. So you can change the culture on these subjects. And when they’ve now had this experience, I think going forward it’s probably easier to change the culture.
- ezra klein
Yeah, that I think it’s possible now in the same way that I think you see remarkable responses in South Korea and Taiwan and some of the countries that dealt with SARS and MERS at different points. But let’s go back. Let’s imagine a better political equilibrium. So let’s say that in 2012 the election had gone differently and Mitt Romney was in his second term. A lot of your main characters are Bush holdovers. They come back. What should we have done? What would the plan have looked like? And when would it have gone into place?
- michael lewis
First, what they would have done is they would not have had this single point of failure at the CDC. So you would have had testing. You would have had it run out of the White House in a much more aggressive way. So let’s assume we have testing like everybody else. Very early on everybody coming into the country is tested for COVID. Everybody quarantines for 14 days. That’s the first thing. There would have been severe travel restrictions I think right up front. They would have closed schools.
- ezra klein
When would they have closed schools?
- michael lewis
January 20. There’s a constraint here that they may not have had if they— in a different world. They might have had better relations with the Chinese, so they would have had better data out of China. But even with the data that Carter Mecher is able to get off Chinese websites and from Chinese morgues, and the way he was trying to figure out what the transmissibility and the lethality of it was, he had a bead on the thing on January 20.
- ezra klein
Do you think people would have accepted the school closure in January of 2020?
- michael lewis
If you explain it badly, no. Do I think you could sell it with some pictures from Wuhan? Maybe. And if not January 20, February 20. I mean, but it’s event — maybe you need the pictures from Italy. I don’t know what you need. But you’re not necessarily closing the schools for good. You’re closing the schools to see where the virus is. And you wouldn’t have been in the position Carter Mecher was in trying to find all kinds of bizarre ways to find the virus, like testing people who have flu-like symptoms everywhere in America when they wander into clinics for COVID. So when you ask me those hypotheticals — would people have accepted — I always think what people accept depends on how they are led. Do I think that a leader could have led them there? Yeah, I think it’s possible. You lay out what you think might be happening. You scare the hell out of everybody. We’re not doing this permanently. We’re doing this until we know what this thing is. And then what we hope to do is contain it so we can have our economy back. So you’re asking me would we have taken a shot at containment? Could you have led people to have a shot at containment? I think it’s possible.
- ezra klein
I’m pushing on this because I think it’s the core question. What I like so much about the book is you’re having the right debate in it. I think so far debates in this country about pandemic response are what happens once the fire is out of control, which I think you’ve got a great — I think it’s Carter who says, you can stop a grease fire with a fire extinguisher. You can’t stop a house on fire with a fire extinguisher. But the difficulty with starting when it’s a grease fire is you got to move people to a place, which maybe you can do in the future because we’ve lived through this unbelievable catastrophe as a collective. But I think it would have been very hard then. And you’re mentioning Australia, which I do think has certain unusual qualities as being as separated and an island as it is. But Europe, for the most part, didn’t. Europe doesn’t have the particular CDC history we do or they didn’t have Trump. And some of them did better for a while. Germany did better than we did for quite some time. But a lot of them didn’t. South Korea is the most interesting to me, because it did take off there and then they stamped it back out. And they’ve had I think something like 2,000 deaths in a society of tens of millions of people.
- michael lewis
But we aren’t just like Europe. The Lancet did the math that back when there were — I don’t know — 480,000 American deaths. The Lancet calculated that if we’d done only as well as the average of the G7 countries, there’d be 170,000 Americans still alive. So there is the second question about how will you handle the house on fire.
- ezra klein
Yes, absolutely.
- michael lewis
And we didn’t handle that well. But it’s a fair point to say that maybe it was not culturally possible to sell containment. It would have been hard to do. The fact we didn’t even try is damning. We didn’t even try. The CDC doesn’t pivot and go from saying this poses little risk to American life to it’s now here and we can’t do much about it.
- ezra klein
Yeah, can you talk about that pivot from downplaying to fatalism? That’s a really interesting thing you pinpoint in the book.
- michael lewis
It’s February whatever — 23rd, 24th — when Nancy Messonnier at the CDC gets up and says that we’ve had domestic transmission and basically we don’t know where it is. It’s here and it’s moving. That’s the day the stock market collapsed and Trump called for her head and all that. What was interesting to me about it was that from the lay point of view, it looked very brave for the CDC to get up and do this. From the point of view of Charity Dean, public health officer, or Carter Mecher, who’s pandemic strategist — people who are really in on it — it was unbelievably cowardly to wait till then, because you could have done that on January the 20th. The CDC played the part of lulling the American people to sleep for a stretch. The public health authority, in order to do their job, they need cover from politicians. But they also provide cover for politicians. They are the experts. And they do what David Sencer did. We think this is dangerous. We think we’ve got to take precautions. We’ve got to do various things. And it enables the politicians to take action. And instead they do the opposite. They gave cover for complacency.
- ezra klein
So there’s an interesting discontinuity in this book, which is — so I read and I loved your book, “The Fifth Risk,” which is about the government as a manager of risk for society, and how Trump and the Trump administration were coming in and basically taking a wrecking ball to that.
- michael lewis
Yep.
- ezra klein
And one might imagine opening this book, that it’s like “The Fifth Risk,” part two. It all came true. Exactly what we thought would happen happened. And you note that when the CDC does eventually come up, even as late as they do, Trump basically sidelines them. That’s been, I think, the dominant story of CDC and Trump up until now. But Trump for a long time, as the head of government, is fighting the parts of the government that are going to come out and say, this is a big deal. He is trying to get people to downplay this, because he doesn’t want the testing. So one might imagine, having read “The Fifth Risk,” this book is going to be about, see, everybody, I was right. [LAUGHS] Michael Lewis was right. But you actually say Trump, obviously not a help, but not the core issue. That this might have been different, but it wouldn’t have been fixed by not having him. Tell me why.
- michael lewis
I go where my characters take me. They took me on that journey. I would have loved to have been able to just write this as the sequel to “The Fifth Risk.” It was just messier than that. And even in “The Fifth Risk,” it was clear that, yeah, Trump is taking a wrecking ball to this machine that we have to deal with existential risks. But it’s like the one tool we have to deal with lots of problems. But that tool, that machine has been allowed to rust for generations. So it was easier to destroy than it should have been. And one form of the rust is like what happened inside the CDC. When I have a character who’s a local public health officer in Santa Barbara County — Charity Dean — this is the main character in the book who is fighting very bravely crazy outbreaks of disease in her county. It’s not COVID. It’s tuberculosis, or it’s HIV, or hep C, or measles in schools. And has little microcosms of the same experience we’ve seen writ large with COVID. Controversies, upsetting people to save lives. And she has — when she takes this job — this sense that there is this federal enterprise that’s there to help her called the Centers for Disease Control. She’s supposed to lean on them for academic help, but also to have her back in cases. And she realizes that they don’t have her back. That, in fact, just the opposite. Any kind of controversy that she causes, they run away from. It’s a premonition of what’s coming. If you had asked Charity Dean in 2015, before Trump is in the air, what’s going to happen if there’s a pandemic, she’d have told you there’s nobody to run it. The supposed institution on top is actually not engaging with the problems in a serious way and the system isn’t a system. It’s just 3,000 of me around the country unconnected, on our own, with no one coming to save us. So it’s a little hard to blame Trump for it all when you have someone telling you that. That it wasn’t working before. Now, there’s no question that Trump made it worse. I mean, there’s a body count you can just blame him for. But would we have gotten out in front of it with someone else? I think probably not. Probably not.
- ezra klein
So “Fifth Risk,” the implicit view of folks in government is that they’re really competent and doing a great job. It’s a very pro-government book. This book I would say actually frames the opposite. Has your view of government changed in doing the two books?
- michael lewis
Not too much. Both stories, if you back away far enough, are about good people and bad systems. There’s no malice in what’s coming out of the CDC. It’s screwed up incentives and the incentives were imposed on them. It’s changing an institution from having a really organic felt relationship with disease on the ground in America and a healthy appetite for taking risks to fight it into a kind of academic institution that is rewarded for writing papers. And we punish them horribly when they make mistakes. So my attitude has not changed at all. It’s true I shifted the light. I had the spotlight — in the first book was on these people who in spite of the systems they are in are doing these extraordinary things. In this case, we had gross system failure. And it wasn’t just at the federal level. I mean, the states are in a funky position, because the states would have assumed that this was going to be managed like a war on a federal level. They weren’t expecting to be told that the Russians are invading, figure out how to defend California. So it’s a little more forgivable at the state level. But it’s hard to write a story of government competence when you have this, which is a failure of systems. But the other thing the books have in common is that the heroes of this book are still government employees. [LAUGHS] They’re just people in a screwed up system trying to make it work and realizing eventually that it won’t, but behaving pretty heroically and doing their best in spite of it. What those guys did in the Bush administration, especially Carter Mecher and Richard Hatchett, two doctors who had hands on patients for much of their careers, in thinking about what we should do in the event of a new pathogen sweeping across our society, I mean that is a story of government triumph. It is the government working. So it’s not all dark. But you’re right, it is different. And it is not — if you’d asked me the last time we spoke what the next book after “The Fifth Risk” was going to look like, I would not have guessed it would look like this.
- ezra klein
So the tone of the book is your characters banging their head on the wall of these failures, trying to get the CDC to move. I’m sure you talked to some people at the CDC who were on the other side of this. What was the most persuasive argument they gave you of why they acted the way they did?
- michael lewis
All my interviews with people at the CDC are guerrilla interviews. And the people I interviewed felt ashamed. I did not get arguments back. What I did hear is don’t be too hard on us, because there are great people here and we’re not all like that. That was the defense. It was people feeling alienated from their own institution. It wasn’t, oh, yes, it was smart to have a test that didn’t work. It was smart to be proprietary about the test. Here’s another failure — and kind of incredible failure — we repatriate Americans from Wuhan. They are in National Guard barracks being quarantined outside of Omaha. There is a facility in Omaha that is a medical facility that was designed just for this, to send people with mysterious or scary illnesses, to treat them and also understand the illness. The guy who runs that facility, James Lawler, calls the CDC and says, we got to test these people who just came back from Wuhan. And it goes all the way up to Redfield. And Redfield says, you’re not allowed to test them, because to test them would be performing experiments on captive people — medical experiments on captive people. All the people in the barracks want to be tested. So they never get tested and they get released into the wild. How do you excuse that? I mean, you can explain it. That they don’t have a test. They’re embarrassed their test might not work. Whatever it is. But the behavior is just quixotic. [MUSIC PLAYING]
- ezra klein
My version of some of this reporting — I’ve done a lot more reporting on the FDA through this period —
- michael lewis
Oh.
- ezra klein
— which I think has often been very far behind on some important things. But the answer I always get from the FDA on why it took so long to, say, clear rapid, cheap, repeatable at-home testing, or why do we still not have clearance on AstraZeneca despite the fact that it’s been used all over Europe and it certainly seems to be working out reasonably well is that they are so afraid of a mistake that they make — a sin of commission, as you like to put it, rather than omission. And what will happen then if the entire structure of public confidence in the regulatory decisions collapses, that they are working with a risk profile that seems completely different than the one I look at from the outside or that some of the people I talk to look at from the outside. And it infuriates some of the public health officials, and the health economists, and epidemiologists I know. But that their general view is that it’s all well and good to lob stones at us from the sidelines. But if we get it wrong, we can never get it right again. And I don’t really buy that, but it is how they see it.
- michael lewis
No, that’s true. No, no, no, it’s absolutely true. The characters in the book make the argument that they have come to regard sins of commission as completely different from sins of omission. But when you’re dealing with a pandemic virus, a sin of omission is a kind of commission. That if you’re not looking for the virus, you don’t stop the virus. People die. So they ended up getting what they most feared. Inaction led to disgrace. And your attitude towards the fear — and maybe mine a little bit — is kind of forgiving. It’s like they’re that way because we’ve made them that way, because we punish them mercilessly when they commit a sin of commission. Charity’s attitude was this is life and death and I find it unforgivable.
- ezra klein
And something threaded through there — and this takes us back to Redfield, the CDC director, saying, well, you can’t give people these tests, because that’s conducting an experiment on them— is there is in a lot of these decisions that weren’t made and then a lot of things we never even considered doing in this country but were effective in other countries, a very American fear of public health authority and public health action. If you look at, say, what South Korea did or what some of the countries that did test, trace, isolate really well did — you talked about one of the original sins here being that the CDC created a point of failure and then failed on testing — completely true. But we also didn’t know what the hell to do with testing. And even in places that did then get it up and running, we didn’t do enough tracing. And then when we did do tracing, we never had what a lot of, particularly, the Asian countries had, which was an isolated quarantine program. And in some of these countries, if you were found to have COVID, you were put into a centralized quarantine location. And if you left or you broke out, you went to jail.
- michael lewis
Yeah.
- ezra klein
And one of the things here was that you really did need to really aggressively enforce it. Not say everybody needs to wear masks, but we’re not going to actually do anything to enforce it. Not say nobody should go out, but if you do, we’re not going to enforce it. And so there really was a tension here that, I would say led to us, as my friend, Matt Yglesias, put it in a piece recently, we ended up a lot less free because of how long we had to be under restrictions.
- michael lewis
Yeah.
- ezra klein
But part of why we ended up so unfree is we were much more uncomfortable than other cultures were with aggressive imposition of public health authority. And that seems like a cultural thing we need to discuss and think about how we want to do next time. Because even if we got testing right, well, what do you do when somebody has a positive test? And even Charity, interestingly to me, is a little wishy-washy on this at a key point. She comes up with this plan and she says, well, it’s all going to be voluntary. And individual counties are going to individually regulate. And what we’re going to do is genomic testing. And even she doesn’t really want in her plan that she comes up with — the Churchill plan — to have the government telling you what to do. And this is tough in a pandemic.
- michael lewis
I think that’s her attempt to acknowledge the political realities and the cultural realities, which she thought was the only way a plan works is if it’s executed at an extremely local level and you have buy-in. People have to buy in. And neighbors have to enforce it upon neighbors kind of thing. That that’s how it was going to work. And that when you saw that your pizza restaurant had to shut down because the neighbor’s boy went to a party or whatever, that social pressure would be created. That’s what she was trying to do. She was just trying to create social pressure. And that the only way you do that is at a very local level. And that did happen in this country.
- ezra klein
Ish.
- michael lewis
Oh, my god. Are you telling me that Berkeley, California didn’t have social pressure to comply?
- ezra klein
Berkeley, California did. But Orange County —
- michael lewis
No.
- ezra klein
— went in the opposite direction —
- michael lewis
Opposite direction.
- ezra klein
— in key places.
- michael lewis
That’s right. But the key part of the plan was you are living with these rules. That if you have this amount of transmission, you’re going to have those kind of closures. That didn’t get done. I mean, so you had to have people seeing that there was a price to be paid for noncompliance at the local level and see that they had the knobs they could turn to control what prices they pay. Whether you could have gotten Orange County to behave like Berkeley, California — probably not. But you might have nudged the country closer to better execution.
- ezra klein
But this is what makes me very pessimistic about containment in the future. At a certain point, this was going on and people were seeing what other places looked like. And partially because the disease is so erratic in the way it spreads, some people, as you talk about —
- michael lewis
This particular one.
- ezra klein
This particular one. Some people give it to 50 people. Some people give it to nobody. You have a lot of luck in what ends up —
- michael lewis
Totally right.
- ezra klein
— catching on fire. In Florida, right now, Governor Ron DeSantis has a totally average performance and is bragging about how he got that average performance by not doing that much in terms of locking down. And so if you want to get the fire not to rage — one of the things that is scary to me about the experience is you look over at the places that did it and they went in on a level of quarantine and isolation and public authority that it feels to me we are nowhere near having learned that lesson.
- michael lewis
Well, we don’t have — and we don’t have the resources at the public health level even to do it. There was also just a fatalism right from the beginning where we didn’t even think what is the smartest way to do it, let’s do it. I mean, I thought what the Japanese did was really interesting with the tracing. That once you know the role of super spreaders, once you know that it isn’t everybody gives it to two other people, but 90% of people don’t give it to anybody who have it and 10% of the people give it to everybody, the game is find the super spreaders and shut them down as quickly as you can. And when you find someone who has COVID, you don’t contract trace forward, you contact trace backward to find out who they got it from and shut that person down. So we were arrogant. We were really slow to look at around the world and say what worked and what can we use, because we basically didn’t think we had the nerve to do it. At the same time, my characters thought we could do it. If you had found Charity Dean at the California Health Department in January or February, she would have said that this is still possible in California if Gavin Newsom is willing to get up and take some risk. And she would say now if Gavin Newsom had taken that risk, he would be better off than he is now. That the performance of California would have been so much better than everybody else, he would have gotten credit for that. The problem with Gavin Newsom was he was half brave instead of being full brave.
- ezra klein
But this is where I kind of do want to keep pushing, because Gavin Newsom — say what you will about him and had his mistakes during this period — California goes into lockdown earlier than anyone else. But at some point, it’s important to recognize that the politician — and take seriously as an issue in response — that the politicians know the politics better than Charity Dean does. Because even when Charity Dean, as we just talked about, begins to come up with her plan, she actually shies away from going full brave and saying we’re just going to quarantine people and have the police enforce it, which is what they do in some of the other countries. And so this is where I actually think the politics are more of a constraint than is sometimes admitted by the characters in the book. In some ways what Gavin Newsom is suffering for now is that people are so angry about the amount of lockdown he did impose, even to get the performance California did. And so to me the great question of the book is, can we keep the fire from consuming the house? Can you actually do containment and suppression, which we did not do. We can make it better on the margins 100 different ways. But could we have not had this happen? Could we have had 50,000, 10,000 people die?
- michael lewis
Or could you have had a state that stood out early on —
- ezra klein
Could you have had a state —
- michael lewis
— early on with a peculiar response that led the country, because the response was clearly so effective.
- ezra klein
But I think the problem is it’s so hard to not have the states intermingling, to say nothing of the counties. The idea that Santa Ana is going to be bad and Newport Beach is — that’s really, really tough, because people have family, they work. I think this is something that I’ve heard from a lot of public health officials that the killer for them, particularly when it would come up to holidays, is you can’t lock people down from the fact that they have friends, family, and employment in different places. And I, the public health official, can’t control that other place. And so it just destroys the entire firewall I built.
- michael lewis
We have tools to build really effective firewalls and we just didn’t use them. Genomic epidemiology, which enables you to trace how the virus moved, is perfectly suited to show you where the hole in the wall is.
- ezra klein
Can you explain that? I think people know about genomic testing as, well, you can see if there’s a new strain. But you’re talking about a whole different play here.
- michael lewis
Yes. And, in fact, California was particularly suited to use it as a tool. And it’s nuts right now that we aren’t doing more of this genomic analysis, because you do want to know when there’s a new strain or when some strain that you know is more transmissible has suddenly arrived in your community. And we don’t know, because we’re not doing the testing in anywhere near the extent we should. But the COVID virus basically mutates once every one or two transmissions. And at least fingerprints. And so if we’re in the studio without masks, and you happen to have COVID and you infect me and our engineer. And we then go out in the wild. And a week later, oh my god, I’ve got COVID, where did I get it? And they’re sequencing your virus and my virus, they will see that my virus is identical to your virus and you gave it to me. You have an older virus. There’s a very good chance that you gave it to me. So you can actually — in a perfect world, if you could sequence genomically all the virus in America, you could create a map of how it moved.
- ezra klein
I want you to clarify one piece of this. So let’s say you’re testing within a business. And it turns out that of your 30 employees, two people have COVID.
- michael lewis
Yep.
- ezra klein
And so what you’re saying is that there’s a real big difference what it implies for the organization. If they have the same variant of COVID — so if it’s external transmission, but people are coming in, well, that’s bad.
- michael lewis
It’s bad —
- ezra klein
But your practices are fine.
- michael lewis
Your practices are fine. And if it’s people that are coming in, what do we do to test them before they come in so that they can’t — they don’t come in from the outside with it. But yes, there’s a difference there. And the genomic information enables you to see the difference.
- ezra klein
This is a whole other thread of the book where I would say Chan Zuckerberg, and particularly, Priscilla Chan, come out really, really well. They spin up this bio hub under Joe DeRisi. They are trying to offer free test analysis, free genomic testing. They got all these volunteers to do it. And it’s really, really depressing what happens next. They are coming to everybody with a gift.
- michael lewis
Yeah.
- ezra klein
A gift. The most advanced bio testing probably anywhere in the world. And they can’t get people to take the gift. Tell me about why that happens. [LAUGHS]
- michael lewis
Because they’re walking into a health care industrial complex that has all these weird incentives in it. So in the first place, you would think the CDC’s test doesn’t work. They create their own test, plus they’ll do the genomic sequencing. And they’ll do it all for free and help you understand the results. It’s all free. You would think there’s nothing better than free. But when they try to engage public health officers with their new service, the public health officer will say, well, this is great, but how am I going to receive the results? Nothing’s digital here. You’re going to have to fax me the results. So there are those constraints. But then Joe DeRisi figures out very quickly that the prisons are going to be high-risk environments, and San Quentin in particular. It’s an old prison, poor ventilation. They’re all jammed in there together. He said — and he went to the prison officials and said, if you have an outbreak there, you’re going to have a lot of death. And he said, let us do your testing. And they were kind of hemmed and hawed and they let him do a round or two of testing. And then they said, we can’t do it anymore. And he said, why? And he said, we have these existing relationships with testing corporations. And we have contracts with them and we’re worried we’ll be in violation of the contract. That we have to pay $100 a test or more to those companies to do our testing, but we’re stuck in that relationship. And they were unwilling to break the relationship. So in the broader picture, Priscilla Chan put it very well. It was like the public health system didn’t know how to receive a gift. And I thought, you know, it reminded me of something. It reminded me of the stories I had written about poverty. And one aspect of poverty, one symptom is you don’t have enough. You simply don’t have things. But another side effect of poverty is you don’t even know how to receive things. You’ve received so little help in your life that when help comes, you don’t know what to do with it. And that was what Joe DeRisi walked into. And it was for him — here he is this MacArthur fellow prize-winning genius of a scientific researcher and creator of all these tools for hunting viruses. He’d never had any interaction with the public health system. I mean, it was like — for him it was like a black box. He just assumed, like me, it was out there and it did stuff. When he actually sees it, he can’t believe how impoverished it is. He thought when they created the bio hub to eliminate disease by the end of the 21st century, he thought he was building tools for poor countries to use, like Cambodia. And that his job was to create, essentially, public health tools for those countries, because they couldn’t afford to do it themselves. What he finds is we’re that country. And he’s as innocent of it all when he walks in as I would have been.
- ezra klein
This to me has been one of the — it’s a depressing part of the book. But it’s one of the depressing threads of the entire pandemic. Take San Francisco. So San Francisco throughout the pandemic actually has, among cities in America, one of the best responses. It is in the coalition of counties that is the first to go into lockdown in the nation. It always keeps its death rate pretty low. We never have the kind of outbreak you see, even in Los Angeles, which isn’t that far from here.
- michael lewis
If the whole country had performed as well as San Francisco, the United States would be regarded as having done this well.
- ezra klein
Exactly. And there’s probably some luck in that, but there really was a lot of brave decision-making and a lot of cultural willingness to stick to it. At the same time, San Francisco, it has so much money, so much technology. Chan Zuckerberg and the bio hub are here. And the thing that I kind of always thought was going to happen at some point — it never did — was that there would be some kind of technological leap in the response. But even now if you go on to the city web page that tracks the disease levels and the vaccinations, it can hardly display on a mobile phone. And if you don’t want to do the kind of high level of public health authority that we were talking about earlier, one of the ways you can get around that eventually is to begin implementing these new technologies really fast, like genomic surveillance. But we didn’t do that either. You might say America, with its individualism, is not going to do what Taiwan is going to do or what South Korea are going to do.
- michael lewis
But maybe we have a different way to —
- ezra klein
But maybe we have a different way. And not only didn’t we have a different way, but nowhere in America had a different way. There wasn’t one city, wasn’t one state that was able to build that kind of technological contact tracing. I mean, early on, you remember, there was announcements from Google and Apple that they had come up with a Bluetooth protocol which could allow for health and contact tracing. And there were issues with all this. It was all going to be hard. But somebody could have really tried it. And they did in other countries. Taiwan did this amazingly well. Taiwan had a tremendous digital surveillance structure which really worked. I wonder if we’ve learned anything there or I wonder if this actually speaks to the difficulty of even using technology to solve these problems, because you might just think one thing we figured out was, well, we had all this stuff, we should have used it, and next time we will. But I’m worried next time we still won’t, because we didn’t even get close to using it this time.
- michael lewis
The question to me is, was the trauma sufficient to elicit a response? If this had been two or three times more lethal or if it had killed kids, I would say no question and we probably would have gotten a different response. It’s been a very peculiar pandemic, because it’s given enough people a feeling of they’re not affected. At the same time, it’s caused enormous tragedy. People can tell themselves a story, oh, this isn’t about me. It didn’t actually implicate everybody in the same way. And so the question I’ve been asking is, was the trauma sufficient to elicit a response? I think so, but who knows. It is true would you say that we could have bought our way — we kind of have bought our way out of some of the tragedy with the vaccine.
- ezra klein
With the vaccines. Yes.
- michael lewis
Right? That’s our triumph. But we could have bought our way out of more by using the technologies we have. The problem was, again, we didn’t have a system to distribute the technologies. The health care system is not a system. It’s 3,000 unconnected nodes led by an organization that has lost the capacity to lead, or maybe it will regain it — but the Centers for Disease Control. So you didn’t have a mechanism for distributing the technology publicly. But it’s there. And its power is being demonstrated in little ways to leaders and decision-makers. I just wouldn’t be surprised if we figure it out, if we bounce in the right direction. But this is just an emotional predisposition on my part.
- ezra klein
Well, let me share your optimism for a minute, but extend my own pessimism. So I kind of do think this trauma will matter. And I think it will be not enough, but enough that next time you have your Charity Deans, and your Carter Mechers, and so on, raising the alarm. People are going to listen on a pandemic. If you come on this particular disaster twice, people are going to say, OK, I’ll hear you out. In the same way that during this period, the financial system began straining and the Federal Reserve just said, nope, we are just going to give it whatever money. We are not going to have a financial crisis again.
- michael lewis
We’re not going to do that again.
- ezra klein
We’re just not doing that.
- michael lewis
Right.
- ezra klein
But it’ll come in a different form. It’ll be a different problem. And you’ve got a series of books now — “The Big Short,” T“he Fifth Risk,” now this one — that are about the ways bureaucracies and systems have trouble hearing the people who are raising the alarm. And I think the right question then is how do systems get better at listening to the kind of people you’re talking about? People who might have been wrong a number of times before, might have seen something coming that didn’t come a number of times before. And so the system has learned to stop listening. It doesn’t want to hear it. And at times it’s been backed up and not hearing it and so it doesn’t. But at some point, we got to get — we’ve been living through an era of just crisis after crisis. At some point we have to become better at listening to people who warn about crises. What have you learned on that?
- michael lewis
Can I be God for a minute?
- ezra klein
Please.
- michael lewis
All right. I’ll be God for a minute and institute reforms that sound kind of technical, but I think would have massive consequences. The first thing I would do is wave a wand over the federal government and get rid of about 3,800 presidential appointed jobs and make them career jobs and create a culture where the person who’s running the FDA or the CDC is going to be there for 10 to 15 years. He’s going to be living in the house, rather than renting it. That will instantly shift his or her concerns to the longer term. And that will lead to lots of helpful changes, like a focus on bringing lots of young talent in, because I’m going to be living with these people for a long time. Refreshing government institutions by changing the incentive structure of the people who lead them and acknowledging just how critically important leadership management is, is like number one. Because when I look at this pandemic, it’s a management problem. It’s not a resource problem. In 2019, a whole bunch of experts got together to figure out who was best equipped to deal with a pandemic. And of all countries, the United States was ranked number one. We have plenty of talent. We have plenty of resources. We were just coached to a losing season. So you change the coaching. So that’s number one. The two is with this you’ve got to create prestige and status where it doesn’t exist now. One of the points of the structure of my book where I took a unknown local public health officer and made her the main character of the book was to flip the status structure that exists now. Public health is just one example, I know. But we made a huge mistake in not understanding the importance of actual battlefield experience and local experience. We misidentified who’s important here and who knows here. So the second thing I’d do is create ways to reward the people who are doing the work well — little people. So that’s number two. Number three, I reintroduce civics into the American curriculum. So every kid needs to know — you can’t get out of the eighth grade without knowing what the Department of Energy does and things like that. We start to educate again the population about what the public sector is. There’s such a branding problem right now. There’s such a screwed up notion about what it’s for and what it’s not for. And four, I’d probably create a national service program where everybody is required to spent a couple of years — it doesn’t have to be in the military, but it has to be in public service — when they come out of college or when they come out of high school. So they’re all mixed up together and they all get to experience the institutions. They’ll have some experience. Maybe they spent their two years working in the National Forrest Service or whatever it is. So people are actually physically, viscerally connected to the public sector.
- ezra klein
I want to ask you about number one on your list of what you’d do if you were a federal government God, which was taking the government out of the hands of appointees and into the hands of the civil service.
- michael lewis
I know what you’re going to say, but go ahead, say it.
- ezra klein
All right. Well, I mean, you’re God, so you would know what I’m about to say.
- michael lewis
And because I’m God, I don’t have to listen to you either. But go ahead.
- ezra klein
Well, I know a lot of people who work in these organizations. And a lot of them also get frustrated that it is so hard to both hire and fire talent.
- michael lewis
Yes.
- ezra klein
That the civil service is — it both has extraordinary people in it, but many of them are frustrated by the other civil servants. And it’s not to say all civil servants are bad or they’re worse than the private sector. That’s not the argument I’m making here. But there are times when the civil service and the bureaucracy needs to move a lot faster. I think if the FDA were more protected from political pressure right now, it would be moving slower, not faster, for instance. That is the sense that I have from my reporting. Their internal culture would be so against sins of commission that if the Biden administration incoming couldn’t actually pull on them, we might not even be moving as fast as we are. And so I wonder how you think about that, because I hear both things. There’s a real problem with political appointees. And at the same time, there’s a problem with the civil service where it is too hard to manage it aggressively —
- michael lewis
If you were —
- ezra klein
— when you needed to change directions.
- michael lewis
We’re talking about the same thing. We’re just talking about it in different ways. If all of a sudden I said, you, Ezra, you’re head of the FDA not for 18 months, but for the next 15 years, one of the first things you would do is figure out how to hire and fire people faster. If all of a sudden you have to live with this institution for a long — and run it for a longer period of time, you would start pressuring the powers that be to change the rules about the hiring and firing of federal employees. An interesting case study is the GAO, the General Accounting Office. It’s an odd bureaucracy in that the head of it is a political appointee, but I think the appointment is for 15 years, instead of the normal — like you’re there 18 months. The Partnership for Public Service, this nonprofit that spends its time evaluating the government and what’s going on, consistently gets the highest employee morale out of that place. Highest sense of purpose. The right answer to the question, do you feel your work is meaningful? You can attack problems, all that kind of stuff. And they think it tracks to that longer term view of the management. Once you’re not in a rental anymore, once you got to own the house, you start thinking about how you make this house work. So yeah, right now the people in the place are immovable forces, but that’s one of the things you would have to address. I’m not taking the job for 15 years if I can’t get rid of the bad people and bring in new good people.
- ezra klein
I think that’s a good place to end.
- michael lewis
All right.
- ezra klein
So let me always ask the final question here. What are three books you would recommend to the audience?
- michael lewis
So I’m going to just pick three books I’ve read recently that have meant something to me. The first one I’m not quite finished, but it’s unbelievable. Kazuo Ishiguro’s “Klara and the Sun.”
- ezra klein
Ooh, I finished it recently. And I won’t ruin anything. But it won’t shock you to know it has an emotional ending. [LAUGHS]
- michael lewis
Well, he has — he’s so generous as a writer. And it’s not fancypants. I mean it is fancypants. But at the level of simple prose, it’s a beautiful work of art. And it’s kind of “unputdownable.” I fell in love with Norman Maclean’s “Young Men and Fire,” which I read for “The Premonition.” And I fell in love with it because it was an unfinished work and you could see — Norman Maclean, the author, did not write his first book until he was 70 years old. He was a professor of English, a Shakespeare scholar at University of Chicago. And he wrote “A River Runs Through It.” And “A River Runs Through It” is his finished work. And it is a beautiful work of art. But with “Young Men and Fire,” you get to see that same mind, that same talent at age 78, or whatever he was when he started it, kind of noodling on how to do this. And I found that just absolutely riveting. So I recommend that. And number three, Casey Cep’s “Furious Hours.” Casey Cep is like a young master at work. And it’s the story of the book that Harper Lee tried to write after “To Kill a Mockingbird,” which was going to be a true crime book, a narrative nonfiction. And she essentially goes and writes the book for Harper Lee. At the same time, she explains why Harper Lee doesn’t write the book. It’s a breathtaking piece of work. So those would be my three.
- ezra klein
Michael Lewis, your new book is “The Premonition.” It is always such a pleasure to talk to you.
- michael lewis
Pleasure talking to you. [MUSIC PLAYING]
“The Ezra Klein Show” is a production of New York Times Opinion. It is produced by Roge Karma and Jeff Geld, fact-checked by Michelle Harris, original music by Isaac Jones and mixing by Jeff Geld. [MUSIC PLAYING]
Michael Lewis Is Asking the Right Question
Why did America’s pandemic response fail so miserably?
transcript
Michael Lewis Is Asking the Right Question
Why did America’s pandemic response fail so miserably?
[MUSIC PLAYING]
- ezra klein
I’m Ezra Klein, and this is “The Ezra Klein Show.” [MUSIC PLAYING]
All right. Before we get into it today, a job announcement. We’re looking for a senior editor for the show. Someone who really understands the show, and the space it occupies, and the kinds of ideas and people that it focuses on. Someone who is really good, loves shaping and editing episodes. This is an editor role. And who will work with me to manage a team and to chart the future of the show. This is, as the title suggests, a senior role — a senior editor. So you need seven years at least of editing experience. It doesn’t all need to be in audio, but some of it should be. And at least two years of management experience. I’ll put the link to the job listing in the show description or you can find it by going to nyt.co.com/careers. But to the episode today — I have to tell you I struggled with Michael Lewis’s new book “The Premonition.” Not the reading it, of course. It’s a joy to read, like everything Michael Lewis does. But I did struggle with its central argument. This book is asking exactly the right question and one we we’re not asking enough in America. How could we have stopped coronavirus from becoming a pandemic here in the first place? Because once you have a pandemic, everything you might do to stop it is either going to be draconian or it’s going to be not enough. So you need to do is not let it become a pandemic in the first place. And there were people who had that plan. Michael Lewis’ book — he’s following characters who saw this coming early and were trying to raise the alarms on it. Carter Mecher, a pandemic expert from the George W. Bush administration, who helped design the government’s pandemic playbook. And he saw really clearly, really early, and was trying to tell others what this was going to be. Charity Dean, a public health official in California, who was fighting her own bureaucracy, her own state, to get them to take this as seriously as the world-shaking event it would later prove to be. And there are villains in this book. And I would say one in particular. It’s the Centers for Disease Control and Prevention. And I don’t want there to be any doubt on my position on this or simply the reality of this. They screwed up in a profound way. First and foremost, by insisting on making their own test and then failing to make a useful test, costing us unbelievably crucial time and information right at the beginning of the pandemic. There is blood on their hands. And yet, for that, I am not sure that the kind of pandemic response Lewis is lionizing here was possible in America ever, because to do this, to have the kind of aggressive public health lock-downs he’s talking about, or his characters are talking about, it wouldn’t just be for this pandemic. We’d be locking down every few years, because every few years we see diseases that could become the next pandemic. And we never know which one it will be. So what would happen if regulators tried to lock us down each time? Would people listen to that? You look around at the way this country has fought shutting down, has fought school closures, fought masks, even when thousands of people were dying each day. You look at how many people won’t take a vaccine even now. And you ask, could we have really done what Lewis’ characters are saying we could have. What are the actual constraints of the public — the constraints the public imposes on public health. So the question then it’s not just what the right playbook would have said we should have done, but realistic, what could we do? And what’s the optimal strategy given what we’ve learned about people and politics in this pandemic? And then maybe what are the new strategies that have emerged now that people understand how bad a pandemic could be? So that’s what this conversation is about. I think it’s one of the most important policy questions we need to answer. As always, my email is ezrakleinshow@nytimes.com. Here’s Michael Lewis. [MUSIC PLAYING]
This is a book that is centered around the failures of the CDC and why they happened. But before we get into the why, tell me the what. What were the CDC’s key failures in your view?
- michael lewis
Key failure number one, not facing up to the severity of what was going on in Wuhan as early as you could have done it. I would say January 20, when my characters have a real bead on what the transmissibility and the lethality of it is. And they had connections within the CDC. They’re talking. They’re trying to get them to pay attention. The “head-in-the-sandness,” kind of, of it. Two, being proprietary about COVID testing so that they created in our government a single point of failure. So that when their test didn’t work, we had no test. And that’s not just the CDC. That’s the FDA, because the FDA was insisting that people use the CDC’s test. We have more microbiology labs than any other country on Earth. They could all have whipped up COVID tests and some of them did. We could have done it a completely different way. Not just that the tests failed, but instead of responding to the failure by saying, this isn’t working, we got to find a different way, clinging to the authority to create a test. That would be two. Three, in the midst of all this, not being able to stand up to Donald Trump and say, what you’re saying about this is false. You’d lose your job maybe. But there was a public information role that they failed repeatedly with. And they failed in both directions. It’s interesting. Saying that masks didn’t do anything, because they didn’t have masks. But also, remember early on there was an obsession with fomites. You can get this thing off of surfaces. And you were cleaning your newspaper before you got it off your front porch if you got —
- ezra klein
Yeah, people were Lysoling their groceries.
- michael lewis
All that. Think about the expense that the whole society has gone to because the CDC only like last week said, actually, that’s not that big a deal. They could have said that last May. So the guidance has been bizarre.
- ezra klein
You root a lot of these failures in a risk-averse culture at the CDC. So let’s ground this conversation in history there. Tell me about the 1976 flu outbreak and the fallout to the CDC’s response.
- michael lewis
Yeah, because that’s the moment where the CDC starts to change. Fort Dix, New Jersey, end of the flu season in ‘76. Some soldiers become ill. One dies. Scientists isolate a new strain of the swine flu. To the best of everybody’s knowledge, they’d never seen a new strain of a flu that was so transmissible and lethal that didn’t result eventually in a pandemic. And so instantly there’s a crisis. The CDC gathers all relevant experts to talk about what to do. It’s presided over by the — and career public servant, David Sencer, who’s the head of the CDC. And there’s a consensus that they should go as fast as possible to vaccinate the American population against this thing, because in the fall it’s coming kind of thing. Sencer, who’s presiding over the meeting, drafts a memo with just his name on it to the then Ford administration saying that this is what we think you should do. And the Ford administration feels, I think, backed into a corner. But also, this is what the experts are saying, so they go and do it. Flash forward to the fall and the vaccine is administered to — I don’t know, I can’t remember — but many millions of Americans. And first, some people get sick. The illness is actually unrelated to the vaccine. Random chance alone some people are going to get sick after they get the vaccine. But the vaccine is blamed on the evening news. Walter Cronkite actually apologizes for that report. And then after that, people actually get sick because of the vaccine. So some people die because of the vaccine. And the swine flu doesn’t come. So overnight, David Sencer goes from trusted leader of the Centers for Disease Control to scapegoat. And the Carter administration has arrived. And they fire him and then commission a book. It demonizes Sencer. And it actually ignores the whole process that led to the decision, which was actually a good process. It was decision-making with a lot of ambiguity and conditions of uncertainty. No one has ever seen a highly transmissible and lethal new strain of the virus not result in a pandemic. The American people had no immunity to it. Everybody basically agreed that’s what you should do is vaccinate them. And if you don’t vaccinate and it happens, you’re going to have a lot of death on your hands. It’s the first step in what then happens over the next six to seven years in the CDC of the politicization of the CDC. Flash forward a few years later and the Reagan administration is starting to insist the CDC do things that are alien to them. I mean, shut down research programs because it angers aspirin manufacturers. That kind of thing. And the Reagan administration decides to change the job of running the CDC. It’s no longer a career civil servant who is basically bubbled up with the approval of his peers. It’s going to be a presidential appointee. That’s a moment where the culture changed. And you can see why, because it goes from being a place that’s run by someone who might run for 10 or 15 years, and who is not beholden to any particular president or White House, and who’s been selected largely because his field finds him highly competent, to someone who’s selected from a smaller pool of possibly very competent people, but who happen to please politically who happens — whoever happens to be in the White House. And that director is going to serve for on average a couple of years. And so it’s like giving a house to a renter instead of a homeowner. They’re just going to behave differently. Their concerns are going to be different. The decision-making is going to be on a shorter political leash. So this is at the end of the book, not the beginning. But it was my attempt to figure out how this institution, the Centers for Disease Control, had acquired this illustrious reputation for controlling disease and why it was so different from that reputation.
- ezra klein
But I start with it, because it seems to me to frame the question of the book really well. Which is, how much do regulators and public authorities — public health authorities — have to worry about the public? And how much can they do things that the public may not want them to do? So I want to do one more historical story before we get into this pandemic, which is H1N1. Talk a bit about what almost happened during H1N1, which is a more modern precursor to coronavirus.
- michael lewis
Right. That’s 2009. That’s an actual pandemic.
- ezra klein
Actual pandemic.
- michael lewis
An incredible number of Americans were infected with that strain of swine flu. The problem early on — and again, in the beginning of a pandemic, it’s very hard to tell what’s going on, which seems strange. You would think, oh, it’s easy to tell what’s going on. But waves of death inside an ICU in Mexico, gruesome reports coming out of Argentina. It looks like it’s really lethal and you just don’t know. And in the Obama White House sat one of my main characters, Carter Mecher, who had been a holdover from the Bush White House and who had essentially created the U.S. pandemic response. The Bush administration had invented the idea of pandemic strategy. Crafted one in the form of a booklet inside the CDC. And then left it to the Obama administration. And he was just supposed to be there for six months. And then when he trained up his successors, he would leave. But he’s there and he happens to be a pandemic savant. But he knew that he didn’t know what was going on. But he thought in an abundance of caution, we need to treat this thing like it’s lethal. And the CDC actually disagreed. The CDC — its advice was don’t rush to vaccinate. We want to wait and see and gather more data. That’s kind of the thing.
- ezra klein
And he wants to close schools, right? He wants to do the whole thing.
- michael lewis
In the very beginning, yes, until they know what they’re dealing with. And the problem generally with waiting to have more data is that by that time you have data, it’s over. The war is over. When you’re looking at disease in the society, you’re looking at star light, as Carter would say, or you’re driving by looking in the rear-view mirror. A death today is an infection from five or six weeks ago with a virus that’s multiplying exponentially. And so if you’ve got one death, you’ve got thousands of cases, kind of thing. And so he was trying to explain to the Obama White House that, yeah, there’s no evidence here that it’s lethal yet, but we don’t know. So Obama decided, rightly as it turned out, not to listen to him. The CDC’s advice to wait until they had certainty ended up being the smart advice. However, one of my other main characters, Richard Hatchett, another doctor who was in the Bush White House, was brought back in to help Carter Mecher manage this thing. He kept a journal through that time. And Hatchett, in the course of the journal, you see him realizing that, yeah, they created this pandemic plan, but had the swine flu actually been lethal, it would have been catastrophic given the response. And he tells Obama, it’s not that we dodged a bullet, it’s that nature shot us with a BB gun and we got lucky. And to his credit, the Obama White House learns a lesson from this. And the lesson is actually you’re not going to manage a pandemic out of the CDC. You’re going to get a particular point of view out of the CDC that is going to be afraid to stick its neck out, insisting on certainty. Whereas, if you wait until you have certainty, it’s too late. And so the Obama administration actually from then on elects to manage pandemics out of the White House. They put a pandemic manager onto the National Security Council, who is directly talking to the president and coordinating the various federal agencies. It’s a position Trump ends up getting rid of. But they learn all over again what the Bush administration learned on its own, which was that the Centers for Disease Control is not really equipped to control disease. [MUSIC PLAYING]
- ezra klein
So I’m going to try to take the side of the CDC for some of this conversation, because this is a very critical of the CDC book. And I agree with a lot of the criticisms. I’ll be clear on this. But the weakness of them, I think, is that I am not sure an agency could do what these characters — your renegade epidemiologists — want to do. And that’s the part of this I want to push on. So we’ve watched during this pandemic that even when the virus is out there killing your friends and neighbors, there are people who will not mask. There are people who will not take a vaccine. There are people who will not socially distance. Kids will go to parties on colleges. The key argument made by a lot of your players — and it’s completely true. I mean, on the facts it is completely true. It is that when you do not know how bad this can be, that is the time to stop it. Lock things down.
- michael lewis
You could contain it.
- ezra klein
You can contain it. You can actually beat the virus. You don’t —
- michael lewis
Australia did this.
- ezra klein
Yeah, you don’t have to wait till the fire is raging out of control.
- michael lewis
Right.
- ezra klein
At the same time, a lot of these come up. I mean, H1N1 being another example. SARS was a possibility. We could have done a lot more here about Ebola and some people were arguing for that. A lot of things come up that you might implement the hard core pandemic playbook to stop and then they fizzle. And if you do that five or six times, the worry of the politicians, of the CDC is that you can’t take the public out of public health. And that there’s going to be a backlash. You’ll lose your seat. You’ll lose the government. The CDC will get neutered the way it was in the ‘80s under Reagan. And so they are not free to take this advice. And so this is my question for you, having talked to these people, do you think it would have been possible to do what they had wanted to do when they had wanted to do it? Do you think a different agency, a different presidential administration could have gotten Americans to go into that kind of lockdown before we knew how bad this was, when there was just a cruise ship docked, I think not that many miles from where we are now.
- michael lewis
You mean, would we have to be a different society in order to pull this off?
- ezra klein
Yes.
- michael lewis
How different are we from Australia? You would have to pull it off for a matter of a couple of months before everybody saw the wisdom of what you’ve done, because you’d be looking at other countries where there was raging disease.
- ezra klein
But that’s this time.
- michael lewis
Yeah.
- ezra klein
If you had done this three or four times —
- michael lewis
I thought we were talking about this time.
- ezra klein
But I’m talking about all of them, because you would have — in a world where we listen to these folks who would have done it for H1N1, we might have done it for Ebola.
- michael lewis
I think you’re imagining a response that even they’re not imagining. They’re not thinking shut down the society. Closing schools is a particular thing. One of the things that Carter Mecher and the inventors of pandemic response figure out is just how central schools are to disease transmission. So that’s a peculiar thing. And it’s not shutting schools for months. It’s shutting them for a couple of weeks. I could imagine a world where we build in as a society a kind of rapid response to a virus that is minimal. It’s like the least you have to do that doesn’t involve closing businesses, for example. That may involve some hesitation about mass gatherings in schools. So this is a matter of public education. I mean, I don’t think that you can be fatalistic about this. And I mean the leadership we had made it impossible. And it wasn’t just the leadership. Even if we had taken the action that these people would have liked to have taken, it has no purpose if you don’t have COVID testing. And we wouldn’t have had testing. But as a society, could we create a mechanism to respond more intelligently than we have in the past? Yes, totally. But you can’t just do it. You have to explain it. You have to say, look, this is going to happen again. It’s like a hurricane. Think about hurricane response. When I was growing up in New Orleans, nobody evacuated. And if you told people they would have to evacuate, they’d say, no, you could never pull that off. You’re not going to get everybody to leave New Orleans. Katrina happens. The meteorologists say it’s time to get in your car. People get in their car. So you can change the culture on these subjects. And when they’ve now had this experience, I think going forward it’s probably easier to change the culture.
- ezra klein
Yeah, that I think it’s possible now in the same way that I think you see remarkable responses in South Korea and Taiwan and some of the countries that dealt with SARS and MERS at different points. But let’s go back. Let’s imagine a better political equilibrium. So let’s say that in 2012 the election had gone differently and Mitt Romney was in his second term. A lot of your main characters are Bush holdovers. They come back. What should we have done? What would the plan have looked like? And when would it have gone into place?
- michael lewis
First, what they would have done is they would not have had this single point of failure at the CDC. So you would have had testing. You would have had it run out of the White House in a much more aggressive way. So let’s assume we have testing like everybody else. Very early on everybody coming into the country is tested for COVID. Everybody quarantines for 14 days. That’s the first thing. There would have been severe travel restrictions I think right up front. They would have closed schools.
- ezra klein
When would they have closed schools?
- michael lewis
January 20. There’s a constraint here that they may not have had if they— in a different world. They might have had better relations with the Chinese, so they would have had better data out of China. But even with the data that Carter Mecher is able to get off Chinese websites and from Chinese morgues, and the way he was trying to figure out what the transmissibility and the lethality of it was, he had a bead on the thing on January 20.
- ezra klein
Do you think people would have accepted the school closure in January of 2020?
- michael lewis
If you explain it badly, no. Do I think you could sell it with some pictures from Wuhan? Maybe. And if not January 20, February 20. I mean, but it’s event — maybe you need the pictures from Italy. I don’t know what you need. But you’re not necessarily closing the schools for good. You’re closing the schools to see where the virus is. And you wouldn’t have been in the position Carter Mecher was in trying to find all kinds of bizarre ways to find the virus, like testing people who have flu-like symptoms everywhere in America when they wander into clinics for COVID. So when you ask me those hypotheticals — would people have accepted — I always think what people accept depends on how they are led. Do I think that a leader could have led them there? Yeah, I think it’s possible. You lay out what you think might be happening. You scare the hell out of everybody. We’re not doing this permanently. We’re doing this until we know what this thing is. And then what we hope to do is contain it so we can have our economy back. So you’re asking me would we have taken a shot at containment? Could you have led people to have a shot at containment? I think it’s possible.
- ezra klein
I’m pushing on this because I think it’s the core question. What I like so much about the book is you’re having the right debate in it. I think so far debates in this country about pandemic response are what happens once the fire is out of control, which I think you’ve got a great — I think it’s Carter who says, you can stop a grease fire with a fire extinguisher. You can’t stop a house on fire with a fire extinguisher. But the difficulty with starting when it’s a grease fire is you got to move people to a place, which maybe you can do in the future because we’ve lived through this unbelievable catastrophe as a collective. But I think it would have been very hard then. And you’re mentioning Australia, which I do think has certain unusual qualities as being as separated and an island as it is. But Europe, for the most part, didn’t. Europe doesn’t have the particular CDC history we do or they didn’t have Trump. And some of them did better for a while. Germany did better than we did for quite some time. But a lot of them didn’t. South Korea is the most interesting to me, because it did take off there and then they stamped it back out. And they’ve had I think something like 2,000 deaths in a society of tens of millions of people.
- michael lewis
But we aren’t just like Europe. The Lancet did the math that back when there were — I don’t know — 480,000 American deaths. The Lancet calculated that if we’d done only as well as the average of the G7 countries, there’d be 170,000 Americans still alive. So there is the second question about how will you handle the house on fire.
- ezra klein
Yes, absolutely.
- michael lewis
And we didn’t handle that well. But it’s a fair point to say that maybe it was not culturally possible to sell containment. It would have been hard to do. The fact we didn’t even try is damning. We didn’t even try. The CDC doesn’t pivot and go from saying this poses little risk to American life to it’s now here and we can’t do much about it.
- ezra klein
Yeah, can you talk about that pivot from downplaying to fatalism? That’s a really interesting thing you pinpoint in the book.
- michael lewis
It’s February whatever — 23rd, 24th — when Nancy Messonnier at the CDC gets up and says that we’ve had domestic transmission and basically we don’t know where it is. It’s here and it’s moving. That’s the day the stock market collapsed and Trump called for her head and all that. What was interesting to me about it was that from the lay point of view, it looked very brave for the CDC to get up and do this. From the point of view of Charity Dean, public health officer, or Carter Mecher, who’s pandemic strategist — people who are really in on it — it was unbelievably cowardly to wait till then, because you could have done that on January the 20th. The CDC played the part of lulling the American people to sleep for a stretch. The public health authority, in order to do their job, they need cover from politicians. But they also provide cover for politicians. They are the experts. And they do what David Sencer did. We think this is dangerous. We think we’ve got to take precautions. We’ve got to do various things. And it enables the politicians to take action. And instead they do the opposite. They gave cover for complacency.
- ezra klein
So there’s an interesting discontinuity in this book, which is — so I read and I loved your book, “The Fifth Risk,” which is about the government as a manager of risk for society, and how Trump and the Trump administration were coming in and basically taking a wrecking ball to that.
- michael lewis
Yep.
- ezra klein
And one might imagine opening this book, that it’s like “The Fifth Risk,” part two. It all came true. Exactly what we thought would happen happened. And you note that when the CDC does eventually come up, even as late as they do, Trump basically sidelines them. That’s been, I think, the dominant story of CDC and Trump up until now. But Trump for a long time, as the head of government, is fighting the parts of the government that are going to come out and say, this is a big deal. He is trying to get people to downplay this, because he doesn’t want the testing. So one might imagine, having read “The Fifth Risk,” this book is going to be about, see, everybody, I was right. [LAUGHS] Michael Lewis was right. But you actually say Trump, obviously not a help, but not the core issue. That this might have been different, but it wouldn’t have been fixed by not having him. Tell me why.
- michael lewis
I go where my characters take me. They took me on that journey. I would have loved to have been able to just write this as the sequel to “The Fifth Risk.” It was just messier than that. And even in “The Fifth Risk,” it was clear that, yeah, Trump is taking a wrecking ball to this machine that we have to deal with existential risks. But it’s like the one tool we have to deal with lots of problems. But that tool, that machine has been allowed to rust for generations. So it was easier to destroy than it should have been. And one form of the rust is like what happened inside the CDC. When I have a character who’s a local public health officer in Santa Barbara County — Charity Dean — this is the main character in the book who is fighting very bravely crazy outbreaks of disease in her county. It’s not COVID. It’s tuberculosis, or it’s HIV, or hep C, or measles in schools. And has little microcosms of the same experience we’ve seen writ large with COVID. Controversies, upsetting people to save lives. And she has — when she takes this job — this sense that there is this federal enterprise that’s there to help her called the Centers for Disease Control. She’s supposed to lean on them for academic help, but also to have her back in cases. And she realizes that they don’t have her back. That, in fact, just the opposite. Any kind of controversy that she causes, they run away from. It’s a premonition of what’s coming. If you had asked Charity Dean in 2015, before Trump is in the air, what’s going to happen if there’s a pandemic, she’d have told you there’s nobody to run it. The supposed institution on top is actually not engaging with the problems in a serious way and the system isn’t a system. It’s just 3,000 of me around the country unconnected, on our own, with no one coming to save us. So it’s a little hard to blame Trump for it all when you have someone telling you that. That it wasn’t working before. Now, there’s no question that Trump made it worse. I mean, there’s a body count you can just blame him for. But would we have gotten out in front of it with someone else? I think probably not. Probably not.
- ezra klein
So “Fifth Risk,” the implicit view of folks in government is that they’re really competent and doing a great job. It’s a very pro-government book. This book I would say actually frames the opposite. Has your view of government changed in doing the two books?
- michael lewis
Not too much. Both stories, if you back away far enough, are about good people and bad systems. There’s no malice in what’s coming out of the CDC. It’s screwed up incentives and the incentives were imposed on them. It’s changing an institution from having a really organic felt relationship with disease on the ground in America and a healthy appetite for taking risks to fight it into a kind of academic institution that is rewarded for writing papers. And we punish them horribly when they make mistakes. So my attitude has not changed at all. It’s true I shifted the light. I had the spotlight — in the first book was on these people who in spite of the systems they are in are doing these extraordinary things. In this case, we had gross system failure. And it wasn’t just at the federal level. I mean, the states are in a funky position, because the states would have assumed that this was going to be managed like a war on a federal level. They weren’t expecting to be told that the Russians are invading, figure out how to defend California. So it’s a little more forgivable at the state level. But it’s hard to write a story of government competence when you have this, which is a failure of systems. But the other thing the books have in common is that the heroes of this book are still government employees. [LAUGHS] They’re just people in a screwed up system trying to make it work and realizing eventually that it won’t, but behaving pretty heroically and doing their best in spite of it. What those guys did in the Bush administration, especially Carter Mecher and Richard Hatchett, two doctors who had hands on patients for much of their careers, in thinking about what we should do in the event of a new pathogen sweeping across our society, I mean that is a story of government triumph. It is the government working. So it’s not all dark. But you’re right, it is different. And it is not — if you’d asked me the last time we spoke what the next book after “The Fifth Risk” was going to look like, I would not have guessed it would look like this.
- ezra klein
So the tone of the book is your characters banging their head on the wall of these failures, trying to get the CDC to move. I’m sure you talked to some people at the CDC who were on the other side of this. What was the most persuasive argument they gave you of why they acted the way they did?
- michael lewis
All my interviews with people at the CDC are guerrilla interviews. And the people I interviewed felt ashamed. I did not get arguments back. What I did hear is don’t be too hard on us, because there are great people here and we’re not all like that. That was the defense. It was people feeling alienated from their own institution. It wasn’t, oh, yes, it was smart to have a test that didn’t work. It was smart to be proprietary about the test. Here’s another failure — and kind of incredible failure — we repatriate Americans from Wuhan. They are in National Guard barracks being quarantined outside of Omaha. There is a facility in Omaha that is a medical facility that was designed just for this, to send people with mysterious or scary illnesses, to treat them and also understand the illness. The guy who runs that facility, James Lawler, calls the CDC and says, we got to test these people who just came back from Wuhan. And it goes all the way up to Redfield. And Redfield says, you’re not allowed to test them, because to test them would be performing experiments on captive people — medical experiments on captive people. All the people in the barracks want to be tested. So they never get tested and they get released into the wild. How do you excuse that? I mean, you can explain it. That they don’t have a test. They’re embarrassed their test might not work. Whatever it is. But the behavior is just quixotic. [MUSIC PLAYING]
- ezra klein
My version of some of this reporting — I’ve done a lot more reporting on the FDA through this period —
- michael lewis
Oh.
- ezra klein
— which I think has often been very far behind on some important things. But the answer I always get from the FDA on why it took so long to, say, clear rapid, cheap, repeatable at-home testing, or why do we still not have clearance on AstraZeneca despite the fact that it’s been used all over Europe and it certainly seems to be working out reasonably well is that they are so afraid of a mistake that they make — a sin of commission, as you like to put it, rather than omission. And what will happen then if the entire structure of public confidence in the regulatory decisions collapses, that they are working with a risk profile that seems completely different than the one I look at from the outside or that some of the people I talk to look at from the outside. And it infuriates some of the public health officials, and the health economists, and epidemiologists I know. But that their general view is that it’s all well and good to lob stones at us from the sidelines. But if we get it wrong, we can never get it right again. And I don’t really buy that, but it is how they see it.
- michael lewis
No, that’s true. No, no, no, it’s absolutely true. The characters in the book make the argument that they have come to regard sins of commission as completely different from sins of omission. But when you’re dealing with a pandemic virus, a sin of omission is a kind of commission. That if you’re not looking for the virus, you don’t stop the virus. People die. So they ended up getting what they most feared. Inaction led to disgrace. And your attitude towards the fear — and maybe mine a little bit — is kind of forgiving. It’s like they’re that way because we’ve made them that way, because we punish them mercilessly when they commit a sin of commission. Charity’s attitude was this is life and death and I find it unforgivable.
- ezra klein
And something threaded through there — and this takes us back to Redfield, the CDC director, saying, well, you can’t give people these tests, because that’s conducting an experiment on them— is there is in a lot of these decisions that weren’t made and then a lot of things we never even considered doing in this country but were effective in other countries, a very American fear of public health authority and public health action. If you look at, say, what South Korea did or what some of the countries that did test, trace, isolate really well did — you talked about one of the original sins here being that the CDC created a point of failure and then failed on testing — completely true. But we also didn’t know what the hell to do with testing. And even in places that did then get it up and running, we didn’t do enough tracing. And then when we did do tracing, we never had what a lot of, particularly, the Asian countries had, which was an isolated quarantine program. And in some of these countries, if you were found to have COVID, you were put into a centralized quarantine location. And if you left or you broke out, you went to jail.
- michael lewis
Yeah.
- ezra klein
And one of the things here was that you really did need to really aggressively enforce it. Not say everybody needs to wear masks, but we’re not going to actually do anything to enforce it. Not say nobody should go out, but if you do, we’re not going to enforce it. And so there really was a tension here that, I would say led to us, as my friend, Matt Yglesias, put it in a piece recently, we ended up a lot less free because of how long we had to be under restrictions.
- michael lewis
Yeah.
- ezra klein
But part of why we ended up so unfree is we were much more uncomfortable than other cultures were with aggressive imposition of public health authority. And that seems like a cultural thing we need to discuss and think about how we want to do next time. Because even if we got testing right, well, what do you do when somebody has a positive test? And even Charity, interestingly to me, is a little wishy-washy on this at a key point. She comes up with this plan and she says, well, it’s all going to be voluntary. And individual counties are going to individually regulate. And what we’re going to do is genomic testing. And even she doesn’t really want in her plan that she comes up with — the Churchill plan — to have the government telling you what to do. And this is tough in a pandemic.
- michael lewis
I think that’s her attempt to acknowledge the political realities and the cultural realities, which she thought was the only way a plan works is if it’s executed at an extremely local level and you have buy-in. People have to buy in. And neighbors have to enforce it upon neighbors kind of thing. That that’s how it was going to work. And that when you saw that your pizza restaurant had to shut down because the neighbor’s boy went to a party or whatever, that social pressure would be created. That’s what she was trying to do. She was just trying to create social pressure. And that the only way you do that is at a very local level. And that did happen in this country.
- ezra klein
Ish.
- michael lewis
Oh, my god. Are you telling me that Berkeley, California didn’t have social pressure to comply?
- ezra klein
Berkeley, California did. But Orange County —
- michael lewis
No.
- ezra klein
— went in the opposite direction —
- michael lewis
Opposite direction.
- ezra klein
— in key places.
- michael lewis
That’s right. But the key part of the plan was you are living with these rules. That if you have this amount of transmission, you’re going to have those kind of closures. That didn’t get done. I mean, so you had to have people seeing that there was a price to be paid for noncompliance at the local level and see that they had the knobs they could turn to control what prices they pay. Whether you could have gotten Orange County to behave like Berkeley, California — probably not. But you might have nudged the country closer to better execution.
- ezra klein
But this is what makes me very pessimistic about containment in the future. At a certain point, this was going on and people were seeing what other places looked like. And partially because the disease is so erratic in the way it spreads, some people, as you talk about —
- michael lewis
This particular one.
- ezra klein
This particular one. Some people give it to 50 people. Some people give it to nobody. You have a lot of luck in what ends up —
- michael lewis
Totally right.
- ezra klein
— catching on fire. In Florida, right now, Governor Ron DeSantis has a totally average performance and is bragging about how he got that average performance by not doing that much in terms of locking down. And so if you want to get the fire not to rage — one of the things that is scary to me about the experience is you look over at the places that did it and they went in on a level of quarantine and isolation and public authority that it feels to me we are nowhere near having learned that lesson.
- michael lewis
Well, we don’t have — and we don’t have the resources at the public health level even to do it. There was also just a fatalism right from the beginning where we didn’t even think what is the smartest way to do it, let’s do it. I mean, I thought what the Japanese did was really interesting with the tracing. That once you know the role of super spreaders, once you know that it isn’t everybody gives it to two other people, but 90% of people don’t give it to anybody who have it and 10% of the people give it to everybody, the game is find the super spreaders and shut them down as quickly as you can. And when you find someone who has COVID, you don’t contract trace forward, you contact trace backward to find out who they got it from and shut that person down. So we were arrogant. We were really slow to look at around the world and say what worked and what can we use, because we basically didn’t think we had the nerve to do it. At the same time, my characters thought we could do it. If you had found Charity Dean at the California Health Department in January or February, she would have said that this is still possible in California if Gavin Newsom is willing to get up and take some risk. And she would say now if Gavin Newsom had taken that risk, he would be better off than he is now. That the performance of California would have been so much better than everybody else, he would have gotten credit for that. The problem with Gavin Newsom was he was half brave instead of being full brave.
- ezra klein
But this is where I kind of do want to keep pushing, because Gavin Newsom — say what you will about him and had his mistakes during this period — California goes into lockdown earlier than anyone else. But at some point, it’s important to recognize that the politician — and take seriously as an issue in response — that the politicians know the politics better than Charity Dean does. Because even when Charity Dean, as we just talked about, begins to come up with her plan, she actually shies away from going full brave and saying we’re just going to quarantine people and have the police enforce it, which is what they do in some of the other countries. And so this is where I actually think the politics are more of a constraint than is sometimes admitted by the characters in the book. In some ways what Gavin Newsom is suffering for now is that people are so angry about the amount of lockdown he did impose, even to get the performance California did. And so to me the great question of the book is, can we keep the fire from consuming the house? Can you actually do containment and suppression, which we did not do. We can make it better on the margins 100 different ways. But could we have not had this happen? Could we have had 50,000, 10,000 people die?
- michael lewis
Or could you have had a state that stood out early on —
- ezra klein
Could you have had a state —
- michael lewis
— early on with a peculiar response that led the country, because the response was clearly so effective.
- ezra klein
But I think the problem is it’s so hard to not have the states intermingling, to say nothing of the counties. The idea that Santa Ana is going to be bad and Newport Beach is — that’s really, really tough, because people have family, they work. I think this is something that I’ve heard from a lot of public health officials that the killer for them, particularly when it would come up to holidays, is you can’t lock people down from the fact that they have friends, family, and employment in different places. And I, the public health official, can’t control that other place. And so it just destroys the entire firewall I built.
- michael lewis
We have tools to build really effective firewalls and we just didn’t use them. Genomic epidemiology, which enables you to trace how the virus moved, is perfectly suited to show you where the hole in the wall is.
- ezra klein
Can you explain that? I think people know about genomic testing as, well, you can see if there’s a new strain. But you’re talking about a whole different play here.
- michael lewis
Yes. And, in fact, California was particularly suited to use it as a tool. And it’s nuts right now that we aren’t doing more of this genomic analysis, because you do want to know when there’s a new strain or when some strain that you know is more transmissible has suddenly arrived in your community. And we don’t know, because we’re not doing the testing in anywhere near the extent we should. But the COVID virus basically mutates once every one or two transmissions. And at least fingerprints. And so if we’re in the studio without masks, and you happen to have COVID and you infect me and our engineer. And we then go out in the wild. And a week later, oh my god, I’ve got COVID, where did I get it? And they’re sequencing your virus and my virus, they will see that my virus is identical to your virus and you gave it to me. You have an older virus. There’s a very good chance that you gave it to me. So you can actually — in a perfect world, if you could sequence genomically all the virus in America, you could create a map of how it moved.
- ezra klein
I want you to clarify one piece of this. So let’s say you’re testing within a business. And it turns out that of your 30 employees, two people have COVID.
- michael lewis
Yep.
- ezra klein
And so what you’re saying is that there’s a real big difference what it implies for the organization. If they have the same variant of COVID — so if it’s external transmission, but people are coming in, well, that’s bad.
- michael lewis
It’s bad —
- ezra klein
But your practices are fine.
- michael lewis
Your practices are fine. And if it’s people that are coming in, what do we do to test them before they come in so that they can’t — they don’t come in from the outside with it. But yes, there’s a difference there. And the genomic information enables you to see the difference.
- ezra klein
This is a whole other thread of the book where I would say Chan Zuckerberg, and particularly, Priscilla Chan, come out really, really well. They spin up this bio hub under Joe DeRisi. They are trying to offer free test analysis, free genomic testing. They got all these volunteers to do it. And it’s really, really depressing what happens next. They are coming to everybody with a gift.
- michael lewis
Yeah.
- ezra klein
A gift. The most advanced bio testing probably anywhere in the world. And they can’t get people to take the gift. Tell me about why that happens. [LAUGHS]
- michael lewis
Because they’re walking into a health care industrial complex that has all these weird incentives in it. So in the first place, you would think the CDC’s test doesn’t work. They create their own test, plus they’ll do the genomic sequencing. And they’ll do it all for free and help you understand the results. It’s all free. You would think there’s nothing better than free. But when they try to engage public health officers with their new service, the public health officer will say, well, this is great, but how am I going to receive the results? Nothing’s digital here. You’re going to have to fax me the results. So there are those constraints. But then Joe DeRisi figures out very quickly that the prisons are going to be high-risk environments, and San Quentin in particular. It’s an old prison, poor ventilation. They’re all jammed in there together. He said — and he went to the prison officials and said, if you have an outbreak there, you’re going to have a lot of death. And he said, let us do your testing. And they were kind of hemmed and hawed and they let him do a round or two of testing. And then they said, we can’t do it anymore. And he said, why? And he said, we have these existing relationships with testing corporations. And we have contracts with them and we’re worried we’ll be in violation of the contract. That we have to pay $100 a test or more to those companies to do our testing, but we’re stuck in that relationship. And they were unwilling to break the relationship. So in the broader picture, Priscilla Chan put it very well. It was like the public health system didn’t know how to receive a gift. And I thought, you know, it reminded me of something. It reminded me of the stories I had written about poverty. And one aspect of poverty, one symptom is you don’t have enough. You simply don’t have things. But another side effect of poverty is you don’t even know how to receive things. You’ve received so little help in your life that when help comes, you don’t know what to do with it. And that was what Joe DeRisi walked into. And it was for him — here he is this MacArthur fellow prize-winning genius of a scientific researcher and creator of all these tools for hunting viruses. He’d never had any interaction with the public health system. I mean, it was like — for him it was like a black box. He just assumed, like me, it was out there and it did stuff. When he actually sees it, he can’t believe how impoverished it is. He thought when they created the bio hub to eliminate disease by the end of the 21st century, he thought he was building tools for poor countries to use, like Cambodia. And that his job was to create, essentially, public health tools for those countries, because they couldn’t afford to do it themselves. What he finds is we’re that country. And he’s as innocent of it all when he walks in as I would have been.
- ezra klein
This to me has been one of the — it’s a depressing part of the book. But it’s one of the depressing threads of the entire pandemic. Take San Francisco. So San Francisco throughout the pandemic actually has, among cities in America, one of the best responses. It is in the coalition of counties that is the first to go into lockdown in the nation. It always keeps its death rate pretty low. We never have the kind of outbreak you see, even in Los Angeles, which isn’t that far from here.
- michael lewis
If the whole country had performed as well as San Francisco, the United States would be regarded as having done this well.
- ezra klein
Exactly. And there’s probably some luck in that, but there really was a lot of brave decision-making and a lot of cultural willingness to stick to it. At the same time, San Francisco, it has so much money, so much technology. Chan Zuckerberg and the bio hub are here. And the thing that I kind of always thought was going to happen at some point — it never did — was that there would be some kind of technological leap in the response. But even now if you go on to the city web page that tracks the disease levels and the vaccinations, it can hardly display on a mobile phone. And if you don’t want to do the kind of high level of public health authority that we were talking about earlier, one of the ways you can get around that eventually is to begin implementing these new technologies really fast, like genomic surveillance. But we didn’t do that either. You might say America, with its individualism, is not going to do what Taiwan is going to do or what South Korea are going to do.
- michael lewis
But maybe we have a different way to —
- ezra klein
But maybe we have a different way. And not only didn’t we have a different way, but nowhere in America had a different way. There wasn’t one city, wasn’t one state that was able to build that kind of technological contact tracing. I mean, early on, you remember, there was announcements from Google and Apple that they had come up with a Bluetooth protocol which could allow for health and contact tracing. And there were issues with all this. It was all going to be hard. But somebody could have really tried it. And they did in other countries. Taiwan did this amazingly well. Taiwan had a tremendous digital surveillance structure which really worked. I wonder if we’ve learned anything there or I wonder if this actually speaks to the difficulty of even using technology to solve these problems, because you might just think one thing we figured out was, well, we had all this stuff, we should have used it, and next time we will. But I’m worried next time we still won’t, because we didn’t even get close to using it this time.
- michael lewis
The question to me is, was the trauma sufficient to elicit a response? If this had been two or three times more lethal or if it had killed kids, I would say no question and we probably would have gotten a different response. It’s been a very peculiar pandemic, because it’s given enough people a feeling of they’re not affected. At the same time, it’s caused enormous tragedy. People can tell themselves a story, oh, this isn’t about me. It didn’t actually implicate everybody in the same way. And so the question I’ve been asking is, was the trauma sufficient to elicit a response? I think so, but who knows. It is true would you say that we could have bought our way — we kind of have bought our way out of some of the tragedy with the vaccine.
- ezra klein
With the vaccines. Yes.
- michael lewis
Right? That’s our triumph. But we could have bought our way out of more by using the technologies we have. The problem was, again, we didn’t have a system to distribute the technologies. The health care system is not a system. It’s 3,000 unconnected nodes led by an organization that has lost the capacity to lead, or maybe it will regain it — but the Centers for Disease Control. So you didn’t have a mechanism for distributing the technology publicly. But it’s there. And its power is being demonstrated in little ways to leaders and decision-makers. I just wouldn’t be surprised if we figure it out, if we bounce in the right direction. But this is just an emotional predisposition on my part.
- ezra klein
Well, let me share your optimism for a minute, but extend my own pessimism. So I kind of do think this trauma will matter. And I think it will be not enough, but enough that next time you have your Charity Deans, and your Carter Mechers, and so on, raising the alarm. People are going to listen on a pandemic. If you come on this particular disaster twice, people are going to say, OK, I’ll hear you out. In the same way that during this period, the financial system began straining and the Federal Reserve just said, nope, we are just going to give it whatever money. We are not going to have a financial crisis again.
- michael lewis
We’re not going to do that again.
- ezra klein
We’re just not doing that.
- michael lewis
Right.
- ezra klein
But it’ll come in a different form. It’ll be a different problem. And you’ve got a series of books now — “The Big Short,” T“he Fifth Risk,” now this one — that are about the ways bureaucracies and systems have trouble hearing the people who are raising the alarm. And I think the right question then is how do systems get better at listening to the kind of people you’re talking about? People who might have been wrong a number of times before, might have seen something coming that didn’t come a number of times before. And so the system has learned to stop listening. It doesn’t want to hear it. And at times it’s been backed up and not hearing it and so it doesn’t. But at some point, we got to get — we’ve been living through an era of just crisis after crisis. At some point we have to become better at listening to people who warn about crises. What have you learned on that?
- michael lewis
Can I be God for a minute?
- ezra klein
Please.
- michael lewis
All right. I’ll be God for a minute and institute reforms that sound kind of technical, but I think would have massive consequences. The first thing I would do is wave a wand over the federal government and get rid of about 3,800 presidential appointed jobs and make them career jobs and create a culture where the person who’s running the FDA or the CDC is going to be there for 10 to 15 years. He’s going to be living in the house, rather than renting it. That will instantly shift his or her concerns to the longer term. And that will lead to lots of helpful changes, like a focus on bringing lots of young talent in, because I’m going to be living with these people for a long time. Refreshing government institutions by changing the incentive structure of the people who lead them and acknowledging just how critically important leadership management is, is like number one. Because when I look at this pandemic, it’s a management problem. It’s not a resource problem. In 2019, a whole bunch of experts got together to figure out who was best equipped to deal with a pandemic. And of all countries, the United States was ranked number one. We have plenty of talent. We have plenty of resources. We were just coached to a losing season. So you change the coaching. So that’s number one. The two is with this you’ve got to create prestige and status where it doesn’t exist now. One of the points of the structure of my book where I took a unknown local public health officer and made her the main character of the book was to flip the status structure that exists now. Public health is just one example, I know. But we made a huge mistake in not understanding the importance of actual battlefield experience and local experience. We misidentified who’s important here and who knows here. So the second thing I’d do is create ways to reward the people who are doing the work well — little people. So that’s number two. Number three, I reintroduce civics into the American curriculum. So every kid needs to know — you can’t get out of the eighth grade without knowing what the Department of Energy does and things like that. We start to educate again the population about what the public sector is. There’s such a branding problem right now. There’s such a screwed up notion about what it’s for and what it’s not for. And four, I’d probably create a national service program where everybody is required to spent a couple of years — it doesn’t have to be in the military, but it has to be in public service — when they come out of college or when they come out of high school. So they’re all mixed up together and they all get to experience the institutions. They’ll have some experience. Maybe they spent their two years working in the National Forrest Service or whatever it is. So people are actually physically, viscerally connected to the public sector.
- ezra klein
I want to ask you about number one on your list of what you’d do if you were a federal government God, which was taking the government out of the hands of appointees and into the hands of the civil service.
- michael lewis
I know what you’re going to say, but go ahead, say it.
- ezra klein
All right. Well, I mean, you’re God, so you would know what I’m about to say.
- michael lewis
And because I’m God, I don’t have to listen to you either. But go ahead.
- ezra klein
Well, I know a lot of people who work in these organizations. And a lot of them also get frustrated that it is so hard to both hire and fire talent.
- michael lewis
Yes.
- ezra klein
That the civil service is — it both has extraordinary people in it, but many of them are frustrated by the other civil servants. And it’s not to say all civil servants are bad or they’re worse than the private sector. That’s not the argument I’m making here. But there are times when the civil service and the bureaucracy needs to move a lot faster. I think if the FDA were more protected from political pressure right now, it would be moving slower, not faster, for instance. That is the sense that I have from my reporting. Their internal culture would be so against sins of commission that if the Biden administration incoming couldn’t actually pull on them, we might not even be moving as fast as we are. And so I wonder how you think about that, because I hear both things. There’s a real problem with political appointees. And at the same time, there’s a problem with the civil service where it is too hard to manage it aggressively —
- michael lewis
If you were —
- ezra klein
— when you needed to change directions.
- michael lewis
We’re talking about the same thing. We’re just talking about it in different ways. If all of a sudden I said, you, Ezra, you’re head of the FDA not for 18 months, but for the next 15 years, one of the first things you would do is figure out how to hire and fire people faster. If all of a sudden you have to live with this institution for a long — and run it for a longer period of time, you would start pressuring the powers that be to change the rules about the hiring and firing of federal employees. An interesting case study is the GAO, the General Accounting Office. It’s an odd bureaucracy in that the head of it is a political appointee, but I think the appointment is for 15 years, instead of the normal — like you’re there 18 months. The Partnership for Public Service, this nonprofit that spends its time evaluating the government and what’s going on, consistently gets the highest employee morale out of that place. Highest sense of purpose. The right answer to the question, do you feel your work is meaningful? You can attack problems, all that kind of stuff. And they think it tracks to that longer term view of the management. Once you’re not in a rental anymore, once you got to own the house, you start thinking about how you make this house work. So yeah, right now the people in the place are immovable forces, but that’s one of the things you would have to address. I’m not taking the job for 15 years if I can’t get rid of the bad people and bring in new good people.
- ezra klein
I think that’s a good place to end.
- michael lewis
All right.
- ezra klein
So let me always ask the final question here. What are three books you would recommend to the audience?
- michael lewis
So I’m going to just pick three books I’ve read recently that have meant something to me. The first one I’m not quite finished, but it’s unbelievable. Kazuo Ishiguro’s “Klara and the Sun.”
- ezra klein
Ooh, I finished it recently. And I won’t ruin anything. But it won’t shock you to know it has an emotional ending. [LAUGHS]
- michael lewis
Well, he has — he’s so generous as a writer. And it’s not fancypants. I mean it is fancypants. But at the level of simple prose, it’s a beautiful work of art. And it’s kind of “unputdownable.” I fell in love with Norman Maclean’s “Young Men and Fire,” which I read for “The Premonition.” And I fell in love with it because it was an unfinished work and you could see — Norman Maclean, the author, did not write his first book until he was 70 years old. He was a professor of English, a Shakespeare scholar at University of Chicago. And he wrote “A River Runs Through It.” And “A River Runs Through It” is his finished work. And it is a beautiful work of art. But with “Young Men and Fire,” you get to see that same mind, that same talent at age 78, or whatever he was when he started it, kind of noodling on how to do this. And I found that just absolutely riveting. So I recommend that. And number three, Casey Cep’s “Furious Hours.” Casey Cep is like a young master at work. And it’s the story of the book that Harper Lee tried to write after “To Kill a Mockingbird,” which was going to be a true crime book, a narrative nonfiction. And she essentially goes and writes the book for Harper Lee. At the same time, she explains why Harper Lee doesn’t write the book. It’s a breathtaking piece of work. So those would be my three.
- ezra klein
Michael Lewis, your new book is “The Premonition.” It is always such a pleasure to talk to you.
- michael lewis
Pleasure talking to you. [MUSIC PLAYING]
“The Ezra Klein Show” is a production of New York Times Opinion. It is produced by Roge Karma and Jeff Geld, fact-checked by Michelle Harris, original music by Isaac Jones and mixing by Jeff Geld. [MUSIC PLAYING]
Michael Lewis’s new book, “The Premonition,” is about one of the most important questions of this moment: Why, despite having the most money, the brightest minds and the some of the most robust public health infrastructure in the world, did the United States fail so miserably at handling the Covid-19 pandemic? And what could we have done differently?
The villain of Lewis’s story is not Donald Trump; it’s the Centers for Disease Control and Prevention. The argument laced through the book is that the C.D.C. was too passive, too unwilling to act on uncertain information, too afraid of making mistakes, too interested in its public image. What we needed was earlier shutdowns, frank public messaging, a more decentralized testing regime, a public health bureaucracy more willing to stand up to the president.
Lewis is asking the right question, and I agree with much of his critique. But I’m skeptical of whether the kind of pandemic response he lionizes in the book was ever possible for America. Put another way: How much of a constraint is the public on public health?
Lewis and I discuss the trade-offs in pandemic prevention, why bureaucracies have such a difficult time managing catastrophic risk, the messy politics of pandemics, the lessons of the masking debate, and ultimately, what the United States needs to learn from this crisis to prepare for the next one. I’m not sure Lewis and I came to agreement, but I’m still thinking about the conversation weeks later.
(You can listen to the conversation on Apple Podcasts, Spotify, Pocket Casts, Google Podcasts, Stitcher or wherever you get your podcasts. A full transcript of the episode can be found here.)
“The Ezra Klein Show” is produced by Rogé Karma, Jeff Geld and Annie Galvin; fact-checking by Michelle Harris; original music by Isaac Jones; mixing by Jeff Geld; audience strategy by Kristin Lin.
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