Of course Michael Lewis is a great storyteller. Some points I found most striking:

- Some of the basic practices of the pandemic response, like having multiple layers of interventions (the "Swiss cheese" approach) rather than a single magic bullet, were only worked out in the mid-2000s. Until that point the conventional wisdom from the 1918 pandemic, based on the experience of Philadelphia, was that public health restrictions didn't really work. Some of the people Lewis talked to figured out that this was incorrect, that Philadelphia was hit hard despite severe restrictions because it had acted too late.

- The CDC comes across as paralyzed by caution in the crisis, perhaps because top management is now politically appointed. In Lewis's portrayal, the CDC went from "there's no reason for concern" to "there's no way to stop the pandemic" overnight. Local public health officials had to take action themselves with no cover from the CDC.

- In a crisis, there's a lot of uncertainty, and waiting until you have more information can be fatal.

An illustrative anecdote, from a doctor who later spent a lot of time working on preventing medical errors:

... [Carter Mecher] couldn't help but notice that very few medical students shared his enthusiasm for human beings on the brink of death. They felt the pressure; the pressure led to mistakes. Carter wound up hearing about a lot of these mistakes, but the first one he witnessed impressed him so deeply that he never forgot it. He was in Los Angeles, finishing his residency inside a county hospital ICU. They wheeled in an older woman suffering from both lupus and pneumonia, and rapidly losing her ability to breathe. Carter intubated her and put her on a ventilator. At the end of his shift, he left thinking she had a fair chance of survival. "I came back the next day," he said, "and the bed's empty." He found the doctor who had followed him on duty. The guy was in shock. The woman had died after her lung had collapsed, he said.

Right away, Carter knew what had happened. Every so often, the pressurized air pumped in by the ventilator escaped the lungs and entered the cavity that held the lungs. The air had nowhere to go, and the cavity expanded like a balloon, squeezing the lungs down. The pressure in the chest can grow so intense that it cuts off the flow of blood to the heart.

He also knew what the doctor should have done. Puncture the cavity in which the lung resided, to release the air. You needed to feel for the top rib and then push in a needle hard just above it, through the chest wall. "Didn't you stick a needle in her chest?" Carter asked, then regretted having asked it. The guy was a mess. He knew he'd choked. He'd asked for an X-ray so he could see what was happening inside the woman's chest. By the time he had the picture, and the comfort of certainty, she was dead.

posted by russilwvong at 5:41 PM on June 1, 2021 [5 favorites]

I finished this book last week, am a long-time Michael Lewis fan. It's an excellent sideways look at a) how truly well prepared the US (and much of the developed world) was on paper for a pandemic and b) how dramatically they f*cked up the response thanks to bureaucracy, inability to think rationally, misinformation, miscommunication, and lack of courage. His heroes -- especially Charity & Carter -- seem like extremely interesting people with a lot to give.

On a related, tragic note, Lewis recently lost his teenage daughter Dixie in a car crash.
posted by chavenet at 3:45 PM on June 15, 2021