The Premonition: A Pandemic Story

On January 8, 2020, Carter Mecher and Richard Hatchett discuss via email a novel coronavirus that originated in China. Carter has now been back at the Atlanta VA for nine years. He begins to study how large agencies distribute their resources. He hates inefficiencies and favoritism, and both play a significant role when organizations ask the government for funding. They can orchestrate their inefficiency to make a need look more urgent than it would be if everyone simply did their jobs well.

During the previous two years, Tom Bossert served as Donald Trump’s first homeland security advisor. Bossert calls Hatchett and Carter to tell them that he’s building a team to respond to biological threats. However, Trump hires John Bolton on April 9, 2018 to serve as national security adviser, and Bolton fires Bossert the next day.

Carter and Hatchett have stayed in touch, working on various projects together and using each other as sounding boards. Over the years, five other like-minded men—Rajeev Venkayya, Duane Caneva, James Lawler, Matt Hepburn, Dave Marcozzi—gravitated toward them, and they formed a small group of seven. They’re all doctors, and most have combat experience in the Middle East. The group calls themselves the Wolverines.

After emailing Hatchett about the China coronavirus, Carter goes on vacation to attend his son’s wedding but forgets to tell the others. On January 18, the Wolverines have been out of contact with Carter for over a week. Lawler sends the others a message, informing them of 17 new coronavirus cases in Wuhan. They calculate that people in Wuhan people travel a lot, which increases their ability to spread infections. The first US citizen tests positive the next day. Carter returns and collects data. Every piece of information makes him think that the outbreak is bigger than it seems. The CDC announces the second US case—a woman who arrived from Wuhan—on January 24, 2020. Carter doesn’t understand the government’s lack or urgency.

Carter often illustrates his ideas with metaphors. He uses fire to describe the dangers of exponential growth. When he considers the COVID pandemic, the 1949 Mann Gulch fire in Montana particularly resonates with him. In this incident, 15 smokejumpers parachuted into Mann Gulch to fight a fire. However, they quickly saw that it was far larger and faster than they’d thought. Ten of them died in the fire, and another died the next day from his burns—but the foreman, Wag Dodge, escaped by using a strategy that would come to be known as an escape fire. When the fire was closing in on him, he lit a new fire that raced up a hill. He followed the new fire up the hill, granting himself a safe escape from the larger wildfire that was rising to meet him from below.

Carter continues to study the COVID outbreak and sees that it moves much faster than SARS. It has more in common with H1N1 than with SARS. On January 29, 2020, US repatriations from Wuhan begin. The government sends people to four separate sites for quarantine, but the CDC tests only those with fever during the two weeks. James Lawler never learns the reason for this decision. He hears that 57 people quarantined in Omaha wanted tests, but the CDC wouldn’t allow it. Again, he never learns why. Carter imagines that at least 100 US citizens are infected, but that not enough testing is being done to find them. He estimates that finding and isolating them will take at least seven times more testing than the current rate.

On January 31, 2020, the US closes its borders and quarantines people returning from China. Carter proposes that hospitals in the five biggest cities test anyone with flu-like symptoms. The CDC refuses to use the word pandemic. The Wolverines want to find one state willing to roll out an aggressive response, hoping that if one state leads by example, the rest of the country will follow suit. Duane Caneva calls Charity Dean and proposes that California be that state. Dean agrees that they’re in trouble.

When Duane Caneva calls Charity Dean, her intuition tells her that something bad has begun. Dean is working to manage the health risks of immigrants during the flu season. She bends the rules and sets up her own migrant health care system, using the Jewish Family Service and other private organizations to help in ways that the public organizations aren’t.

Duane Caneva tells her that he’s a member of a small group of doctors who have influence with the White House. He asks her to help make California the lead responder. She reads the Wolverines’ old email chains. Dean dislikes her new job and is intrigued by Carter Mecher’s approach to problems. She’s surprised by how little data California has on COVID. She starts reading Chinese newspapers and forming a better picture of the reality in China. Using the virus’s spread in Wuhan, she makes projections for California, and the numbers shock her. She takes them to Angell. However, Angell ignores her, saying that they must wait for guidance from the CDC.

Dean thinks in the long term. If the pandemic worsens, she knows that the fatalities will overrun morgues. She starts investigating the possibility of mass graves if the cemeteries get overwhelmed. Angell forbids her from using the word pandemic. Dean, who read a Winston Churchill biography, feels like someone watching as Hitler’s threat grows while others downplay the Nazis’ rise. She refuses to see herself as a victim and begins viewing herself as a warrior. However, she feels crazy because no one confirms her concerns. Dean joins Hatchett and Carter on a conference call, and Carter impresses her. She explains that she’s not in charge of California’s response and that it has no real system of public health. She says that everything will be worse than they thought and that they can’t expect the CDC to be proactive.

Charity Dean’s conversation with Ken Cuccinelli sets the thematic tone for Part 2. Cuccinelli should have had much more influence than Dean, as he had greater proximity to power and held a much higher position. Nevertheless, Dean says:

He wasn’t pleading with me to do the right thing. He was yelling at me. He was basically implying that the White House is not going to do the right thing. The White House is not going to protect the country. So California needs to take the lead. That was the moment she learned that the White House was listening in on the calls—and also the moment when she realized just how lost and desperate the people at the top were. ‘He’s the deputy director of homeland security. He can just go talk to the president. And he’s relying on some random blond girl to save the country. Really?’ (225).

While Dean and the Wolverines can devise effective strategies for the COVID pandemic, they’ll never be as effective as possible if they must act on their own. Cuccinelli infers that Dean should go rogue and subvert the White House because he knows that the administration won’t do anything to damage its image.

Dean’s call with Cuccinelli is thematically resonant with what Joe DeRisi refers to as

[t]he last mile problem in medical science. Corporations were only interested in stuff that made money. Academics were interested in anything worthy of publication, but once they had their paper done, they tended to lose interest. The government was meant to fill in the blanks (157).

DeRisi understands that the incentives to act correctly are all wrong. If the people with the most influence base their choices on a desire for political gain or profit taking, they cannot make choices that will help the greatest number of people.

Those choices are a part of what creates the gap between the spread of COVID and the endless lag of the inefficient government. Part 2 effectively develops the theme of lethal hesitancy. Carter’s repeated use of the Mann Gulch analogy—and of fire in general—clearly distills the problem:

You cannot wait for the smoke to clear: once you can see things clearly it is already too late. You can’t outrun an epidemic: by the time you start to run it is already upon you. Identify what is important and drop everything that is not. Figure out the equivalent of an escape fire (172).

By using the Swiss cheese approach, Carter can assure himself that they tried every way to help. His approach to decision-making is based on personal and professional integrity. However, he also makes decisions to avoid the greatest possible regret in the future. He recommends, “Play forward whatever you are thinking about doing, or not doing, and ask yourself: Which decision, if you are wrong, will cause you the greatest regret?” (178).

Lewis writes, “Everyone has a story they tell themselves about themselves. Even if they don’t explicitly acknowledge it, their minds are at work retelling or editing or updating a narrative that explains or excuses why they have spent their time on earth as they have” (199). Carter’s approach to decision-making is a positive example of Lewis’s remarks about the purposes of personal narrative. The CDC officials and other ineffective leaders exemplify the flipside of that. They constantly maneuver in hopes that no one will blame them for anything in the future. However, they’re happy to take credit for successes, even if the successes come from the work of groups like the Wolverines.

Carter is only interested in results and has no need to take credit: “History will long remember what we do and what we don’t do at this critical moment. It is time to act and it is past the time to remain silent. This outbreak isn’t going to magically disappear on its own” (217). He only wants to solve problems, save lives, and keep his conscience clear. Like Carter, Dean uses a fire metaphor to illustrate the problem, but it’s less sanguine than his: “The CDC does not know how to pull the fire alarm. In fact, there is no fire alarm in this country” (196). If no recognizable mechanism exists to warn people about the dangers of the pandemic, no number of warnings will be sufficient.

As Part 2 ends, Gavin Newsom is calling Joe DeRisi’s Red Phone. In a functioning organization, this could foreshadow that people with greater influence are taking notice of the Wolverine’s methods and that positive change may be forthcoming.