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Book Review: The Premonition by Michael Lewis

Book Review: The Premonition by Michael Lewis

Reading Time: 5 minutes


This is the first book review I’ve written since being in secondary school, which…well, was a while ago, so go easy on me. I was inspired by a tweet a few weeks ago…

There has been some chatter both online and offline recently about the ‘visibility of emergency management’. Professor David Alexander’s article last summer asked “where are the emergency planners?“. The Emergency Management Growth Initiative has been seeking to bring greater awareness. And there have been recent challenges to the narrative that ‘plans didn’t exist’ for the UK response to the COVID pandemic. 

Generally, there’s a view from within, that that emergency management needs to be more mainstream, especially in the minds of political leaders. 

Over the last 9 years I’ve also tried to use this blog as a way to bring greater visibility to emergency management issues; most directly in an early post about breaking out of the bunker, which is simultaneously the natural habitat of the Emergency Manager but can also be what holds us back as a profession.

It was with great excitement that I ordered Michael Lewis’ book The Premonition, about a group of like-minded (and like-frustrated!) individuals who know that something serious needs to be done about pandemic planning. The book tells how a small group initiated and then performed repeated course corrections to US pandemic planning in the face of indifferent, layered, and fragmented bureaucracies. Speaking about the Swine Flu pandemic of 2009 one of the cast notes “there was no one driving the bus” and that despite pockets of good work across the country, the formal bodies people looked to for leadership (the Centre for Disease Control gets an especially scathing review) were deeply dysfunctional.

The book repeatedly asks the question “What happens when the people in charge of managing the risks have no interest in them?”. Pretty much every time it circles back to passionate people fighting to be heard and finally breaking through (often to be un- or under-appreciated).

Like Love Actually, there are several intertwined stories at play. Initially, each of the main characters (they’re actually real people) are doing their own wonderful things in splendid isolation, solving local problems using local means. But characters are brought together through chance meetings, introductions or happenstance, and realise their collective power.

One observation is that for a Public Health Officer in the States, there is no defined career path. I’ve heard similar representations about Emergency Management. This is thought to represent a problem because it means such a diversity of approaches and backgrounds and therefore a lack of a common approach. However, I would argue that this allows multiple perspectives to be more easily readily and more organically, but agree that some standardisation could be beneficial.

Like in an emergency, rapid response is vital to control and reduce the impact of disease outbreaks. The response to outbreaks and emergencies often needs to be instinctive, Kahneman’s ‘System 1’ rather than the more considered ‘System 2’. As one of the protagonists remarks about a Hepatitis C outbreak “if we had waited for enough evidence to be published in journals then we would have already lost,” and similarly, later in the book talking about wildfire response, someone remarks “you cannot wait for the smoke to clear – once you can see things clearly it’s already too late.”

Active vs passive choice seems to be another recurring theme throughout The Premonition, reminiscent of the Trolley Problem:

In particular, there is a chapter that considers a response to potential health issues following a Californian mudslide and one of the stars of the book is described as “She processes information quickly and spits out a decision fast, that makes people nervous. You don’t find people like that in government.”

Considering the profession, or at least the decision-makers background, there is an observation that the Homeland Security Council was “staffed by military types who spent their days considering attacks from hostile foreigners, not the flu” and that this had the effect of cognitive narrowing, choosing to not see the things which were unfamiliar. 

One of the characters talks about how they wanted to try to get the President, then George W Bush, to pay attention to the widespread impact that a serious pandemic could have across all society, not just healthcare. I was particularly amused that rather than formal submissions and briefings, actually what got the President interested was providing him with an annotated history book.

An intensivist doctor talking about touch clinical decisions remarks that “I felt like my best when shit hits the fan. I focus like a laser when everything is going to shit” and someone else mentions “You are going to make mistakes. The sin is making the same mistake twice and best is to learn from other people’s mistakes.”

The Premonition isn’t a popular science review of pandemic interventions and response strategies. Although, if there is a Hollywood adaptation (like Lewis’ Moneyball) then there would be parts for Selena Gomez to reprise her role in explaining dense public health theories and concepts. There’s an extended section which compares 1918 influenza pandemic interventions in Philadelphia and St Louis and supporting evidence which indicates “cities that intervened immediately experienced less disease and death” and further that cities which “caved to pressure from businesses to relax social distancing then experienced a more severe second wave.” 

Lewis also presents research that concludes that you “couldn’t design a better system for transmitting disease than the school system,” which got me thinking about perceptions, and why there is a persistent view that closing schools is a bad idea? Surely it’s only a bad idea if it is done badly?

The book notes how we are notoriously bad at understanding statistics and complex dynamics. Exponential growth is hard for us to visualise beyond the first few steps. Lewis provides an example of folding a piece of paper 50 times being able to reach a distance of 70 million miles. It just doesn’t seem right.

What comes through most clearly is that more often than not this doesn’t come down to expertise or evidence. Success often is the result of people who work around the system. Individuals with passion projects that compensate for the failings and deficiencies of their organisations.

My own passion project has been to try and better surface and understand interdependencies between different systems. It’s easy to become a specialist in your own field, but to see how that connects and relates to other areas is less common. My Anytown project started off as a way to try and convey the ‘whole society’ impact of various scenarios. The Premonition covers some of this in a short section that identifies the pressures on the production of nasal swabs which are only manufactured in three locations worldwide and are in extreme demand during a pandemic.

However, Lewis also makes the observation that decisions can no longer be made purely on the basis of technical evidence and draws the book to a conclusion noting that “greater attention needs to be paid to how decisions might appear to a cynical public.”

There are some wild claims throughout, such as “The US invented pandemic planning in 2005”, which I’m not sure would stand up to much scrutiny. And I’m sure that trying to tell a history of COVID whilst we are all still living through COVID means there is more to be uncovered. But overall, The Premonition is an easy to read yet insightful book which casts light on, more often than not, the failings of government-level risk management and the commitment and passion of public health and emergency management professionals, noting that some are “so committed it’s more of a mission than a job.” 


Next on my reading list: Catastrophe and Systemic Change by Gill Kernick

Help me find a wild goose!

Help me find a wild goose!

Reading Time: 2 minutes

What started as a good idea has got me stumped, and I need your help! I’m on the hunt for the first edition of the London Emergency Services Liaison Panel Major Incident Procedures Manual. Snappy title huh?!

It was published in hard copy only in, or around 1986, and was the first attempt to describe the multi agency response to a civil emergency.

  • Are you an emergency planner with an extensive library?
  • Do you know any ex police/fire/ambulance staff? Are they a bit of a hoarder?
  • If so, share this post with them or encourage them to contact me!

Why am I after a document that’s as old as I am?

LESLP started life in different times. Whilst many of the risks that London faced in 1973 are the same in 2015, others have changed and more have been identified (hello: cyber hacking). However, it’s not just the risks that change, the capacity and capability to respond have also changed.

It’s hard to look at how things have changed when you weren’t there to experience it first hand. From the outside the police in 2015 is markedly different to the Life on Mars image I have in my mind. Similarly for the other emergency services, there has been massive change not just in terms of what can be done, but also in how things are done.

A couple of years ago, as a response to Lady Justice Hallett’s inquest report, the Home Office initiated the Joint Emergency Services Interoperability Programme. The aim was to develop national consistency regarding major and complex incident response. However, in London LESLP has been in place for over 40 years, and there was a sense from some corners of ‘we already do that’. True, the LESLP procedures do call for joint working and articulate organisational roles and responsibilities. However, I thought, wouldn’t it be an interesting exercise to compare Version 1 with Version 9 to see how things have changed? How have lessons from incidents have been incorporated into policy? What about international best practise and changes in national response capability, have they been included? And most importantly of all, wouldn’t this sort of historical analysis make for a fine blog piece!

However, tracking down the first edition is proving to be more problematic than I initially thought! The Met Police are the document owners, but the my colleagues there don’t have a copy. I’ve contacted the Cabinet Office and Emergency Planning College (who were able to send me a copy of Version 2, but didn’t have version 1). I’ve also contacted the Met Police Heritage Centre, the London Fire Brigade Museum and the Emergency Planning Society. I haven’t heard back from those organisations yet but I’m beginning to think that Version 1 might be a wild goose.

I hope that you’re able to help me in my search. I’m a big believer in the six degrees of separation. I know I’m only a connection away from finding someone who has what I’m after!



Right Royal Resilience

Right Royal Resilience

Reading Time: 2 minutes

I’ve been thinking lately, motivated by on-going projects at work, about what influences our resilience. My ponderings tend to wind up at etymology, what did the word or term originally mean and what does that tell us, if anything, about how we should or could understand it.


Whilst many people believe ‘resilience’ has roots in 1970s environmentalism, in his paper (Resilience and disaster risk reduction: an etymological journey) David Alexander suggests resilience traces back considerably further to classical cultures, I therefore got to thinking about the broader history of resilience.

Fittingly, I visited Rome earlier this year and recognised the symbolic nature of the Colosseum – both as a reminder of the destructive power of the 1349 earthquake, but also that such destruction doesn’t always equate with decline. Similarly London has also exhibited significant ‘ability to endure’ and to prosper in the face of catastrophic events. Flooding, Fire and Plagues have befallen the city, but it remains standing as a leading world power.

My first post on this blog nearly a year ago concerned Doomsday Preppers, who have taken preparing to the next level compared to the general public. Staring across the River Thames at the Tower of London today, I realised that the notion of a ‘Prepper’ isn’t new.

The Tower of London is typical of medieval castles, and employs some similar strategies those of modern doomsday preppers.

  • Multiple layers of defences (see image above), including ditches and moats, fences, stone walls and towers – even the ancient wall of Roman London also served a defensive purpose – and the origins of The Barbican are in a fortified outpost or gateway to the city
  • Self sufficiency – in order to withstand a prolong siege, the area inside the castle was used for farming, water, and small industries.

As important as the Kentish ragstone walls, pots of boiling tar or portcullises no doubt served to be, they alone do not define resilience. As I reflected on the link between royalty I realised that the parallels weren’t just in the hard measures either.

The British Monarchy has demonstrated resilience as an institution (having had it’s fair share of low points from which it has ‘bounced back’) but I wonder whether monarchical rule itself exerts any influence on wider resilience? Does it represent continuity between the past and the present, or provide hope of stability and order during times of uncertainty and change.


Image Source: Wikipeadia

Plague and Progress

Plague and Progress

Reading Time: 4 minutes

Following incidents responders undertake debriefs to identify lessons for the responder community; I’ve participated in and facilitated many such events. However, investigation of past disasters can also reveal information on how they were caused, contributing factors and identify options for prevention or mitigation – essentialy progress is (at least partly) driven by past experience.

black death

Cries of “make way for the Plague Doctor” were heard from the back of the auditorium as Dr Carole Reeves (UCL), in long coat, beaked mask and hat, made her way to the lectern. It’s safe to say that not all lectures start as dramatically as the one I attended today, entitled Plague Bones: how London’s Black Death became a tropical disease.

The Museum of London (arguably one of my favourites) has amassed quite the collection of bones, sourced from plague pits or during the construction of the London Underground, which are made available to researchers to help analysis of past events, including the Black Death.

As a term, “Black Death” didn’t arrive until relatively recently in the 19th Century, with “plague” or “pestilence” the terms in 14th Century vogue. As an emerging (or re emerging) infectious disease there was little or no inherent population immunity. It was therefore devastating.

At the time, Plague (Yersinia pestis) was seen as a sign of a displeased deity (interestingly, Islamic doctrine at the time was that Plague was the will of God and was to be endured). However, through providing ministry to the dying, the clergy had a higher degree of exposure and was one of the hardest hit populations, with 1 in 3 perishing.

Plague doctors, their leather beaks stuffed with herbs and spices to ward off evil airs, were in short supply in the Middle Ages. However, other professions rolled up their sleeves to provide diagnosis and treatment, notably barbers (have you noticed the red and white striped pole outside some barbers – this has it’s roots as an advertisement of the practice of bloodletting). Treatments of the day included purging, cupping, cauterisation and lancing. Some more outrageous suggestions were also suggested including placing a frog on the buboes, rubbing oneself with a chickens bottom, drinking snail tea or chopping up a puppy and applying it, still warm, to the victims chest.

On the authority of the Pope, top Parisian doctors concluded the conjunction of Saturn, Jupiter and Mars in the sign of Aquarius in 1345 was the cause of the pestilence – causing the earth to “exhale poisonous vapors”. Offering some prescription, the same report advised:

No poultry should be eaten, no waterfowl, no pig, no old beef, altogether no fat meat. . . . It is injurious to sleep during the daytime. . . . Fish should not be eaten, too much exercise may be injurious . . . and nothing should be cooked in rainwater. Olive oil with food is deadly. . . . Bathing is dangerous.

With such helpful medical advice, it’s no wonder that people turned to religion and ritual; there was a strong reliance on charms and lighting of fires of juniper and rosemary to ward of the mal arias (or bad air, from which we get “malaria”).

The significant numbers of fatalities put extreme pressure on burial space, and in London, saw the construction of large emergency cemeteries, the final resting place of some 20,000 victims, some in coffins, but many in burial pits 6 deep.

Infections don’t emerge (or re-emerge) in a vacuum, their mutation is linked to climatic and, ecosystem factors, levels of health and immunity and coexisting infections. It’s thought that a contributory factor to the Black Death could have included a series of famines including The Great Famine 1315-1317, movement of military and opening of trade routes between Europe and Asia, and coexisting infections of tuberculosis, lice and intestinal parasites.

The modern plague doctor has a much more sophisticated range of tools at his disposal:

  • Border Biosecurity – ships suspected of coming from infected areas were turned away. Today, much effort goes into maintaining bio-secure borders – partly the reason that there are restrictions on what you can take on holiday with you
  • Containment – some settlements isolated themselves from the disease through isolation for 40 days (hence the term quarantine). Whilst this was only minimally effective at the time, containment was one of the response strategies during the 2009 Swine Flu Pandemic
  • Surveillance – absent in the Middle Ages, we now have vastly improved international schemes to monitor the epidemiology of human, animal, insect and plant diseases which mean that decisions can be taken much further in advance
  • Medical Treatments – a significant step on from the ‘frogs and dogs’ approach, with a continually developing understanding of the body, pharmacology and disease we now have access to a much better range of effective treatments
  • Protection – with advances in materials and understanding, we’re now able to protect ourselves against infections through hand and respiratory hygiene and barriers such as gloves and masks rather than beaked leather masks stuffed with herbs and spices.
  • General Health – again rooted in understanding of disease, the notion of germs and the rise of cleanliness, we now have access to clean water, flushing toilets and it’s difficult to imagine a situation where public health authorities recommend exercise being injurious!

plague doc modern doctor

Much of this has progress has been the result of learning stemming from past incidents. Whether the Black Death hundreds of years ago, or recent outbreaks of SARS, lessons from the past must continue to shape our preparedness for the future.


Image Credits: Corbis, Paul Fürst, Brian Thomas Humek,