- Welcome to Pandemic Superheroes.

I'm Peter Arcuni, Science Reporter

for KQED Public Media in San Francisco.

I am joined by Michael Lewis author

of "The Big Short," "Moneyball,"
and "The Fifth Risk."

Michael's new book, "The
Premonition: A Pandemic Story"

tells the true story of the scientists

who saw COVID-19 coming

and how they jumped into
action when others wouldn't.

Also joining us are two
people featured in the book,

Dr. Joe DeRisi, co-president
of the Chan Zuckerberg Biohub

and professor of
biochemistry and biophysics

at the University of
California, San Francisco,

and Priscilla Chan, co-founder and co-CEO

of the Chan Zuckerberg Initiative.

I am so excited to be with
all of you here today.

But, Michael, let's start with you.

I'm curious, when did you first
have the idea for this book

and what was that story
that you set out to tell?

- Well, it was, it started by
kinda fits, fits and starts.

I felt it was very odd
because I'd written this book,

"The Fifth Risk," which
framed the federal government

as this manager of a portfolio
of existential risks and--

- Right.

- Basically asked the question,

what happens if one of
these bad things happens?

And the tool we have is
falling into disrepair

and the people who do
have their hands on it

don't know how to use it.

And it was really, the pandemic happens

and it's clearly the thing.

At that point, several
things at once happened.

But apropos of this conversation,

my mind reeled back to meeting Joe DeRisi

like five years ago.

And it was a really funny encounter

because I was taken to dinner

by a San Francisco money
manager named Carl Kawaja,

and he said, I've got your
next character for you.

And I said, who?

And he said, his name is Joe DeRisi.

And I said very politely,
yeah, yeah, yeah, yeah, yeah.

Then he just, he filled my
ear to the point where I just,

where I called up Joe and
we had a sandwich together,

just as the Biohub was
kinda getting underway.

And I sat, I came from
that encounter thinking,

God, if only I was smart
enough to write about him,

that, or if only I had some
excuse to write about him.

Because the material's fantastic,

but it really belongs
in the hand of someone

who didn't get a D in biology his

sophomore year in high school.

And so I just didn't.

But so what happens then,
flash-forward five years,

and I'm sitting here thinking like,

how do I even start
thinking about this subject?

And I got back in touch with him.

And he says, we've just created

a big, fast COVID testing lab

and we're going virus hunting.

And I kind of rode shotgun
with them, as they did that.

And that was like one of two
or three things that happened

that led to me thinking, my
God, there's a book in this.

- Hey, Peter, can I tell
my version of the story?

- Yeah, please do.
- Wait, so

before you, it's Priscilla,

I just wanna say, I have,
now that you tell that

how you met Joe story in that way,

I have a very similar version where I was,

I don't know, maybe a second
year medical student at UCSF,

and I went to a lecture from Joe

and he was talking about the ViroChip.

And I almost never talk about

sort of like med school with Mark

'cause he gets a little queasy sometimes

but I like ran home that
day, and I was like,

I just like had a lecture
from the most amazing person.

And I told him all about the ViroChip.

And he still remembers this
how sort of animated I was

from that experience.

And then it wasn't until, let's see,

probably a little bit
more than five years,

but, and not much more than that,

not much more than five years later.

I called him again to say like,

hey, do you wanna start a Biohub?

What's your dream there?

- That was awesome.

I'm so glad that I gave a
decent lecture that day.

My first year of the
meeting Michael story,

and we can come back to the
beginnings of the Biohub too

was that Michael called me
up on Carl Kawaja's advice

and we had that sandwich
together, and I thought,

oh man, this is the guy
who wrote "Flash Boys"

and "Moneyball" and all
that, like this is awesome.

I have got to pitch
him on a science story.

And I rolled out my best stuff.

I was like, this science story is so cool

and this infectious disease
project is so awesome.

I said, Michael, you gotta
write a book on this.

This would be great.

I'm pitching this hard.

And Michael's face was
like, yeah, nah, nah.

(all laugh)

- The true story comes out.

Well, I wanna talk about this a little bit

'cause it sort of relates to the book.

As Michael describes in the book, Joe,

your labs became sort of
this red phone places, UCSF,

where you became known as
somebody that could identify

an unknown virus, like
understand its genetics

and its origin.

So tell me a little bit
about how that works,

and Priscilla mentioned the ViroChip,

and at one point you're
identifying an unknown pathogen

in boa constrictors.

So like tell me about that,
like how does one do that?

- Yeah, sure.

Let me give you just a
little condensed version.

So first of all, right,
there is no actual red phone.

It's just a metaphor.

(Peter laughs)

- Oh really?

I was picturing like the
bat cave or something.

- Yeah, exactly.

You and many others have asked
to see the actual red phone,

and there is no red phone.

It's really just a metaphor.

But that's hilarious.

Yeah, so a lot of what we do in the lab

use the genomic technology to do

sequencing of a human sample.

And we really just separate
what's human from not human

and then figure out what
the not human part is,

to diagnose hard, to diagnose infections.

And together with a great
neurologist, those in my lab,

Michael Wilson and many
others here at UCSF,

we've been doing this for some time

for diseases of unknown
cause in many patients,

especially those with
neurological infections.

And so that's been something
that we've continued,

but really it's actually blossomed

into something much bigger

with the initiation of the Biohub.

And together with the Chan
Zuckerberg Initiative,

we now have like a global version of this

that operates in a lot of low-
and middle- income countries

where infectious disease
burden is actually the highest.

- Right.

So one of my take homes from
the book was that at this,

at this time, like there
was this time period

where you were identifying these viruses

but the way Michael describes it is like

unless somebody knew you or knew your lab,

they wouldn't even know to call you.

And I can imagine like that
was sort of frustrating

and maybe this is where
the Biohub comes in

because it sort of finds this gap of,

well, nobody really,
outside of the community,

nobody really knows
about Joe and his work.

So maybe, Priscilla, can you talk about

what the goal was there.

- In the founding of the Biohub?

- Yeah, and sort of the idea
of trying to scale this up.

- Yeah.

So our goal, the Chan
Zuckerberg Initiative,

is really thinking about
how do we accelerate

the pace of science?

How do we make it so that we
can actually cure, prevent,

and manage all disease

not because we're solving
one disease at a time,

but because we're
actually like accelerating

the pace of work, discovery,
knowledge sharing.

And part of that is actually
building fantastic tools

and allowing others in
the scientific community

to share with that.

And that's sort of what
was the initial spark

of like remembering, like,
Joe as the tool builder,

as the tinker.

And like, I started digging into

sort of thinking about how
he works in his own lab.

But the really amazing thing about Joe

and what's sort of embedded
in the Biohub culture now

is the sort of open science,
the sharing is like,

yeah, like let's do this together.

How do we help?

And so something that we built together

between CZI and the Biohub
is a tool called IDseq.

It started by someone in
Joe's lab building it.

And then it became something

that we put an engineering team against

and started building at
CZI so that we could share.

And it's a tool that
allows you to figure out

what someone is infected with,

with a PCR and without sort
of a pre-existing hypothesis.

But that's sort of
sharing and accelerating,

like Joe has partners all
over the globe doing this.

And then when the pandemic
struck, we're like,

oh man, this is really
useful for figuring out COVID

and how COVID changes over time,

and we sort of continued
to morph that tool.

But like Joe's work, it's just an example

how Joe's work is in service
of the broader community,

which is just so, both beautiful
and fantastic for science.

- And it seems like there's,

Michael gets into this in a book,

but there's like, there
was no like infrastructure

in the public health care system for this.

So, Michael, maybe you wanna,
circling back to the book,

maybe talk about some of the
people you're profiling here

in the book to sort of address this issue

of there was no system,
at least in our country,

to respond to a pandemic
before now really.

- Well, I wrote the book
at kind of a fever pitch.

And it was a funny
experience because I felt,

yeah, this is workin'.

I'm not gonna ask myself
too many questions

about why it's workin'.

These people just swing on
the page and I'll figure out,

I remember, at the end of it,

I'm not gonna figure out
what this thing was about.

And what it was about were

a handful of extraordinary characters

trying to operate inside
of a broken system.

And in the way they operate
and the things they do

and the things they fail to
do, you're sort of able to,

they just end up describing
the problems in the system.

And Joe is like perfect for this.

Joe, I'm sorry I gotta talk
about you as if you're not here.

But--
- Oh man.

- But he was perfect
for this because this,

this gets the spirit of his lab.

It isn't just an, I hate
to use the word just,

but it isn't just an
academic enterprise, right?

When they figure out
that the Chinese woman

has got balamuthia in her brain,

that's where a lot of,
I think, academic minds

would come to rest.

And what was so cool about Joe and his lab

was that they asked like,
how do we cure this?

Is there a cure for this?

There's this kind of maker's spirit,

it's like almost an engineering
spirit in the thing.

And so when you take
that and you thrust it

with all the tools and
resources that the Biohub has

and you thrust it into the
US public health system

as it tries to cope with a
pandemic, man, it was poetry.

It was unbelievable.

And Joe, I think, would say

that he didn't have any real clue

what the public health system looked like.

He never really had to interact with it.

But when he interacts with
it, he and his team find that,

well, basically what
you have is not a system

but a lot of local public health officers

and you go to the public health office

and they're so, as Priscilla put it,

they're so kind of starved of resources

that they don't even
know how to accept help,

that it's sort of like, and it is,

poverty does this to people,

that poverty is not just a
lack of material or resources,

it's also you get to a
point where you don't know

how to accept help
because you never had it.

And the story of the
Biohub trying to reach out

and do the things that effectively,

that a decent government
would do, I find breathtaking.

Dave Dynerman who is no
longer at the Biohub,

but wasn't the Biohub when
all this was going on.

He put it really well.

As a small child, he was born in Poland,

he lived in Poland before
the fall of the Wall.

He says, I look at our
public health system here

and it's Poland before
the fall of communism.

Poland now works better than this,

that you wander around
these local health offices

and what you're seeing is
symptoms of a failed state.

That's just an extraordinary statement.

I would never had that flashlight

on the situation had Priscilla and Joe

not thrust themselves into the
situation the way they did.

And the way they did it was,
it's very much of a piece

with how Joe has lived his career.

It's like, here's a problem,
I'm gonna go try to address it.

- Let's focus on that for
just for a second, Michael,

and get some perspective.

First of all, you flatter me, thank you.

But we set that thing up,

this COVID testing lab at the Biohub,

we did it in record time.

But it was like, at the beginning,

we threw a party and no one showed up.

And I'd love to get Priscilla's take

because she really stepped in

and like actually made
that thing come alive

because she was coming at
it from the state side.

Priscilla, I don't know
what kind of insights

you can give us there from what
it looked like on your side

and how you kinda made that happen.

- Well, I remember just getting on,

at that point, was it daily
or like twice weekly calls

where we were looking at the numbers.

You set up that testing
lab, and we're like,

we're like, okay, what
is our surge capacity,

what can we do, everyone's
asking for testing,

and we had like trickles
of samples coming in.

And I just remember being like,

okay, there's clearly a barrier

that we are not seeing properly.

And on the other hand, I was
sort of working in partnership

with the state in this
sort of trying to answer

the same questions, I was like,

okay, the state is saying
that they need more testing

and they need support and
they're interested in this,

and we have this resource,

and literally no one is showing up.

What is going on?

And so I was like, there's
gotta be a breakdown somewhere.

And so we decided to just
like ask and we went out,

we sort of cold called all
these public health officers,

which we sort of were super nervous about

'cause really they're
probably really busy, right,

like they're fighting a pandemic.

- Just kinda.

- Kinda busy.

I remember with you and Steve

trying to be like, okay, like, how do we,

we just wanna be of service.

It's like, all we want in this moment,

like tell us how we can be helpful.

And that was our sort
of approach going in.

And it was a fascinating conversation

because then we got down
to like the nitty gritty,

like it's important to understand

how the public health departments operate

and how they get samples in

and how information needs to flow.

And so like it's not enough
just to show up and say like,

how can I be helpful,

like you have to sort of
understand, deeply partner,

and become a trusted resource over time.

- Yeah, and you were key
for that, by the way.

- Before we go any further,
I just wanna say hi to anyone

who's just joining the room.

We're here talking about
Michael Lewis's new book,

"The Premonition: A Pandemic
Story" with Michael himself,

along with two people
featured in the book,

Joe DeRisi, co-president of
the Chan Zuckerberg Biohub,

and Priscilla Chan,

co-founder of the Chan
Zuckerberg Initiative.

If you missed the beginning,

the conversation will also be available

on chanzuckerberg.com.

Okay--
- Hey, Peter,

can I tell a swab story?

- You can tell as many
stories as you want, Joe.

Go for it.

- No pun intended.

Here's a swab story.

One of the things that
came up on that call

that Priscilla was just talking about

was, well, we don't have test kits.

We can't send you any samples.

We don't have any test kits,

which meant a tube and a swab.

And like really, that's the problem,

that's one of the problems?

I knew it was a problem, but
I didn't know how bad it was

until we reached out.

And I got on a phone, I had a phone call

almost immediately afterwards
with a giant tech company

who makes devices and all
kinds of electronics and stuff.

And they were saying, a
big multinational company,

hey, we can make devices that
monitor your temperature,

other things like that,
is that what you need?

And I said, well, I just
got off this other call,

what we really need are nasal
swabs, can you make those?

- They're like, what you
really need are Q-tips.

- Well, Q-tips aren't sterile, man.

And so--
- Fair enough, fair enough.

- There's this long pause, right?

And then somebody, one
of the engineers said,

yeah, we don't know how to do that.

- Yeah, well, the hunt for swabs

could've been an entire
chapter in the book.

In fact, someone very, more clever than I

could do a whole book about
what happened with swabs

during the pandemic.

Because in response to,
I mean, think about this.

It's just that I never
imagined that nasal swabs

would be the limiting factor in my life.

But then they spin up this
very sophisticated lab,

you've got 200 and something postdocs

volunteering their time,

they're all ready to give away for free

the thing that America needs
most to control a deadly virus

and the one thing they
can't find is nasal swabs.

And the federal government,

in the form of the Trump
administration, says,

governors, go get your
supplies all by yourself.

So you compete with each
other to go get these swabs.

And no one has completely
documented what happened then,

and Joe clearly sees it
as a glimpse of the chaos,

but basically like Americans started

competing with Americans to
buy phony swabs from China.

The Chinese factories,
for every one real swab

that was manufactured, like
20 fake ones were, and sold.

And so Joe has these boxes of phony swabs

turning up on his doorstep.

- Yeah, they were mascara applicators.

- And I actually talked to a guy, a dude,

you would say, Joe,

I talked to a dude, a Chinese
American guy, who was in Ohio,

who the Ohio governor knew,
and he was an entrepreneur

and he knew his way around China.

The Ohio governor brought
him to help him find swabs.

And the stories he told were
just, it was just incredible,

that he had people on the ground

going from factory to factory

and these factories were actually,

they spun up to make fake swabs
in response to our demand.

So this kinda like total
breakdown at that point,

it was such, to me, it was like of a piece

with this bigger story.

And the bigger story was

people trying to operate in the system

and the system is this screwed up.

And what they experience
is really teaching you

about what we need to
do to fix the system.

- Right, like so much of
the book is about that,

how the system really didn't exist.

It was more this patchwork,
as you described it

and some of the characters describe it.

The other piece of this that
the book really dives into

is that there was sort of a
pandemic plan that was made,

just nobody was really
paying attention to it.

So you introduced this group
of like White House scientists

who essentially invented the
playbook for pandemic planning

in the early 2000s.

But strangely enough,

even though it was their job to do that,

their ideas weren't really embraced

by Centers for Disease Control

or really even the White House.

So what I'm wondering, Michael,

is what could they see
that others couldn't

and why did this plan
sort of fall on deaf ears?

- Well, so that's the mistake

that those characters make in retrospect,

that I don't know how
they would've avoided.

So they're tasked by President Bush,

who has just read a book
on the 1918 pandemic,

and is freaking out, like
this could happen here.

And Bush asks, like AIDS, what's the plan?

And he's told, we don't have a plan.

So these two doctors
take it upon themselves

to cook up an answer to one
question that the plan raises.

And the question is, what do you do?

What do you do if there's a pandemic

before you have a vaccine?

And what I had not appreciated,

and it would seemed actually
kind of bewildering,

was that prior to their work,

the conventional wisdom in
the public health community

was that social distancing,

all the various social interventions

so-called non-pharmaceutical
interventions didn't work,

that they hadn't worked in 1918,

that you had different
cities doing different things

and everybody ended up
having death and disease,

so these things were more
troubled than they were worth.

And what these two guys, Richard
Hatchett and Carter Mecher

spend a couple of years doing
is showing that the fact,

they had worked, that you get a different,

the fraction of the death in St. Louis

than you had in Philadelphia

because of the timing of the
interventions in St. Louis

in relation to the arrival of the disease.

And they sell everybody on this idea.

They actually did sell the White House

and they sold the, they not
only sold the CDC on the plan,

but had the CDC believing
it was their idea

by the end of it.

And the great irony is
that the CDC went and sold,

marketed this idea both to
the World Health Organization

and to individual countries,
and Australia, for example.

You ask why Australia,
it's been so good in part

at containing the virus,
is they have a guy

who was taught the plan by the CDC.

And so the basic ideas end
up being well-understood

by other countries and
well-implemented by other countries.

In this country, it was just
a messier picture, I think,

and it was a combination
of a whole bunch of things.

But at the center of our problem

is that the thing was
framed right up front

as lives versus livelihood,

as economy versus having your economy

or having your grandmother alive.

And it's really a false framework

because if you just let this thing run

and you have a million
or so Americans dying,

you're not gonna have your economy.

Who's gonna be going to restaurants

if this thing is running in
any kind of unmitigated way?

The situation was always not
either/or but neither/or both.

And so the mistake those guys made

when they were cooking up their plan

and embedding it in the CDC

is their mistake was that
the CDC had the capacity

to run like, operate like
a general in war time

and actually, actually implement the plan

in the way that like Australia did.

And the fact is they just did.

- Right.

Another big theme in the
book is this sort of catch-22

of when you have the data on a pandemic,

all the great data that all makes sense

it's already sort of too late.

And I'm just curious, Michael,
you can speak to this,

Joe and Priscilla, you can too,

how do you know when the
data's good enough to act

and really make a difference?

And how do you convince
people with limited data,

how do you get ahead of this?

- Well, first, you have to have,

I mean, this is interesting here.

I've written about this on
board with my own views of this,

but, Joe, I would love to
hear what Joe and Priscilla

have to say about this.

But the fact is they were responding

to the fact we had like zero
information on the ground here

'cause we had no testing.

And they understood that even,

to get even the partial
information, you needed to act,

you needed to have testing.

So the possibility of us
having data was severely

sort of compromised by the CDC's
failure to generate a test.

But having said all that,
the characters in my book

could have sat you down
at the end of January

and I think persuaded
you pretty thoroughly

that this was a big problem.

- Priscilla, what do you think?

- Oh, I think there was a lot of pressure

to have full information

at a point where there just
wasn't full information.

And I think public health
leaders needed cover

to be able to operate
with an emerging framework

and to sort of do the best
they could at a given time.

But if there was a sense
that if you couldn't have

sort of a complete framework
or a complete system,

that it wasn't sort of
enough or validated enough

and that's partially sort
of why it was so hard to get

Joe's COVID testing lab
and also the variant

monitoring off the ground
'cause it was emerging.

And the public health system
didn't know how to absorb

something that's new and coming in

because of the way they're
traditionally trained

to weigh risk and benefit.

And who's gonna say it's okay
if they sort of make a mistake

with an emerging framework?

- Yeah, yeah, I remember
being on the phone

with you, Priscilla, several times

and just the pervading
sense of uncertainty.

Like we don't know where this is gonna go.

We don't know how fast it's gonna move.

We don't know how many
asymptomatics are spreading it.

There was so much missing information,

which, as a scientist, just
bothers the hell out of me.

But I recall that, I
don't know if you said it

in these exact words, but
there's a price for inaction too.

- Yeah, totally.

And I think so many people,

Michael was talking about a need

for sort of like central
command and control,

but someone just giving a
general direction for folks

to sort of say, okay, this is my box,

I can be creative within these parameters,

would've been enormously helpful.

- It's interesting.

We started sequencing
COVID genomes around April

or late March, early April

long before people were talking about,

or most people in the general community

were talking about variants
or the arise of them,

although I think many in
the scientific community

were already thinking that.

But at the state level,
public health level,

like that just wasn't a thing.

I know that you, Priscilla,
had some conversations

that really kind of got
that into their awareness.

Do you remember what those were?

- The sort of the sequencing?

- Yep.

- I remember taking that
slide that you had for,

I think it was our April board meeting,

that show the phylogenetic tree--

- For the mission district.

- Of the Mission District.

And I was like, look at this,

you can tell like how COVID is spreading

throughout a community.

And because COVID has a
predictable pattern of evolution.

It mutates every two to three transfers.

And being able to see that and see like,

okay, like this group of
people from the nail salon

is different from this group
of people at the nursing home.

But look, there is
potentially a connection,

or knowing that you've
sort of missed cases.

'Cause do you remember at the beginning,

there was a hope that you
could capture all the cases.

And so you could actually
look at the phylogenetic tree

and say, okay, I see a
grandparent generation,

I see the grandkid generation,

I have no one in the parent generation

in this sort of family tree, if you will.

You have to go out and find those cases.

And again, I would chop that
slide around and say, like,

we have to do something about this.

Look at this tool.

Look at what the scientists
at the biohub can do.

And there was just general
like, yeah, that is really cool.

But then like again, we
would get lost in the middle

of like, okay, then
how do we, what's next,

like how can I follow-up?

And a lot of what Charity's doing

is sort of filling in that middle of like,

how do you actually
operationalize these tools

instead of sort of like
looking at what's possible

but being unable to bring it to life?

- I have a question.

My question to both of you, it
was when Joe first showed me

the power of the genomic information,

the ability to actually see how the,

who got it from whom and how it moved,

whether the virus came in from outside

or whether it's spreading
internal to some community.

I thought, my God, this is like magic.

We're gonna use this all over the country.

And instead, we used it in Humboldt County

and nowhere else (laughs).

That's an exaggeration, but kinda true.

That instead it's just
never gotten picked up

as a tool, well, for, in a serious way,

as a tool for epidemiology.

And I can't understand it.

I can't understand why

there are a thousand disease detectives

demanding this information

and using it to sort of
get their minds around

how the thing moved.

And I'm curious, like, to hear

if you were perplexed about that

or what experiences you had

trying to proselytize the
importance of the information.

- Well, sure.

I can comment on that.

But first of all, Michael,
I remember showing you

like the power of genomic epidemiology.

And your response was, holy crap,

we could apply this to the White House.

- Yes, the Rose Garden outbreak,

you could've actually, you
got all those viruses, right,

you would figure it out, you
could probably figure out

who gave it to whom more or less, right,

and maybe who even introduced it.

But--
- Absolutely.

So, Joe, maybe unpack that a little bit,

the power of using the
genome and sequencing.

- Sure, sure.

(faint voice talking)

So what people are most
familiar with right now

is using the sequencing-defined variance,

that is, hey, there's a new mutation,

and it might be less susceptible
to the vaccine protection.

And that is a dominant usage.

That's fair.

That's a good thing to do.

When we have been
sequencing to always do that

but go a step beyond, be able
to apply that information

so that it would become actionable

at the public health official level.

And so we engage literally
dozens of counties

around California to both
sequence their COVID genomes

and then supply it back to them

in a way with a lot of
high-touch interaction

to sort of help them
understand what it meant

and to be able to make decisions.

So, for example, if you had
four or five individuals

in a factory line all get
COVID, the question could be,

well, did the safety
protocols in that factory fail

or did they coincidentally
bring it in from outside?

Without the genomic information,

either it's plan of, I don't know,

probably totally possible
given community transmission.

But the sequencing could really
rule in or rule that out.

And if they did get it from each other,

and you would know that immediately

'cause all the genomes will be identical,

you would then visit
that factory and be like,

you gotta shut down this line
or change safety protocols.

- Right.

- Conversely, you could
do something different.

And those are the kinds of connections

that the data can make that
we would really like to

empower our local health officials

with being able to do on a
regular basis, all right?

And I'm thinking of nursing homes too,

like that population is, yup,
it's very, very vulnerable,

and you have that same sort of set up

where you have like an
inside, closed system

and then there's people
entering that system.

So I imagine that tool
could be so powerful.

There's also another component

to all this viral surveillance
that we're talking about,

which is the equity issue,

and sort of understanding
how different communities

are disproportionally
affected by the virus.

And we saw that, we're in San Francisco,

so we saw that here,
we're in the Bay Area.

I'm curious, if any of you wanna talk

a little bit about that in your role

or other people's role in
identifying communities in need

and making sure we have that
type of surveillance we need

in those communities.

Well, hell, yeah.

So, Priscilla, maybe you
can comment on CZI support

of Diane Havlir's project?

- Yeah, well, I think this was,

early on, we started getting a sense of,

okay, like COVID first
came into our communities

via travelers.

But then pretty soon after,
you started getting a sense

that there was, COVID
was just exacerbating

existing inequities in our community,

especially with the folks
that are essential workers,

frontline workers that
needed to continue working

to be able to support their families.

And Diane Havlir, a professor at UCSF

who was also on the frontlines
of the HIV epidemic,

just did an incredible study.

She set up a, looked at a
community in San Francisco

that both had folks who could telework,

including someone that worked at CZI,

lived in that community, and was like,

someone from the Biohub
came and swabbed my nose,

is that right?

And a pretty mixed community of folks who,

predominantly Latino families,

who were living in packed households

that were essential workers.

And she did something fantastic

that we really love, is
just like having that work

be community-driven and partnered
with the local nonprofits

to build trust, gain trust,
and actually test everyone,

and being able to actually find out

who had coronavirus within that community.

And, Joe, I mean, we found
something awesome, fascinating.

It's not awesome.

But say more about what we--

- Sure, sure.

So, yeah, and just to underline
that previous statement.

By partnering with local
communities and organizations

like the Latino Task Force
really made this happen.

So like Diane's team,
together with Biohub,

literally tested everybody

in a four by four block area
there in the Mission District,

and what we found was sort of,

I mean, I suspected it but I
just was sort of blown away.

So two things of importance:

One, 50% of the people that
were positive were asymptomatic,

never had a symptom, never did.

And this sort of reflects
what also happened

on the Diamond Princess,
but really brought it home.

Like, oh my God, how are
we gonna control a pandemic

if we don't know who's sick
and without good testing?

You don't know.

'Cause they're asymptomatic,
they're just lurkers.

And then the second one

that speaks to the real inequities is,

there was almost a thousand Caucasians

in that neighborhood that were tested

and there were no infections.

95% of the infections were
in the Hispanic, Latino,

Latin X community.

And I could recapitulate the
statistics just by asking,

do you need to work outside
the house every day?

Or could you like shelter in place?

And how many people live in your house

and what's your median household income?

Those were really the social determinants

that indicated increased
risk for getting COVID.

And that was a huge eye-opener for us.

I mean, we thought we maybe
knew that was gonna be the case,

but this sort of blew us away.

- Well, if you're new to the room,

we're here talking with Michael Lewis,

author of the new book, "The
Premonition: A Pandemic Story,"

Joe DeRisi, co-president of
the Chan Zuckerberg Biohub,

and Priscilla Chan,

co-founder of the Chan Zuckerberg
Initiative are here too.

They both appear in Michael's book.

So, Michael, I wanna bring it back to you.

In reading the book, I
would say my reaction

was feeling so grateful
for these individuals,

like Joe and Dr. Charity Dean,

who's a health officer here in California,

and to Carter and Richard,
these clairvoyant individuals

who had the foresight and the conviction

to step up where these big institutions

and the federal government failed.

At the same time, I really felt terrified

that there was no system in
place to handle all this.

Obviously we've learned
a ton about pandemics

in the past 12, 16 months.

But I'm curious.

In synthesizing all this,

do you think the public
health system is more prepared

for the next one, like
has the system changed?

- No.
- No.

It hasn't yet.

I'm just a writer and so I'm
gonna be very uncomfortable

going where I'm about to go,

but it seems really clear
that we need to build a system

and change the way, and the
question is, how you do that.

- Right.

- But it's not what we have.

I mean, if you want a mental,
sort of mental picture

of the world the virus rolls into,

when it rolls into this country,

we have 3,500 local health officers

who have lots of authority
over their little area

of the planet.

In California, we have 61 of 'em.

58 counties and three weird cities,

including my own in Berkeley

that have their own public health officer.

And these people were operating,

they have a trade association.

All the California Public Health officers

kinda who each other are,

but they're basically on
their own in normal times.

I mean, Charity Dean, was such
a wonderful character in part

because she dramatized the plight

of any local health officer
who was doing her damnedest

just to stop communicable disease.

She went to such great lengths.

And so (audio cuts) how hard it is.

And her mantra, her mantra in her job was,

no one's coming to save me.

That she takes the job
thinking, oh, we have a system

and the systems are
overseen and run by the CDC,

and I'm a soldier in an organized army.

And instead, really what
she was, was a lone warrior

with very little backup from anybody,

who whenever she had to do anything

that was the slightest bit controversial.

Close a doctor's clinic
because you strongly suspect

that he was infecting people
with Hep C in dirty needles.

And that kind of thing.

That her job was on the line.

And that the CDC, who was
meant to be there, in theory,

to back her up, had retreated
into this kind of pose

of an omniscient academic institution

that wanted to wait to act

until it knew, until it
was completely certain.

But it is the nature of disease control

that if you wait until
you're completely certain,

you've lost.

Yeah, yeah, a lot of people
died and yes, it was here.

They didn't stop it.

So you got these people who,

I mean, and it's so bad
from her point of view

that a couple of years into her job,

instead of revering the CDC,
she's saying things about it,

like, I was so disappointed
in the man behind the curtain

and he turned out to be such a pansy,

or she bans the CDC from
her disease investigations

'cause they get in the way.

So we have this system that's not a system

with all these people
operating kinda on their own

and how well they do
it is just an accident.

It's like an accident
of the local territory.

Sometimes you get Charity Dean,

but sometimes you get
the retired veterinarian

who'd rather be breeding dogs

and is doing it kinda part-time.

So it's, it's

if that's kinda patchwork,

if that's our organization,

we have no ability to kinda coordinate.

And so the question is like,
how you move into that,

the existing arrangements, and change them

so that they can move together and have,

and the big thing is have cover from above

so that they can do what they do well

and not have to risk their jobs
every time they make a move

that saves a life.

So we've done nothing
to change the system.

What's happening right now, I think,

if I had to bet, I'm just guessing,

but just watching what's going on

in the Biden administration,

is that the Biden administration

completely understands the
CDC was inadequate to the task

and it isn't just that Donald
Trump was a bad president,

that actually we lack the mechanism

for dealing with this particular threat.

And the question is, like,
how do you introduce the idea

of another mechanism?

Or how you create a lever
at the federal level

that enables a coordinated response

of all these 3,500 separate
individual health officers?

And I think if I'm them,
I think the answer is

you gotta network 'em,

that it isn't a big, the
top test to provide cover,

but that the way you
strengthen this network

is by connecting all these
people in different ways,

and you resource them and connect them.

But I haven't, it's
still pretty early days

and you can forgive the
Biden administration

for they're pretty busy.

But I'm hoping and I'm guessing

they're thinking about what you do.

- And, Priscilla, maybe
you can speak towards this.

It seems like there may
be a role for philanthropy

and nonprofits to really lead the charge

for some of this or to fill in the gaps.

What's the role there, as you see it?

- Yeah, I think this is
still sort of nascent

and we're trying to figure out

how we can best support the public health

departments in our country.

It's a field in a sector that's
been chronically neglected

and underfunded.

And honestly, when we first came to help,

a lot of times it would,

there was the initial
conversation is like,

do you want something, the
public health department's like,

are we in trouble?

Do you want something from us?

Like, what do you want?

And like the first thing
to table that was like,

we just wanna help.

And so getting to a place where we have

a healthier support system

where we can have public
health departments

who can ask for things and get help

and have a vibrant nonprofit government

and sort of philanthropy partnership

where we can actually support
these groups effectively.

And ultimately, they are the groups,

they are the organization
that are gonna keep us safe

as a community.

And right now, they don't have access

to what they need to do their jobs.

- Can I tell a funny story
that's emblematic of this?

- Are you gonna tell
the fax machine story?

- You can tell it if you want.

- No, you tell the fax,
I like you telling it.

- I know some of you already
heard this, so forgive me,

but I do think it's one
of the more symbolic,

and I don't think it's
in the book, Michael.

So it's worth saying.

One of the issues with
our fractured system

or patchwork of jurisdictions

is they don't have information systems

that talk to each other.

And we need basic information systems

to transmit data back and forth.

And that fundamental
thing is missing actually

from a lot of public health.

And we ran into this like a brick wall.

We set up the COVID testing lab.

We have all these high-tech robots

and we have pretty
sophisticated data sciences

and information systems.

And it turned out that,
for some of our counties,

actually a lot of them, that the only way

that we could legitimately
get them records of results

was by fax machine.

And we didn't even own a fax
machine, we have to go buy one.

And then we bought a fax machine.

I thought it was gonna
be really embarrassing

to actually go to a board meeting and say,

we had to request funds
to buy a fax machine,

but that's another issue.

And one of our counties immediately said,

hey, why does your testing kind of suck?

We only got half the results yesterday.

And I said, that's ridiculous.

We did them all.

There's no way you only got half.

No, we only got half.

And after some debugging,

we figured out that the
circa 1990s fax machine

only had a 40 page buffer,

meaning after the first
40 pages of results,

it just stopped without an error

and they didn't get the other
70 patients' worth of data,

which, Florida, I mean, we were just,

we were flabbergasted.

As they woke, you guys should just buy

another fax machine that's better.

No, it's not in the budget.

We'd have to do a
requisition, this and that.

Like, oh my God, we're
gonna have to buy you

a fax machine, aren't we?

So Emily Crawford, who helped set up

the Biohub COVID testing
lab, she goes to Best Buy,

she takes curbside delivery

of the only fax machine model
that they actually sell,

drives it physically up north
to the county in question,

drops it off, and they're like,

oh my gosh, this is so amazing,
you bought us a fax machine.

And the question that they
gave us next blew me away.

They said, hey, when do
we need to give this back?

I'm like, oh my God.

We never want this back, never.

Keep it, please.

And then the final
anecdote to that is this,

oh, so who do we thank?

We thank Mark and Priscilla?

I'm like, Emily said, yeah,
yeah, that's for sure,

but the real person who
authorizes this is Joe DeRisi,

and they're like, who's that?

- So I have a question.

My question, and I never
really get into it in the book.

The book is such a story, it really was,

I left it to the reader
to figure stuff out,

rather than figure stuff out for them.

But one of the things that
just drops out of the story

is how much more highly functional

and efficient the nonprofit entities are

than either the for-profit
or the government.

And I would love your
thoughts on this subject.

Why is it that a nonprofit found itself

solving problems that
one ideology would say

the market was gonna solve

and the other ideology would say

the government's gotta solve?

- Oh, that's a Priscilla
question right there.

- Oh, I think we just had

the privilege of immense flexibility.

I remember calling Joe in February

and just being like, what should we do?

And it's just like, whatever
you, like think about,

think flexibly, like we're
willing to support you

and like being able to
make an impact here.

And Joe is not the only
group that we called,

but Joe took us seriously.

And he was like,

okay, here's where I
can add the most value.

So having like truly, from our,

what we did on our end was
like truly flexible funding

and really getting down to
what is the actual problem,

like the fax machine,
that needs to be solved.

It doesn't need to be sexy.

It just needs to work.

And Joe and a whole
bunch of students at UCSF

and Sam Hawgood, like,
just rolled up their sleeve

and made it happen.

- I think we should acknowledge,

and this is sort of building on that,

that the coronavirus
pandemic isn't over yet

On parts of the world
it's worse than ever.

We're seeing new variants.

We're dealing with vaccine
hesitancy in some communities.

And so in thinking about
where to direct the energies

moving forward, what's your
read on the current situation,

this is really for any of you,

and what do you think are the next steps

in things that still need to be done here?

- Wow, that's a big question.

Maybe I'll just lead off and
then Priscilla and Michael,

you guys should chip in.

But, first of all, I just wanna say

that the vaccine efficacy
has been tremendous,

especially the mRNA vaccines.

Our project with Diane Havlir
continues to this very day

in the Mission.

And that site is now a vaccination site

and we do prospective screening of people

that have been vaccinated to look

for so-called vaccine escapes.

And there really hasn't been any.

I mean, the efficacy is off the charts.

It's way better than what
I would've ever predicted

a year ago.

And so we're seeing
infection rates plummet.

We're seeing vaccine uptake
that's really positive.

I think we'll probably
hit 80% of San Francisco

by the first week of June or something.

And this is having a dramatic impact.

And so that part of the
pandemic is going really well

in terms of the vaccine,
the West Coast, and so on.

Now, I'm cautious here.

I'd like to see even faster,
even more aggressive uptake.

I'm really thrilled that
it's 12 years old and up now.

I just got my daughter vaccinated

and I can't wait 'till it drops down,

even down to kindergarten age.

But speaking to the rest of the world,

yeah, it's a huge danger.

The vaccine isn't being
distributed very evenly.

There's different versions of the vaccine

with different efficacy that
are in different places.

And there's been a sort of
a drop in, I don't know,

caution in some places that
have caused big outbreaks

like what we saw in India.

I don't know, Priscilla,
what do you think?

- I think this is a
case where like we all,

to be safe in our community,

we truly need to think
about our whole community.

And so like making sure
that, like, there is access,

especially for those
traditionally underserved

and also, honestly, like in this era,

it's really easy to get
into sort of stereotypes

or partisan tropes on sort
of why different folks

aren't getting the vaccine,

but this is the place where it really,

like going back to my physician training,

like we need to hear each person out

because each person we get vaccinated

keeps everyone else healthier.

And so, like, this is another place

where it's like regardless of sort of

what your political beliefs are,

regardless of sort of like

how you think this
problem should be solved,

and like we all need to get to a place

where we understand for ourselves

what we want for the vaccine
and then get vaccinated.

And so we've been, at CZI,

we've been looking at this
problem in supporting groups

and getting out information
rather to religious groups

or to physicians to actually
have the time and bandwidth

to answer people's questions.

Because with public health,
it's really, it's truly,

we need everyone to participate

to keep each other healthy and safe.

- Well, said.

We have a few more minutes.

I'm gonna try to bring it,

not that it's been a total downer,

but this stuff is heavy and weighty.

And we saw a lot of failures
at the federal level

and at other levels with testing

and shutting stuff down quick enough

and embracing social
distancing quick enough.

I'm curious, though.

Like, Michael, when you
write one of these things

and then you kinda look at it,

what are the bright spots here?

I mean, because there were some
amazing success stories here

and some of what the characters

in your book did was amazing.

We have not one, but several vaccines

essentially within a year.

So in looking at all this,
Michael, I'm curious,

what can we learn from the successes?

- So let me answer it this way.

I had this very unusual
experience writing a book

because on the one hand, the
subject is a downer, right?

It seems depressing.

On the other hand, I wrote in
a state of total exhilaration

for eight months and I couldn't figure out

what was so exhilarating.

I mean, it's not like
an unhappy book, right?

It's, dare I say, almost a
fun book about the pandemic

and it's these people
who electrify the thing.

It's Joe, it's Charity, it's
Carter Mecher, and so on.

And I think that all this way,

that there was a reason that
the United States in June,

in a study that was done in June of 2019,

was ranked most prepared of
all countries for a pandemic,

that the resources and talent
available at our fingertips

are extraordinary.

And it really is a bit like,

I feel like what has just happened

is if you took the Golden
State Warriors three years ago,

the one that had Durant on the team,

and somehow manage them to
like a 10 and 72 season,

and it's a catastrophe, right,

and everybody's kinda
moaning and groaning.

But then you walk in

and you look at what's in the locker room,

and you realize this is
not a not fixable problem.

If we didn't have like the talent,

we'd have a bigger problem.

And it's clearly a management,

kind of management coaching problem

and that the talent is not
being organized properly.

And I think that's a lot easier to fix

than the other kind of problem.

So I think that was partly
sort of like explain the spirit

in which the thing was operating.

And the second sort of, I
mean, this isn't exactly

a bright spot but it's
kind of a bright spot,

it's a point Charity Dean
makes at the end of the story,

that she looks at this, and
as tragic as it has been,

and it has been tragic,
a lot of people died

who really shouldn't have died,

that compared to what it could have been,

we got off lightly.

That you imagine the same,

you imagine it if it
was lethal in children,

if it was more lethal, you would've had a,

you would have a different
sort of catastrophe.

And her line is, mother
nature gave us a gift.

They gave us a gift to
get our act together,

It's revealed our weaknesses,

and now we at least have a
shot to do something about it.

And if we don't, shame on us.

But now we know what the problem is.

And I think there's some
hopefulness in that.

- I think that's a great place to wrap up.

Thank you so much.

I wanna thank today's guests,

Michael Lewis, Joe DeRisi, Priscilla Chan.

It has been an absolute pleasure
speaking with all of you

and reflecting on the pandemic.

Michael's new book, "The
Premonition: A Pandemic Story"

is out now.

Our full conversation
will be available later

on chanzuckerberg.com.

Thank you so much and take care, everyone.

- Thank you.
- Thank you.

- Thank you.
- A lot of fun, see you.