The author, Michael Lewis, explains that the premise of his 2018 book, The Fifth Risk, was that the federal government manages a portfolio of existential risks. In this book, he examined the Trump administration—focusing on energy, agriculture, and commerce—and posed this question: “What happens when the people in charge of managing these risks, along with the experts who understand them, have no interest in them?” (xiii). Months later, the COVID-19 pandemic hit, providing a perfect framework for that question.

In October 2019, the Nuclear Threat Initiative (partnering with Johns Hopkins and The Economist Intelligence Unit), created the Global Health Security Index, which ranked 195 countries by their preparedness to face a pandemic. In overall preparedness, the US placed first on the list. However, by February 2021, COVID-19 deaths in the US had reached 450,000, or 20% of the global total—and the US was among the top two countries in COVID mortality.

Lewis compares the Global Health Security Index to a football team’s preseason record, which predicts how well the team will fare in the regular season but isn’t a guarantee. When the COVID-19 pandemic began in earnest, it was clear to Lewis that the US preseason rankings wouldn’t guarantee victory.