Last year August, science writer Ed Yong put it very nicely: “you see, the immune system is very complicated“. Yet, understanding it is important to understanding how the COVID-19 pandemic might evolve, why we are faced with certain public health measures, and how we can hope to combat the pandemic with tests and vaccines. In this brief book, physics and chemistry professor Arup K. Chakraborty and immunologist Andrey S. Shaw offer a general introduction to how our immune system reacts to viruses, and how our medical inventions help out.
Viruses, Pandemics, and Immunity, written by Arup P. Chakraborty and Andrey S. Shaw, published by MIT Press in February 2021 (paperback, 206 pages)
I was particularly looking forward to this book. Amidst the growing crop of books on COVID-19, the immunological details have been somewhat neglected. Kucharski’s The Rules of Contagion looked at the epidemiology of disease outbreaks but was written just before the pandemic materialised (the paperback addresses this to some extent), while Rabadan’s Understanding Coronavirus does what it says on the tin, focusing on the virus, SARS-CoV-2, and the disease, COVID-19.
Viruses, Pandemics, and Immunity is nicely balanced in the way it treats all the relevant elements to understand this topic. You get two chapters with history, introducing you to early procedures and to important scientists such as Edward Jenner, Robert Koch, and Louis Pasteur. By the end of it, you will understand the difference between variolation and the vaccine methods of respectively Jenner and Pasteur. This is followed by three chapters with the scientific nuts and bolts, looking at viruses, the immune system, and epidemiology, and two final chapters looking at the medical countermeasures of antiviral therapies and vaccines. In all of these chapters, details and findings on SARS-CoV-2 and COVID-19 are highlighted.
“Viruses, Pandemics, and Immunity is nicely balanced in the way it treats all the relevant elements to understand this topic, [highlighting] details and findings on SARS-CoV-2 and COVID-19.”
I admit that I found the middle three chapters a bit hit and miss. The one on viruses is, I think, great, explaining how viruses work by taking over the host cell’s replication machinery, how DNA and RNA viruses differ, why COVID-19 went global while SARS and MERS—also caused by coronaviruses—did not, and how SARS-CoV-2 differs from other RNA viruses that we understand better, such as influenza and HIV.
In light of what I said earlier about the immune system, it is not surprising that the chapter on immunity is the longest. It introduces the two components of our immune system, innate and adaptive, and how both function when the body detects an intruder. The innate immune system is, relatively speaking, the simpler of the two, responding to infection immediately by recognizing general characteristics of bacteria, viruses, and fungi. The authors can describe this in five pages, including details on Toll-like receptors and cytokines. The adaptive immune system needs more time to gear up, 5–10 days in humans, and is the more complex of the two. In some 20 pages, the authors here introduce the byzantine arrangement of B lymphocytes that combat viruses directly, and T lymphocytes that destroy infected cells in the body, as well as the memory cells that both types contribute. But rather than discuss the innate and adaptive immune system in the order in which they get activated, the authors discuss them in reverse order, which I found a bit counterintuitive. Given the complicated nature of the beast, the level of detail might challenge readers not well-versed in biology, though a helpful “putting it all together” section runs you through it all again at the end of the chapter.
“Given the complicated nature of the [immune system], the level of detail might challenge readers not well-versed in biology, though a helpful “putting it all together” section runs you through it all again […]”
Similarly, the chapter on epidemiology explains the relevant concepts: the basic reproductive number R0, epidemiological models, the effects of public health measures (“flattening the curve”), and herd immunity. The authors also highlight why different countries have been less or more successful in addressing the pandemic, something that will be explored in-depth in Fighting the First Wave. But here, too, the writing sometimes gets a bit complex. The authors spend three pages on a convoluted explanation with numerical examples to tell you that the more infectious a virus is, the higher the fraction of your population that needs to be immune before herd immunity kicks in. Furthermore, they exclusively discuss social distancing and different strategies to achieve herd immunity, from intermittent lockdowns to simply “weathering the storm”. But the two other pillars of public health measures, hand washing and face masks, are not even mentioned, even though they make important contributions to reducing R0.
The last two chapters are spot on again, focusing on the two main weapons in our medical arsenal. Antiviral therapies block one or more steps (entry, replication, assembly, and release) in the viral lifecycle and there is a brief discussion of existing antiviral therapies such as remdesivir and dexamethasone that have been repurposed for use against SARS-CoV-2. Vaccines, then, stimulate our immune system and this is where the immunological details come in again. How to Make a Vaccine covers all these topics in more detail, but there is a good introduction here to the different types of vaccines, clinical trials, and vaccine development, as well as the logistical challenges of the currently required large-scale production and a brief note on why vaccines are safe and certainly preferable over the alternative. Unavoidably, when discussing promising vaccine candidates against COVID-19, some information is already dated. The Moderna vaccine was undergoing trials when this book was written, while the AstraZeneca and Pfizer ones were in the developmental stages. All three are now being rolled out.
“[…] the book is livened up with cartoony illustrations [though] the decision to not include figure captions limits their utility.”
Throughout, the book is livened up with cartoony illustrations by Philip J. Stork, a senior scientist at Oregon Health & Science University. However, the decision to not include figure captions limits their utility in my opinion. Despite annotations in the figures, some are quite cryptic by themselves. Captions could have formed the perfect bridge and condensed the sometimes complex details found in the body of the text.
Viruses, Pandemics, and Immunity bundles introductions to a number of relevant topics, effectively replacing the need to e.g. get several Very Short Introductions. By highlighting what we know about COVID-19 and SARS-CoV-2 for each of these topics, this welcome book plugs a gap, especially where the immune system is concerned. General readers will want to heed Yong’s warning though, because, you see, the immune system is very complicated.
Disclosure: The publisher provided a review copy of this book. The opinion expressed here is my own, however.
Other recommended books mentioned in this review:
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With the COVID-19 pandemic shaping up to be one of the most influential public health crises in living memory, it was only a matter of time before books would be written about it. One of the first to make it to press is Understanding Coronavirus by systems biologist and bioinformatician Raul Rabadan. Amidst the swirl of dubious and outright false information that is circulating, there is desperate need for a book that clears up misconceptions and gives a concise introduction to what we know about the virus so far. Given that he spearheaded research in 2009 that confirmed the animal origin of swine flu, Rabadan seems like the right man for the job. Is this the primer that everybody should have on their bedside table?
Understanding Coronavirus, written by Raul Rabadan, published by Cambridge University Press in June 2020 (paperback, 120 pages)
Understanding Coronavirus inaugurates a new series from Cambridge University Press called Understanding Life that offers concise introductions to current biological topics. If you are familiar with Oxford University Press’s Very Short Introduction series, this first book looks a bit like that: a slim, 120-page paperback that will slip in your average coat pocket.
The book consists of an introduction followed by seven chapters written in a question-and-answer format with the table of contents helpfully listing each question. Rabadan mentions it is written for the lay reader with minimal knowledge of biology, virology, epidemiology, or medicine. I would change that to “some knowledge” as it does get rather technical in places. Personally, I got along fine with it but I am somewhat hesitant to give this to, say, my mother.
What Understanding Coronavirus does very well is clarify virology and epidemiology basics. Asking how quickly the virus spreads means explaining the basic reproduction number R0 and concepts such as “flattening the curve” and herd immunity that everyone has been confronted with. It explains the symptoms, the typical course of the disease, how deadly it is, and that, yes, children and young adults get infected too, but their symptoms are usually less severe.
“What Understanding Coronavirus does very well is clarify virology and epidemiology basics [such as] the basic reproduction number R0 and concepts such as “flattening the curve” and herd immunity”
Next to these basics it also goes into the frequent comparisons made with SARS and influenza, something specific to this pandemic. Rabadan explains their origins and clarifies the differences and similarities with COVID-19. Regarding SARS, the viruses 
SARS-CoV and SARS-CoV-2 are very similar, but the diseases are different enough that the World Health Organization gave them two different names. Regarding influenza, Rabadan calls the comparison to COVID-19: “one of the most unfortunate and confusing metaphors from the beginning of the COVID-19 outbreak”. Although we can draw some useful lessons from previous influenza pandemics where public health measures are concerned, the two are not related by any stretch of the imagination. Also, can you explain the difference between seasonal and pandemic influenza? You will after reading this book.
All of this is supported by numerous colour illustrations that demystify concepts. Rabadan’s explanations are concise and the reference list at the back helpfully includes a short note on what each paper or book contains. But I feel that in the middle the book goes off-script somewhat and betrays Rabadan’s specific interests.
“[….] as a bioinformatician and computational biologist Rabadan is fascinated by the evolution of complex systems. […] Now, it is not that these topics are not relevant—because they are—but more to the research community than the average lay reader.”
See, as a bioinformatician and computational biologist Rabadan is fascinated by the evolution of complex systems. Thus he provides details on the molecular biology of SARS-CoV-2: its structure, the size and architecture of its genome, and the cell receptor (a protein called ACE2) that the virus uses to enter host cells. And he specifically discusses how the virus is changing: how we can draw up evolutionary family trees (phylogenetic trees) to track its spread and determine from what animal it jumped to humans (its zoonotic origin). For an evolutionary biologist such as myself, these are mightily interesting details: I did not know that, next to point mutations, viruses also evolve by recombination, just as many other organisms do. But I feel Rabadan almost forgets who he is writing for. For example, when discussing ACE2, he casually mentions that protein levels differ between men and women because (in brackets) “the gene is located on the X-chromosome”. To a biologist, this little throwaway clause makes sense (those are the sex chromosomes, women are XX, men XY, so women have two copies of the gene producing ACE2, etc.), but to most people, this will not be self-evident, I think.
Now, it is not that these topics are not relevant—because they are—but more to the research community than to the average lay reader. What they probably will want to know, and what I found noticeably missing, are questions regarding prevention. Why is washing of hands so important? Why is there a difference between using soap and bottled hand sanitiser? How and why do contact tracing strategies work? Why has there been such conflicting advice on wearing face masks? And how do they work? (hint: it is not just to protect you from others, but especially others from you.) What do we know about the survival of the virus on other surfaces? Can we transmit the virus via clothing or packaging material? Rabadan does mention viral half-life in water droplets and on metallic surfaces in one sentence, but I have been wondering about this. Since viruses are not really alive, they cannot really die. But apparently, virus particles can degrade or decay. How? Is that because of exposure to light or heat? Chemical instability with time? These are the kinds of mundane questions many people have.
“Unsurprisingly, the publishing floodgates have been opened […] amidst this deluge of books, you need to have your basics covered. […] Understanding Coronavirus provides a lot of relevant information in a very readable and concise format.”
One risk of a book published under the current circumstances is that it ages quickly. There is a brief “updates at press” section where Rabadan can just in time point out that hydroxychloroquine, initially considered a promising drug treatment, is not so effective after all, and mention that COVID-19 also seems to attack other organs. Of course, none of this is Rabadan’s fault: the science moves particularly fast in this area and you go with the best information you have at publication.
Unsurprisingly, the publishing floodgates have been opened. Already several books are in the making or due any moment, for instance the reportage COVID-19 from journalist Debora MacKenzie or the very critical The COVID-19 Catastrophe by the editor of The Lancet Richard Horton. Simultaneously, many publishers have spotted an opportunity to reissue older books on pandemics with some extra material: Sonia Shah’s 2016 Pandemic is reissued with a new preface, Mark Honigsbaum’s 2019 The Pandemic Century contains a new chapter, and David Waltner-Toews 2007 The Chickens Fight Back is updated and now titled On Pandemics. I am surprised that David Quammen’s Spillover has not been reissued yet (he has since revisited some of his interviewees for a piece in The New Yorker). And given that Ed Yong has been rehired by The Atlantic to cover the pandemic it does not seem like a crazy idea that he might write a book in due course as well.
Amidst this deluge of books, you need to have your basics covered. Despite a few topics being of interest primarily to scientists while a few other topics are not covered, Understanding Coronavirus overall provides a lot of relevant information in a very readable and concise format. And at this price, you cannot really go wrong.
Disclosure: The publisher provided a review copy of this book. The opinion expressed here is my own, however.
Other recommended books mentioned in this review:
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