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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Out of the first crop of books relating to the coronavirus pandemic, this one seemed especially relevant. Author Richard Horton is the editor of the leading medical journal The Lancet which has been an important publication outlet for new research results on both the virus SARS-CoV-2 and the disease COVID-19. Having also served at the World Health Organization (WHO), Horton thus has had an insider’s view of the pandemic and here brings a sharp critique to bear on the sluggish political response in Europe and the US.
The COVID-19 Catastrophe: What’s Gone Wrong and How to Stop It Happening Again, written by Richard Horton, published by Polity Press in June 2020 (paperback, 133 pages)
As I have done previously, let me just briefly comment on what is not in the book. The COVID-19 Catastrophe really focuses on the science-policy failures that have allowed this disease to rampage out of control. At only 133 pages, this does not leave much room for anything else, so for a primer of the biological details known so far, I once again refer readers to Understanding Coronavirus.
Something that other books have only touched upon, but that Horton reveals more about here, is what happened in China in early January: how early warnings from doctors were gagged before the news reached Beijing, and how the WHO got involved. This culminated in the WHO issuing a PHEIC, a Public Health Emergency of International Concern, which is the most serious warning they can send into the world.
“Horton […] focuses primarily on the lessons not learned from the 2002–3 outbreak of the SARS virus. A painful highlight is the 2016 […] tabletop exercise Cygnus which simulated a scenario of pandemic influenza, showing that the UK was not prepared.”
Other books such as Spillover and COVID-19 have pointed out that virologists have been warning of the threat of pandemics for decades, and both books give detailed histories of previous pandemics such as HIV, Ebola, SARS, MERS, and others. Horton mentions these briefly but focuses primarily on the lessons not learned from the 2002–3 outbreak of the SARS virus. A painful highlight is the 2016 UK government tabletop exercise Cygnus which simulated a scenario of pandemic influenza, showing that the UK was not prepared. Even so, nothing much has been done with all this information. Horton blames it on a combination of factors. Complacency in the face of warnings. A widespread arrogant attitude that Western societies are somehow above nature, untouchable by disease. And the political unwillingness to place public health ahead of economic growth, which shows in the lack of stockpiling of medical supplies and protective equipment, the lack of investment in research and disease surveillance, and, worse still, continuous budget cuts in the health sectors of most developed nations.
When the inevitable finally did happen, subsequent actions, or lack thereof, only made things worse. This is where Horton is at his most strident, pointing out the weeks and months that passed in which governments did not prepare themselves, thinking they could somehow escape unscathed as if viruses respect borders; the too-little-too-late attempts to contain the virus through lockdowns; the political blame games rather than international collaboration; the confused, contradictory, and sometimes misleading messages from politicians towards the public (the UK and the US are mentioned in particular); the lack of protective equipment for medical personnel etc. If you have followed the news, this has become a sad but recognisable litany of failures by now.
“[…] months […] passed in which governments did not prepare themselves, thinking they could somehow escape unscathed as if viruses respect borders.”
The publisher described this book as hard-hitting, one reviewer mentioned it pulls no punches, The Guardian called it “a polemic of the first order”, and Revolutionary Socialism in the 21st Century “uncompromisingly scathing”. Horton labels Trump’s decision to cut funding to the WHO as a crime against humanity. The UK government’s claims that protective equipment was being delivered to the front lines and that healthcare workers were safe are called bare-faced lies. The failure of governments to protect their citizenry, gross incompetence. Perhaps by British standards Horton is outspoken, but the blunt Dutchman in me sees factual statements here, not hyperbole. I am not sure how you can come to any other conclusion.
Where the roles of China and the WHO are concerned, Horton is balanced. There were questionable things happening in China, and the Chinese government was downplaying the situation or actively suppressing information at various levels within its hierarchy. “There is a gap in the timeline of the pandemic […]” (p. 19) and we need “[…] a more detailed explanation of what took place in Wuhan” (p. 22), writes Horton. But at the same time, Chinese scientists, policymakers, and health workers have been extraordinarily committed and effective in acting and collaborating to contain and defeat this disease. The WHO is similarly described here as an imperfect bureaucratic institution, but one that nevertheless did what it could within its limitations (MacKenzie provided useful background information on these limitations in COVID-19, which Horton omits here). But do not be fooled by governments who are seeking to deflect attention, writes Horton: “to blame China and the WHO for this global pandemic is to rewrite the history of COVID-19 and to marginalise the failings of Western nations” (p. 88). If you take just one thing away from this book, this might well be it.
“”to blame China and the WHO for this global pandemic is to rewrite the history of COVID-19 and to marginalise the failings of Western nations“. If you take just one thing away from this book, this might well be it.”
In the final few chapters, Horton looks towards the future and becomes rather philosophical. He asks what the effects of COVID-19 are on human society so far and turns to the ethics of anthropologist Didier Fassin, highlighting an ethical trend of “biolegitimacy”, of seeing human life in purely biological terms, without considering the political conditions within which it exists. And he draws on the writings of Michel Foucault and Jeremy Bentham’s idea of the panopticon* when pondering what the need for enhanced disease surveillance will mean for our personal freedom. These sections feel somewhat sketchy. I am sure much more could be said about this, but Horton does not develop these themes further here. His list of what our post-COVID world should look like, coupled with his concerns about what will likely happen instead, are pages to take to heart though.
This short and punchy book contains some incisive reporting on how countries failed to act in the face of this pandemic. No doubt, future reporters can explore this topic in far greater depth for many more countries. But we must start this now. Horton has seen first-hand how political disinformation campaigns are already trying to rewrite the narrative of the pandemic. We must document these attempts, he writes, which makes The COVID-19 Catastrophe an urgent and timely book.
In closing, you might wonder how this book compares COVID-19 by journalist Debora MacKenzie, the subtitle of which is very similar to this book. A longer book, it provides more background information on previous pandemics, as well as the role of bats and the complexity of societies in the current one.
* The panopticon is an architectural design for prisons that allows complete surveillance by one security guard without prisoners knowing whether they are being watched.
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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Saying that the COVID-19 pandemic should not have happened will likely elicit one of two responses. Blaming China for initially trying to cover it up, or saying: “shit happens, this is speaking with the benefit of hindsight”. Appealing as these may sound, they are missing the bigger picture. The awful truth is that we have had this one coming for a long time.
COVID-19: The Pandemic that Never Should Have Happened, and How to Stop the Next One, written by Debora MacKenzie, published in Europe by The Bridge Street Press (a Little, Brown Book Group imprint) in July 2020 (hardback, 279 pages)
Seeing this is a very hot topic, I think it is worth pointing out what you will not find in this book before diving into the rest of the review. Despite the title, you will not find all that much about the virological, epidemiological, or clinical details of COVID-19 and the virus SARS-CoV-2. As we are still in the middle of learning the biological details, you are better off just keeping a close watch on the news. That post-mortem will have to wait—although the primer Understanding Coronavirus provides useful basics on what we know so far.
The clue is in the subtitle. Debora MacKenzie writes this book from her unique vantage point as a veteran journalist reporting on infectious diseases for New Scientist and other outlets for over 30 years. With the world’s attention on pandemics, now is the best moment to draw our collective attention to her shocking tale of neglect and complacency in the face of warnings from the scientific community. This was true when Quammen wrote Spillover, and it still holds today.
“The clue is in the [book’s] subtitle […] now is the best moment to draw our collective attention to [a] shocking tale of neglect and complacency in the face of warnings from the scientific community.”
Judging by what MacKenzie describes here, it has been a perfect storm of various factors that got us to this point. There was a surge of optimism in the 1970s: we eradicated smallpox, we had vaccines to prevent childhood diseases, and antibiotics stopped all sorts of harmful bacteria. A leading medical textbook at the time even declared the future of infectious diseases to likely be very dull. Research departments were downsized as funding dried up. Public health stopped being a state-funded public good as the medical industry was swept up in the wave of privatisation of the 1980s. And networks for research and disease monitoring in developing countries were cast off as excess baggage from colonial times. In short, high on its medical triumphs, the world grew complacent.
But our victory was short-lived.
Ever since AIDS went global in the 1980s, disease experts have been trying to predict what might be the next big threat. We all know of the rise of antibiotic-resistant bacteria, but we also have had plenty of viral near-misses, such as Ebola, Zika, SARS, and MERS. Seeing the relevance of the latter two—they are both caused by coronaviruses—MacKenzie covers their outbreaks in detail. And then there is a whole chapter on flu, the annual recurrence of which has become so routine that we have stopped calling it a pandemic. Next to straightening out the misconception that COVID-19 “is just another kind of flu”, this is relevant because what little governments have in the way of pandemic preparedness plans is based around flu outbreaks. And those prominently do not recommend containment measures: pointless for the fast-moving flu, but relevant for COVID-19.
“[…] MacKenzie asks: what about traditional Chinese medicine? Both horseshoe bats, which carry coronaviruses, and their faeces are ground up wholesale and used to, for example, treat eye infections.”
This is the background against which warnings have been issued and, by and large, ignored. The World Health Organisation (WHO) has had a list of the viral Most Unwanted for years, prominently mentioning coronaviruses. Disease experts, reporters (MacKenzie amongst them), and writers of popular books have sounded the alarm for years. But hey, we have had enough of experts, right? If that was not enough of a slap in the face of science deniers, she ruthlessly despatches some harmful conspiracy theories (no, this virus was not brewed up in a laboratory).
Before getting to proposed solutions, MacKenzie dives down a few rather relevant rabbit holes. One is a very interesting chapter on bats. Bats host numerous viruses that can jump to humans, so they warrant close monitoring. MacKenzie issues a plea to not shoot the chiropteran messenger: certain groups are important pollinators. Plus, and this will not go down well with some but is something I appreciated, human overpopulation and the accompanying encroachment into wild habitats are the root causes here. She dispels as a red herring the idea of pangolins as an intermediate host. But most interesting of all, she casts a shadow of doubt on the whole bushmeat and wet market story. Yes, bats are eaten in parts of the world, but they are usually larger fruit bats. Instead, MacKenzie asks, what about traditional Chinese medicine? Both horseshoe bats, which carry coronaviruses, and their faeces are ground up wholesale and used to, for example, treat eye infections. Next to that potential infection pathway, it involves catching and handling bats. So far this is speculation, but these are reasonable questions to ask. One of the things I really appreciated in this book is that MacKenzie does not mince her words and is not afraid to broach contentious topics.
The other seeming rabbit hole is that of the complexity of our societies. What if a more lethal pandemic emerges? This is a short trip into the science of complex systems, feedback loops, tipping points, resilience to shocks, global supply chains, and, ultimately, the possibility of rapid collapse. Oh, and, depending on your point of view, a (un)surprising list of typically undervalued and poorly paid jobs that actually keep society running.
“the most important lesson […] is recognizing that profit-driven market forces cannot deliver new vaccines and antibiotics. “
These two topics return in the extended list of seven lessons for the future with which MacKenzie sees the book out. Most of these involve changes at the international level. What we do not need now is blame games. What we do need is more openness and cooperation regarding disease surveillance. Despite some criticism of the WHO here, she also highlights just how limited their budget is, and how their hands are tied due to the sovereign rights of nation-states that can simply hide information and refuse health inspections. We need more preparation, both in the form of research and stockpiling of supplies. We need to recognize systems complexity and accept reduced efficiency (and thus increased costs) to allow more redundancy and resilience in global supply chains. But the most important lesson, I thought, is recognizing that profit-driven market forces cannot deliver new vaccines and antibiotics. This is not about “evil corporations”, it is simply that the risk of failure and the frequent lack of return on investment work against us. This is why we have governments that fund public goods.
MacKenzie admits that COVID-19, written as it was in a mere two frenetic months, is somewhat rough around the edges. Personally, I think illustrations would have helped to explain certain biological details that she presumes understood, and an index would have been useful. But given the circumstances, their omission is perfectly understandable. What the book does deliver is a perfectly-timed, intriguing, and revelatory story of the dangers of ignoring science. And for a debut book, this is all the more impressive.
In closing, you might wonder how this book compares to The COVID-19 Catastrophe by the editor of The Lancet Richard Horton, the subtitle of which is very similar to this book. That book is shorter, focuses exclusively on the science policy failures, and leaves out a lot of the background provided here and elsewhere. It does, however, provide an insider’s perspective of someone who worked for the WHO.
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 world in the throes of the COVID-19 pandemic, the questions posed by the subtitle of this book are on everyone’s mind. Associate Professor at the London School of Hygiene & Tropical Medicine Adam Kucharski here takes the reader through the inner workings of contagion. From violence and idea to financial crises and, of course, disease – some universal rules cut right across disciplines. So, is this the most topical book of the year? Well, yes and no.
The Rules of Contagion: Why Things Spread – and Why They Stop, written by Adam Kucharski, published in Europe by Profile Books in March 2020 (hardback, 341 pages)
Kucharski is uniquely positioned to write a wide-ranging book like this. Next to his current position, he is trained in mathematics and did a spot of interning with a bank when the 2008 financial collapse hit. As such, he is at ease explaining both epidemiology and investment banking.
On the disease front, Kucharski covers recent outbreaks of fairly novel diseases such as Zika (which he encountered first-hand in Fiji in 2015), AIDS, Ebola, and SARS. He does not provide the full history of these the way David Quammen did in Spillover, but nevertheless gives you the relevant points in a concise form. Similarly, there is attention for some historical cases such as the miasma theory (the idea that bad air was behind diseases) and how John Snow’s work on cholera in 1850s London disproved this.
Particularly relevant to this moment in time are the epidemiological details, the titular rules of contagion. Kucharski introduces you to the SIR model, which describes how people move through three groups during a disease outbreak (Susceptible, Infectious, Recovered), how this plays into the concept of herd immunity, and how vaccination influences this. He explains the reproduction number R, its four components, abbreviated DOTS (R = Duration × Opportunities × Transmission Probability × Susceptibility), and how this explains why measures such as washing your hands and social distancing have an effect. And then there are those mysterious superspreaders which requires Kucharski to delve into network topology (the architecture of connections in a network). Having read this book, you should come away with a far better understanding of these parameters and mechanisms.
“here is the kicker of the book: these rules [of contagion] are not unique to disease outbreaks.”
But here is the kicker of the book: these rules are not unique to disease outbreaks. Ideas from public health can and have been applied to numerous other fields. This sees Kucharski branch out widely and cover a huge number of seemingly unrelated topics. His internship with a bank has given him an insider’s view of financial contagion, allowing him to clarify pyramid schemes and financial bubbles, but also how the notion of superspreaders applied to the 2008 banking crisis.
The transmission of ideas similarly follows many patterns seen in disease outbreak, although Kucharski is careful to consider ideas other than social contagion for how information spreads. His reminder of some of the psychological biases that can hinder or encourage the spread of information is a topic that will never lose its relevance. On the other side, online contagion can be encouraged by e.g. social media companies who apply epidemiological knowledge to viral marketing and the never-ending battle for your attention. This has a darker side too, ranging from echo chambers and online manipulation to the privacy concerns of many citizens about the amount and nature of data harvested by these companies.
Of course, you cannot talk about technology without touching on computer viruses, and Kucharski is equally capable of writing engagingly about computer viruses and worms, malware, botnets, DDoS attacks, or the danger of poorly secured devices that are forming the Internet of Things (see also the forthcoming Crime Dot Come and my review of Industry of Anonymity). Or what of the little-known habit of programmers to borrow pieces of code for online applications that all need to be called on, creating a vulnerable chain of dependency? This chapter might at the outset feel like a digression. But Kucharski beautifully circles back to the topic at hand by showing the parallels between virus evolution in both living and artificial systems. It is a neat writing tactic that crops up several times.
“One particular example that made me squeal with delight was how phylogenetics […] can be applied to […] the history of folk tales.”
More eye-opening for me was the long history of applying epidemiological ideas to public health. The spread of violence, riots, even suicide, can be studied and understood in this framework. One topic that made me squeal with delight was how phylogenetics (the study of evolutionary relatedness by identifying common ancestors) can be applied to a completely different field such as the history of folk tales.
From the above, it is clear that, next to disease outbreaks, The Rules of Contagion ricochets off a huge number of topics. Not all of these will interest everyone, but the enthusiasm with which Kucharski covers them is tangible, and the universal relevance of the epidemiological rules striking. Some of his metaphors are particularly lucid. Of models, he writes that they are “just a simplification of the world, designed to help us understand what might happen in a given situation […] particularly useful for questions that we can’t answer with experiments“. While of the difficulty of applying phylogenetic analysis to a slowly evolving pathogen, such as measles, he writes it is “a bit like trying to piece together a human family tree in a country where everyone has the same surname“.
“[…] of the difficulties of understanding the spread of a pathogen that evolves only slowly […] he writes it is “a bit like trying to piece together a human family tree in a country where everyone has the same surname“.”
The timing of publication of this book was uncanny, right as the COVID-19 pandemic started ramping up around the world. This presents both a blessing and a curse. On the one hand, there is a sudden, huge interest in the topic of epidemiology, and the publisher has understandably been keen to emphasize this while marketing The Rules of Contagion. On the other hand, its publication in March 2020 meant that the writing for it will have finished when the pandemic was but Chinese whispers on the wind.
Given the urgency with which people now want accessible information, many will come to this book with a narrow focus of interest and might end up frustrated or disappointed with what they see as too many irrelevant asides. Some Amazon reviews suggest this has already been the case. Personally, I think this is both unfair and misses the point. One only has to look at Kucharski’s Twitter feed to see how involved he is with the ongoing pandemic. If he had finished writing it later, would it have been a different book? I would not be surprised if the paperback* will contain a new introduction or post-script. Or Kucharski might follow Quammen’s example. A year after Spillover was published he excerpted and adapted part of it at the start of the 2014-2016 Ebola outbreak.
Whatever Kucharski will do next, here is a writer to keep an eye on. The Rules of Contagion is an incredibly engaging piece of cross-disciplinary popular science that will hold its relevance well beyond the COVID-19 pandemic.
* Update February 2021: Having leafed through a copy of the UK paperback, I can confirm that Kucharski has chosen to update some sections of his book to reflect the events of 2020.
Disclosure: The publisher provided a review copy of this book. The opinion expressed here is my own, however.
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, Ours is the latest generation to be engaged in a blood-soaked conflict that has lasted millennia. The quote “we have met the enemy, and he is us” might come to mind, but no. Rather, as E.O. Wilson once wrote: “It is the little things that run the world“. Historian Timothy C. Winegard here offers a sweeping history of major turning points in human history observed through the compound lens of the mosquito. With an estimated compound death toll of 52 billion an insect that is truly worthy of the title “destroyer of worlds”.
The Mosquito: A Human History of Our Deadliest Predator, written by Timothy C. Winegard, published in the US by Dutton Books in September 2019 (hardback, 480 pages)
Though readers might be suspicious of single-cause explanations for historical events, the general thrust of environmental history books such as these rings true: our historical narratives are particularly enamoured with pivotal wars, politics, religion, and economics, while side-lining the influence of environmental factors. As Winegard shows, though, those stories are no less fascinating.
After a short overview of the mosquito, the diseases it can harbour, and the genetic defences humans have evolved against malaria in particular, Winegard takes the birth of agriculture as the starting point of our shared history. Or, as he so poignantly puts it: “cultivation was shackled to a corpse“. Land clearance, irrigation, and the keeping of livestock all brought us a lot closer to mosquitoes and created the perfect feeding and breeding grounds for them. Out of agriculture rose city-states, commerce, and conflict, all of which encouraged the spread of disease.
The role of trade was highlighted in Mark Harrison’s book Contagion. Winegard focuses more on conflict, which is not entirely surprising given his background as an officer and his previous books on military history. In colourful prose, often steeped in military metaphors, he takes the reader on a riveting tour of duty through prominent theatres of war.
“[…] “cultivation was shackled to a corpse“. Land clearance, irrigation, and the keeping of livestock all brought us a lot closer to mosquitoes […]”
Winegard covers ancient history with Ancient Greece and the military campaigns of Alexander the Great, Ancient Rome (with a nod to Harper’s magnificent The Fate of Rome), the Crusades, and the Mongol hordes of Genghis Khan and subsequent barbaric invasions. More modern history follows with the period from the “discovery” of the Americas, the Columbian Exchange, and African slavery, all the way to the First and especially Second World War. Given my limited knowledge of these periods, I was particularly interested reading about the colonial war games between Spain, France, Britain over Caribbean colonies, and the conflicts and revolutions giving rise to the modern United States, followed by the American Civil War.
This tour of duty takes up the lion’s share of the book and is neatly divided over a series of absorbing and very readable chapters. Winegard convincingly shows how, at every turn, General Anopheles stalked the battlefields, attacking people indiscriminately. The death toll from malaria, yellow fever, dengue and other diseases is mind-numbing, virtually always overshadowing combat casualties, sometimes by an order of magnitude.
Insidiously, as Winegard shows, it did not take military commanders long to cotton on to that. The causes of these diseases may have long escaped us*, but the correlations did not. Starting very early on, a preferred battlefield strategy was to use local terrain to one’s advantage. By forcing, luring, or manoeuvring enemy troops into swampy areas, mosquitoes could take a heavy toll, after which the weakened and decimated survivors could easily be mopped up.
“The death toll from malaria, yellow fever, dengue and other diseases is mind-numbing, virtually always overshadowing combat casualties, sometimes by an order of magnitude.”
Despite Winegard’s initial assertion that historians often neglect the role of disease, this is far from the first popular book that tries to take in the fast sweep of history. Diamond’s Guns, Germs and Steel, McNeill’s Plagues and People, and Shah’s The Fever are but three examples. Indeed, Winegard’s notes are a treasure trove of references for further reading, showing the amount of work he has ploughed through in the writing of The Mosquito. The books mentioned here so far are but a sample.
What I particularly liked about Winegard’s writing was that he does not shy away from unpleasant observations and some healthy historical correctives. There is his amusing takedown of the fabricated narrative around Pocahontas: “In Disney’s vision, Pocahontas and Smith run barefoot through the utopian natural splendor of the New World, frolicking in its idyllic waterfalls. In truth, the situation in Jamestown was a cannibalistic, mosquito-ravaged mess“. Others are more serious, such as his observation that the African slave trade flourished in part because some African tribes willingly captured and sold enemy tribe members to Europeans. Some are ruthlessly pragmatic: “a sick soldier is just as useless to the war effort as a wounded soldier, and twice the burden of a dead soldier“. Others downright chilling: during the Second World War the US was scrambling to find a cure for malaria, using inmates as voluntary test subjects in experimentation that “mirrored the Nazi procedures being carried out on Jewish prisoners at Dachau“.
“Winegard’s writing […] does not shy away from unpleasant observations […] Some are ruthlessly pragmatic: “a sick soldier is just as useless to the war effort as a wounded soldier, and twice the burden of a dead soldier“.”
The final few chapters chronicle how the mosquito was finally unmasked in 1897 as the agent of disease transmission, and the temporary success story of pharmaceuticals and the insecticide DDT in combating malaria during and after the Second World War. A premature feeling of victory, indiscriminate use of these cures, and the profit-motive of pharmaceutical companies all have led to insufficient research on new cures, quickly resulting in resistant mosquitoes threatening humanity once more (a pattern that is seen more widely). Winegard briefly discusses CRISPR as the latest weapon in our arsenal and seems hopeful this could go a long way in fighting back.
If you are fond of big history books, The Mosquito is easy to recommend. Winegard has written a captivating and absorbing narrative history book that serves as a powerful reminder just how much disease has plagued us in the past and just how large a share of this is courtesy of a certain diminutive flying insect with a stinging proboscis.
*The word malaria, for example, comes from the mediaeval Italian “mala aria”, meaning “bad air”, pointing to the long-held miasma theory that blamed noxious fumes associated with marshy and swampy areas for the disease.
Disclosure: The publisher provided a review copy of this book. The opinion expressed here is my own, however.
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“Virusphere: From Common Colds to Ebola Epidemics: Why We Need the Viruses that Plague Us“, written by Frank Ryan, published in Europe by William Collins (a HarperCollins imprint) in March 2019 (hardback, 278 pages)
Ah yes, that was the subtitle of Michael Cordingley’s book (see my review of Viruses: Agents of Evolutionary Invention). With Virusphere, Ryan has written a book along largely the same lines, although it is a good deal more accessible than Cordingley’s. A good two-thirds of the book is a catalogue of disease and a history lesson in microbiology.
We are introduced to Charles Chamberland and Louis Pasteur’s germ-proof porcelain filter, which was vital in establishing that some disease-causing agents were very tiny indeed. Or the famous story of how in 1854 London, anaesthetist John Snow linked cholera to contaminated drinking water, ultimately leading to improvements in sanitation in cities. Or how we rid the world of smallpox.
But foremost it is an opportunity for Ryan to entertain the reader with facts and first-hand encounters with viral diseases: measles, flu, polio, norovirus, smallpox, hantavirus, HIV, Ebola, rabies. Some of these are the subject of dedicated books (e.g. Virus Hunt: The Search for the Origin of HIV/Aids, Ebola: Profile of a Killer Virus, and my review of Spillover: Animal Infections and the Next Human Pandemic), but in case you want to read just one book, Ryan has got you covered. It is not all horror stories though. His message that the vast majority of viruses are innocuous to humans and vital components of organisms and ecosystems is echoed by Rob Dunn regarding bacteria and insects (see my review of Never Home Alone: From Microbes to Millipedes, Camel Crickets, and Honeybees, the Natural History of Where We Live).
“The virus particles that burst out of an infected cell and linger in the environment, waiting for a new host? Ryan likens them to dormant seeds rather than inanimate matter.”
Ryan is an admirer of the thinking of Lynn Margulis and mentions her ideas on symbiosis and holobionts in several places (the latter term refers to the whole formed by two or more interacting partner species, see also Symbiosis as a Source of Evolutionary Innovation). The idea that viruses and hosts live in a symbiotic relationship – encompassing parasitism, commensalism, and mutualism – is an idea he has been pushing pretty relentlessly for a few decades now (see his previous books Virus X: Understanding the Real Threat of New Pandemic Plagues, Darwin’s Blind Spot: Evolution Beyond Natural Selection, or Virolution). He teases the reader with this idea from the start, but it is not until chapter 16 that he finally develops it. Judging from the many references each chapter suddenly receives (and the numerous notes I was taking), this is really where the book gears up.
Biologists have typically portrayed viruses as parasites that straddle the border between life and non-life. Ryan goes against that grain, preferring to pull viruses into the domain of the living. Yes, they depend on their hosts for their replication, but virtually all organisms (bar the rare autotrophic bacterium) depend on other living organisms in the web of life. The virus particles that burst out of an infected cell and linger in the environment, waiting for a new host? Ryan likens them to dormant seeds rather than inanimate matter. He ends the book making a case for considering viruses as the fourth domain of life (in addition to the three that Carl Woese defined, see my review of The Tangled Tree: A Radical New History of Life).
I went into this a bit sceptical, but Ryan gives some fascinating examples. Starting with a scene straight out of the pen of Matt Simon, that of a wasp injecting eggs into the living tissue of a caterpillar (see my review of Plight of the Living Dead: What Real-Life Zombies Reveal About Our World – and Ourselves), Ryan adds the observation that there is a third partner involved. To turn the caterpillar into a zombie larder requires a virus that is injected along with the wasp’s eggs. A nice example of mutualism, where both virus and wasp profit from each other. And what of the bacteriophages (viruses that infect bacteria) that release both a persistent toxin and a short-lived antitoxin? This leaves the host with no option but to accept the virus. If it kills the virus, it will succumb to the toxin.
“To turn [a] caterpillar into a zombie larder requires a virus that is injected along with the wasp’s eggs.”
We furthermore know that viral genes become incorporated in the genome of hosts. Especially retroviruses such as HIV-1 do this (more on those in Discovering Retroviruses: Beacons in the Biosphere). The striking bit, as Ryan explains, is that some of these inserts have been repurposed by hosts as regulatory regions to control the transcription of their own genes. And the research he mentions that shows that such retroviral material has been implicated in the evolution of the mammalian placenta caused me to do a double take on that paragraph. I’m afraid that Cordingley already blew my mind with the concept of viruses as quasispecies (something which Ryan mentions, but Cordingley did a better job of explaining). Curiously, Ryan, too, completely omits any mention of CRISPR (see my review of A Crack in Creation: The New Power to Control Evolution). This is another striking example of incorporation of viral DNA in the host’s genome, in this case post-infection to be used in future host immune responses.
Ryan’s writing has its stylistic idiosyncrasies. Introducing viruses, he asks how we can study such minuscule entities, suggesting “that there is an obvious guide […] whose perspective has only recently been opened up to us in wonderful detail through the deepest penetration of the living world by the enlightenment of modern scientific techniques” (p. 5). On parents who have children with a fever, Ryan remarks: “How natural that our hearts should falter with the beloved child temporarily tossing in a perspiring fever […]” (p. 33). I cringed a bit at his mention of readers as “ordinary folk”, which is only mildly better than the patronising “common man” I sometimes come across. Throughout the book, his colleagues are esteemed, distinguished, eminent; the ideas novel, astonishing, profound. I personally found it a bit grandiose and self-aggrandising in places. It will no doubt depend on your taste in writing what you make of that, but it distracted somewhat from my pleasure in reading this book.
Because, make no mistake, Virusphere is a fascinating book that is well structured, with short, absorbing chapters. As Ryan makes clear, in many areas we have only started scratching the surface, and the potential of new techniques such as metagenomics (the study of genetic material recovered directly from environmental samples, really useful to find viruses) still has to be fully appreciated. Whether future researchers will remember Ryan as a pioneer in the vein of Margulis remains to be seen, but Virusphere makes an engrossing and fervent argument that he is on to something.
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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“Viruses: Agents of Evolutionary Invention“, written by Michael G. Cordingley, published by Harvard University Press in June 2017 (hardback, 373 pages)
And let there be no mistake, viruses are unusual. They straddle the border between living and non-living matter. By themselves, they are inert collections of nucleic acids (either RNA or DNA), often, but not always, wrapped in a protein capsule. They don’t eat, they don’t breathe, they don’t move. For all intents and purposes, they are just another collection of macromolecules that make up the world. But give them a living host and they appear alive: invading, multiplying, and evolving. In the first few chapters, Cordingley highlights many peculiarities and traits that make viruses so important and unique in evolution, and I will highlight three of them here.
For one, they are numerous. Because viruses can infect all lifeforms, including microbes (themselves already very numerous) the virosphere contains an astronomical number of individuals at any given time. A conservative estimate of 1031 viruses is mentioned. This is a lot of genetic information for natural selection to work with. The viruses that infect microbes, bacteriophages, make up a large part of this and reproduce quickly due to the short generation time of bacteria.
Second, viruses literally inject their genetic material into cells, and some of it can and will be accidentally incorporated into the host’s genetic blueprint (its genome). This means genetic information is not only moving between generations – from parents to offspring during conventional reproduction – but also within generations in a sideways fashion, which is known as horizontal gene transfer. Quammen further explores the importance of this in The Tangled Tree: A Radical New History of Life, but consider for a moment that this mechanism is implicated in the speed with which bacteria can develop resistance to antibiotics, previously discussed in Superbugs: An Arms Race Against Bacteria. The incorporation of viral DNA in the host’s genome is directly causing mutations and generating variation on which natural selection can act.
“For all intents and purposes they [viruses] are just another collection of macromolecules that make up the world”
The final example I want to highlight are RNA viruses, such as the poliovirus. Replication of RNA, the single-stranded relative of double-stranded DNA, is notoriously messy. Error rates are as high as one per 1000 to 10,000 bases, compared to one per ten million bases for DNA viruses (a base is the unit of genetic information, consisting of an organic molecule known as a nucleotide – in DNA these occur in pairs, hence base pairs, which form the familiar double helix when strung together). This means that the individuals in a population of RNA viruses are so genetically diverse you can’t really call them conventional species anymore. Cordingley introduces the concept of quasispecies: diffuse groups of closely related but genetically distinct individuals. This hypervariability makes viruses particularly adept at adapting. When environments change, the genetic variation present in a population of “conventional” organisms is probably not enough to immediately supply an individual that is optimally adapted, so further evolution will happen. As environments are constantly changing, in reality this means that most “conventional” species are constantly lagging behind, chasing the evolutionary optimum. The hyperdiverse members of an RNA virus population, meanwhile, are far more likely to already have well-adapted members present when environments change, which will immediately be favoured in reproduction. I had not heard of this concept before, but it blew my mind when considering it.
A large part of the book deals with human viruses and the diseases they cause: influenza, HIV-1 and AIDS, ebolavirus, cross-species infections and animal reservoirs of viral zoonoses (i.e. diseases that can be transmitted from animals to humans), and the unique world of retroviruses. Most of these topics have been the subject of dedicated books (e.g. Virus Hunt: The Search for the Origin of HIV/Aids, Ebola: Profile of a Killer Virus, and my review of Spillover: Animal Infections and the Next Human Pandemic), though not yet retroviruses. This group *must* nestle themselves into the host’s DNA before they can replicate, which means they are by definition heritable. In contrast, most other viruses will use their host for their own replication, but if the host survives and reproduces, the viral DNA is not passed on to the host’s offspring. Skalka writes more about these unique viruses in Discovering Retroviruses: Beacons in the Biosphere.
“the concept of quasispecies […] blew my mind”
In all these chapters, the focus is on the mechanics of these viruses and the particular evolutionary viral tricks they use. While introductions are light and terminology and concepts are explained, the reading quickly gets technical, sometimes to the point that I felt I was reading a journal paper rather than a popular science book. Although I found Viruses an incredibly fascinating book, I can’t say it is easily accessible. A basic understanding of microbiology is a must to really get the most out of this book. The lack of a glossary doesn’t help, but probably the biggest drawback is the complete absence of illustrations. The many complicated and often theoretical concepts could have been made much more accessible by illustrations. A Crack in Creation: The New Power to Control Evolution is a shining example of illustrating concepts in bacterial and viral genetics. Given the diversity of topics covered here, the number of required illustrations would perhaps have been prohibitive.
Speaking of A Crack in Creation, given what we now know about the incorporation of viral DNA in the host’s genome post-infection to be used in future immune responses, I was surprised to find no mention of CRISPR in this book whatsoever. Not even in the chapter on using viruses as human tools that covers such topics as the use of viruses in vaccines, as biological control agents, or as agents to combat cancer. It seems like an odd omission in an otherwise very thorough and wide-ranging book.
Though not a popular science book such as, say, A Planet of Viruses, Cordingley nevertheless provides an up-to-date and detailed account of the evolutionary power and prowess of viruses that should appeal to biologists with an interest in evolution or microbiology.
Disclosure: The publisher provided a review copy of this book. The opinion expressed here is my own, however.
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“Superbugs: An Arms Race Against Bacteria“, written by William Hall, Anthony McDonnell, and Jim O’Neill, published by Harvard University Press in April 2018 (hardback, 246 pages)
Superbugs: An Arms Race Against Bacteria is a small book written by two economists and a public policy professional, and follows on their work on the independent Review on Antimicrobial Resistance, which was commissioned by former UK prime minister David Cameron and published in May 2016. The book chronicles the rise of resistant bacteria (you may have seen headlines mentioning MRSA, which is a microbe resistant to methicillin), and why this rise has happened. Part of the failure to develop new antibiotics has to do with the complexity of the science. But far more important are economic and political problems. A combination of the long time required before a drug is approved due to the trials that are needed and the limited duration of patents on these drugs means that it is economically not attractive for pharmaceutical companies to invest in researching new ones.
The second part of the book outlines the solutions proposed by the authors to address this problem. They cover what incentives are required to stimulate drug development, how to prevent disease transmission, how to reduce the use of unnecessary antibiotics in humans, and the need to tackle the abuse of antibiotics in the livestock sector. That last point might come as a surprise to many readers, or so claim the authors. However, I think that animal welfare campaigners have been tabling this topic for long enough for it not to be a particular secret anymore. The reason that the overuse of antibiotics in livestock is so problematic is that these are very similar to the ones used in humans, which means that we are shooting ourselves in the foot – this is another way to encourage evolution of drug-resistant bacteria.
Throughout the book, the authors include quotes and fragments of interviews they have had with scientists and policymakers, providing interesting viewpoints. Lucidly written, the book is far from alarmist, but the situation it sketches is very alarming nevertheless. Whether the solutions proposed here can be put into practice in a timely manner (if at all) remains to be seen. But this is one of those books that you hope will end up in the hands of politicians, for they need to understand the severity of the threat we are facing. One only has to think back to the 2013-2014 Ebola crisis (see Ebola: Profile of a Killer Virus) to realise how difficult it is to control disease outbreaks once they occur. Beyond that group, this book is an excellent primer and overview of the what, how, why, and the “what now” of antibiotics and resistant bacteria that should be widely read.
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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