So far, most of the books I have read on the COVID-19 pandemic have either been of the backwards-looking, how-did-we-get-here type, or have dealt with practical virological, epidemiological, or immunological details. I picked up Apollo’s Arrow as it promised a forward-looking perspective while drawing parallels with past pandemics. Nicholas A. Christakis, a physician and sociologist directing the Human Nature Lab in Yale, got drafted into working on the pandemic from the start, tracking the spread of the virus, and sat at the bedside of many dying patients while working as a hospice doctor in New York. I believe we need to hear these frontline stories.
Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live, written by Nicholas A. Christakis, published by Little, Brown & Company in November 2020 (hardback, 384 pages)
Accompanied by excellent infographics by Cavan Huang, Apollo’s Arrow provides you with all the basics in case you need them. Christakis starts with an overview of how the virus was first detected in China and then spread around the world. He details the differences with the SARS and Spanish Flu pandemics to explain why COVID-19 became so destructive, along the way introducing epidemiological parameters and details such as infection fatality rates, case fatality rates, the basic reproduction number R0, herd immunity, asymptomatic transmission, the concept of flattening the curve, and how exponential growth keeps catching us out. Usefully, he also discusses the full range of non-pharmaceutical interventions that we have at our disposal: physical distancing, mask-wearing (a basic topic some other authors have omitted), testing and tracing, border closures, and lockdown.
Throughout, Christakis includes eyewitness testimony of, and insightful comparisons to, past pandemics. From recent ones such as SARS, influenza pandemics in 1957 and 1968, and the Spanish Flu, to historical ones such as the bubonic plague or the plague of Athens, pandemics have long been with us, shaping the course of history. I think there is much value in providing historical perspective, and there is no shortage of recent books surveying pandemics through the ages, many now being reissued with new chapters or added prefaces. What sets apart Apollo’s Arrow is that it focuses on COVID-19 through the eyes of a physician who is interested in history. As Christakis discusses the short, medium, and long-term consequences of the pandemic, the past is a constant companion to show that “What happened in 2020 was not new to our species. It was just new to us” (p. 84).
“As Christakis discusses the […] consequences of the pandemic, the past is a constant companion to show that “What happened in 2020 was not new to our species. It was just new to us“”
There are the familiar companions of grief, over lives and livelihoods lost; fear, and the scapegoats on who we take it out; and lies, the conspiracy theories and propaganda. What has not helped the disease being taken seriously, Christakis writes, is that COVID-19 lacks visible symptoms. And with many people dying alone in healthcare facilities, “Americans did not see how the virus did its awful work” (p. 204). As has historically happened, much of the impact ran along the faultlines of existing inequalities, with groups such as Hispanic and African American communities, homeless people, prisoners, or meatpackers particularly hard-hit. But the coverage here is not all negative. Unsurprisingly from an author who wrote Blueprint, he highlights the healthcare workers who put their lives on the line, and the altruism and charity as everyday people helped each other in myriad ways. The penultimate chapter is a grab bag of observations and questions—some speculative, others less so—on how the pandemic affected for instance the environment, children and education, the economy and supply chains, jobs, religious beliefs, or practices in public health care.
I was particularly pleased to see Christakis repeatedly mention the Three Horsemen of the Apocalypse: “The lack of scientific literacy, capacity for nuance, and honest leadership” (p. 320). Unique to our time, social media provided “a bonanza of disinformation” (p. 151), while academic preprint servers containing unvetted information proved to be a double-edged sword. It has been galling to see basic, uncontroversial hygiene practices being drawn into politicized discussions over “personal freedom”, ignoring its partner-in-crime, “collective responsibility”. Or to see delusional wishful thinking, as if the pandemic “could end by fiat” (p. 319). Christakis reminds us that “[…] denial is an old ally of pathogens” (p. 157).
“[Unless] you have religiously kept up with the deluge of news items and opinion pieces on the pandemic […] this book is a welcome and well-written perspective from a qualified professional, looking forward from his particular point in time.”
For those inclined to unwarranted accusations at the address of “elitist academics”, the above is coming from a physician critical of his own profession. He thinks the privacy lost to contact tracing apps is not worth the limited epidemiological benefits and high likelihood of false positives. He remarks on the surprisingly small role of medicine in the historic decline of most infectious diseases, which are instead largely due to socioeconomic improvements and basic public health measures. And he points to iatrogenesis: illness or injury caused by medical actions, something that actually declined during the pandemic as many operations and hospital visits were delayed.
So far, so good. Christakis offers plenty of sharp observations to digest. I have, however, two caveats. First, as the publisher’s blurb also points out, this book is rather US-centric. Second, the book is dated in places. This is not a criticism of the author; rather, the pandemic is a rapidly moving target and I am to blame for reading this book as late as I have. Especially his concern that we might not have vaccines in good time seems cautious with the benefit of hindsight. Their rapid development has been a noteworthy achievement, and other authors are already lining up to tell these success stories. I hasten to add that it has been a typical human achievement, replete with follies such as vaccine nationalism as countries competed to secure supplies.
Even though some of Christakis’s questions and concerns have been supplanted by new ones, many others remain. If you have religiously kept up with the deluge of news items and opinion pieces on the pandemic, a lot has already been discussed since. But I imagine that for many readers, myself included, life will have gotten in the way. If so, then this book is a welcome and well-written perspective from a qualified professional, looking forward from his particular point in time. It does present the author and the publisher with a challenge for the paperback that is slated for October 2021. Reissuing the book as-is does not strike me as very useful. But bringing it up to date with the many developments since then would be a mighty task, tantamount to rewriting it. If Christakis were to go down the route of a thorough update, I have no hesitation in recommending that you buy the paperback upon release. I can see how the hardback will have been very impactful upon publication last year, and I found the comparisons with past pandemics to be particularly eye-opening.
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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