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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A pandemic is probably a good moment to understand how vaccines are developed and how they work. This short and educational primer offers relevant background information on viruses and the immune system, and goes into much more detail on vaccines than other recent introductory books. How to Make a Vaccine is written by immunologist John Rhodes who brings to the table both his background in academic research on vaccines and his experience working for GlaxoSmithKline from 2001 to 2007. His narrative approach of choice is to tell the story of viruses, immunology, and vaccines through the history of scientific discovery.
How to Make a Vaccine: An Essential Guide for COVID-19 & Beyond, written by John Rhodes, published by the University of Chicago Press in March 2021 (paperback, 184 pages)
Some of these historical episodes were by now familiar to me. For example, Charles Maitland’s first variolation experiments on prisoners, Edward Jenner’s use of cowpox vaccine to combat smallpox, and the 1950s race for a polio vaccine between Jonas Salk and Albert Sabin. Or the bizarre history of the 19th-century maritime expeditions to distribute the first vaccines around the world, keeping them alive on the long journeys through a carefully orchestrated living chain of infection. Other episodes were new to me. For example that Jenner was not the first to experiment with cowpox vaccination. How Wendell Stanley first visualized viruses under an electron microscope in 1935, and how June Almeida first visualized coronaviruses in 1968.
The only place where I felt this historical approach broke down a bit was when it came to the immune system, which is a complicated topic. The components of our byzantine immune system were not necessarily discovered in a logical order, and I would have loved some illustrations here. Instead, there is a useful table on page 22 summarising the different B and T-cells and their myriad tasks. Nevertheless, I found Rhodes’s explanations of how the different components of the immune system function the clearest I have come across so far. For example, I keep confusing antibodies and antigens (I know, as a biologist I should be ashamed for having to admit this). However, when Rhodes writes “the fragments of germs (pathogens) […] soon became known as antigens” (p. 16) it finally activated a mnemonic in my head.
“[…] I found Rhodes’s explanations of how the different components of the immune system function the clearest I have come across so far.”
Chapters four and five are, to me, the core of this book and obligatory reading. I found them exceedingly useful. The first explains the six steps in vaccine development: exploratory, preclinical, phase I, II, and III trials, and regulatory review. This strict procedure ensures vaccines are safe. In part, it is a product of past errors, such as the 1955 Cutter Incident when a particular batch of polio vaccines had not been properly prepared. The only question I felt Rhodes could have asked and answered more explicitly is how COVID-19 vaccines could be developed so quickly. Many people worry that they have been rushed and might not be safe. You have to read between the lines a bit, but the answers are there. For instance, existing vaccine platforms that can quickly be repurposed, technological advances in genetic sequencing and engineering, rapid dissemination of new findings through open publishing platforms and preprint servers, and financial investment such as Operation Warp Speed in the US. Importantly, a large fraction of your population is exposed to the disease during a pandemic, which allows you to rapidly see what fraction of vaccinated people still fall ill, i.e. how effective your vaccine is. Normally, gathering enough data to draw statistically robust conclusions takes a long time, and an epidemic might burn itself out before you get a chance to do so. As a result of all this, there were 232 (!) candidate vaccines when this book went to print.
The second chapter walks you through the six established types of vaccines. All vaccines rely on exposing your immune system to an antigen to activate an immune response, but there are different approaches. Rhodes provides much more detail and for each type also gives examples of COVID-19 vaccines that are being developed. But, briefly, one way of categorising them is the non-living versus living vaccines. The former use dead viruses, parts of viruses (protein subunits), or virus-like particles, but typically need an additive, a so-called adjuvant, to elicit a sufficiently strong immune response. The latter are more potent and rely on living but weakened viruses or use a replicating or non-replicating carrier, a so-called vector, that is modified to contain fragments of a particular virus.
“Chapters four and five are, to me, the core of this book and obligatory reading. I found them exceedingly useful. The first explains the six steps in vaccine development […] The second chapter walks you through the six established types of vaccines.”
And then there are the new kids on the block, DNA and RNA vaccines, which differ in that they get straight to the heart of the matter. After all, the sole purpose of a virus is to deliver its DNA or RNA to a host cell and commandeer its machinery to produce more viruses. These vaccines achieve the same by directly administering engineered pieces of DNA or RNA that code for viral proteins. As Rhodes highlights, especially RNA vaccines hold great promise as they do not replicate, do not integrate into the host’s DNA, interact directly with the cell’s machinery without intermediate steps, and, like other RNA fragments, after a while are naturally broken down by resident housekeeping enzymes. Both the Pfizer and Moderna vaccines that are currently being rolled out to combat COVID-19 are RNA vaccines.
Finding and testing vaccines are only the first steps to getting a virus under control, so I was very pleased to get an immunologist’s perspective on the additional hurdles. This concerns practical logistical problems such as mass-producing billions of syringes and glass vials, figuring out who should be vaccinated first, and the problem of nations competing rather than collaborating to get their hands on vaccines.
“[…] I was very pleased to get an immunologist’s perspective on the additional hurdles. This concerns practical logistical problems [but] more importantly […]the vexing problem of what he understatedly calls vaccine hesitancy.”
More importantly, however, Rhodes addresses the vexing problem of what he understatedly calls vaccine hesitancy. I found his approach here admirably balanced. He gives the background to a few infamous vaccine scare stories (e.g. the Wakefield affair) while explaining some of the actual problems that can sometimes arise, and how lessons have been learned from this to design safer vaccines. Nor does he trivialize the anti-vaccination movement entirely: “Is it right to attribute all issues of vaccine refusal to superstitions, conspiracy theories, and irrationality? Of course not.” (p. 114), while highlighting more subtle reasons. At the same time, he makes the sharp observation that we need to rebalance “perceptions of individual liberty versus collective responsibility and the good of the community” (p. 116). This, I would add, is true of several other public health measures over which some vocal minority groups have been making a right kerfuffle.
How to Make a Vaccine joins several recent pocket-sized paperbacks that offer brief overviews, whether it is of viruses in general, SARS-CoV-2 in particular, or the botched response of governments. It is an especially nice complement to Chakraborty’s and Shaw’s Viruses, Pandemics, and Immunity that focused more on the immune system and only briefly covered vaccines. Helpfully, the further reading section at the back breaks down references per chapter into general and technical literature.
At a time when online searches for books on vaccines are more likely to turn up misinformation than reliable literature, How to Make a Vaccine is a required primer that demystifies concepts and gives an informative overview of how vaccines are developed and how they work. An essential guide indeed.
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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]]>In the wake of the COVID-19 pandemic, many publishers have seen an opportunity to reissue previously published books on viruses and pandemics. As a reader, it is always difficult to know whether you are actually getting any updated content beyond the obligatory new preface or afterword, or whether this is just a quick cash-grab. Fortunately, the third edition of Carl Zimmer’s famous virology primer A Planet of Viruses is here to prove those suspicions wrong.
A Planet of Viruses, written by Carl Zimmer, published by the University of Chicago Press in March 2021 (paperback, 144 pages)
A Planet of Viruses was first published in 2011, followed by the second edition in 2015, and now the third edition in 2021. The book is a collection of short essays, many of which were originally written for World of Viruses, a National Institutes of Health-sponsored pop-science project to communicate virology to a wider audience.
In Zimmer’s trademark crisp prose, each of the twelve essays focuses on a particular virus or class of viruses while simultaneously explaining certain virology concepts. Thus the chapter on tobacco mosaic virus discusses how viruses were discovered and led to breakthroughs in microbiology, while the essays on rhinoviruses and influenza explain how our immune system combats viruses and how rapid evolution means viruses and their hosts are locked in a perpetual arms race. But there is hope. The short history of smallpox introduces the important concepts of variolation and vaccination, and how some viruses can, in principle, be eradicated.
Although each essay is short, Zimmer has the enviable quality to highlight interesting facets in each story. The essay on HIV explains the crossing of species boundaries by infectious diseases, zoonosis, the origins of HIV, and how this virus, to quote David Quammen, has since diversified “like an infectious starburst“. A piece on the West Nile Virus shows how viruses can go global, and how insect vectors such as mosquitoes can assist. And then there are the viruses that infect bacteria, bacteriophages, that outnumber us to a mind-boggling degree. As two of the essays here show, our world is a virosphere rather than a biosphere.
“Although the placenta is one of the features that made us mammals, this is ultimately thanks to a viral stowaway.”
Other essays delve into virus evolution. Studies of ancient DNA have not only revealed that our ancestors interbred with Neanderthals, but also that we may have acquired some of their viruses, such as the cancer-causing human papillomavirus. Retroviruses, meanwhile, go far beyond taking over a host’s cellular machinery: they nestle themselves into its DNA and remain there. Our genetic material is riddled with such endogenous retroviruses, one of which produces the protein syncytin that is vital for the formation of the placenta during pregnancy. This infection has ancient roots, as the virus’s genetic code is found throughout the mammalian family tree. Although the placenta is one of the features that made us mammals, this is ultimately thanks to a viral stowaway.
Viruses even force you to ponder philosophical questions such as the definition of life. Viruses are typically considered to be non-living. Yet, the essay on giant mimiviruses and their large genomes containing thousands of genes shows that these lines are blurred. Consider this essay a taste of things to come in Zimmer’s new book Life’s Edge. And as he did in She Has Her Mother’s Laugh when discussing genetic mosaics, he can implode your sense of identity with a single sentence. When discussing retroviruses he concludes that “There is no us and them—just a gradual blending and shifting mix of DNA” (p. 71).
“It was not until I looked at the references that I realised each essay has been updated with new research published in the last six years.”
By now you might be chomping at the bit. What about COVID-19? New to this edition is the essay “The Pandemic Age”, which has replaced “Predicting the Next Plague” on Ebola from the second edition. This introduces coronaviruses more generally, briefly chronicles how the SARS and MERS outbreaks proceeded and how COVID-19 differs, and discusses some of the molecular details, such as how it enters the host cell. This essay felt a bit thin on the ground and did not provide all that much new information, especially given that Zimmer has written interesting pieces on vaccines and the virus’s structure for the New York Times. I guess book publication and news cycles will forever be out of step with each other.
Now, before you conclude that this is a somewhat disappointing update on the previous edition, let me stop you there. It was not until I looked at the references that I realised each essay has been updated with new research published in the last six years. It would have been easy to just slap in the COVID-19 essay, send it off to the printers, and call it a third edition. This is not the case, however, which reflects very well on both the author and the publisher. Furthermore, this edition features stylish woodcut-like illustrations from Ian Schoenherr that open each chapter (though, unfortunately, there are no illustrations included to explain biological concepts).
A Planet of Viruses is a captivating primer to the world of viruses that requires zero background in biology. The brevity of the essays and the small size of this book make it a suitable first introduction to this fascinating part of our world. Even for a biologist such as myself, there is much to admire in Zimmer’s writing: these essays are miniature masterclasses in science communication. If, for some reason, you have so far missed out on this book then what are you waiting for? At this price and this size, you have no excuse not to indulge.
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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]]>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:
]]>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 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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]]>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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, Some books, it seems, sit on your shelf just waiting for the right moment. David Quammen’s Spillover may have been published back in 2012, but it eerily foreshadows the 2019-20 coronavirus pandemic that currently keeps the world in its grip, and provides many insights. Right now, most people are of course concerned with the direct impact on public health and their jobs. While we try to slow down the spread of this disease, the global economy is taking a nosedive as country after country goes into lockdown. Once we come out on the other side though, there will be deeper questions to be asked. Could this happen again? How do we prevent that? And what the actual fuck just happened? Let Quammen be your guide, for, as he will show, everything comes from somewhere…
Spillover: Animal Infections and the Next Human Pandemic, written by David Quammen, published by Vintage in August 2013 (paperback, 592 pages)
Quammen likes to write big, chunky books. Spillover tops out at 587 pages. But do not let this put you off, for he is a master at writing a suspenseful narrative and has chopped up the book in 115 short chapters that irresistibly flow into each other.
He kicks off with the pandemic that wasn’t. You can be excused for never having heard of Hendra. First recognized in Brisbane, Australia, in 1994, it killed a dozen horses and one man. After months of research, it was traced back to bats. This crossing of species boundaries by infectious diseases is at the heart of Spillover and is a phenomenon known as zoonosis (professionals will want to refer to Zoonoses).
Zoonosis leads on to the second important concept in this book: reservoir hosts. The reason viral diseases such as polio and smallpox no longer plague us is that they only occur in humans. With nowhere else to hide, they can be eradicated by sustained vaccination campaigns. Zoonoses, in Quammen’s words, are more like guerilla fighters. They strike unexpectedly and disappear again, sometimes for years, while living on in other organisms where they cause little harm. Tracking down these reservoir hosts requires intrepid individuals willing to leave the confines of their laboratory. Several such virus hunters have written about their adventures.
“[…] the second important concept in this book: reservoir hosts. […] Zoonoses are more like guerilla fighters. They strike unexpectedly and disappear again, sometimes for years. But where do they go?”
Quammen spares no effort and accompanies many such scientists in the field, specifically to learn more about Ebola. The bloody details of this disease have been slightly exaggerated in the (in)famous book The Hot Zone (Quammen provides a healthy corrective). But it still is a horrific disease that stalks Africa, periodically popping up in humans but also killing many gorillas. The hunt for its reservoir host continues, although bats are a likely candidate. Quammen’s vivid and personal descriptions of the fieldwork, the extraordinary working conditions, and the chance scientific breakthroughs are what make Spillover such a pleasant mix of popular science and reportage. It is worth noting that at the beginning of the 2014 Ebola outbreak, a part of Spillover was updated and republished. It was a bit premature in hindsight, as that outbreak lasted until 2016.
Of course, a large part of virological research plays out in the lab, and Quammen shows himself equally at home here. The long chapter on AIDS and HIV is a perfect example, describing the decades-long research effort that has pushed the emergence of this disease back in time, all the way to the start of the 20th century. At the same time, the family tree of HIV has exploded “like an infectious starburst”, and Quammen skillfully guides the reader down the warren of HIV-1 and HIV-2, the different groups within these, and, nested within those, the many subtypes. Oh, and of course the numerous variants of the closely related simian immunodeficiency virus, or SIV, found in apes and monkeys. He relies on interviews and close reading of publications to reconstruct the tumultuous and twisting history of scientific breakthroughs and blind alleys.
Quammen also shines when it comes to memorable metaphors and masterful distillation of technical details. All of this is helped by crisp writing, short and straightforward sentences, and the repeating of salient points. He knows the details are complicated, yet he enlightens you in a conversational tone without ever being condescending. He is equally at ease giving you a potted history of the important epidemiological parameter R0, as he is highlighting the unique character of retroviruses such as HIV. The former is the basic reproduction number that you will have seen in the news lately.
“There is some eerie foreshadowing when Quammen asks: “Will the Next Big One come out of a rainforest or a market in southern China?” […] once we get out on the other side, there will be some uncomfortable and probing questions to be asked.”
Particularly relevant now is the distinction between DNA and RNA viruses, coronaviruses belonging to the latter. As highlighted in my review of Viruses, single-stranded RNA lacks the error-correction mechanisms of DNA and is thus much more prone to mutation and rapid evolution. Quammen throws three metaphors at you to emphasize this point before repeating it: “RNA viruses mutate profligately“.
A host of other, lesser-known diseases fills these pages: herpes-B, Nipah, Marburg, bacterial zoonoses such as Lyme disease, psittacosis, and Q-fever. Even a surprise zoonotic strain of malaria. After all, most strains of malaria are vector-borne diseases, mosquitoes being their vector. They are incredibly deadly, but they are not zoonoses.
All of these have fascinating backstories. But one point jumped out at me in particular: bats. Bats are, or are suspected to be, the reservoir hosts of many zoonoses. Why? Quammen highlights some of the unique aspects of their biology that might contribute to this: there are many species (a little-known fact is that about 20% of mammal species are bats!), they roost and hibernate at extremely high densities, and they fly. For more, see Bats and Viruses, Bats and Human Health, and the practical FAO manual Investigating the Role of Bats in Emerging Zoonoses.
“Many will have been left bewildered by the abrupt arrival of the current coronavirus pandemic. To better understand the world that has just gate-crashed ours, Spillover is (still) a magnificent piece of science reporting”
Viruses are everywhere: some speak of the virosphere rather than the biosphere, while Carl Zimmer calls ours a planet of viruses. Of the Ebola virus, Quammen writes that it “is not in your habitat. You are in its.” And the virosphere is a Pandora’s box that we have ripped wide open through our actions. A recurrent and important message in Spillover is how habitat fragmentation and destruction exposes us to a menagerie of new viruses as wild animals are forced to live and die in our midst.
Particularly fertile breeding grounds for zoonoses are the bushmeat trade and the so-called wet markets in Asia where a wide range of poached animals are traded and slaughtered. Nuwer’s Poached highlighted the exotic tastes and conspicuous consumption by wealthy diners as one of several driving forces behind the demand for wild meat. These markets were ground zero for the SARS outbreak in 2002-03, and likely too for the current coronavirus pandemic. There is some eerie foreshadowing here when Quammen asks: “Will the Next Big One come out of a rainforest or a market in southern China?” As I said at the beginning, once we get out on the other side, there will be some uncomfortable and probing questions to be asked.
COVID-19 is only the latest in a long line of zoonotic diseases, and will certainly not be the last. But rather than wanting to make you more worried, Quammen wants to make you more smart. Many will have been left bewildered by the abrupt arrival of the current coronavirus pandemic. To better understand the world that has just gate-crashed ours, Spillover is (still) a magnificent piece of science reporting that weds exceptional clarity to spell-binding storytelling.
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“Discovering Retroviruses: Beacons in the Biosphere“, written by Anna Marie Skalka, published by Harvard University Press in October 2018 (hardback, 177 pages)
I was really looking forward to this book and have mentioned it a number of times in previous reviews as several authors have highlighted that retroviruses are something quite special (see e.g. Viruses: Agents of Evolutionary Invention and Virusphere: From Common Colds to Ebola Epidemics: Why We Need the Viruses that Plague Us). Where normal viruses commandeer the host’s biomolecular machinery for their reproduction, retroviruses are even more intimately entwined with their hosts, transferring their genetic information to them.
Skalka first sets the stage with a short history of genetics, from Mendel to Crick and onwards to the “central dogma” (see my review of Unravelling the Double Helix: The Lost Heroes of DNA for more). That dogma refers to the finding that DNA is copied into single-stranded RNA which is then translated, three letters at a time, into amino acids that, when strung together, make up the workhorses of the cell: proteins. It has become a cornerstone of genetics. And exactly because of this, many scientists were not ready to accept the first suggestions in 1964 that retroviruses do it backwards, turning their little RNA genome into a string of DNA that becomes part of the host genome. Rather than a textbook approach that lays out the facts, Skalka chooses to tell the story chronologically, following the timeline of discoveries and introducing all the key players.
“In answer to the question: “what makes us mammal?” […] ultimately, as Skalka shows here, retroviruses did”
As also mentioned in Human Errors: A Panorama of Our Glitches, from Pointless Bones to Broken Genes, modern sequencing technology has revealed that our DNA is littered with remnants of retroviruses, many of which have become inactive and have suffered random mutations. The numbers are quite staggering: whereas ~1% of the human genome codes for all the proteins that make us tick, another 8% is of retroviral origin and larger fractions still consist of other jumping elements and so-called retrotransposons. Slowly but surely, what was initially deemed junk actually has a function (see also Junk DNA: A Journey Through the Dark Matter of the Genome and The Deeper Genome: Why There is More to the Human Genome Than Meets the Eye).
For one, this extra DNA offers hotspots of so-called recombination (i.e. the re-arranging of parts of an organism’s genetic material), which is one way to generate the genetic variation on which evolution can act. In the process, things sometimes break and diseases are caused. But it is not all bad news. Skalka details how this extra genetic material has been co-opted by our immune system; has added the digestive enzyme amylase, found in the pancreas, to our salivary glands allowing us to digest starch better; and has also been involved in the evolution of the placenta. Liam Drew asked the question: “what makes us mammal?” (see my previous review of I, Mammal: The Story of What Makes Us Mammals). One of his answers was: “the placenta did”. But ultimately, as Skalka shows here, retroviruses did. Without them, the placenta would not have happened. And, amazingly, mammals evolved them on five independent occasions!
There are other fascinating revelations about evolution throughout the book. Retroviruses may have very well been a necessary link in the transition from an RNA world (which is how many scientists believe life started, see Life from an RNA World: The Ancestor within) to a DNA world. I was similarly fascinated to read more about the use of retroviruses as an independent line of evidence when drawing up phylogenetic trees (i.e. family trees based on molecules such as DNA). As stretches of retroviral DNA are initially inserted in identical pairs, one way to mine them for information is by comparing mutation rates. This can reveal a timeline of when certain infections occurred and whether this happened before of after two species evolved to become separate. (My explanation leaves out some subtleties, Skalka goes into far more detail)
“retroviruses [can be used] as an independent line of evidence when drawing up phylogenetic trees”
Two further chapters give detailed accounts of how retroviruses have been implicated in causing both certain cancers and AIDS. Especially the chapter on AIDS and HIV goes into great detail on the biochemical and genetic basis of the disease, the development of drugs, the scary denialism propagated by a small minority (see also Pseudoscience: The Conspiracy Against Science), and the research that traced the origin to a virus that jumped from primates to humans in the 1900s (see also Virus Hunt: The Search for the Origin of HIV/Aids). And, as opposed to Viruses and Virusphere, Skalka does describe the recent discovery and developments around CRISPR, which consists of viral DNA stored in the host as a kind molecular vaccination card (see also A Crack in Creation: The New Power to Control Evolution).
Discovering Retroviruses is a short book, but it is dense and quite technical. I found I had to give it my full attention, sometimes going over certain passages twice to make sure I understood them. The readability is slightly hampered by the many abbreviations and gene and protein names that come with this field (a glossary would have been welcome in that regard), but that is made up for by a large number of clear colour illustrations that are very helpful in schematically showing how certain mechanisms work. The chronological format also means that you have to tease some of the details out of the narrative, although Skalka does an excellent job summarising things at the end of each chapter, and in her epilogue. As far as I know, Skalka’s is the first book on this topic aimed at a wider readership. If you have a serious interest in viruses, and retroviruses in particular, this well-researched and scholarly book is a must-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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