This book is by Nicholas A. Christakis, a physician and sociologist at Yale University. As we begin to see the end of the coronavirus pandemic, I’m reading books to try and gain insight as to what the future will look like. The book’s subtitle, The Profound and Enduring Impact of Coronavirus on the Way We Live, is what drew me in. It was published in October 2020.
The book starts with the virus evolving in bats and then suddenly leaping to humans late in the fall of 2019. The first known infection was detected on December 1, 2019 in Wuhan. The disease was named SARS-2 at that time.
The first U.S. case was in Snohomish, WA in a man returning from Wuhan on January 15th. He was diagnosed on January 20th. Then he was isolated at Providence Hospital in Everett, the U.S.’s patient zero. Patient zero exposed 60 people, none of whom got sick. Nor did his care givers. This case was a lucky dead end.
The Life Care Center nursing home in Kirkland was seeded by someone else who has never been identified. It was the firemen who noticed how many calls they were getting from this nursing home. There were 167 cases including 101 residents, 50 care providers and 16 visitors. At least 35 died.
It turned out there were earlier cases in other parts of the U.S., but they went undiagnosed. Back in Seattle, the Seattle Flu Study group started analyzing results and realized the disease was already everywhere. In Washington State, the governor shut things down March 17th.
Scientists in China mapped the genome, which isn’t that hard since the genome is only 29,903 letters long. Having the genome is important because it allows for tracking of different variants of the virus. RNA viruses mutate about once every two weeks. These mutations are so regular that they function like a molecular clock.
Sequencing of the WA outbreak was done in the lab of Trevor Bedford at Fred Hutch. And while the virus mutates every two weeks, it typically spreads in about a week. So, tracking the variations isn’t perfect.
SARS-1 appeared in 2002. It was largely contained. It was quite deadly, which meant it didn’t get spread as much. It also caused people to have symptoms when they got infected, which made it easier to contain. This also meant it tended to infect healthcare workers.
The best-known case was a Dr. Liu, who got it and self-isolated at the Metropole Hotel in Hong Kong, in room 911. Really. Guests on that floor of the hotel got sick based on how close they were staying to room 911. People in about one-third of the rooms on that floor got sick.
SARS-1 is airborne, which is worse than the more common droplet transmission. Droplets fall to the ground within six feet. Airborne viruses can get into the HVAC systems. Guests of the Metropole spread the disease worldwide. But the outbreak was over by 2003. SARS-1 was the first virus outbreak that was addressed with modern genetic techniques.
SARS-2 seems to have the transmissibility of the common cold but the lethality of SARS-1. SARS-1 was not transmissible until a person had symptoms. SARS-2 (Covid-19) is transmissible in asymptomatic individuals. In fact, one can spread SARS-2 for one to two days before they show symptoms.
Then there is the reproduction number, or the average number of people infected by each infected person. Ro (R naught) for measles is 12-18, for chicken pox is 10-12, smallpox is 3.5-6, Ebola is 1.5-1.9 and seasonal flue is 0.9-2.1. If above 1.0, the cases will grow.
There are two broad ways to respond to an epidemic. One is pharmaceutical interventions such as medications and vaccines. The second is nonpharmaceutical interventions, or NPIs. These include individual and collective practices. Individual includes hand washing, wearing masks and self-isolating. Collective actions are typically imposed by government. They include closing borders, shutting schools, banning gatherings, testing and contact tracing.
Many animals can learn. Some can learn by observing. But humans teach one another. When natural disasters strike, people will leave warnings for future generations, such as high-water marks in floods and tsunamis.
In the case of Covid, this learning from prior generations is playing out in the amazing response of pharmaceutical companies striving to create vaccines. There are multiple approaches, and they are coming faster than ever before. Altruism plays a role here too; there are thousands of people needed for the trials of these vaccines.
This book was written before the first vaccines were available and the author speculated that they might not arrive until 2022, by which time we may have achieved herd immunity through natural means. The author speculates about vaccine availability in early 2021, which seemed doubtful at the time, but which has happened.
One of the most interesting observations in the book comes from London-based journalist Tom McTague, who wrote, “It is hard to escape the feeling that this is a uniquely humiliating moment for America. As citizens of the world the United States created, we are accustomed to listening to those who loathe America, admire America, and fear America (sometimes all at the same time). But feeling pity for America? That one is new.”
The author also laments the progressive denigration of science and the fundamental idea that is possible to have an objective appreciation of the truth. Most of this is right-wing based, but there are also cases of the left denying the role of genetics in human behavior. Extremists have pushed a downgrading of belief in elites with specialized expertise.
There are several ways for a pandemic to end. One is to use nonpharmaceutical interventions to stop transmission to zero. The pathogen is still out there, so this is a false ending. A pandemic can end when the disease becomes endemic. Covid could weaken and come back every year, like the cold or flu.
A pandemic can end when people evolve to respond to the disease. The strong survive and the population can tolerate the disease. But this takes a lot of time. Another way a pandemic ends is herd immunity, either through natural processes or widespread vaccinations or both. We seem to be headed towards a combination of those who have survived the virus, those who have been vaccinated and Covid-19 becoming somewhat endemic and coming around in different forms every year.
It is an interesting book, but it illustrates the perils of writing on a topic that is in the headlines daily. The statistics are outdated by the time the ink dries and the author’s anticipation of when vaccines will become available was inaccurate. It was also short on what to expect post-Covid, which was my main reason for reading it.
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