Apollo's Arrow: The Profound and Enduring Impact of Coronavirus On The Way We Live

 

Nicholas A. Christaki, “Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus On The Way We Live, Little Brown, 2020, 324 pp.

Note that this book was written between March and August 2020.

Sociologist, physician, and author Nicholas Christakis, who directs the Human Nature Lab at Yale, offers a deeply informative overview of the coronavirus pandemic, taking into consideration the biology of the pathogen and the social, economic, psychological, and political impacts of the virus on society. Drawing on scientific, medical, and sociological research, he assesses the virus transmission, responses worldwide, and prognosis for the pandemic’s end. In addition, he places Covid-19 in the context of past epidemics: plague in ancient Athens, the Black Death in medieval Europe, polio epidemics in 1916 and the 1950s, influenza in 1918, and HIV in the 1980s. “It’s very important to emphasize that, as bad as COVID-19 is,” writes the author, “it’s not remotely as bad as epidemics of bubonic plague, cholera, or smallpox that have killed much larger fractions of the population and that have had much larger and longer-lasting effects.” Nevertheless, he underscores the disastrous effect of inadequate responses, especially from the Trump administration: a “botched” rollout of early tests, lack of coherent national strategy, and repeated “denial and lies.” It’s inarguable, he writes, that “the lack of scientific literacy, capacity for nuance, and honest leadership hurt us.”

Christakis emphasizes the importance of wearing masks and enforcing social distancing, two interventions that slow the spread of the virus, which is essential while treatments and vaccines are being developed. While acknowledging “colossal uncertainty” about the future of the pandemic, he predicts that at least until 2022, Americans will live in a changed world. It will be necessary to wear masks, abstain from shaking hands, avoid crowds, and receive medical care online rather than in person. Hopefully, he writes, “one of the unexpected impacts…may be that a society that feels besieged by the threat of the virus will increasingly treat scientific information, and not just scientists, seriously.”

Notes:

R_o:   R_o is a measurment of the capacity of the pathogen to start an outbreak, it reflects the degree to which the pathogen is infectious, absence any measures to control it.  (i.e., no masks, crowded indoor assembly, etc)

R_e: The R_e factor reflects the real-time spread of the epidemic later in the course, when the population is no longer naïve and they begin to socially distance, wear masks, etc.

CFR:  Case Fatality Rate.

Pg. 9:  By January 25, 2020, nearly all of China was shut down.  People were required to shelter in their homes and were given permission to leave only once or twice a week for essentials.  All people retained six feet of separation and everyone wore a mask in public.  Schools were moved online for millions of pupils.  At least one person had Sars-2 in the US state of Washington by the middle of January.  However, it wasn’t until the middle of March that the threat was widely acknowledged in the US.

Pg. 20:  Modern genetic techniques are available for understanding the fundamentals of the virus and ascertaining where it spread and if it changed (mutated).  Changes occur at fairly regular intervals, one tiny mutation every two weeks, on average.  By studying these cumulative haphazard mutations collected from many thousands of specimens around the globe, scientists can reconstruct the movement of the virus (if testing is adequate).

Pg. 24:  The US had placed broad travel restrictions on China on January 31 2020, on Iran on February 29, and on Europe on March 11.  By March 19, 2020, the virus had been detected in all fifty US states.  On March 11, WHO declared Covid-19 to be a pandemic.  As of April 1 there were 219,622 known cases and 5,114 deaths in the US and 936,851 cases and 47,210 deaths worldwide.  By July 1, there were 130,761 recorded deaths in the US and 518,135 deaths worldwide—and no end in sight.

Pg. 26f:  Covid-19 is the disease caused by the virus Sars-2.  As respiratory infections go, Covid-19 is particularly protean, encompassing a great variety of symptoms, from fever to cough to muscle pain to the loss of the sense of smell.  The symptoms that a patient experiences depend in part on which cells in the body the virus infects and how the body responds immunologically.  The primary form of the disease is respiratory and involves cough and fever, the two most common symptoms, and shortness of breath.  Less common are musculoskeletal symptoms and gastrointestinal symptoms.  But many other symptoms—such as rash, headache, dizziness can occur.  Perhaps half of those infected are asymptomatic. The death rate is near 1 percent, overall.  (may be as high as 1 in 5 for those over age 70).

Pg. 29-45:  Plagues have been with us since we began living in large enough groups in cities about three thousand years ago.  For instance, there was the plague of Athens in 430 BCE, plague of Justinian in 541 CE, the Black Death in 1347, and Spanish Flu in 1918.  And in 2003, we faced the first pandemic of a coronavirus that closely resembles the one of 2020.  Reviewing how it differed from SARS-2 helps shed light on why and how the pandemic of 2020 came to be so very serious.  The 2003 SARS-1 pandemic also started in China and also came from bats.  It too spread far and wide, reaching the US and twenty-nine other countries.   Efforts to respond to SARS-1 were so successful that WHO declared the pandemic contained on July 5, 2003.  Only 8,422 people had been infected worldwide.  As SARS-1 was much more deadly than SARS-2, it killed its victims so rapidly that the pathogen did not have much time to spread.  This is also why the super deadly Ebola epidemics tend to burn out. 

Pg. 45f:  The 2003 outbreak of SARS-1 infected only 8,422 people worldwide, 916 died and health-care workers accounted for 20 percent of the deaths.  Since the disease killed 916 out of 8,472 cases, its CFR is computed by dividing cases by deaths which yields 10.9.  When a disease is this deadly, it kills its victims so rapidly that the pathogen does not have much time to spread.  On the other hand, it is hard to compute the SARS-2 CFR as the denominator and numerator are difficult to determine at this point.  However, the CFR for Covid-19 is estimated to be between 0.5 and 1.2 percent. (The problem with this calculation is that the CFR for the entire population is much lower than for segments, like the elderly in nursing homes or on a cruise ship).

Pg. 51:  When the reproduction number (whether the R_o or R_e) is above 1, it means the number of cases will grow.  Some pathogens are more transmissible than others and spread very easily from one person to another while other pathogens are much less infectious.  For instance, measles is one of the most infectious diseases known with an R_o estimated to be 12 to 18 (that is, a single infected person typically can infect between 12 and 18 people).  Chicken pox is 10 to 12; Smallpox 3.5 to 6; Ebola 1.5 to 1.9; and seasonal influenza 0.9 to 2.1.  Most estimates place the R_o of SARS-2 at about 3.0 while the ordinary flu is at 0.9 to 2.1.  So, SARS-1 was 10 times deadlier than SARS-2.

Pg. 58ff:  The environment may facilitate super-spreading events, such as the SARS-2 outbreak in a Washington State choir in March 2020.  The act of singing involves the expulsion of air at high force.  In this case, an infected person was part of a group of sixty-one singers who were in a densely packed area for two and a half hours.  As many as fifty-two of them caught the virus from the index case; three of them were hospitalized, and two of them died. 

Pg. 67:  The 1918 flu pandemic killed around thirty-nine million people worldwide, 550,000 of them in the US; some experts put the worldwide toll as high as one hundred million.  Life expectancy was still low in the US at the time (for men in 1915 it was 52.5 years, women 56.8 years).

Pg. 74:  Using the calculus of ‘Excess Deaths’ it appears that Covid-19 reported death rates are at least 22 percent too low.

Pg. 78:  The bubonic plague is estimated to have killed around two hundred million people over the fourteen hundred years it ravaged worldwide populations, primarily in three major pandemics beginning in the sixth, fourteenth, and nineteenth centuries.  Of these, the plague beginning in 1347 and lasting until 1353, is what we think as the Black Death wiped out as much as half the population of Europe.  (This had a big influence on ending feudalism as help was hard to find).  The plague can be cured today with streptomycin or tetracycline.

Pg. 94:  The shutdown of the US in the spring of 2020 may have prevented sixty million cases and probably more than three hundred thousand deaths during the acute shock of the first wave of the pandemic. 

Pg. 99:  The herd immunity threshold can be calculated by the formula (R_o-1)/ R_o   which using 3.0 for SARS-2 means that 67 percent of the population must be immune.  However, this calculation assumes that all people in the population have an equal chance of exposure, which is patently false as some people have fewer interactions than others.  So, herd immunity may actually occur at 50 percent.

Pg. 106:  In the summer of 2020, Georgia, Governor Brian Kemp, in defiance of good public health practices, explicitly banned cities and counties from enacting rules requiring masks. 

Pg. 115:  Many countries around the world had started testing for the virus by early 2020, but not the US.  First, the CDC released a test that was flawed.  Second, the FDA refused to allow hospital labs to develop their own tests, even though most elite hospitals in the US could do this.  Third, the Department of Health and Human Services took its time to work with outside labs to increase the availability of commercial tests and did not get it done until it was too late.  (this was the period of time that Trump was claiming we tested too much).

Pg. 116:  The lack of federal coordination for testing in the US, prompted by the undue politicization of the pandemic, severely hampered the US ability to identify reservoirs of infection.  As a result, its presence continued to grow exponentially to the point where it became impossible to do contact tracing at all.  When contact tracing became impossible, physical distancing had to be implemented.  By March 22^, 2020, New York City had become the epicenter of the pandemic in the US, accounting for approximately 5 percent of the world’s confirmed cases.

Pg. 153:  On February 25, 2020 Dr. Nancy Messonnier, a CDC official who was the director of the National Center for Immunization and Respiratory Diseases noted during a press conference that the CDC was preparing for a pandemic.  Trump wanted her fired. (Subsequent leaks revealed that Trump had been presented with information about the seriousness of the virus and its pandemic potential beginning at least in early January 2020).

Pg. 166:  As late as May 18^th Trump again championed the use of hydroxychloroquine announcing that he was taking the drug preventatively.  Interestingly, an analysis of two hundred million tweets about the pandemic collected from January through May 2020 found that 62 percent of the top one thousand retwetters were bots originating from Russia and China.  The bots really weighed in on online conversations regarding ending stay-at-home orders and ‘reopening America.”  There is increasing evidence that the Chinese and Russian governments have a long-standing and ongoing program in place to undermine Americans confidence in science and scientists.  (In early May Trump framed the pandemic as an attack by China).

Pg. 183:  The mortality rate for Covid-19 varies widely with age.  Overall, mortality among those under twenty is very low, on the order of between one and three people dying out of ten thousand who get sick.  For patients in their late fifties, this rises to about one in one hundred.  For patients eighty or older, it rises to about one in five.  Overall men suffer 50 percent more mortality than women.  (So, if a person is less than age 70, the risk of death is less than 1 percent).

Pg. 228:  Until Covid-19 vaccine development, one of the fastest vaccines ever developed was the vaccine for the Ebola virus which took five years to approve in 2019.  The usual time frame had been ten years.  Yet, for many diseases it has been impossible to develop a vaccine.  After four decades we still do not have a vaccine against HIV, nor for the common cold.  Moderna developed a vaccine for Covid-19 in just forty-two days after the gene sequence of the virus was published in China. 

Pg. 271:  The pandemic has reshaped the US economy.  On March 27, 2020, Congress passed the trillion dollar rescue package.  American GDP fell by 9.5 percent and had an annualized decline of 32.9 percent—a drop so rapid and deep that it was unprecedented in our history.  Nearly five years of growth had been wiped out. 

Addenda:

Pg. 100f:  At the beginning of the Covid-19 pandemic, some officials, including in the US,  proposed just letting the epidemic take its course and get it over with.  The UK toyed with this idea but then rejected it.  However, Sweden did adopt this course.  By May 2020 they had at least four times the rate of Covid-19 deaths as its Nordic neighbors with similar demographics and economies.  Ultimately they admitted the policy had not worked out and their economy was just as hard-hit as the economies of its neighbors who had pursued full lockdowns.  Physical and economic health are inextricably linked.