It takes a bold person to write a 400-page book about a profound historical event while it is still unfolding, but Nicholas Christakis is nothing if he’s not bold. “Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live” (Little Brown Spark, 2020) was written and published just eight months into the COVID-19 pandemic and combines the immediacy of contemporary reporting with a deeply informed and thought-provoking long term historical and sociological viewpoint.
The Sterling Professor of Social and Natural Science, Internal Medicine, and Bioengineering at Yale, Christakis has degrees in medicine, public health and sociology from Harvard and Penn. His previous book “ Blueprint” took the long view of human history viewing millennia of evolution as a positive force, nudging Homo sapiens towards socially supportive behavior and a hopeful future.
At this fraught moment in the year of the pandemic, he has again taken up his pen and produced an admirable overview of the COVID-19 world in which we are living. With enough hard science and graphs to engage those among us with a scientific background and with a style that is both animated and straight-forward for the lay reader, this is a valuable book for anyone who wants to go beyond the sound bites of the nightly news.
Christakis places the COVID pandemic in its historical context, describing the role that plagues have played throughout human history. The title of the book refers to the ancient’s explanation for the epidemic that killed so many Greeks as they assailed the walls of Troy more than three thousand years ago. At that time, the understanding of disease and death led Homer to attribute the deaths to the gods, specifically the eponymous Apollo, who launched his arrows to defend the city that looked to him for protection.
Today’s science has moved beyond the arrows of the gods, but progress has been slow. In the Middle Ages the blame for the bubonic plague was placed at the feet of the Jews, and as recently as the 19th century, epidemics of cholera, smallpox, measles and polio were variously blamed on foreigners, miasma, or witches. Humans have always lived in a tense standoff with microbes, and society’s reactions to the COVID-19 pandemic beginning in late 2019 in Wuhan, China have fit neatly into the historical pattern of initial denial morphing into anger, bargaining, and finally acceptance.
Drawing upon his deep background in sociology, Christakis moves beyond the impact of the pandemic on the individual and brings a scientific eye to understand the spread of the virus from Wuhan to the entire globe. What likely started in a live animal market in a city of 11 million, quickly spread through the marvels of modern day jet travel and found a host that was naïve in terms of its immunological preparation. Caught unprepared and lacking a coherent response from the federal government in the U.S., COVID moved rapidly across the country from its first cases in Seattle to nursing homes, hospital workers, front line essential workers, and those with underlying illnesses to kill more than 330,000 in its first year.
With his judicious use of graphs and plain language explanations, Christakis helps the reader understand IFR (infection fatality rate), CFE (case fatality rate), incubation and latent periods, R (reproduction rates), and the other epidemiologic acronyms that accounted for COVID-19’s rapid spread and lethality.
Christakis describes three phases of the pandemic. The immediate pandemic period which we are still experiencing has seen shortages of protective equipment, ICU beds, and trained personnel, super-spreader events, and now our third spike in deaths across the entire country. He predicted that this period would last through 2022, a prediction that he would likely revise today in view of the recent release of two RNA vaccines for COVID-19.
The intermediate pandemic period which will last until herd immunity is reached via the vaccine or widespread infection will be characterized by recovery from the overall clinical, psychological, social and economic shock of the pandemic. Christakis predicted that this will require adjustments through 2024.
Finally, the post-pandemic period will see far-reaching changes in our behavior, our society, and our world which we are only now beginning to appreciate. The disappearances of the handshake, the cross country trip for a one hour meeting, the hours spent commuting to a downtown office — all of these changes and more will become a routine part of our post-pandemic world.
This timetable will likely be shortened by one of the major scientific accomplishments of modern history — the development, manufacture, testing, and now distribution and administration of millions of doses of a vaccine to prevent COVID-19 infection. In the past, the development of vaccines has taken 3-8 years, but an unprecedented effort involving massive government funding, international cooperation and rapid communication, and scientific advances have resulted in an effective vaccine in less than 12 months.
With this fine book, Christakis has made an outstanding contribution to our ability to grasp what assailed our world in 2020, but I was disappointed that he is so circumspect in his criticism of President Trump and the administration’s response to the pandemic. When intelligence briefings as early as January indicated the likelihood of a serious pandemic spreading from China to the U.S., a government-wide mobilization to prepare the nation and the medical system for what was coming was still possible. Instead, the Trump administration and the president served up a daily menu of lies, misinformation, dangerous comments about potential cures (injectable bleach, no less!), and false hopes. They suppressed scientific facts from the Centers for Disease Control and refused to institute the Defense Act to produce the needed personal protective equipment. These irresponsible and politically motivated actions have resulted in the potentially avoidable deaths of hundreds of front-line health care workers and hundreds of thousands of other Americans.
History, as it always does, will judge the performance of the Trump administration harshly as we mourn thousands of Americans all across this nation who have died because they were abandoned by their government in this time of great need.
For Christakis, an otherwise bold, brilliant, and objective scientist and writer to “pull his punches” on this is disappointing. His references to Trump’s comments as “misinformation” and “plainly scientifically false” underestimate and minimize these criminal acts.
That said, this is a valuable and readable contribution to our struggle to come to terms with the pandemic of 2020. As Christakis points out, “So we will reach herd immunity, or the pathogen will evolve to be less lethal, or (after a very long time) humans will evolve to be resistant. That is the biological end of the story. But pandemics are also sociological phenomena, driven by human beliefs and actions, and there is a social end to pandemics, too when the fear, anxiety, and socioeconomic disruptions have either declined or simply come to be accepted as an ordinary fact of life.”
Now that there is an effective vaccine and more than 4,000 Vermonters have already been vaccinated as we enter 2021, the biological end of this pandemic appears to be within reach. The sociological end of COVID-19 with its long-term changes in our society remains uncertain, but Christakis has given us the science and the sociology to at least dimly foresee what that future will look like.