The Rules of Contagion: Why Things Spread — and Why They Stop Adam Kucharski Wellcome Collection (2020)
COVID-19: The Pandemic that Never Should Have Happened and How to Stop the Next One Debora Mackenzie Hachette (2020)
Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live Nicholas A. Christakis Little, Brown Spark (2020)
Understanding Coronavirus Raul Rabadan Cambridge University Press (2020)
The Pandemic Century: A History of Global Contagion from the Spanish Flu to Covid-19 Mark Honigsbaum WH Allen (2020)
The Plague Cycle: The Unending War Between Humanity and Infectious Disease Charles Kenny Scribner (2021)
To make sense of a year in which decades’ worth of events have happened in weeks, books help — from those that are centuries old, to those that are out of date as they hit the shelves. Just as diarist Samuel Pepys showed us the Great Plague of 1665 through the eyes of a government administrator, pandemic-era scientists, doctors, historians and journalists are already refracting history-in-the-making through the prism of their own experiences.
Adam Kucharski’s The Rules of Contagion makes eerie reading now. Written pre-pandemic, it was published in February when, according to the World Health Organization (WHO), SARS-CoV2 was a public-health emergency of international concern but not yet a pandemic. The words ‘coronavirus’ and ‘COVID-19’ don’t even appear in the index; Chris Whitty, the chief medical officer for England and an almost-daily fixture in the UK media for much of 2020, makes only a fleeting appearance as an advocate of mathematical models, saying: “[T]he key is usually not that they are “right”, but that they provide an unpredicted insight.”
Unpredicted insights are what the author, a mathematician at the London School of Hygiene & Tropical Medicine, reveals by considering the concept of contagion in biology and society, from financial markets to social media and fake news.
As a toddler, Kucharski had the rare immune condition Guillain–Barré syndrome (GBS). Discharged from hospital with a toy horn to test his respiratory muscles, his long recovery faded from memory until many years later, when he came across the disease again as an epidemiologist working in Fiji. A WHO report of unusual clusters of GBS across several Pacific islands ultimately pointed to Zika virus infections as the cause, which Kucharski and his team then modelled mathematically.
Kucharski’s examples range widely: British physician Ronald Ross’s early investigations into the role of mosquitoes in malaria transmission; physician John Snow’s experiments in cholera-ravaged Soho; the flu of a century ago; and more recent investigations into the spread of HIV/AIDS. He notes that Gaëtan Dugas was misidentified as Patient Zero in the US HIV epidemic as a result of the misreading of his clinical record card that was marked ‘O’, not zero, for ‘Outside California’. How often do such errors occur? And his accounts of tracking Dengue, Ebola, Zika and severe acute respiratory syndrome (SARS) trace the conflicts and convergences between biological evidence, political necessities, social control and the awful rise of fear, racism, inequality and economic strife. With every disease comes missed opportunities, obfuscation and marginalization — see, for instance, Laura Spinney’s outstanding account of the 1918–19 pandemic, Pale Rider (see T. Tansey Nature 546, 207–208; 2017) and journalist David Randall’s tale of the 1900 plague outbreak in San Francisco (see T. Tansey Nature 568, 454–455; 2019).
Kucharski considers other clusters. Suicide rates can increase in the wake of a celebrity taking their own life; a study from Columbia University in New York City identified a 10% increase following the suicide of comedian Robin Williams, for instance. One-quarter of gun murders in the United States in 2015 occurred in areas containing less than 2% of the country’s total population. And he explores economic panics, from seventeenth-century tulip mania in the Netherlands to the Bitcoin craze of the past decade, and the way that markets spread economic problems from country to country. Clearly, his role as an intern at a London investment bank during the 2007–08 financial crash made a lasting impression.
The most pressing question he tackles is why do contagions stop? There is no neat answer on the final pages. But it is clear throughout that the prompt interaction between understanding and control is key. This rule applies for biological pandemics, financial disruptions, crime, violence and every form of social-media contagion Kucharski identifies.
Of several authors that explicitly address the present pandemic, two take similar approaches: Debora Mackenzie (COVID-19) and Nicholas Christakis (Apollo’s Arrow). Mackenzie, who writes on health for New Scientist, and physician and sociologist Christakis are players in the stories they tell, and both have produced crucial works at phenomenal speed (Mackenzie’s was published in July, Christakis’s in October). And, like The Lancet editor-in-chief Richard Horton in The COVID-19 Catastrophe (see S. Buranyi Nature 582, 478–479; 2020), they are angry. Angry at the mistakes that allowed the virus to flourish, and at the inequalities that the epidemic has exposed and amplified. Still, neither matches Horton’s fury that so many have died owing to the complacency of governments.
Christakis directs Yale University’s Human Nature Lab in New Haven, Connecticut. He focuses particularly on the US experience of COVID-19 from epidemiological, social and medical perspectives. As befits an erstwhile hospice physician and friend of the late medical ethicist Renée Fox, to whom the book is dedicated, he gives moving accounts of patients, their experiences of the disease and their sad, lonely deaths. He bears witness to the doctors and nurses forced to use refuse sacks because of a lack of personal protective equipment, and turned out of their accommodation by landlords and neighbours fearing contagion. And he recognizes the personal and community grief that has resulted — for the lives and ways of living lost across the globe.
His rage at health inequalities and lack of access to universal health care for homeless people, prisoners and low-income workers is palpable, as is his wrath, for example, at the threat of enforced water shut-offs in the middle of the pandemic, with an estimated 15 million Americans unable to pay their utility bills. Not surprisingly, much of his anger is directed at US President Donald Trump and his administration, and in particular the snake-oil salesmen peddling unsubstantiated ‘cures’, such as bleach, silver solutions and the antimalarial drug hydroxychloroquine, encouraged by the confusion emanating from the White House.
Yet Christakis is an optimist. History suggests, he argues, that humanity will emerge from COVID-19 with renewed senses of purpose and possibilities, “albeit after tremendous sorrow”. He foresees a licentious era beginning around 2024, akin to the Roaring Twenties that followed the First World War and the 1918 flu pandemic. We can look forward to increased religiosity, risk-taking and intemperance.
Mackenzie relates the United Kingdom’s catastrophically slow response compared with other research-rich economies, such as New Zealand, Singapore and Taiwan, where COVID-19 was swiftly contained. She quotes some of her own prescient reporting from years past. In 2013, after watching a less-than-satisfactory simulation of a bird-flu pandemic at the WHO’s headquarters in Geneva, Switzerland, she wrote in New Scientist: “Information will flood in; body counts will mount. Governments will be told that their demands for vaccines and drugs cannot be met. [The WHO] will issue declarations, hold briefings, organise research, tell people to wash their hands and stay home. Mostly, though, it will just watch helplessly.”
She reflects on how COVID-19 has brought home the terrible power of pestilence to wealthy countries, which for too long have been oblivious to the toll of malaria, tuberculosis, HIV and more in the global south. How could this have happened, she asks, despite all the wonder drugs and high technology? Mackenzie’s diagnosis points to global ecological problems: too many people, increasing pressure of space for food and habitation, and the encroaching dangers of forests as intensive farming pushes people and livestock into wildernesses that harbour new animal-borne diseases.
Paul Rabadan’s Understanding Coronavirus is a very different offering. This pocket volume offers a series of questions and answers, ranging from basic virology, such as ‘What is a coronavirus?’, to more complex issues such as ‘How does the COVID-19 outbreak compare to the SARS outbreak in 2003’? There is a ‘Summary of common misunderstandings’ and a couple of pages of notes added as the book went to press. Although the text is clear and cogent, the problems of balancing content with presentation are clear in the illustrations — many are too small, and several are too complex for the non-specialist. Some sections have inevitably dated quickly, such as ‘Are there vaccines for coronaviruses?’. That said, this small book could be required reading for many politicians and journalists — along with Carl Bergstrom and Jevin West’s book, Calling Bullshit, on data presentation and interpretation, and their significance in the contagion of ideas (see E.-J. Wagenmakers Nature 584, 36; 2020).
Until next time
Two more volumes take broader historical sweeps. Mark Honigsbaum, a medical historian and investigative journalist, has reissued his well-received 2019 volume The Pandemic Century with new material addressing the current pandemic. A gripping read, it covers the usual wide range of infectious diseases — plague, flu, Ebola, AIDS, SARS, Legionnaires’ and Zika (see B. Kiser Nature 567, 459; 2019). There is also a chapter on the outbreak of psittacosis, or parrot fever, that started in 1929 in the United States: a respiratory disease caused by the bacterium Chlamydia psittaci. In a similar way to COVID, psittacosis can be mild or appalling. It is now very rare, thanks to widespread antibiotic treatment of infected people and commercial flocks of birds, especially domestic poultry.
In the new final chapter on ‘Disease X’, now known as COVID-19, Honigsbaum also blames complacent politicians but bemoans the lack of medical research into coronaviruses, too. He calls them the “Cinderellas” of the virus world: ambitious young microbiologists were warned that the waxing and waning of interest and funding for such research was no way to ensure a successful scientific career.
An economist at the Center for Global Development in Washington DC, Charles Kenny (The Plague Cycle) takes an even longer view. His starting point is a discussion of prehistoric humans’ susceptibility to disease, focusing on 2,500 years of civilization’s interaction with infections, especially in today’s urban societies. This is big-picture medical history. It takes in pestilence including plagues, malaria, smallpox and polio. It snapshots antibiotics and vaccines, and the problems of drug development, anti-vaccine campaigners and drug resistance. And he looks at social and medical reform, including sanitation, nutrition and the development of professional medical science and public-health systems. This all-encompassing view of humanity’s battles against disease provides a useful background to the more-specialized COVID-19 volumes.
The conclusion of The Rules of Contagion makes poignant reading. Kucharski writes that close analysis of previous outbreaks — learning what was predicted and what was ignored — offers the opportunity to prevent or control future outbreaks. Unfortunately, as the rest of these books relate, memories are short, political wills are weak and effective contingency plans are tweaked, ignored or forgotten. Reading Pepys’ diary entry for 31 December 1665 — “Now the plague is abated almost to nothing … to our great joy, the town fills apace, and shops begin to be open again” — we know there’s always a next time.