A most consequential virus
Title: Apollo's Arrow: The Profound And Enduring Impact Of Coronavirus On The Way We Live
Published: October 27, 2020
Publisher: Little, Brown And Company
In Apollo’s Arrow, Nicholas A. Christakis tells an essential, if incomplete, story about Covid-19 and the pandemic through which we are still living.
1. A Novel Virus Spreads
A bat flaps its wings in China and the world shudders.
Reports of atypical pneumonia in Wuhan, China in December 2019 was among the earliest signs that something was amiss. Not long thereafter Dr. Wienlina Li, an ophthalmologist living in Wuhan, alerted fellow Chinese doctors of this ominous development. Be aware, he pleaded. Chinese authorities reacted swiftly to Dr. Li’s pronouncement. He was charged for spreading malicious ‘rumours’ and forced to recant his professed alarm. Such a response on the part of the Chinese government betrayed an elementary truth: viruses do not cease to spread in the face of censorship or bullying. Sanctioning a doctor alerting his colleagues of a new virus would not somehow make the virus disappear. Dr Li’s unexpected prominence would grow, but for the most tragic of reasons. Only weeks later he would catch this novel virus while treating a patient. He would develop the sort of severe symptoms about which he warned only weeks earlier and die of the disease in the first week of February. He was 33 years old. That he was so young and a doctor would be another sign of what had been set in motion, another portent of what was to come. A novel virus was circulating that not only put the general population at risk. The virus in question would be called SARS-CoV-2 and the disease to which it could give rise Covid-19 or, Covid for short. In treating those stricken with this unknown pathogen, doctors and nurses and other health care providers would also be at risk of infection, serious illness and death. Many health care systems around the globe would soon be under severe strain and often overwhelmed.
SARS-CoV-2 and the pandemic it has spawned is the subject of Nicholas Christakis’s Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live. Christakis is well suited to the task he sets for himself. He’s a medical doctor and a sociologist with a keen interest in the relationship between social networks and the spread of disease. He was also working collaboratively with Chinese scientists when the virus was identified. The result is a significant, if occasionally dull, book written at breakneck speed about Covid and the pandemic through which we are still living. It’s broad in scope but thus hardly exhaustive. Christakis anticipates, as the title suggests, Covid’s impacts into the not too distant future. One intriguing possibility is that the prolonged burdens of physical distancing and isolation will usher in a period of increasingly licentious mores. People will crave that which has been so long denied: the experience of crowded spaces, the freedom to speak to strangers without fear of exchanging a potentially deadly pathogen. Yet it’s his insights into the pandemic as it has thus far unfolded that are most relevant. So much of both the virus and the pandemic remains fiercely, often absurdly contested: its origins, the nature of the threat it poses and the appropriate response to its spread. Fumbled pandemic responses and the emergence of more virulent variants, moreover, have left many feeling as though we are groping our way through an endless darkness. In Apollo’s Arrow, Christakis walks us through the facts, provides urgently required perspective and, in so doing, sheds some necessary light.
Dr Li’s death was revealing in other ways. Both his humiliation at the hands of the Chinese state and death due to the virus made him a hero to Chinese citizens. A martyr who dared to speak scientific truth to power. His death alone was almost enough to create a crisis of legitimacy for the Chinese government. More urgently, to treat SARS-CoV-2 and the health care workers in so cavalier a way risked a pandemic of catastrophic proportions within its own borders. To begin with, a culture of fear between scientists and political authority was hardly conducive to transparent communication in the early stages of the virus’s spread. Yet transparency is precisely what is required to detect emerging patterns and potential outbreaks. Moreover, China is a vast country of 1.4 billion people with many densely populated cities and regions. The country’s late January lunar New Year celebrations were fast approaching. Chinese citizens would be traveling across the country in greater numbers than any other time of the year. One would be hard pressed to imagine more propitious conditions for the virus to spread.
In short order the Chinese government changed course. The scope of the threat was acknowledged, including to the World Health Organization, among other international institutions. Authorities now insisted that only a highly coordinated, epidemiological inspired response could quell the virus’s transmission rate and contain the pandemic. That is to say, only a combination of strictly enforced isolation and an appropriate amount of testing for the virus could get the transmission rate to below one. Quarantines were established and strictly enforced. Roadblocks prevented people from travelling. Government papers were issued. Hospitals for those rendered sick with Covid-19 were built in a matter of days. By the end of January, the virus wasn’t completely contained, but worst case scenarios were averted. In so doing, the country was shedding important light on how politics could affect the pandemic’s trajectory. In particular, the authoritarian nature of China’s regime helps to explain both the failure to initially contain the outbreak and then to so decisively get it under control.
A picture, incomplete but revealing, started to quickly form as to the origins of this novel virus. SARS-CoV-2 is part of the coronavirus family, a series of viruses that more typically cause the common cold but which which was also the source of SARS in 2003. The coronavirus spike shaped protein is adept at latching onto a receptor — the ACE2 — on human cells. Once latched, the virus is able to access cells and use the cellular machinery for the singular purpose of reproducing.
Many of the earliest victims of Covid-19 had a connection to a wet market in Wuhan. It’s a market at which live animals are traded, purchased and butchered for human consumption. Bats are the original host of the virus, making Covid a zoonotic based disease. Bats are not, however, sold at the market in question. It is believed that the virus was passed on to another animal — likely a pangolin — that acted as an intermediate host and which are sold at the market. (Pangolins are highly sought for their uniquely scaly skin and their perceived medicinal value.) Bats, as Christakis explains, are often hosts for human disease causing viruses. The bat, from their perspective of the virus, is a good partner with which it can co-evolve. Scientists continue to speculate on the various reasons for this apparent affinity and why the bat might occasionally shed the virus. Flying for bats is, as another scientist describes, “metabolically expensive.” Flying, in other words, requires a lot of energy. Normally the energy expended does not render the bat susceptible to illness caused by the virus. Scientists speculate, however, that when bats are forced to expel even more energy — during lactation or if bats are food deprived — the virus may cause illness. The bat’s immune system responds. Included in this response is an attempt to shed the virus, thereby making the bat infectious.
For all of Christakis’s insight, he says little about the wider context in which a virus would spread from a bat to potentially a pangolin and then to a human. Wuhan and the surrounding regions have been subject to a combination of deforestation and the introduction of manufacturing hubs. Thousands of small scale farmers have, as a result, been driven to urban slums. One enduring consequence has been to fuel the dynamic of often poor urban dwellers moving between city and and increasingly denuded countrysides in search of wild animals to sell at wet markets such as those found in Wuhan. Such a dynamic, in turn, elevated the chances of a pathogen, hitherto contained, making a fateful jump from one species to another. This is among the reasons why scientists were warning about the potential for a zoonotic based pandemic beginning in this part of the world. Now that’s it has happened, it’s among the reasons why the pandemic has prompted reassessments of our relationship to the natural world.
2. A Global Pandemic
Beyond China, scientists looked on with the sort of concern that quickly transitioned to alarm. As the number of infections grew inside Wuhan, infectious disease specialists and epidemiologists believed the virus was likely already seeded outside of China. By early February of last year, it was understood that a Covid pandemic was inevitable. Its severity and duration, however, remained an open question and would revolve around the complex interplay between the virus’s epidemiology and the politics of each country in which the virus would have a presence. The more the political response followed the scientific response, the more effective a country or subnational jurisdiction would be at stemming the tide of infections.
Although Christakis’s purview is global, the focus of his analysis is America’s experience with the virus. What’s most striking is the almost immediate disconnect between the effort of scientists and the hopelessly uneven, inadequate and indifferent political response. The inevitable discovery of the virus’s presence in America happened in February when a young man living in Seattle experienced symptoms we now associate with Covid. By quickly discerning its genome, micro-biologists were able to identify variants of the virus in places outside of Seattle, such as California. That discovery was another crucial sign: community transmission of the virus was already happening. Many scientists sounded the alarm. SARS-CoV-2 could spread exponentially, giving rise to a deadly pandemic. Alas, warnings were scarcely heeded by too many of the country’s political leaders.
Italy’s experience, moreover, was a terrifying harbinger of what was to come. For reasons that remain unclear, by February 2020 Italy became the pandemic’s epicentre. Nevertheless much about the country was conducive to the aggressive spread of the virus, including its multigenerational living arrangements. Soon, one of the pandemic’s recurring and defining features was also manifest. Hospitals were overwhelmed by unrelenting streams of those severely sick with Covid. There were severe shortages of Intensive Care Unit (ICU) beds. Life saving ventilators were in such short supply doctors were forced to make choices as to who to save and who to allow to die. There were so many dead that churches were used as makeshift morgues. The risk of further transmission from the sick to the healthy meant that those gravely ill with the virus had to die in the absence of family and other loved ones. Many doctors and nurses themselves would contract the virus and die from the disease. For others, the psychological toll was like nothing they had ever experienced.
Timing is critical in a pandemic. In America, there was a tragic lag between the introduction of the virus in places like Seattle and California and the sort of coordinated, fulsome response necessary to curtail its spread. Testing capacity was almost non-existent. In those early days the combination of contact tracing and isolation could have severely interrupted Covid’s transmission patterns. Alas, before too long that window of opportunity was closed in much of America, as well as elsewhere. The virus was too widespread for contact tracing to be a viable and effective response.
The more strictly political response only exacerbated the spread of the virus. If China’s federal government was guilty of initially censoring the scientific community’s early warning signs, the Trump administration was guilty of a combination of wishful thinking and gross, even criminal negligence. Instead of insisting on the pandemic’s potential severity, the country’s president repeatedly contradicted the administration’s own infectious disease experts such as Dr. Fauci and Dr. Birx. The president repeatedly insisted the virus would ‘disappear’ or that the country had a ‘turned a corner’ when every indication was the worst was yet to come. He emboldened Covid skeptics by dismissing the importance of mask wearing and physical distancing. He encouraged states to open their economies — ‘liberate’ Michigan he once tweeted — as experts warned of staggeringly high infection rates. Indeed, the administration abdicated its federal responsibility at precisely a time when a national pandemic strategy was required. America is the home of the Centres of Disease Control and Prevention as well as some of the best resourced and most advanced science institutions in the world. Nevertheless, the country has consistently experienced over a quarter of global cases of Covid infections. By December of last year, thousands of Americans were dying every day of the disease.
Viruses do not discriminate on the basis of skin colour or class. At first and even second glance, it’s reasonable to think that SARS-CoV-2 would afflict populations with the same range of possible symptoms and outcomes. Yet as the pandemic unfolded patterns of infection, illness and death quickly emerged. Race and class shape to a significant extent the virus’s trajectory, both within populations and within individuals. As Christakis makes clear, Covid’s spread in America is a case in point. In cities like Detroit and New York the virus proliferated much more aggressively among Black communities. Blacks are much more likely to die from the virus, too. Such discrepancies between the Black population and their mostly white counterparts were initially mysterious. The mystery was quickly solved. A significant portion of the Black population suffer from the sort of co-morbidities that renders them susceptible to more severe experiences with the disease: diabetes and high blood pressure. This alone renders those within the Black community more susceptible than their white counterparts to the severest reactions to the virus, including death. But the susceptibility is made worse by the combination of poverty and substandard housing. They are thus likely to live in over crowded housing; more people living in close proximity is, of course, conducive to spreading the virus. Finally, the poor and working class are more likely to have to work during the crisis and more likely to have to take public transit. For this reason, they are less likely to be able to self isolate when that is the surest way to protect oneself and one’s family from infection.
The tragic and absurdist political theatre surrounding America’s botched pandemic response made it the focus of much of the world’s attention. Yet virtually every country has been subject to horrors caused by the virus. Every country has had to strike a precarious balance between competing imperatives: disease prevention, on the one hand, and sustaining the economy and maintaining civil liberties, on the other. In Canada, Covid spread like brushfires through nursing homes in places like Bobcaygeon, Ontario and Montreal, Quebec. A funeral in Newfoundland and Labrador was a ‘super spreader’ event. In India, when the pandemic struck millions of landless labourers working in Delhi and other urban areas were suddenly without work and thus without an income. Without either, there was no money to transfer to families residing in rural communities, many of which can be hundreds or thousands of miles away from where the loved one was working. The hardship was compounded by the national government’s decision to announce at 8 p.m. on a March night that a lockdown would come into effect four hours later at midnight. A country of over a billion people was thus given only four hours notice to prepare to not only isolate but to cease all travel. Landless labourers were, without warning, thrust into a no-man’s land. The only way out was to attempt to walk hundreds of miles to the communities from which they came. Malnourished and dehydrated, many succumbed on such journeys. In Ecuador, Covid took such a swift and severe toll that public health authorities did not have the resources to retrieve all of the dead in a timely fashion. Bodies were left on sidewalks. A son talked to a journalist for The Guardian of having nowhere to put his deceased father after having succumbed to the virus in the home they shared. He remained with him for four days before his body was at last picked up. A late but tiny mercy.
3. A Question of Perspective
The world SARS-CoV-2 burst onto was one already characterized by various crises of truth and authority. In the information eco-system social media has wrought, the virus and the pandemic has only served to amplify these crises. Legitimate questions and debates have had to compete in the public imagination with conspiracy theories no longer embraced by only a radicalized few. Almost immediately suspicion and mistrust of both science and political authority became a crucial feature of the pandemic. A combination of misinformation and disinformation started to spread as rapidly as the virus itself. For example, the relatively close proximity of the Wuhan Institute of Virology to the wet market where it is believed SARS-CoV-2 was introduced into the human population was treated as evidence of a nefarious scheme. The virus was a manufactured Chinese bio-weapon accidentally or intentionally released onto an unsuspecting world. The experience of mild or even non-existent symptoms after a Covid infection suggested to many that lockdowns and calls for physical distancing and mask wearing were excessive, if not altogether pointless. Covid wasn’t nearly as fearsome as the dire warnings predicted. Worse, such efforts were part of a more insidious campaign to take away personal, political and economic freedom. Alternatively, the virus’s lethality was proof of a campaign of population control. Intentionally initiating its spread was an attempt at human culling. That so many of the misconceptions were contradictory did nothing to diminish their corrosive and divisive power. “Truth is another casualty of plague. Some of the most damaging and self-injurious responses to an epidemic are denial and lies,” Christakis writes.
The distrust of science grew more fervent the closer scientists got to developing Covid vaccines. For Covid skeptics, the accelerated development of vaccines means, at the very least, they are not safe for humans. At worst, administering the vaccines is in fact a strategy for the stealth injection of a ‘micro chip’ into every recipient. Vaccines do not constitute a vital public health measure, from this perspective. Like the other measures ostensibly used to disrupt the spread of the virus, vaccines are instead part of an insidious campaign of surveillance and social control, led by the likes of Bill Gates. Or, at the very least, a manufactured opportunity to create obscene profits for the pharmaceutical companies tasked with developing vaccines. Such thinking masquerades as skepticism, but is, in fact, deeply ahistorical, unscientific and dangerous.
Apollo’s Arrow is a much needed corrective. Indeed the book’s chief virtue is the desperately required perspective – both scientific and historical – it provides on the Covid pandemic. When Christakis employs the language of infectious disease experts and epidemiologists the effect is to both clarify and counter many of the misconceptions about Covid. In writing of the difference between the latency period and the incubation period, for example, he goes a long way to explaining why a virus with only a 1% lethality rate would require such a severe response – a lockdown global in scope – to stem its spread. The latency period is the time between infection and infectiousness; put more simply, the time between infection and being able to infect others. The incubation period is the time between infection and the onset of of symptoms, if one has any symptoms at all. Understanding the relationship between these two epidemiological variables helps explain, for example, why the SARS pandemic of 2003 was so effectively contained but the Covid pandemic has been so fiendishly challenging to wrestle to the ground. People who acquired the SARS virus were generally not infectious until they were sick themselves. Although the virus was ten times more lethal than SARS-CoV-2, its spread was thus largely confined to health care settings. This is in stark contrast to the virus fuelling Covid: the considerable gap between the latency and the incubation periods contributed to conditions ideally suited to the virus’s global and exponential spread. As Covid has demonstrated, for such a virus a relatively tiny lethality rate will still have ominous implications. Although the pandemic is far from over, the number of deaths due to Covid is closing in on three million. It’s thus the combination of the virus’s epidemiological traits that have rendered it such a grave threat.
Yet Christakis’s aim is not simply meant to offer a Covid timeline or a primer on how and why SARS-CoV-2 so aggressively spreads or why it warrants the attention it has received. His more fundamental aim is to locate the Covid pandemic within the context of humanity’s history with infectious disease. That history is as long as humanity itself. Christakis repeatedly refers to the Plagues of Athens in 430 BC, the Justinian Plague of 541 AD and the Black Death of 1347. Ancient scourges have, of course, more recent parallels: the Spanish Flu pandemic of 1918-19 and the still ongoing HIV/AIDS pandemic, among many others. As if to remind readers of what’s at stake, he describes the toll pandemics take on human communities. The social divisions and prejudices they exacerbate. The often sudden, lonely and excruciatingly painful deaths pathogens can cause. As will eventually be true of Covid, vaccines (as well as antibiotics) have done much to shield humanity from the worst such scourges can inflict. Nevertheless Covid reminds us that when confronted with a novel, highly infectious and potentially deadly virus, humanity will always be playing catch up. The threat of pandemics a part of the human experience. This surely must be one of Covid’s enduring lessons.
Christakis also uses metaphor to provide perspective on this bewildering moment. Among the most resonant he invokes is that of a butterfly flapping its wings in one place and causing a hurricane in some other distant part of the world. The far fetched notion is meant to highlight an increasingly germane idea: the most innocuous seeming event can initiate a series of effects at once unpredictable, upending, far reaching and profound. In the case of Covid, the butterfly metaphor resembles something quite literal. A bat flapped its wings and shed, as Christakis describes SARS-CoV-2, a most “infinitesimal thing.”
Not for the first time, a virus would change the world.