What intrigued me most about Nicholas Christakis’ new book, “Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live,” was its promise to explain the long-term impact of COVID-19 on our lives. For months we’ve learned many details about the virus, but I’d not seen a forecast as to what the next few years will bring. Will things ever get back to “normal”? If so, how long will this take? Will there be a “new normal” post-coronavirus? Christakis addresses these questions in his detailed telling of all things related to COVID.
Christakis makes it clear that epidemics have been normal occurrences throughout human history and provides stark descriptions of past epidemics. Christakis provides a nice balance of technical detail and readability as he explains how viruses work and how a virus spreads within our bodies as well as through the community. I found Christakis’ explanation of medical terms used by epidemiologists in tracking a virus (infection fatality rate, attack rate, effective reproduction number, etc.) quite helpful in understanding their work toward protecting society. These data enable the reader to understand why, for example, the SARS-1 outbreak in 2003 was ten times deadlier than today’s SARS-CoV-2 — the disease that causes COVID-19 — outbreak, restricting its ability to spread. Also interesting is that the SARS-CoV-2 outbreak is ten times deadlier than the ordinary flu, and has the ease of transmission of a common cold.
The coronavirus came from bats, as have other deadly diseases, and the outbreak began in Wuhan, China. Christakis details China’s response, both bad and good. After initial denial and secrecy, China detonated a “social nuclear weapon” to prevent the virus spreading. By the end of January 2020, nearly all of China was shut down. It was the largest imposition of public health measures in human history.
Christakis explains how the virus came to the U.S. and how it spread, much through asymptomatic transmission. With COVID-19, carriers can spread the disease for two to four days before they are symptomatic. America’s resistance to COVID protocols reflects our country’s inability to accept hard realities. Christakis writes that “Americans had put on blindfolds when they should have put on masks.” Our Centers for Disease Control botched the initial test rollout. We suffered greatly from lack of a national plan to fight the pandemic. It was like we had 50 different epidemics, with governors fighting for needed supplies. Lack of a coordinated response was as ineffective as “having a peeing end of a swimming pool.” Trump’s false statements did not make the virus go away and instead undermined science and rationality. Trump was largely playing to the desires of a large number of Americans wanting the pandemic to be less serious than it is.
If the U.S. had implemented physical distancing one week earlier, infections would have dropped by over 60% and deaths by 55%. Pandemics mostly heighten and highlight inequality, and as a result, working class and immigrant communities were the hardest hit.
Christakis describes the two broad ways to respond to an epidemic: pharmaceutical interventions and nonpharmaceutical interventions, such as social distancing, hand washing, wearing a mask, self-isolating, shutting schools, banning large gatherings, etc. Masks work by dampening the propulsive force of droplets leaving a mouth and can be up to 99% effective. Wearing a mask is a public good and should be seen as a civic duty. Christakis details the importance of testing, contact tracing and closing schools. By keeping kids from acting as vectors and forcing parents to stay home, school closures are the most important nonpharmaceutical intervention that can be employed, short of requiring everyone to stay home.
Christakis provides a history of vaccines, how they are developed, the different types and how they work. Vaccines are a key toward getting us to herd immunity. Herd immunity is when a group is collectively immune even if everyone is not individually immune, because it’s highly unlikely a person will contact someone else who can transmit the virus. Roughly two-thirds of the population needs to be immunized to confer herd immunity.
Christakis states that SARS-CoV-2 will mostly become like the other viruses that circulate amongst humans, such as the flu or the common cold. SARS-CoV-2will ultimately become endemic and will regularly circulate around us at some low, steady level. In the future, children will be exposed to SARS-CoV-2, have a mild disease, get some immunity, and then avoid serious disease later on. As always, human defenses will evolve over time.
Until 2022, Americans will continue to live in an acutely changed world. We will continue to wear masks. Bans on large gatherings will last a couple years. For a few years after we reach herd immunity, we will still be recovering from the shocks of all this, including clinical, psychological, social and economic shocks.
Around 2024 expect things to gradually enter a “new-normal.” We might see the end of hand-shaking, and we may become compulsive handwashers. Medical care will continue to be allowed over the phone or internet. Many small retailers will go out of business, damaging the job market. Other changes could include a continuation of employees working from home, a major reduction in business travel and hybrid models of remote and in-person schooling. America’s poor response to the pandemic will have lasting negative impact on America’s economy as well as on our global leadership. Look for China to get a boost.
Christakis assures us that America will beat the coronavirus. He writes “plagues always end.” However, America was unprepared emotionally, politically and practically to respond to COVID-19. We lacked the needed equipment. We didn’t understand the threat. Hopefully we have truly learned important lessons from this pandemic and will make necessary changes to keep us safer in the future.
I found that reading Christakis’ treatise “Apollo’s Arrow” provided not only a better understanding of the pandemic, but also provided a better sense of control over something that often feels so out of control.
Read more of the Jan. 27 - Feb. 2, 2021 issue.