Apollo's Arrow The Profound and Enduring Impact of Coronavirus on the Way We Live

So far, most of the books I have read on the COVID-19 pandemic have either been of the backwards-looking, how-did-we-get-here type, or have dealt with practical virological, epidemiological, or immunological details. I picked up Apollo's Arrow as it promised a forward-looking perspective while drawing parallels with past pandemics. Nicholas A. Christakis, a physician and sociologist directing the Human Nature Lab in Yale, got drafted into working on the pandemic from the start, tracking the spread of the virus, and sat at the bedside of many dying patients while working as a hospice doctor in New York. I believe we need to hear these frontline stories.

Accompanied by excellent infographics by Cavan Huang, Apollo's Arrow provides you with all the basics in case you need them. Christakis starts with an overview of how the virus was first detected in China and then spread around the world. He details the differences with the SARS and Spanish Flu pandemics to explain why COVID-19 became so destructive, along the way introducing epidemiological parameters and details such as infection fatality rates, case fatality rates, the basic reproduction number R0, herd immunity, asymptomatic transmission, the concept of flattening the curve, and how exponential growth keeps catching us out. Usefully, he also discusses the full range of non-pharmaceutical interventions that we have at our disposal: physical distancing, mask-wearing (a basic topic some other authors have omitted), testing and tracing, border closures, and lockdown.

Throughout, Christakis includes eyewitness testimony of, and insightful comparisons to, past pandemics. From recent ones such as SARS, influenza pandemics in 1957 and 1968, and the Spanish Flu, to historical ones such as the bubonic plague or the plague of Athens, pandemics have long been with us, shaping the course of history. I think there is much value in providing historical perspective, and there is no shortage of recent books surveying pandemics through the ages, many now being reissued. What sets apart Apollo's Arrow is that it focuses on COVID-19 through the eyes of a physician who is interested in history. As Christakis discusses the short, medium, and long-term consequences of the pandemic, the past is a constant companion to show that "What happened in 2020 was not new to our species. It was just new to us" (p. 84).

There are the familiar companions of grief, over lives and livelihoods lost; fear, and the scapegoats on who we take it out; and lies, the conspiracy theories and propaganda. What has not helped the disease being taken seriously, Christakis writes, is that COVID-19 lacks visible symptoms. And with many people dying alone in healthcare facilities, "Americans did not see how the virus did its awful work" (p. 204). As has historically happened, much of the impact ran along the faultlines of existing inequalities, with groups such as Hispanic and African American communities, homeless people, prisoners, or meatpackers particularly hard-hit. But the coverage here is not all negative. Unsurprisingly from an author who wrote Blueprint, he highlights the healthcare workers who put their lives on the line, and the altruism and charity as everyday people helped each other in myriad ways. The penultimate chapter is a grab bag of observations and questions – some speculative, others less so – on how the pandemic affected for instance the environment, children and education, the economy and supply chains, jobs, religious beliefs, or practices in public health care.

I was particularly pleased to see Christakis repeatedly mention the Three Horsemen of the Apocalypse: "The lack of scientific literacy, capacity for nuance, and honest leadership" (p. 320). Unique to our time, social media provided "a bonanza of disinformation" (p. 151), while academic preprint servers containing unvetted information proved to be a double-edged sword. It has been galling to see basic, uncontroversial hygiene practices being drawn into politicized discussions over "personal freedom", ignoring its partner-in-crime, "collective responsibility". Or to see delusional wishful thinking, as if the pandemic "could end by fiat" (p. 319). Christakis reminds us that "[...] denial is an old ally of pathogens" (p. 157).

For those inclined to unwarranted accusations at the address of "elitist academics", the above is coming from a physician critical of his own profession. He thinks the privacy lost to contact tracing apps is not worth the limited epidemiological benefits and high likelihood of false positives. He remarks on the surprisingly small role of medicine in the historic decline of most infectious diseases, which are instead largely due to socioeconomic improvements and basic public health measures. And he points to iatrogenesis: illness or injury caused by medical actions, something that actually declined during the pandemic as many operations and hospital visits were delayed.

So far, so good. Christakis offers plenty of sharp observations to digest. I have, however, two caveats. First, as the publisher's blurb also points out, this book is rather US-centric. Second, the book is dated in places. This is not a criticism of the author; rather, the pandemic is a rapidly moving target and I am to blame for reading this book as late as I have. Especially his concern that we might not have vaccines in good time seems cautious with the benefit of hindsight. Their rapid development has been a noteworthy achievement, and other authors are already lining up to tell these success stories. I hasten to add that it has been a typical human achievement, replete with follies such as vaccine nationalism as countries competed to secure supplies.

Even though some of Christakis's questions and concerns have been supplanted by new ones, many others remain. If you have religiously kept up with the deluge of news items and opinion pieces on the pandemic, a lot has already been discussed since. But I imagine that for many readers, myself included, life will have gotten in the way. If so, then this book is a welcome and well-written perspective from a qualified professional, looking forward from his particular point in time. It does present the author and the publisher with a challenge for the paperback that is slated for October 2021. Reissuing the book as-is does not strike me as very useful. But bringing it up to date with the many developments since then would be a mighty task, tantamount to rewriting it. If Christakis were to go down the route of a thorough update, I have no hesitation in recommending that you buy the paperback upon release. I can see how the hardback will have been very impactful upon publication last year, and I found the comparisons with past pandemics to be particularly eye-opening.