Seven months after emerging as a mysterious viral disease in China, Covid-19 continues to rage around the world, abating in some regions and gaining fury in others. As the global death toll approaches 600,000, calls for investigations and inquiries into the causes of the catastrophe — to learn lessons for future pandemics — are getting louder.
But authors are already publishing their own personal explorations of what went wrong and how to do better next time, which will provide fine primers for the official inquiries to come. Leading the way in the English-speaking world are books by Richard Horton, editor-in-chief of The Lancet medical journal for 25 years, and Debora MacKenzie, who has covered infectious diseases for New Scientist magazine for 30 years.
They will help to inform the global debate about humanity’s response to coronavirus. Expect an outpouring of books about every aspect of the pandemic over the next few months, from its social and economic impact to the origins of the virus responsible.
Anyone who wants to prepare by reading a clear scientific guide to Covid-19 can pick up Understanding Coronavirus by Raúl Rabadán, a biology professor at Columbia University in New York. If you are unsure how Sars-Cov-2 (which causes the disease) relates to its cousin Sars-CoV (which caused Sars in 2003), or how it gets into our cells (by inserting its surface “spike protein” into the human ACE2 receptor) then this book, the first written by a scientist working on the virus, is for you.
Of course all three books were produced in a rush, when compared with the publishing industry’s normal leisurely schedule, but none of them reads like a rushed job in the negative sense of slapdash writing and poor editing. Rather, they convey the urgent need to understand the causes of this pandemic, from the biomedical and political perspective, to help guide future policy.
Each author adopts a distinctly different tone. Horton’s Covid-19 Catastrophe is a well-reasoned roar of rage at the failure of many western governments to follow the emerging scientific evidence about the pandemic potential of the novel coronavirus. The book amplifies his voice as one of the medical world’s leading critics of policymakers, which has already been heard loudly through social media and Lancet editorials.
Although the UK government receives Horton’s most extensive criticism, his most intense venom is directed at the Trump administration for not only failing to protect American citizens but also undermining the global solidarity that is essential when fighting a pandemic. He is particularly scathing and unforgiving in his assessment of President Trump’s decision to cut US funding of the World Health Organization. “By attacking and weakening WHO while the agency was doing all it could to protect peoples in some of the most vulnerable countries in the world, President Trump has in my view met the criteria for the act of violence the international community calls a crime against humanity,” he writes.
MacKenzie is one of a small band of superb science journalists (also including Laurie Garrett and Helen Branswell) who have covered emerging infections and epidemics for many years. Her book, Covid-19: The Pandemic that Never Should Have Happened, is the most comprehensive of these three, combining policy analysis and criticism — in a calmer tone than Horton — with scientific insights.
Rabadán avoids politics altogether but his ultra-concise account illuminates coronavirus science not only with clear writing but also with good graphics and illustrations, which the other two books lack. Research itself is one thing that has performed well on the whole during the pandemic — in contrast with what policymakers have done with the science.
Tens of thousands of researchers around the world, with backgrounds from psychology and behavioural science to microbiology and mathematical modelling, have redirected their computers and labs to coronavirus — a crisis response not seen since the second world war.
The rapid advance of molecular biology and computing gives these recruits to the battle against Covid-19 technological firepower that was not available to the smaller scientific armies fighting other recent epidemics such as swine flu, Ebola and Zika, let alone Sars in 2003. For example, scientists can see how Sars-Cov-2 spreads around the world, by tracking individual mutations in the 30,000 letters of the viral genetic code in patient samples from Austria to Zambia.
The rush to release research results has caused some mis-steps, including the retraction by The Lancet and other journals of studies in which the data was not properly checked. There has also been significant collateral damage to other biomedical fields, from cancer to dementia, as researchers and their funders shifted to Covid-19 work.
But the resulting outpouring of knowledge about Sars-Cov-2 has supercharged the search for diagnostic tests, treatments and vaccines against what is turning out to be a remarkable virus — with far more complex and diverse effects on the human body than the pneumonia-like lung disease originally reported from China.
Although many mysteries remain, notably the strength and duration of the human immune response to Covid-19 and the long-term medical effects of the disease, “the global scientific community made an unrivalled contribution to establishing a reliable foundation of knowledge to guide the response to the Sars-Cov-2 pandemic,” Horton writes. “Yet the management of Covid-19 represented in many countries the greatest science policy failure for a generation. What went wrong?”
While Horton concentrates his search for answers in the western democracies, MacKenzie demonstrates what China might have done to suppress the epidemic at source before it spread around the world.
Yes, Chinese officials were more open about Covid-19 than they were 17 years ago about Sars, but still they “delayed reporting the illness, the virus and especially the all-important person-to-person spread,” she writes.
“Possibly, with memories of Sars still raw, authorities were afraid to frighten people with the news that it might be back.”
If China had not censored the brave doctors treating early cases in Wuhan, who tried to alert the world to what was happening, if the authorities had cancelled civic gatherings and sealed off the city before the great exodus for the Chinese new year, and if they had admitted earlier that the infection was moving between people, “that might have slowed the epidemic enough to make Covid-19 much less damaging and perhaps, just perhaps, kept it from reaching pandemic proportions,” MacKenzie believes.
Stopping Covid-19 entirely might have required faster action than any government could have managed. There is also the possibility — likelihood even — that by the time the first cases were recognised in Wuhan in December, the virus had already left China on international flights and was smouldering elsewhere, ready to ignite an epidemic.
When and how Sars-Cov-2 first moved from its original animal hosts — bats — into people is scientifically controversial. MacKenzie says horseshoe bats probably transmitted the virus directly to humans, though some researchers think it passed through another mammal as an intermediate host.
Genetic analysis of viral mutations suggests that the first humans were infected in November — and dismisses more outlandish theories about its origin that have been circulating via social media, such as the idea that scientists deliberately created Sars-Cov-2 by genetic engineering. Rabadán even quotes mockingly a suggestion that the virus arrived from space in a meteorite that reached north-east China in autumn 2019. But it remains possible that it was a natural bat virus being studied in a Wuhan lab from which it escaped accidentally.
However even if China had slowed the epidemic there and given the world more time to prepare, this might not have been used wisely. We will never know. Horton’s account suggests that many governments would have wasted any head start and delayed action until the disease was raging on their doorstep.
As it was, the likelihood of a devastating pandemic was clear by late January, as cases began to emerge outside China. Covid-19 transmitted very easily — on average each person with the virus passed it on to two or three others — and it killed almost 1 per cent of those infected. But western governments were lamentably slow to introduce social-distancing measures, the only action guaranteed to reduce transmission in the absence of effective antiviral drugs and vaccines.
They also failed to prepare health systems for the coming crisis by building up supplies of personal protective equipment, particularly for nurses and doctors, and ensuring that they had sufficient capacity to test people for Covid-19 and trace their contacts. These failures will be familiar to readers who have been following the coronavirus crisis in the media and are well-documented by Horton and MacKenzie, though neither has uncovered significant new material for his or her book.
The Bodley Head/FT Essay Prize
Now in its eighth year, the FT and The Bodley Head, one of Britain’s leading publishers of non-fiction, team up to find the best young essay-writing talent from around the world. The competition has been the springboard for many writers; entries can be submitted at ft.com/bodley2020. It is open to anyone between 18 and 35 years of age.
Looking ahead, these authors warn that we are only just beginning to recognise how deeply Covid-19 is going to change almost every aspect of human society, from government and education to the way we work and play. And there may be more powerful agents of viral destruction out there, replicating in animals and waiting for a chance encounter with people to trigger an even deadlier pandemic. MacKenzie describes several potentially apocalyptic viruses, with brain-swelling Nipah top of the horror list.
As devastating as Covid-19 and the flu pandemics of the 20th and 21st century have been, readers may conclude that, as these books suggest, we have been lucky to avoid worse.
The most important requirement for the future is global solidarity in surveillance and tracking emerging infections and then the fastest possible international action to stop them spreading. “Viruses don’t care about human borders, identities or ideologies — just human cells,” MacKenzie concludes. “The question now is: Do we care enough about defeating them to truly join forces?”
The Covid-19 Catastrophe: What’s Gone Wrong and How to Stop It Happening Again, by Richard Horton, Polity, RRP£12.99, 133 pages
Covid-19: The Pandemic that Never Should Have Happened, and How to Stop the Next One, by Debora MacKenzie, Bridge Street, RRP£18.99, 279 pages
Understanding Coronavirus, by Raúl Rabadán, Cambridge University Press, RRP£9.99, 120 pages
Clive Cookson is the FT’s science editor
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