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The pandemic is as much about society, leaders, and values as it is about a pathogen

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

Nicholas A. Christakis
Little Brown
384 pp.
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In 2019, the Global Health Security (GHS) Index ranked the United States as the most prepared country in the world for a pandemic. Just over a year later, the United States has not only failed to control coronavirus disease 2019 (COVID-19), many consider the nation’s response to the pandemic to be one of the worst in the world. Was the GHS Index biased? Or did the country’s preparedness change drastically during this period?
Answering these questions requires understanding the pandemic as a complex system—one that reveals our greatest strengths and most debilitating weaknesses.

In his provocative new book, Apollo’s Arrow, Nicholas Christakis uses such an approach, drawing on his experience as both a hospice physician and a leading network scientist to integrate societal, technological, and biological data into a single cohesive narrative of the unfolding pandemic. Not surprisingly, the book is far-ranging, covering relevant aspects of epidemiology, human behavior, social networks, technology, immunology, and applied mathematics.

The book’s title refers to a plague that befell the Achaean troops in The Iliad, which was brought about by the Greek god Apollo in response to the bad behavior of the Achaean leader Agamemnon—a fitting analogy for our current predicament. Christakis turns to another literary analogy to further illuminate the complexity of human behavior during pandemics, which can range from fear-induced debilitation to profound acts of courage, with a short story by Ernest Hemingway about a soldier, a nurse, and a patient dying of the 1918 flu. (The nurse demonstrates incredible heroism by caring for the patient until he dies, whereas the soldier cannot even bring himself to embrace the nurse, his lover, for fear of infection.) Within the past 6 months, we have seen similarly divergent responses to the current pandemic, from recovered individuals selflessly donating plasma to defiant customers who refuse (sometimes violently) to wear a mask while out in public.

As Christakis repeatedly shows, the United States could have taken a different path. “The upward trajectory as the pandemic initially took root in each nation was grimly similar,” he observes. While countries such as Vietnam, Mongolia, New Zealand, and Japan quickly implemented test-trace-isolate strategies, which accounted for the role of so-called “superspreading” events in COVID-19 transmission, and were able to control the epidemic, other countries, including the United States, the United Kingdom, and India, failed to do so, revealing the joint effects of underfunded public health systems and a lack of experience dealing with diseases that, like COVID-19, require a complex-systems approach to control.

“In many real-world social networks, most people have very few contacts and a small minority have many connections,” notes Christakis, highlighting one of the many factors that can influence disease transmission. This variability in social contact network structure, coupled with human behavior and pathogen biology, can result in epidemics where a minority of infected individuals give rise to a majority of cases. COVID-19 exploits this variation, perpetuating itself largely by way of superspreading events.

Conventional public health wisdom in the United States suggests that forward-looking contact tracing is essential for preventing epidemics. However, for diseases that rely heavily on superspreading events for sustained transmission, backward-facing case investigation is often even more important. As Christakis repeatedly shows, seemingly trivial differences in the public health response to COVID-19—for example, Japan’s focus on “cluster-busting” versus the investment in contact tracing in the United States—can lead to large differences in outcome. Such dependence is the hallmark of complex systems.

In the United States, the COVID-19 pandemic has been aggravated by long-standing racism and xenophobia. Communities of color, Native Americans, and recent immigrants too often have reduced access to health care, a higher disease burden, and greater economic insecurity, argues Christakis, and the outcomes for those in these communities who contract the virus have been staggering. Native Americans, Blacks, and Hispanics, for example, have thus far experienced at least twice the population-adjusted rate of mortality. Here, Christakis echoes growing cries that we must confront and repair the long-standing health inequalities borne by nonwhite communities.

There is no shortage of books that argue that pandemics are complex or ones that discuss the public health issues raised in Apollo’s Arrow, and it is unlikely there will be a shortage of future works that dissect domestic and international responses to the COVID-19 pandemic. What sets Christakis’s work apart is that it was written in real time by an expert who astutely shows how pandemics are as much about our societies, values, and leaders as they are about pathogens.

About the author

The reviewer is at the Network Science Institute, Northeastern University, Boston, MA 02115, USA, and the Santa Fe Institute, Santa Fe, NM 87501, USA.