A GPS for Those Lost in the Pandemic: Apollo's Arrow by Nicholas Christakis

Most of us can recall the early days of 2020 before we recognized that COVID-19 was going to be the ultimate disruptor of our lifetimes. I was in the most dramatic of locations, on the Inca Trail to Machu Picchu, when the initial U.S. COVID travel ban was announced. That summer day in Peru, scrambling to find a way to return home after vacation, I first realized that nothing in my prior medical or personal experience had prepared me for living through a plague. It was impossible to predict the upheaval in our professional and academic realms, the financial turmoil, the personal loss, and finally this unstable truce with the virus even as a major war looms in the horizon exactly two years later. Those were weeks that felt like decades as we fast forwarded through history.

How can we as people living through these times make sense of all this change? Dr. Nicholas Christakis attempted to chronicle and decipher this story in real time. Apollo's Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live is one of the first major histories of humanity's encounter with SARS-CoV-2. Dr. Christakis is a palliative care physician and a medical sociologist who studies the intersection of technology, behavior, society, and human evolution. I highly recommend listening to his two TED Talks on social networks.After discussing those early days of the pandemic in Wuhan and the possible pathways of its spread, he demonstrates how our interactions with pathogens have shaped societies repeatedly in human history. The silver arrows of Apollo that befell the ancient Greeks speaks to some similar pestilence in our collective unconscious. I found Dr. Christakis' chronicle of the initial days of the pandemic particularly useful, with discussion of similarities and differences with the SARS outbreak and the Chinese government's attempts to initially downplay the illness. Neither the Centers for Disease Control and Prevention nor the U.S. government escape criticism, especially given the series of initial miscommunications, lack of a national plan, competing fragmented interests, and steady undermining of science in society. Dr. Christakis collates a wealth of genetic, immunologic, and epidemiologic data and argues that COVID-19 as an illness is at least 10 times deadlier than the flu with a steep age-related fatality gradient.

For a physician, the outstanding aspects of this book are the discussions of the various past pandemics interspersed throughout the book and the author's views on how society will adapt to this experience. The OC43 pandemic of 1889 (known as the Russian flu or Asiatic Flu) has arguably the closest parallel with COVID-19 and offers clues as to how a combination of diminishing biologic lethality and acquired herd immunity will eventually lead to a milder endemic respiratory illness that persists in our species. Considering that the book was written before the Omicron variant and widespread global vaccination efforts, this was a surprisingly accurate prediction. Another important and well-argued position of the author is that nonpharmacologic interventions (NPI) are much more important than pharmacologic ones even as he points out that Americans put on blindfolds instead of masks. As we ponder over why a million of our fellow citizens perished in this pandemic, having fragmented rather than collective national NPIs (“having a peeing end of a swimming pool”) places the blame squarely on our own society and its leaders.

Dr. Christakis is at his best as a sociologist when he discusses how humanity will move on from this and adapt to a “new normal.” Travel, work, medicine, etiquette, and social behavior will likely carry permanent imprints of our encounter with this little RNA strand while major geopolitical and economic upheavals could also be expected. The reduction in workforce (the so-called “pandemic quit”), people re-evaluating priorities, sociopolitical movements, and demands for more equality in society are all happening around us, and I find Dr. Christakis to be quite honest about the unpredictability of this inevitable change. Around 2024 is when the author predicts we will enter the post-pandemic phase. There are no doubt other sociologists and historians who will chronicle COVID-19, but this book, though an early history, has helped me to rise above the daily cycle of COVID-19 news and drama played out on med-Twitter, largely by pseudo experts, affording me a much needed logical and historical overview. An important reminder to us hematologists is that communication and coordination are even more important when we are all in a collective crisis. The astounding scientific success of getting an effective approved mRNA vaccine will not bear fruit if we cannot effectively communicate and convince our fellow citizens. As a society we cannot undermine science and rational thought in the public sphere and expect any better outcomes than how we fared during this crisis.