Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live by Nicholas A. Christakis
Review
A very clear and elaborate essay on pandemics in general, and the lessons learnt of previous pandemics to covid-19. Even though it is a terrible crisis, Christakis helps us put this period of despair in context, highlights both negative and positive future effects and gives us the bright prospect that all pandemics eventually end.
Apollo’s Arrow
Preface
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And there is much that only the passage of time will reveal, including the long-term health effects of the infection and the long-term consequences of our response to the contagion (such as how our physical and social distancing might affect the mental health and education of our children and the economic prospects of a generation of young people presently entering adulthood)
1. An Infinitesimal Thing
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Exhaustion from the physical toll of the virus is intensified by its emotional toll, given the contagious nature of the disease. Many patients felt guilty about having unknowingly transmitted the virus to others when they were still asymptomatic. Doctors also think that many patients may have long-term consequences of infection with SARS-2 in many organ systems, in what is called “post-COVID syndrome.”
2. An Old Enemy Returns
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In fact, in many cases, it seemed that the one to two days before a person manifested symptoms was when COVID-19 was possibly most contagious.
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Ordinarily, pathogens evolve to be less deadly, since it does not suit their interests to kill their hosts. A dead host cannot easily spread the germ to others, so causing milder illness is “better” for the pathogen from a Darwinian point of view.
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People who would have gotten sick do not, and they pile up for the winter. Like a dam, the weather and the host behavior hold the epidemic back. But eventually, the dam breaks. This results in recurrent outbreaks (and, ultimately, a seasonal pattern) after the initial introduction of the pathogen.
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While the way we have come to live in the time of the COVID-19 pandemic might feel alien and unnatural, it is actually neither of those things. Plagues are a feature of the human experience. What happened in 2020 was not new to our species. It was just new to us
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To summarize, SARS-1 was ten times deadlier than SARS-2, which in turn is ten times deadlier than the ordinary flu
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I became increasingly convinced that the pandemic that COVID-19 would most resemble was the 1957 influenza pandemic.
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But SARS-2 has a smaller dispersion in Re, meaning that transmission chains are somewhat less likely to be dead ends, which makes it easier to reliably spread SARS-2 than SARS-1.
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For SARS-2, however, probably at least 40 percent of the human population worldwide will be infected in the end, and perhaps as much as 60 percent
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Herd immunity is the idea that a group of people can be collectively immune to an infectious disease even if not everyone in the population is individually immune
3. Pulling Apart
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By the end of April, the curve had been flattened. But the result of the outbreak was staggering: a statewide antibody testing survey found that 21.2 percent of the city’s residents had contracted COVID-19 in the first wave.127
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Some countries will undoubtedly manage it better than others, and my guess is that the nations that fare best will be the ones with high public trust and strong science-based leadership
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Indeed, even if masks reduced the transmission rate of the virus by only 10 percent, our models indicate that hundreds of thousands of deaths would be prevented around the world, creating trillions of dollars in economic value. This is a big effect of a small thing
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In my view, if decision-makers are prepared to close schools at all, they should be closed before the first case in a school, when disease cases begin to appear in the community or in nearby areas. This is called proactive closure and it’s more controversial. Rigorous analyses show that proactive closure is one of the most beneficial interventions that can be employed to reduce the impact of epidemic disease.72
4. Grief, Fear, and Lies
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Another analysis of two hundred million tweets about the pandemic collected from January through May 2020 found that 62 percent of the top one thousand retweeters were bots.
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it’s also why people can find mask-wearing beneficial: it gives them something concrete to do in the face of the threat, regardless of the exact benefits of masks (which are considerable). This helps restore their sense of control
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The epidemics of emotions and of misinformation intersect in worrisome ways with the underlying epidemic of the pathogen itself.
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To cope with a plague in the twenty-first century, we responded not only with familiar interventions, but also with familiar feelings
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These terms are nowadays preferred to the erstwhile epidemic hysteria.31 In such outbreaks, people can develop physical symptoms that have no physiological basis, driven by anxiety and fear. In the “pure anxiety” type, people report a variety of symptoms, including abdominal pain, headache, fainting, dizziness, shortness of breath, nausea, and so on.
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In fact, one of the great travesties of the COVID-19 pandemic in the United States has been the undermining and muzzling of the widely respected CDC
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the denial of the reality of the COVID-19 pandemic is the latest manifestation of a fissure between science and politics that has been widening for decades in the United States, especially when scientific consensus has implications that are inconvenient to policymakers
5. Us and Them
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What is most helpful, in my view, is to emphasize our common humanity. What is needed in order to confront a pandemic is solidarity and a collective will for disease control.
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Holders of such immunity passports could then return to nonessential (not just essential) jobs and could participate in large gatherings with their similarly immune brethren
6. Banding Together
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All this is what cooperation and teaching were able to accomplish. And this is how, in the end, we will defeat the virus. By connecting, volunteering, and learning, we can affirmatively work together to outlast the predations and limit the damage of such a tiny thing
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Even wearing a mask is partly an act of kindness, and there is no guarantee that the generosity will be reciprocated.
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a widely shared peril erodes prior divisions, bringing large numbers of people into the category of “us.” Everyone becomes part of the group confronting the problem
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After all, humans are moral actors capable of transcending their own self-interest
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That year, statewide marriage rates increased significantly (by an average of 0.70 per 1,000 people, which may sound trivial but is not), temporarily reversing the steady decline observed over two decades prior to the disaster
7. Things Change
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Moreover, working from home could undergo unappealing changes; surveillance of the kind we saw for exam proctoring might be attempted by some companies (for example, by using keystroke monitoring to make sure employees stay on task or tracking e-mails or calendars more stringently).
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But even if the apps worked, there could be issues. I was reminded of Benjamin Franklin’s adage (which he articulated in a rather different context) that “those who would give up essential liberty, to purchase a little temporary safety, deserve neither liberty nor safety.” The erosion of liberty weakens a democracy
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The COVID-19 pandemic revealed the country’s dependence on essential low-wage workers, and even without large numbers of working-age-adult deaths, laws that better enshrine worker protections in the United States in the post-pandemic period are likely
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, our arts and literature will be imbued with pandemic-related symbolism.
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Perhaps after the dust settles from the pandemic, and humanity moves on to other threats that require scientific understanding, such as climate change, the voice of experts might be given more weight
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The pointlessness of much in-person medical practice was driven home by another physician colleague, Michael Barnett, who noted that a major reason that patients came in to see their doctors had nothing to do with good medical care or their clinical needs—many of these appointments were to satisfy insurance regulations that mandated visits for routine matters (like getting a prescription refill) that could easily be handled remotely.
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Experts are seen as out-of-touch elites, and expert knowledge is seen as a kind of conspiracy aimed at obtaining resources for the privileged at the expense of the masses
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Then, gradually, things will return to “normal”—albeit in a world with some persistent changes. Around 2024, the post-pandemic period will likely begin.
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Finally, there is the loss of the capacity for nuance in our public discourse. Problems and policies are framed—and seen—as black-and-white. The tolerance for shades of gray and complexity is low
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a CEO noted that he felt this experience “put an end to the ‘fly across the country for a one-hour meeting’ expectation forever.”82
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Dr. Fauci declared that post-pandemic America would involve “compulsive handwashing” and “the end of handshaking
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For a few years after we either reach herd immunity or have a widely distributed vaccine, people will still be recovering from the overall clinical, psychological, social, and economic shock of the pandemic and the adjustments it required, perhaps through 2024. I’ll call this the intermediate pandemic period
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The shift to working from home will also linger. In the post-pandemic period, workdays for many employees will get shorter or be better aligned with school days.
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Filling a cart with canned goods, flour, cleaning products, and batteries made many people feel like they could influence what happened to them.
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Psychologist Adam Grant has argued that the ripple effects of the pandemic may even include more ethical leadership of our major corporations
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However, a minority of children may actually return to school with more resilience, and they could fare better in the long term
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After many people die in a serious pandemic, labor is generally scarce, relative to capital (this is in contrast to major wars, which typically result in destruction of capital in addition to human lives). Investment opportunities are depressed, given the excess of capital
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Either way, until 2022, Americans will live in an acutely changed world—they will be wearing masks, for example, and avoiding crowded places. I’ll call this the immediate pandemic period.
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Lenore Skenazy, an advocate for independence among children, ran an “independence challenge” essay contest in the spring of 2020, and some of the responses illustrated the ways in which children thrived with less supervision
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Despite all this, I think that one of the unexpected impacts of the COVID-19 pandemic may be that a society that feels besieged by the threat of the virus will increasingly treat scientific information, and not just scientists, seriously
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there has been a progressive denigration of science. Science has come to be seen by too many as serving political ends. Many people have even abandoned the fundamental idea that it is possible to have an objective appreciation of the truth.
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Gilbert Welch, argued that we were probably previously treating too many minor issues—everything from mammographic irregularities (which might disappear on their own) to mild heart attacks (which often have better outcomes without medical care than with it—since patients are often subjected to risky procedures driven more by the financial exigencies of the hospitals and specialists than by the patients’ needs)
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But this localized, familial way of living was not so unusual for our species.
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Some scholars have speculated that this set the stage for the rise of capitalism and even of the Reformation, since it became very clear that the priests had no way of stopping mortality from the plague
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Over the intermediate term, cities could be duller, as many small retail firms go out of business, leaving only large, well-capitalized chains to fill the urban landscape
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If history is a guide, it seems likely that consumption will come back with a vengeance
8. How Plagues End
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It’s very important to emphasize that, as bad as COVID-19 is, it’s not remotely as bad as epidemics of bubonic plague, cholera, or smallpox that have killed much larger fractions of the population and that have had much larger and longer-lasting effects
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Banding together to implement the various NPIs fostered a recognition of the importance of collective will and helped set the stage for political activism to address other long-standing problems in our society, from economic inequality to racial injustice to health-care inadequacies
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But most of all, we did not have a collective understanding of the threat that we are facing. The COVID-19 pandemic awakened Americans to the importance of public health in the same way that 9/11 opened our eyes to the sophisticated threats to our national security, the great recession to the fragility of our financial system, and the election of various populist leaders around the world in the twenty-first century to the dangers of political extremism.
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blind hope is a fickle companion for our woe. It is not enough. Still, by forcing our gaze to the future, hope can serve another purpose: it can motivate us to prepare
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Globalization, mass migrations, rapid airline links, the ever rising size of the human population, and humanity’s increasing localization in huge and densely packed metropolises also contribute to the persistence of deadly infectious diseases
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Nevertheless, COVID-19 increases the baseline risk of death at every age. Most parents worry about all kinds of uncommon calamities happening to their children. But if we worry at all about our children drowning or being kidnapped, we should rationally be worrying more about COVID-
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And reductions in social mixing via bans on gatherings will surely have to be present for a couple of years.56
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So we will reach herd immunity, or the pathogen will evolve to be less lethal, or (after a very long time) humans will evolve to be resistant.
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These observations about human evolution indicate that, over very long periods, measured in thousands of years, pandemics end by reshaping our species.
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Here, the pathogen is still around, but it has a much more difficult time reestablishing itself. This resembles a well-vaccinated population for any infectious disease; there are only occasional, small outbreaks among nonimmune people.
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Another reason that the commitment to addressing the pandemic waned over the summer of 2020 was that the serious illnesses and deaths were still mostly happening offstage.