I heard several interviews of Nicholas Christakis, the Yale physician and sociologist on various podcasts. So when his book came out, I decided to pick it up. Christakis wrote 8 hours a day this summer to publish it while the pandemic is still going strong. I enjoyed the book, especially the first part that covered the medical and science part of the pandemic. I was less enthused reading the sociological impact of the virus. He is qualified to write on both aspects and that may appeal to readers.
He puts in many fascinating facts about the disease and its spread.
- Pharmaceutical companies and university laboratories were able to produce a vaccine in the fastest time in history because of today’s gene technology. The genome of 29,903 letters was sequenced from a sample taken from a Huanan market vendor. Fudan University of Shanghai released the sequence to the public on January 11, 2020. Laboratories were able to quickly develop diagnostic tests and less than a year later, several vaccines are on the market.
- This coronavirus (SARS-2) is 96.2% identical to a coronavirus found in a bat in a cave in Yunnan, China several years ago. This confirms that the SARS-2 originated in bats.
- The Re number is the “effective reproductive rate” and measures the average number of people does an individual infect. The Re differs from the Ro because human actions (environment) determines the rate of spread along with the “capacity of the pathogen to start an outbreak” (R0). With ubiquitous testing, contact tracing and quarantine/isolation protocols, a system can reduce the Re greatly.
- Christakis refers to studies showing a case is MOST infectious 1-2 days BEFORE symptoms appear and they are possibly most contagious during this time frame. In one study in Wuhan, 73% of secondary cases were infected before symptoms.
- Christakis estimates between 40-60% of the world will be infected by the end of the pandemic.
- Historically, vaccines and medications played a small role in the stopping of most infectious diseases. Measles, TB, typhoid, diphtheria were already nearing the bottom of their infection curves when vaccines were developed. This is known as the McKeown Hypothesis.
- Masks are effective not only in reducing propulsion of exhalation particles, but they also reduce people touching their face. People touch their face roughly once every 4 minutes. Masks also signal to others to keep their distance from the wearer. A Yale study analyzed mask use in 46 countries around the world. Countries where mask use had always been the norm had many fewer deaths than those where it was not.
- Many quack remedies were sent around social media and one study of 200 million tweets from January – May 2020 showed 62% of the top 1000 retweeters were bots.
- Children are less likely to become infected. Early studies in China showed children under 9 living with an infected family member have a 7.4% attack rate while adults ages 60-69 had a 15.4% rate. The mortality rate for people under 20 was low, between 1-3 people out of 10,000 dying. For patients in their late 50s, 1 of 100 and for patients above 80, 1 in 5.
- He does not think contact tracing apps work. His lab at Yale developed an app, Hunala, to estimate one’s risk with doing certain activities. I need to explore this app and perhaps introduce it to our school community.
- Christakis points out correctly in discussing American university education that “huge investments in residential facilities (student centers and dorms with fancy amenities) and lots of midlevel deans and administrators contributing to higher tuitions and alarming debt loads”
- Young doctors in training during the pandemic will view their profession as a calling more than an occupation due to the crisis.
- The pandemic of 1889, the last flu epidemic of the 19th century, was first reported in Bukhara, Uzbekistan and killed over 1 million people. It was known as the Russian or Asiatic Flu.
- COVID-19 patients with blood type A are 50% more likely to need oxygen therapy than patients with other blood types.
I was particularly interested in his take on school closures. He writes “the evidence is mixed, and it is very difficult to be sure”. He continues “An even more difficult issue relates to the usual utilitarian calculus of public health – whether the lives saved by closing the schools are, in fact, worth the short-term and long-term cost to children and to society.”
Apollo’s Arrow – Nicholas Christakis
Christakis does go on detail his take on school closures. He thinks school should be closed BEFORE the first case appears in a school, when the disease cases begin to appear in the community or in nearby areas. The proactive closure is more controversial, but research shows it is one of the most beneficial interventions that can be employed to reduce the pandemic. The rationale is a school will have to close when the disease becomes more prevalent in the community, so with a proactive closure, everyone will be inconvenienced by the school closure, but many cases will be averted because of the early closure. Much of the benefits of school closures come from the parents also staying at home. In a study of the 1918 Spanish Flu epidemic, earlier and longer school closures saved a lot of lives.
In reflecting what we did at TIS, we shut down when the first official case was reported in March, 2020 and stayed closed/virtual until October, 2020. That is an early and long school closure that probably saved some lives. Upon reopening the campus, we put in many measures to reduce transmission (outdoor learning, hand-washing, ventilation, masks, limit parents/visitors, etc.) and as in retrospect a public service, offered families the choice of virtual learning.
Apollo’s Arrow was a valuable read and I would like to thank Dr. Christakis for helping me understand the pandemic more. I also learned about the Greek god Apollo’s affiliation as bringer of plagues, hence the title.
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