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Monday, January 17, 2022

Review: World War C

 I approached World War C with very limited expectations. After all, we've all had almost 2 years of COVID at this point, and there's been no shortage of coverage of it in the news. What more could you expect? It turned out to be quite a bit. For instance, I didn't know that COVID19 was the 3rd leading cause of death for Americans over 40:

COVID became the third-leading cause of death for individuals forty years old and over in 2020, with an overall annual mortality rate of 325 deaths per 100,000 individuals, behind only cancer and heart disease. In addition, for individuals forty years old and over, the case fatality rate for COVID was greater than the case fatality rate for motor vehicle accidents. (Kindle Loc 3730)

Sanjay Gupta gave more credence to the "lab leak" theory of COVID19 than I would have expected:

 How did a novel bat coronavirus get to a major city in the dead of winter when most bats were hibernating, and turn a market where bats weren’t sold into the epicenter of an outbreak? Their resulting paper, which pointed to two local laboratories where research on bat coronaviruses took place, lived on the Internet for a blip in time before vanishing...The institute has become a world leader on bat coronaviruses and has established one of the largest strain collections, but this lab also has a history of lax safety standards. The world’s outbreak began right in its backyard. Its lab director, Dr. Shi Zhengli, published studies about manipulating bat coronaviruses in a way that could make them more infectious to humans.21 Also known as “Batwoman” for her long history of hunting for coronaviruses in bat caves to study, Zhengli and her colleague Jie Cui are the ones who discovered that the SARS coronavirus likely originated in a population of cave-dwelling horseshoe bats in the Yunnan province in southern China. In their 2017 paper that reported their findings, they warned that “another deadly outbreak of SARS could emerge at any time.”...In 2012, six miners working in a bat-infested copper mine in Yunnan province were infected with a bat coronavirus. All of them developed symptoms exactly like COVID. Three of them died. Number two: Viral samples from these miners were taken to the Wuhan Institute, the only level 4 biosecurity lab in China that was also studying bat coronaviruses. And number three: When COVID made its bona fide Wuhan appearance in late 2019, its closest known relative was the same virus sampled from the Yunnan mine where the miners had been infected. (kindle loc 1250-1278)

Even on the topic of the vaccines, there were little titbits that I didn't know:

 During the Pfizer vaccine trials, twenty-three women volunteers involved in the study became pregnant, and the only one who suffered a pregnancy loss had received not the actual vaccine but a placebo. (Kindle loc 1759)

Dr. Gupta is an inveterate optimist. He's very confident that society will bounce back from COVID.  Like many doctors and scientists, he didn't take the antiscience component very seriously until it stared him in the face:

what caused the failures in America’s COVID response were things that scientists aren’t typically taught to think about during our training: war, political collapse, urbanization, climate change, and, of course, an aggressive antiscience movement...antiscience is one of the biggest threats to humanity, on par with a nuclear weapon: “Antiscience is right up there with things that we build a lot of infrastructure to wall off, like nuclear proliferation, global terrorism, and cyberattacks. We need to do the same with antiscience. We have to treat it just as seriously, and do something about the anti-vaccine groups beyond just amplifying the (science-based) message.” (kindle loc 2157-2179)

There's a little bit of everything: history of pandemics with lessons from 1918, a discussion of how quarantine could have been a little more effective, and even an analysis of the more effective Canadian response. There's also very sobering analysis of how little money the CDC had:

Between 2002 and 2017, the CDC’s core emergency preparedness funding was cut by over 30 percent, or $273 million.11 Insufficient funding has also meant public health labs have been understaffed or shut down, which resulted in painful effects when COVID arrived...the cost to prepare for a pandemic would be a few dollars per citizen—about $30, or the cost of a couple movie tickets. We could have vaccine platforms ready to roll, virus hunters like Wolfe in the field, robust surveillance, and a strong public health infrastructure. None of that seemed important until it became the only thing that is important. (kindle loc 2302-2311)

What's even sadder (and which the very optimistic Dr Gupta doesn't mention) is that many of the public health tools that were available have been recently rolled back, with the net result that rather than providing a wake-up call to American society as to how unprepared we are for pandemics, the politicization of the pandemic has made things worse.

My biggest criticism of the book (which admittedly isn't very big), is that Gupta buys big into the "personal responsibility" piece of healthcare, telling the reader to set clear boundaries on work (ha!) and take time to exercise, eat well, and otherwise take care of yourself. The problem with those prescriptions is that as he himself noted, many of the obesity epidemics in the USA happen in food deserts, and happen to people who are in poverty or who are minorities living in food deserts, or all of the above!  But maybe people who fall into those categories aren't likely to be reading this book either.

The book was surprisingly good, and very readable. Recommended.

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