With the COVID-19 pandemic shaping up to be one of the most influential public health crises in living memory, it was only a matter of time before books would be written about it. One of the first to make it to press is Understanding Coronavirus by systems biologist and bioinformatician Raul Rabadan. Amidst the swirl of dubious and outright false information that is circulating, there is desperate need for a book that clears up misconceptions and gives a concise introduction to what we know about the virus so far. Given that he spearheaded research in 2009 that confirmed the animal origin of swine flu, Rabadan seems like the right man for the job. Is this the primer that everybody should have on their bedside table?
Understanding Coronavirus inaugurates a new series from Cambridge University Press called Understanding Life that offers concise introductions to current biological topics. If you are familiar with Oxford University Press’s Very Short Introduction series, this first book looks a bit like that: a slim, 120-page paperback that will slip in your average coat pocket.
The book consists of an introduction followed by seven chapters written in a question-and-answer format with the table of contents helpfully listing each question. Rabadan mentions it is written for the lay reader with minimal knowledge of biology, virology, epidemiology, or medicine. I would change that to “some knowledge” as it does get rather technical in places. Personally, I got along fine with it but I am somewhat hesitant to give this to, say, my mother.
What Understanding Coronavirus does very well is clarify virology and epidemiology basics. Asking how quickly the virus spreads means explaining the basic reproduction number R0 and concepts such as “flattening the curve” and herd immunity that everyone has been confronted with. It explains the symptoms, the typical course of the disease, how deadly it is, and that, yes, children and young adults get infected too, but their symptoms are usually less severe.
“What Understanding Coronavirus does very well is clarify virology and epidemiology basics [such as] the basic reproduction number R0 and concepts such as “flattening the curve” and herd immunity”
Next to these basics it also goes into the frequent comparisons made with SARS and influenza, something specific to this pandemic. Rabadan explains their origins and clarifies the differences and similarities with COVID-19. Regarding SARS, the viruses SARS-CoV and SARS-CoV-2 are very similar, but the diseases are different enough that the World Health Organization gave them two different names. Regarding influenza, Rabadan calls the comparison to COVID-19: “one of the most unfortunate and confusing metaphors from the beginning of the COVID-19 outbreak”. Although we can draw some useful lessons from previous influenza pandemics where public health measures are concerned, the two are not related by any stretch of the imagination. Also, can you explain the difference between seasonal and pandemic influenza? You will after reading this book.
All of this is supported by numerous colour illustrations that demystify concepts. Rabadan’s explanations are concise and the reference list at the back helpfully includes a short note on what each paper or book contains. But I feel that in the middle the book goes off-script somewhat and betrays Rabadan’s specific interests.
“[….] as a bioinformatician and computational biologist Rabadan is fascinated by the evolution of complex systems. […] Now, it is not that these topics are not relevant—because they are—but more to the research community than the average lay reader.”
See, as a bioinformatician and computational biologist Rabadan is fascinated by the evolution of complex systems. Thus he provides details on the molecular biology of SARS-CoV-2: its structure, the size and architecture of its genome, and the cell receptor (a protein called ACE2) that the virus uses to enter host cells. And he specifically discusses how the virus is changing: how we can draw up evolutionary family trees (phylogenetic trees) to track its spread and determine from what animal it jumped to humans (its zoonotic origin). For an evolutionary biologist such as myself, these are mightily interesting details: I did not know that, next to point mutations, viruses also evolve by recombination, just as many other organisms do. But I feel Rabadan almost forgets who he is writing for. For example, when discussing ACE2, he casually mentions that protein levels differ between men and women because (in brackets) “the gene is located on the X-chromosome”. To a biologist, this little throwaway clause makes sense (those are the sex chromosomes, women are XX, men XY, so women have two copies of the gene producing ACE2, etc.), but to most people, this will not be self-evident, I think.
Now, it is not that these topics are not relevant—because they are—but more to the research community than to the average lay reader. What they probably will want to know, and what I found noticeably missing, are questions regarding prevention. Why is washing of hands so important? Why is there a difference between using soap and bottled hand sanitiser? How and why do contact tracing strategies work? Why has there been such conflicting advice on wearing face masks? And how do they work? (hint: it is not just to protect you from others, but especially others from you.) What do we know about the survival of the virus on other surfaces? Can we transmit the virus via clothing or packaging material? Rabadan does mention viral half-life in water droplets and on metallic surfaces in one sentence, but I have been wondering about this. Since viruses are not really alive, they cannot really die. But apparently, virus particles can degrade or decay. How? Is that because of exposure to light or heat? Chemical instability with time? These are the kinds of mundane questions many people have.
“Unsurprisingly, the publishing floodgates have been opened […] amidst this deluge of books, you need to have your basics covered. […] Understanding Coronavirus provides a lot of relevant information in a very readable and concise format.”
One risk of a book published under the current circumstances is that it ages quickly. There is a brief “updates at press” section where Rabadan can just in time point out that hydroxychloroquine, initially considered a promising drug treatment, is not so effective after all, and mention that COVID-19 also seems to attack other organs. Of course, none of this is Rabadan’s fault: the science moves particularly fast in this area and you go with the best information you have at publication.
Unsurprisingly, the publishing floodgates have been opened. Already several books are in the making or due any moment, for instance the reportage COVID-19 from journalist Debora MacKenzie or the very critical The COVID-19 Catastrophe by the editor of The Lancet Richard Horton. Simultaneously, many publishers have spotted an opportunity to reissue older books on pandemics with some extra material: Sonia Shah’s 2016 Pandemic is reissued with a new preface, Mark Honigsbaum’s 2019 The Pandemic Century contains a new chapter, and David Waltner-Toews 2007 The Chickens Fight Back is updated and now titled On Pandemics. I am surprised that David Quammen’s Spillover has not been reissued yet (he has since revisited some of his interviewees for a piece in The New Yorker). And given that Ed Yong has been rehired by The Atlantic to cover the pandemic it does not seem like a crazy idea that he might write a book in due course as well.
Amidst this deluge of books, you need to have your basics covered. Despite a few topics being of interest primarily to scientists while a few other topics are not covered, Understanding Coronavirus overall provides a lot of relevant information in a very readable and concise format. And at this price, you cannot really go wrong.
Disclosure: The publisher provided a review copy of this book. The opinion expressed here is my own, however.
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