Out of the first crop of books relating to the coronavirus pandemic, this one seemed especially relevant. Author Richard Horton is editor of the leading medical journal The Lancet which has been an important publication outlet for new research results on both the virus SARS-CoV-2 and the disease COVID-19. Having also served at the World Health Organization (WHO), Horton thus has had an insider’s view of the pandemic and here brings a sharp critique to bear on the sluggish political response in Europe and the US.
As I have done previously, let me just briefly comment on what is not in the book. The COVID-19 Catastrophe really focuses on the science policy failures that have allowed this disease to rampage out of control. At only 133 pages, this does not leave much room for anything else, so for a primer of the biological details known so far I once again refer readers to Understanding Coronavirus.
Something that other books have only touched upon, but that Horton reveals more about here, is what happened in China in early January: how early warnings from doctors were gagged before the news reached Beijing, and how the WHO got involved. This culminated in the WHO issuing a PHEIC, a Public Health Emergency of International Concern, which is the most serious warning they can send into the world.
“Horton […] focuses primarily on the lessons not learned from the 2002-3 outbreak of the SARS virus. A painful highlight is the 2016 […] tabletop exercise Cygnus that simulated a scenario of pandemic influenza, showing that the UK was not prepared.”
Other books such as Spillover and COVID-19 have pointed out that virologists have been warning of the threat of pandemics for decades, and both books give detailed histories of previous pandemics such as HIV, Ebola, SARS, MERS, and others. Horton mentions these briefly, but focuses primarily on the lessons not learned from the 2002-3 outbreak of the SARS virus. A painful highlight is the 2016 UK government tabletop exercise Cygnus that simulated a scenario of pandemic influenza, showing that the UK was not prepared. Even so, nothing much has been done with all this information. Horton blames it on a combination of factors. Complacency in the face of warnings. A widespread arrogant attitude that Western societies are somehow above nature, untouchable by disease. And political unwillingness to place public health ahead of economic growth, which shows in the lack of stockpiling of medical supplies and protective equipment, the lack of investment in research and disease surveillance, and, worse still, continuous budget cuts in the health sectors of most developed nations.
When the inevitable finally did happen, subsequent actions, or lack thereof, only made things worse. This is where Horton is at his most strident, pointing out the weeks and months that passed in which governments did not prepare themselves, thinking they could somehow escape unscathed as if viruses respect borders; the too-little-too-late attempts to contain the virus through lockdowns; the political blame games rather than international collaboration; the confused, contradictory, and sometimes misleading messages from politicians towards the public (the UK and the US are mentioned in particular); the lack of protective equipment for medical personnel etc. If you have followed the news, this has become a sad but recognisable litany of failure by now.
“[…] months […] passed in which governments did not prepare themselves, thinking they could somehow escape unscathed as if viruses respect borders.”
The publisher described this book as hard-hitting, one reviewer mentioned it pulls no punches, The Guardian called it “a polemic of the first order”, and Revolutionary Socialism in the 21st Century “uncompromisingly scathing”. Horton labels Trump’s decision to cut funding to the WHO as a crime against humanity. The UK government’s claims that protective equipment was being delivered to the front lines and that health care workers were safe are called bare-faced lies. The failure of governments to protect its citizenry, gross incompetence. Perhaps by British standards Horton is outspoken, but the blunt Dutchman in me sees factual statements here, not hyperbole. I am not sure how you can come to any other conclusion.
Where the roles of China and the WHO are concerned, Horton is balanced. There were questionable things happening in China, and the Chinese government was downplaying the situation or actively suppressing information at various levels within its hierarchy. “There is a gap in the timeline of the pandemic”, we need “a more detailed explanation of what took place in Wuhan”, writes Horton. But at the same time, Chinese scientists, policymakers, and health workers have been extraordinarily committed and effective in acting and collaborating to contain and defeat this disease. The WHO is similary described here as an imperfect bureaucratic institution, but one that nevertheless did what it could within its limitations (MacKenzie provided useful background information on these limitations in COVID-19, which Horton omits here). But do not be fooled by governments who are seeking to deflect attention, writes Horton: “to blame China and the WHO for this global pandemic is to rewrite the history of COVID-19 and to marginalise the failings of Western nations.” If you take just one thing away from this book, this might well be it.
“”to blame China and the WHO for this global pandemic is to rewrite the history of COVID-19 and to marginalise the failings of Western nations.” If you take just one thing away from this book, this might well be it.”
In the final few chapters Horton looks towards the future and becomes rather philosophical. He asks what the effects of COVID-19 are on human society so far and turns to the ethics of anthroplogist Didier Fassin, highlighting an ethical trend of “biolegitimacy”, of seeing human life in purely biological terms, without consider the political conditions within which it exists. And he draws on the writings of Michel Foucault and Jeremy Bentham’s idea of the panopticon* when pondering what the need for enhanced disease surveillance will mean for our personal freedom. These sections feel somewhat sketchy. I am sure much more could be said about this, but Horton does not develop these themes further here. His list of what our post-COVID world should look like, coupled to his concerns of what will likely happen instead, are pages to take to heart though.
This short and punchy book contains some incisive reporting on how countries failed to act in the face of this pandemic. No doubt, future reporters can explore this topic in far greater depth for many more countries. But we must start this now. Horton has seen first-hand how political disinformation campaigns are already trying to rewrite the narrative of the pandemic. We must document these attempts, he writes, which makes The COVID-19 Catastrophe an urgent and timely book.
In closing, you might wonder how this book compares COVID-19 by journalist Debora MacKenzie, the subtitle of which is very similar to this book. A longer book, it provides more background information on previous pandemics, as well as the role of bats and the complexity of societies in the current one.
* the panopticon is an architectural design for prisons that allows complete surveillance by one security guard without prisoners knowing whether they are being watched.
Disclosure: The publisher provided a review copy of this book. The opinion expressed here is my own, however.
Other recommended books mentioned in this review: