The COVID-19 pandemic remains a global health issue, putting unprecedented stress on health-care systems, with important implications for cancer care. Although at this stage the data are fairly limited, we know that patients with cancer are far more vulnerable to worse outcomes, including a greater need for respiratory support and higher mortality rates. As our nation struggles to contain and ultimately halt the spread of COVID-19, unanswered questions need to be addressed to prevent, or at least better prepare for, the next pandemic.

Not surprisingly, books on the pandemic are emerging almost daily. One of the most topical is COVID-19: The Pandemic That Never Should Have Happened and How to Stop the Next One, by science journalist Debora Mackenzie, who has been covering emerging diseases for more than 30 years. Ms. Mackenzie has been on the front lines throughout her career, reporting on how pandemics start, why they spread, and how to stop them. Before becoming a journalist, Ms. Mackenzie worked as a biomedical researcher.

BOOKMARK

Title: COVID-19: The Pandemic That Never Should Have Happened and How to Stop the Next One

Author: Debora Mackenzie

Publisher: Hachette Books

Publication Date: July 2020

Price: $27.95, hardcover, 304 pages

Warnings From the Past

Organized into eight well-structured chapters, COVID-19 is less about today’s pandemic than about our collective failures to act on warnings from prior epidemics, in which noted epidemiologists had pointed to the pandemic potential of the family of coronaviruses. Ms. Mackenzie, who is based in Europe and is a contributing writer to New Scientist, makes a valid case that governments often fail to take action despite these forewarnings.

In chapter one, “Could We Have Stopped This Whole Thing at the Start?” Ms. Mackenzie uses anecdotes and details to illustrate years of admonitory messages from the scientific community. Peter Daszak, a British zoologist, has estimated that 335 novel microbes have struck human populations since 1940; 60% of them were transmitted via animals, and 72%, including Ebola and West Nile fever, developed from human interaction with wildlife, such as happens in the sub-Saharan bushmeat trade. According to Ms. Mackenzie, the emergence of severe acute respiratory syndrome in 2003 and Middle East respiratory syndrome in 2012 should have precipitated a dedicated global preparation for coronavirus outbreaks.

Predicting Human Behavior

Ms. Mackenzie wisely examines the various human reasons behind our slow-motion reaction to the threat that was brewing in Wuhan, China. It’s not only enlightening but interesting, one of the reasons that biologic outbreaks have been used ad nauseum as a conceit for Hollywood producers. For instance, noted researcher, Neil Ferguson and his colleagues at the Imperial College London are among the world’s most respected mathematical epidemiologists. They construct complex computer models that describe how diseases are observed to behave and then use them to predict how new ones will spread.

In January 2020, they used a comprehensive database of airline passengers to calculate how many people in the catchment area around Wuhan typically traveled internationally. It seemed plausible that the percentage of travelers found to be infected with COVID-19 should be the same or at least less than the percentage of the population back home that was infected, as there was no discernible reason to think that people with the virus would be more likely to fly abroad than their uninfected fellow citizens. They crunched the numbers and reported the results, which were later found to be perilously off target. However, even as they began reworking the data, the official consensus was that human-to-human transmission was limited at best. This calculation we later found, after the damage had been done, to be factually incorrect. The bottom line is that predicting human behavior sometimes defies the most elegant mathematical models.

Ms. Mackenzie does a capable job fleshing out one of the world’s first big outbreaks, which has been analyzed almost in real time. Hence, the author tells readers that she adopted a style referred to by trade nonfiction publishers as a “crash book,” written quickly to coincide with the rising public interest in pandemics. This approach resulted in an essay-style format, without revealing the human players, their motives, and the effects of their decisions. Much of the chaotic and juicy domestic and international political dramas were also foregone for the sake of a short publication deadline.

Lessons for the Future

After charting the etiology and course of the pandemic in the first two chapters, Ms. Mackenzie turned to the meat of the narrative, which explores our societal frailties and offers sound, science-based lessons on what not to do when the next inevitable pandemic strikes. In a series of numbered subchapters on lessons for the future, Ms. Mackenzie suggests developing far better monitoring and reporting strategies of emergent viruses, stockpiling medical supplies (eg, face masks and antibiotics) to combat diseases that are already known to us, and developing what she terms surge capacity in manufacturing.

Although most of her suggestions are well grounded in biology and epidemiology, at times Ms. Mackenzie drifts into rants, which, within the context of her original premise, read like totally distracting word fill as she perhaps hurried to meet a deadline. For instance, she writes: “When publicity-shy, certainty-averse scientists put these traits aside and start screaming that there’s a really threatening thing out there, we need to listen and make it someone’s job to respond…. I have no doubt this lesson will eventually filter through when climate change starts causing massive crop failures, uninhabitable cities, and unprecedented waves of refugees. By then, of course, it might be a little too late to act on it.” Here, the reader will wonder how Ms. Mackenzie’s prediction of apocalyptic climate change dovetails into preparing for the next pandemic.

Readers eager for wild conspiracy theories will be disappointed, as Ms. Mackenzie also notes that “one thing we can say for sure: COVID-19 was not created in a lab.”

Despite certain flaws that the author blames on her rush-to-publish deadline, COVID-19 has enough interesting science and information about pandemics to make it a worthwhile read for The ASCO Post audience.