Pandemics: Rethinking to understand

By Karin Lock

As we settle into our lockdown routine, it is evident that the human, economic and social cost of the COVID-19 pandemic has been grossly underestimated. Many questions persist: What are we actually testing? Is immunity possible? Why are men and BAME communities more susceptible? And how did the virus disappear so quickly from China?

Amidst such confusion, The Rules of Contagion provides some answers with its straight talking
analysis of epidemiology – the study of disease transmission and control. Written before the current global catastrophe, the author’s chilling prediction is prescient: “pandemic preparedness requires long-term engagement with politically complex, multidimensional problems.”

Adam Kucharski is an award winning mathematician from the London School of Hygiene and Tropical Medicine who has first-hand experience of the Ebola and Zika epidemics that spread through West Africa, South America and the Pacific. His theory is clear-cut: to understand contagion we must rethink everything we think we know about why and how infection occurs.

The Rules of Contagion opens with a history of malaria, the world’s oldest disease. Spread by female mosquitoes, it is treatable yet unbelievably still kills over 400,000 people a year, many of whom are children. Eradicated from Europe 45 years ago, malaria is also the first malady where mathematical modelling was trialled as a tool for disease research.

Kucharski examines infection and recovery rates of recent pathogens such as the 2003 SARS and 2009 swine flu viruses. He concludes that data is unreliable and mathematical models are a hit-and-miss affair. Yet models can convince decision makers that a problem exists, as we saw recently here with the Imperial College study of COVID -19 death projections.

Disease theories can also explain other contagious scenarios like financial crisis, gun violence, suicide memes and drug addiction. Alluding to America’s opiate crisis, the writer notes drug overdose as the leading cause of death for under 55s, shortening life expectancy year on year. In Britain, suicide is the main cause of male deaths under 30, resulting in strict rules on newspaper reporting to prevent epidemics.

The book also combines stories and science to dispel ongoing myths associated with public health research. Gun violence has been attributed to everything from poverty, unemployment, school exclusion and absentee fathers. Yet map clusters of incidents that resemble cholera infestations suggest that violence is a social contagion that spreads from preceding
violent events.

The Rules of Contagion demonstrates the importance of behavioural change in outbreak control. Some British pundits are advocating Big Brother-style population monitoring with national ID cards and immunity passports. Others recognise the risks of excessive surveillance, even though this already happens through our mobile phone tracking systems.

Non-consensual human experimentation for disease study is another concern. For example, the 1950-60s infections of New York children with hepatitis; or the Black Tuskegee syphilis sufferers (and their wives and children) who died between 1932-1972.

The issue of trust and consent is at the heart of The Rules of Contagion. The ‘infodemic’ transpiring from this current coronavirus outbreak has uncovered the public’s mistrust of both government and technology. Facebook personal data harvesting (during the Brexit referendum) and the
numerous NHS data breaches, may scare off potential users of contact tracing apps.

There is much to learn from this absorbing study. Although pandemics are part of our evolution, we are still not responding in time. Kucharski is clear: vaccinating every person is not necessarily the answer, but the longer it takes to tackle COVID-19, the larger the control efforts will have to be.

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