A candid account of the pandemic's journey

What if you were offered a real-time backseat view of the pandemic as it broke in China to spread across the world, and the car’s driver happened to be a scientist of worldwide experience who offered expert commentary at every stop?

I would grab the opportunity.

Spike is a detailed narrative on how the pandemic evolved in the first 18 months. It is written by Dr Jeremy Farrar who is a tropical medicine expert and member of SAGE, the scientific advisory group for emergencies in the UK. Although much has been written about the pandemic, this book pieces together all the events as they unfolded, meticulously documenting it through the eyes of a medical doctor. While written from a global perspective, the book focuses on Britain’s dilemma, response and experience in some detail.

The book’s title, Spike - could not have been more apt, as it refers not only to the spike protein of the SARS-CoV-2 virus, but perhaps also signifies that a spike in cases (and deaths) could occur from failed decisions, or worse– failing to decide .

The early part of the book is written like a thriller. The first chapter opens with the author seated in an airport lounge in Rwanda on December 31, 2020, scanning through his phone - when he first became aware of a certain situation in China. The reader gets a first-person account of how Dr Farrar networked with important people across the world, in an attempt to decipher the true nature and extent of the problem.

The reader's interest is kept hooked in both the science of the pandemic, as well as the human and fallible side of being a concerned scientist. Dr Farrar has annotated his prose with his own emails and tweets, recreating a sense of the real-time urgency he faced.

A large number of names appear in the 231 pages of text. Medical scientists, data analysts, doctors, epidemiologists, virologists, politicians, administrators and office bearers of organizations appear in various roles - big and small. Although Dr Farrar introduces each one of them in the most interesting manner possible, it can become cumbersome for the reader to relate to what each individual does, in particular when first names are used liberally in the narrative. A topic as vast as this also brings with it a fair share of acronyms, like SAGE, ONS, NERVTAG. He has helpfully included an index of the key persons, technical terms and acronymsmentioned in the book.

Virology and epidemiology apart, Spike is also a goldmine of practical wisdom; it is essentially a how-to guide for those interested or involved with decision-making. Barriers to decision-making are elegantly outlined, and this would be one of the key take-aways from the book. For instance, you could involve several brilliant and individually competent people in a project, but that need not necessarily result in the best possible outcome. The chief reason is that effective decision-making has little to do with the sum of the total academic achievements of a group of people.

Dr Farrar demonstrates how individual perception of an evolving situation can vary for different individuals - based on their personality, past experience, personal failures, individual preferences, influence of peer groups and multiple types of bias. In particular, he highlights two forms of bias that corrupt decision-making during a crisis – they are optimism bias and confirmation bias.

He also warns of the intrusion of pseudoscience in the guise of science, referring specifically to ‘The Great Barrington Declaration’ which essentially was interpreted as “let the disease run its course”. He explains why the concept of ‘herd immunity’, while applicable to pathogens like poliovirus, does not apply to the SARS-CoV-2 virus. Unfortunately, the price to pay for an initial delay in implementing even basic measures was a large number of deaths, and today, the world knows that Britain was not the only wealthy nation that suffered the consequences of early hesitancy.

In spite of Britain having had the opportunity to witness the devastation caused by the pandemic in more than one country, writes Dr Farrar: “The UK was suffering its own long-standing malady: the arrogance of exceptionalism”

He notes how the WHO had issued a global strategy as early as 4 February 2020, and how countries that applied these had done well. He quotes Dr Maria Van Kerkhove of WHO here: “There is no rocket science or secret or magic solution. These are tried-and-tested public health actions. If you don’t take those actions and if you wait, it gets worse”

Although criticised for its tepid initial response, Britain has shown the way for the world in several other aspects of the pandemic. This includes the RECOVERY trial, which gave the world the first scientifically proven life-saving treatment for Covid-19, that was dexamethasone. A considerable part of our knowledge of variants is owed to the work of British scientists. Public Health England generates regular updates on variants, and on the effect of vaccines. Spike provides a rare insider’s perspective into how these elements were put together for a common good.

Although the pandemic is far from over and knowledge is rapidly getting outdated, Spike will no-doubt hold its position as a candidly written early narrative on the topic - by a person of authority and competence. Dr Farrar’s book will enthuse general readers, policy makers as well as healthcare workers, all of whom have been involved or affected by the pandemic one way or another

Spike The virus vs The People: The inside story

by Jeremy Farrar with Anjana Ahuja

Profile Books

253 pages; Rs 480

Check out the book on Amazon

(Dr Rajeev Jayadevan is a specialist physician, public educator, author and is a member of the National Task Force of IMA for Coronavirus pandemic)