Pandemic Perspectives: A filmmaker's journey in 10 essays

Howard Burton

• Publisher: Ideas Roadshow
• Year: 2022
• eBook ISBN: 9781771703017
• Topic: Medicine
• Subtopic: Diseases & Allergies

With Thomas Lewis as his guide, Howard Burton takes us on a thought-provoking personal journey of deepening his understanding of a wide range of key societal issues illuminated by the COVID-19 pandemic, from biomedical science to the nature of politics, as part of the process of creating the documentary film, Pandemic Perspectives, and having detailed conversations with 32 leading experts in biology, education, history, law, philosophy, politics and more. In the different essays Howard thoughtfully weaves together the different expert perspectives and makes intriguing connections through an engaging narrative.Examples of societal issues that are examined: - The need to rethink current educational practices- The future of scientific research- The challenges of making evidence-based public policy in an age of rapid information and misinformation- The widespread confusion about how science actually works- The importance of balancing basic and applied research- The implications for coherently addressing climate change- The tension between individual liberties and communitarian idealsThe need to critically evaluate the level of care in our society- The importance of looking at history during a time of crisis- The perils of nationalism and the necessity of thinking globally- To what extent the pandemic has revealed our true moral nature

1. In Search of Lewis Thomas

“The record of the past half century has established, I think, two general principles about human disease. First, it is necessary to know a great deal about underlying mechanisms before one can really act effectively. Second, for every disease there is a single key mechanism that dominates all others.”1

When the seriousness of the COVID-19 pandemic began to really sink in—when it could no longer be denied that, unlike SARS or MERS or any of the other potentially transformative global crises that had grabbed the headlines for a few days before simply fading away, this one was going to be different—the first thing I did was to head to my bookshelves to search for a copy of one of Lewis Thomas’ books.

At the time, I was hardly what you might call a “Lewis Thomas fan.” I owned two of his books—The Medusa and the Snail and Late Night Thoughts on Listening to Mahler’s Ninth Symphony—both of which I vaguely remembered having leisurely thumbed through in the late 1990s, some 20 years or so after they’d been written.

But this time was different: No longer idly searching for a stimulating read to spice up my evening, now I needed help; and my lingering recollection was that, as increasingly panicked media reports of contagion moved from Wuhan to Bergamo to New York, Thomas’ unique combination of lucid, penetrating writing skills and detailed biological understanding would be just the ticket.

Of course, I thought, since the books were written more than 40 years ago, it was inevitable that much would be out of date. But then, given that I knew next to nothing about biomedical matters and Thomas had been a hugely accomplished and wide-ranging physician, researcher and administrator, it seemed an appropriate place to start. Which it most certainly was. But what I hadn’t bargained for was that the more I read, the manifestly less “out of date” it seemed.

I plunged in, naturally enough, with the essay “On Disease,” mid-way through The Medusa and the Snail—eight and a half pages of penetrating prose, punctuated with regular invocations of technical terms that I immediately glossed over: lymphocytes, endotoxins, phagocytosis and so forth.

What I was searching for had nothing to do with official immunological jargon: I needed a reference point for our contemporary understanding of the nature of disease, an intellectual framework for comprehending what the hell was happening around me.

In fact, that’s probably not right. More likely, what I was really looking for was confirmation of what I already “knew”: that we live in a hostile world of zillions of microbial pathogens bent on destroying us, and the reason we manage to compete in this deadly zero-sum game of survival is thanks to our wonderfully sophisticated immune system honed by billions of years of evolution that can, in most cases anyway, manage to eventually destroy almost anything that nature throws at us.

But that’s not what I got.

“On Disease” begins by talking of meningitis.

“The meningococcus, viewed from a distance, seems to have the characteristics of an implacable, dangerous enemy of the whole human race…But it is not so.”

It turns out, Thomas tells us, that of all the people infected with the bacteria in question, only a very small percentage go on to develop the terrible invasion of the central nervous system that is meningitis.

“The rule for meningococcal infection is a benign, transient infection of the upper respiratory tract, hardly an infection at all, more like an equable association.”

Why, then, does meningitis occur?

“It is still a mystery that meningitis develops in some patients, but it is unlikely that this represents a special predilection of the bacteria; it may be that the defense mechanisms of affected patients are flawed in some special way, so that the meningococci are granted access, invited in, so to say.”

From there we are taken on a rapid survey of a number of well-studied instances, from the generalized Shwartzman reaction to endotoxin shock, where the principal existential threat to an organism is not so much from the unrelenting determination of an invading pathogen but rather the host’s own immune response—or, perhaps better put, “over-response”—to it.

This was not at all what I had expected. But it did, eerily, resonate strongly with an obvious question that increasingly surfaced as the COVID-19 storm rapidly swept over us and hospital staff began to speak of the fatal impact of “cytokine storms”: Why were some people dying from being infected with a virus that others didn’t even notice they had?

It resonated, too, with something vastly more mundane that had long perplexed me: Why, exactly, do I have to ice a sprained ankle? I’ve played enough sports to know that whenever a minor injury occurs, the standard treatment for the first few days is “RICE”—rest, ice, compression and elevation—to “treat the inflammation and reduce the swelling.” Which definitely works. But why? Why on earth should it make sense to be officiously interfering with my body’s spontaneous reaction to a routine injury that was presumably honed by billions of years of evolution? What’s going on? Should tigers out in the savanna be properly icing their sprained ankles in order to more successfully dominate their habitat?

Of course I was aware that there were people who were known to have specific issues with their immune system—the so-called “immunocompromised” or “immunodeficient”—and thus had the misfortune to often suffer deeply from a range of afflictions that the rest of us could fight off with relative ease, just as those who had problems with their lungs or heart were more susceptible to pneumonia or coronary disease, but that’s clearly a different sort of situation.

Most people, I had naturally assumed, were blessed with immune systems that worked optimally in order to fend off the constant onslaught of invading pathogens. But that seems to be a decidedly naive way of looking at it. And once you stop regarding the immune system as a perfectly-tuned machine and more like a work in progress—staggeringly effective most of the time and in most cases, but a work in progress nonetheless—the picture becomes vastly more nuanced.

So that was the first big shock.

The second shock was that the timeworn image of us engaged in a perpetual battle with a pathogen-infested world out to destroy us at every turn is, well, flat-out wrong.

Of course, there are lots of nasty things out there and our immune systems are mind-bogglingly wondrous at being able to protect us from them in all sorts of remarkably comprehensive ways, but while Thomas unhesitatingly avers that modern advances in sanitation, nutrition and housing have correspondingly transformed public health by dramatically reducing the risk of infection from such would-be attackers, he consistently takes aim at the popular perception that we are locked in an unremitting Darwinian duel with the microbial world.

“It is true, of course, that germs are all around us; they comprise a fair proportion of the sheer bulk of the soil, and they abound in the air. But it is certainly not true that they are our natural enemies. Indeed, it comes as a surprise to realize that such a tiny minority of the bacterial populations of the earth has any interest at all in us. The commonest of encounters between bacteria and the higher forms of life take place after the death of the latter, in the course of recycling the elements of life. This is obviously the main business of the microbial world in general, and it has nothing to do with disease.”

Moreover—and it is a very big moreover—it’s not just that most of the microbial world ignores us, it is that, in a very real way, we are actually dependent on them. Opinions vary these days about the exact ratio between microbial cells and human cells in the average human body—a decade or so ago it was thought to be 10:1 and present estimates are about 1:1—but given that we are talking about some 1013 human cells, an order or magnitude or two hardly makes any difference in getting the point across. The prospect of having roughly 30 000 000 000 000 microbes inside each and every one of our bodies, many of which are actively engaged in a symbiotic relationship with us so as to directly help us perform a range of essential human functions, gives a strikingly different picture to the “us vs them/zap the invader” framework we are constantly bombarded with.

And lest you be thinking, Well, perhaps that’s the case for bacteria, but what about viruses? It turns out not to matter one jot. Indeed, in a later essay,2 Thomas speculates on a possible key evolutionary role that viruses might play in “picking up odds and ends of DNA from their hosts and then passing these around, as though at a great party,” given that, “After all, we live in a sea of our own viruses, most of which seem to be there for no purpose, not even to make us sick.”

He continues musingly:

“We can hope that some of them might be taking hold of useful items of genetic news from time to time, then passing these along for the future of the race. It makes a cheerful footnote, anyway: next time you feel a cold coming on, reflect on the possibility that you may be giving a small boost to evolution.”

At this point it might be worth stepping back and taking a moment to emphasize that I am most definitely not some kind of perversely virusphilic fellow who greeted the arrival of the COVID-19 pandemic with a cheerful Panglossian shrug, wistfully wondering what sort of potential, long-term evolutionary benefit Homo sapiens might receive in exchange for us being locked in our homes for a while. Like everyone else, I am most emphatically committed to doing whatever it takes to somehow rid the world of SARS-CoV-2, or at least render it as benign as possible to my fellow humans.

But in order to apprecia...

Table of contents

• 1. In Search of Lewis Thomas
• 2. Reframing Education
• 3. Appreciating Science
• 4. Making Decisions
• 5. Information & Misinformation
• 6. Research, Evolving
• 7. Necessarily Global
• 8. Values
• 9. Biology, Better
• 10. Conclusion