Survival of the City: Living and Thriving in an Age of Isolation

Survival of the City: Living and Thriving in an Age of Isolation by Edward L. Glaeser and David Cutler

I wanted to like this book. The general idea and the conclusions are great. However, the execution just leaves something to desire. The authors come from different political perspectives and find issue with the way things are tackled politically. We need to get long term solutions to the big problems rather than just short term crowd pleasers. Policing is an example. On one side you have "defund the police". They are seeking to limit the harm that people experience due to police violence and excessive incarceration. On the other side you have "tough on crime" and "three strikes" policies aiming to prevent people from being harmed by crimes. People with lower incomes and minorities are often the most likely to be incarcerated and the most likely to be victim of crimes. Rather than a zero sum of "tough on crime" vs. "defund the police" we need to improve policing to reduce crime and incarceration. This does not bring itself to easy soundbites, but will provide a better solution. We need to address similar areas of education and health. Income, housing availability and costs are also related. Zoning has created havoc on the United States as a whole. Previously, people would migrate from poor areas to areas with opportunity, gradually leading to an equalization. Now the areas with opportunity are so expensive that migration is limited. The high cost of housing and limited availability makes it difficult for people to relocate there. A combination of the car and end-runs around racial integration have wreaked havoc on our cities. The poor bear the biggest burden of these changes. Despite these issues, people still desire to live in these cities. 

The Invisible Siege: The Rise of Coronaviruses and the Search for a Cure

The Invisible Siege: The Rise of Coronaviruses and the Search for a Cure by Dan Werb

Coronaviruses have been around for a long time. However, they have only been extensively studied in the past few decades. Previously they were most commonly seen as just causing a common code and only studied by an odd dedicated researcher. This all changed with SARS. It appeared in Asia in the early 2000s. It was deadly and started to attract a great deal of interest. There was work to sequence as well as to identify the source. Work was also started on vaccines. However, after it was contained, the enthusiasm died off. 

A decade later, Mers appeared. This was also extremely deadly. Interest in Coronaviruses popped up again. It also lead to tracing the source - and identifying camels instead of bats as an animal vector. This one was also contained, and interest again died off. 

In 2020, Covid-19 started to spread. The people had been doing work on coronaviruses and vaccines were ready to jump into action. Covid-19 ended up causing a widespread worldwide pandemic. People could carry and spread the virus without showing symptoms. It could be deadly for some people, but for others they suffered minimal (or no symptoms.) This allowed it to spread much more than the previous viruses. Luckily, the past research enabled vaccines and treatments to be quickly put into place. (Though in the field of medical research, a year is seen as amazingly fast.)

This book covers the history of coronavirus research. It does a great job of putting Covid-19 in context of the previous viruses. There are a number of factors involved. Politics and relationships can be as important as science. Countries and rulers are reluctant to admit they have a problem. This can make it difficult for scientists and public health official to identify and combat the virus. One scientist that had success built up relationships by way of non-judgemental science. Science also had internal conflicts, with those advocating open science versus those concerned about patents and financial return. Money is needed to bring drugs to market, but if vaccines are too expensive, the poorer parts will not receive it, limiting world immunity.

The Premonition: A Pandemic Story

The end of The Premonition drives home the big problem with our current public health system. In the mid-1970s the US public health authorities anticipated a deadly swine flu outbreak. They chose to institute a max vaccination campaign. Unfortunately, the local health infrastructure was not up to the task and was only able to vaccinate a fraction of the population. Some of those vaccinated died. Even though many of the deaths were not related to the vaccine, the presence of deaths together with the no-show of the deadly outbreak lead to a piloring of the health officials. Today, public health policy tends to be led in a cautious manner. People are concerned more about protecting their image. Government appointments are often made with regard to "optics" rather than expertise. Altogether, this leads to slow and inadequate reactions. Actions that avoid a deadly epidemic will be judged harshly if a few people had died. Meanwhile, positive improvement after a deadly epidemic are more likely to be praised.

The book traces the experience of a few key "behind-the-scenes" people that are doing the work to protect us. One person had worked as an administrator for the veterans administration. His hospital suffered greatly in the realm of public opinion because some of the patients had died. He later helped drive planning for pandemic response. Another key player worked as a public health official in Santa Barbara County, California. There she welded great power with limited resources. Then she accepted a state position where she was stuck behind bureaucracy when the covid pandemic played out. The third prong of the story focuses on research labs that have done work to identify and trace disease. They offered free, fast covid testing - yet bureaucracy slowed the uptake. (There were a variety of reasons - some places had relations with other vendors or could not bill $0). The lab also had the ability to rapidly identify different contagions. They even used this to identify drugs that could help cure things. Alas, these skills were often used. The government would even recommend a non-working treatment rather than the one that worked.

We do have great skill for responding to public health crises. We just can't necessarily take advantage of it.