Michael Lewis's books are never dull, and often very eye-opening. This one is no exception. This is not his best work, but still worth a look.

The book lacks an index. In today's world, one could index a book of this size in a few days. There is no excuse for not having one.

But that is a minor quibble.

Lewis' books are interesting narratives wrapped around important issues. This book is about health care and epidemics. The players are a number of really smart people surrounded by gutless, bureaucratic pencil pushers. It is difficult to summarize the story and I will not try.

Charity Dean is one of the good guys (gals, actually). Smart and insightful. Ditto Carter Mecher.  They both had the courage of their convictions and were able to think outside the box.

One thing that the book makes clear from simulations and history is this: Shutting down schools is imperative in an epidemic! The CDC was against it for political reasons. We are still arguing over that today.

The book's bad buys are politicians and the CDC. The CDC is now headed by a political appointee. That is bad. When Trump hired John Bolton as a security advisor, the first thing that dim bulb did was to dismantle the epidemic threat team.  When Americans were repatriated from Wuhan, the CDC declined to even test them (because they were "prisoner's"), despite the fact that they all wanted to be tested.  Politicians (i.e.: Mike Pence) forbade anyone from saying anything that might alarm the public… even if it was true and important  for their survival.

"Just in time manufacturing" is a broad term for using computers to anticipate demand  and save money. The down side of  this is that there is no depth to the system because inventories were kept at minimum levels. In other words, spikes in demand will break it. And that is what happened. 

There are two ways to fight an epidemic. One is vaccination and a charge toward herd immunity. The other is to contact trace and stamp out each occurrence... a labor intensive exercise. The  latter technique was used to stamp out small pox world-wide. There are now genomic tests that can rapidly identify which variant of COVID a person has. Because COVID changes over time (at a useful pace… not too fast, not too slow), testing can determine not only what you have, but also from whom you got it. The US government, and Canada's too, ignored this route.  The correct thing to do is both.

Fun facts:

The US did less genomic testing than any other advanced country in the world.
It is estimated that the Mango Mussolini is responsible for roughly 200,000 US deaths.    

Snowden is a Yale University professor of Medical History. This is a big book.  Five hundred pages with a small font and tight leading. It consists of 22 chapters, in chronological order, each basically dealing with a different disease and/or time period. Each chapter can be read stand-alone as a short essay.

Each essay discusses the disease; how it is transmitted; how it was dealt with, how effective those actions were; and its impact on history. I am a slow reader. The fact that this book held my interest from page one to page five hundred is telling. Even a brief summary of each chapter would make this a long document.  

The book was published just before the COVID pandemic really got going. It is impossible to read it and not compare the actions of today with those of previous generations fighting other diseases.

The main diseases discussed include the black plague, small pox, yellow fever, dysentery, typhus,  cholera, TB, malaria, polio, HIV/AIDS, SARS and Ebola.

Do you know what a bubo is? Neither did I. A bubo is a swelling and hardening of a lymph node, and it is the root word of Bubonic Plague.

It is not possible to sum up such a large volume in just a few words. So I will cherry pick a few notables.

In the beginning, there were the Humors. There were four because back then they liked that number. Four cardinal points, four winds, four seasons so… four humors. "Balancing the humors" gave us bloodletting. A really stupid idea.

Like most diseases, the Bubonic plague had multiple variants… some worse than others. The rat borne flea was the vector, but not all fleas, nor all rats, were equal. The etiology of  the plague is complex, which explains why it took so long to understand it. As most people know, shipping carried the rats and fleas from port to port, creating pandemics. The locals would grasp at and blame anything and anyone that they thought might be involved… like Jews for example.

A recurring theme through history is religion sticking its nose in where it did not belong. From blaming Jews  in the 1300s to burial practices used in the Ebola outbreak. Ignorance and religion made the problems much worse.

Smallpox has been eradicated. But in the past it was feared and weaponized.  The reason we were able to get rid of smallpox is because it has no animal hosts in which to hide. Edward Jenner used a similar disease, cowpox , to create a vaccine-- the first in history. Smallpox is extremely nasty, and yet the objections to the vaccine then (government over reach, religion, and science denial) are the same as they are today.

In an odd turn of history, yellow fever  led to the liberation of slaves on Hispaniola. It so decimated the population that fresh "unbroken" slaves had to be imported  all the time.  Soon, these uppity new slaves had the upper hand and the island became independent.

Disease has had huge influences on politics and war. When Napoleon drove to take Moscow, he was beaten by several factors, including typhus and dysentery.

In the 1700s, medicine started to make large advances toward the modern world.  The French School was born. TB (aka consumption) was one of its targets. TB created its own fashion trend: Rail skinny women, with a grey/white pallor was the rage.

TB and cholera led to sanitation (and the Sanitary Report) that gave us modern sewers and clean streets. Cholera is passed in large part from human feces to human mouths.  Staying clean became  important.

In the 1800s, Louise Pasteur pushed the germ theory of disease. It was mocked by many until he developed a vaccine for anthrax, saving France from the economic ruin of their sheep and cattle dying by the thousands. Pasteur also created treatments for rabies and invented pasteurization, which saved countless lives.    

With the microscope came lab medicine. Bacteria like TB could be seen under the microscope, allowing for accurate diagnosis and an interruption to the transmission chain. It also led to anti-bacterials like streptomycin.

Malaria has probably killed more than any other disease. This is because it has been around longer than any other.  This make the mosquito the worst killer in history. Malaria and Yellow Fever are both mosquito borne. 

Polio has proved hard to get rid of. But we are close. If we can eradicate it, it will be the second, and probably the last, disease to be thus dispatched.

The book closes with AIDS and Ebola. AIDS is mostly transmitted by heterosexual contact, not homosexual contact.

A recurring theme in the book is that disease generally hits the poor much harder than others. Genetics also play a role. For centuries, and to this day, the disadvantaged are blamed and most impacted by disease, while those less at risk turned their collective backs.

All in all, a fascinating read. My only regret is that much of it will disappear from my brain because diseases and their etiologies are very complex. Most diseases come in various strains, as we are finding out with COVID. And stupid people who avoid vaccines are part of that problem.  They increase the number cases and thus the opportunity for mutations to develop.

A pox on them all.