The Long Grind

At some point, an invasion becomes a relationship, even without the invaded party’s consent. If an occupying force can dig in and avoid defeat, the two sides will begin to adapt and to develop the conditions of a shared long-term existence. These wars of attrition can lead to several outcomes, but they often grind to a messy stalemate — and a transformed reality.

We have entered a long-term relationship with COVID‑19. Many of us have been infected by the virus formally named severe acute respiratory syndrome coronavirus 2 or know someone who has been. An increasing number of us have had it more than once. Globally, SARS‑CoV‑2 has officially claimed the lives of some 6.3 million grandparents, parents, siblings, and children, and the actual number is probably more than twice that, according to recent estimates by the World Health Organization. We are all tired of life being like this. Yet our relationship with this virus is still relatively young, as these things go. We are still adapting to it and learning to accept its constant presence in our lives.

Compared with most of us, a few people have had a much longer engagement with the family of viruses from which COVID‑19 is descended. They have tangled with Coronaviridae in labs and caves and Bavarian castles, seeking out data that has taken them back thousands of years and through the bloodstreams of dozens of species. And their work has played a significant role in providing us with the defences we have so far deployed against this pandemic.

Dan Werb’s The Invisible Siege: The Rise of Coronaviruses and the Search for a Cure tells their story. Structured like a sprawling novel and densely packed with information, the book works simultaneously as a celebration of those whom Werb calls “the most consequential scientific minds of our time” and as a detailed biography of the disease that has affected our world so profoundly — perhaps more frequently than we might have thought. It is a rewarding read and a major addition to the literature about coronaviruses and COVID‑19.

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The Invisible Siege opens in an intensive care unit in March 2020, as Werb plunges us right into that moment — you remember it — when the virus loomed on the horizon like a huge toxic slug and life was a torqued rope of tension and fear. His vehicle for this awful feeling is Nick Mark, an ICU physician in Seattle who, in that moment, was coming to understand exactly what the pandemic would mean for his job, his family, and his safety. It’s a potent beginning that sets up the question of heroism as one of the book’s themes by presenting us with an obvious but dreadful truth: Those front-line workers we celebrated with nightly percussion and encouraging lawn signs? They were terrified.

In addition to writing books, Werb works as an epidemiologist and policy analyst specializing in infectious diseases, with academic positions at the University of California San Diego and the Dalla Lana School of Public Health at the University of Toronto. His expertise gives him an educated and sympathetic take on the past two-plus years. But after revisiting the Moment Everything Changed, he steps back to reveal a longer perspective and the real protagonists of his story. First, we get a brief tour of epidemiological history, including deadly coronavirus outbreaks that may have been misidentified in New York City, in 1889, and in China, during the Northern Song Dynasty around the turn of the first millennium. This look back establishes another theme repeated throughout The Invisible Siege : we call the virus we face today “novel,” but it is actually “an old story” that took us by surprise — one that is “playing to an ancient script.” There’s a yin‑yang of optimism and doom. We have seen this kind of agent before; we will see it again.

Early in the book, we get a taste of Werb’s poetic mode, which turns melancholic at times:

We look to the faces and bodies of our loved ones — our friends, our parents, and our children — for evidence of how grueling our journey through time really is. A wrinkle, a gray hair, momentary apprehension when walking up a flight of stairs — if we had no other way to measure time, our bodies would be enough to signal how far we’ve come and how quickly the path before us is dwindling.

The writer’s command of language and his ability to frame a story in human terms helps him juggle complex science with the names and roles of a constellation of virology wizards. A few gradually emerge as lodestars. Primary among them is Ralph Baric —“coronavirology’s only titan”— who is almost a figure of worship for both his peers and the author. A humble genius who sought a quiet life of study in what he assumed would remain an insignificant field, Baric ended up at the very centre of the pandemic. We also meet the Canadian stem cell biologist Derrick Rossi, who developed mRNA vaccines and co-founded the pharmaceutical company Moderna; and Shi Zhengli, whose pioneering work on coronaviruses in bats, at the Wuhan Institute of Virology, in China, prompted allegations of a lab leak. Piecing together the big picture like a mosaic, Werb introduces us to dozens of other scientific and business-focused minds who have contributed to our knowledge of coronaviruses and how to fight them — and these, he admits in his acknowledgements, are still a mere fraction of the huge network of people who make up a much denser understorey.

The wrangling of vast amounts of complicated information into a “shorthand that distills the work of hundreds down to the actions of a few singular figures” is no small feat. Werb sprints out of the starting gate, though, following his historical tour by digging into COVID‑19’s immediate predecessors: severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). There is a deeply satisfying chapter about the discovery of the latter in camels, which reads like a stand-alone novella and features Marion Koopmans, a Dutch virologist who is one of the few women with starring roles in the book. We also get a behind-the-scenes glimpse at how the United States government responded to the first wave of COVID‑19, including a late-night request from the White House that feels lifted from a spy thriller.

Moreover, Werb offers context and background for a lot of the language, trends, and small crises that have helped shape the zeitgeist since early 2020. We get a sober, honest assessment of various drugs touted as potential treatments, including hydroxychloroquine and remdesivir. We see the workings of viruses on a cellular level and become particularly well acquainted with COVID‑19’s insidious protein spike. We also learn some enjoyable trivia. Did you know, for example, that the “m” in mRNA stands for “modified” and is responsible for part of Moderna’s name?

This is not, however, a book that breezes through its subject. As I read it, I felt holes in my understanding being patched up, a fuller picture coming into view. For instance, Werb makes it clear why we stopped hearing about patients being intubated — a common nightmare scenario at the pandemic’s outset — as new data changed our understanding of how the virus behaves and how to treat it.

Partly as a result of its rigour, The Invisible Siege labours a bit in the later chapters, when the text is thick with acronyms, technical language, and statistics. The disorientation caused by the density of data is amplified in passages about recent events; Werb’s use of the past tense here does not seem to jibe with the sense that this history is still unfolding around us. What keeps everything afloat is the author’s obvious enthusiasm for his subject. You can tell he loves these people and their work. This tone gives the book further strength as a kind of ode to research, experimentation, and science — all of which have taken unfair beatings in this time of poisoned politics and widespread disinformation.

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I first encountered Dan Werb as a musician who played in the band Woodhands and participated in an arts documentary series I produced. He’s a rare person who has found success in both creative and strictly clinical fields. So it’s fitting that The Invisible Siege celebrates diverse ways of thinking about and approaching problems. Many of the book’s central characters are mavericks — not of the Silicon Valley tech‑bro type but of the sort willing to buck authority and the status quo for what they think is right. They are creative thinkers working within the necessary parameters of science and public health.

Werb prefers this rendering of scientists — committed maestros working away in their labs to tease the secrets of virology from delicate molecular strands — to the one that frames them as sacrificial warriors. He presents Ralph Baric as an almost monkish figure, who craved a quiet corner of epidemiology where he could tend his weird little virological pets for the sake of pure knowledge. And in one of the book’s more jarring passages, he returns to Nick Mark, the ICU physician in Seattle. “Mark loathed the ‘healthcare workers as heroes’ discourse, which he saw as insidious,” Werb writes. Why? In Mark’s own words: “You expect heroes to die.”

The COVID‑19 pandemic has thrown into stark relief the ways in which our society gauges the value of human life. Although The Invisible Siege offers a lot of hope and puts a great deal of faith in science, it also includes a few gut punches that reiterate how our current predicament could get worse — or happen all over again. Werb points to the epidemic triangle —“the shifting interaction between a pathogen, its host, and the environment within which their relationship plays out”— as the battleground in an ongoing showdown between Coronaviridae and humankind. The siege is not what we think it is; we are not harangued by aggressive viruses attempting to annex our land and lives. Rather, the destructive, pressurized relationship we have with the global biosphere —“the epidemic triangle shifted to obscene angles”— is forcing these heretofore hidden pathogens to adapt and thrive in ever-expanding human territory. Chances are good it won’t be long before we shake another one out of some cave or den and into our daily lives. (Recent cases of monkeypox in the United Kingdom, Spain, Portugal, and elsewhere help underscore the point.) As Werb writes at the end, channelling his best Werner Herzog, “The only way to truly blunt the threat of future pandemics is for humanity to retrench itself from the grim task of salting the earth.”

The last we hear from Nick Mark is a bleak prognostication that “he’d be in for many more pandemic seasons” in the ICU, filled with breakthrough cases in vulnerable populations and “people who are, like, very into natural cures.” In the U.S., vaccine hesitancy continues to be a major roadblock to herd immunity, and politics and corporate greed are dominant forces in public health. As long as SARS‑CoV‑2 continues to spread freely through the unvaccinated, it’s likely new variants will continue to emerge. “I guess there’s a lot of things it could do,” Ralph Baric says of the virus’s future. “What it’s going to do, I don’t know.”

In other words, welcome to the long grind.