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Summary
Summary
Geoff Manaugh and Nicola Twilley have been researching quarantine since long before the COVID-19 pandemic. With Until Proven Safe , they bring us a book as compelling as it is definitive, not only urgent reading for social-distanced times but also an up-to-the-minute investigation of the interplay of forces---biological, political, technological--that shape our modern world.
Quarantine is our most powerful response to uncertainty: it means waiting to see if something hidden inside us will be revealed. It is also one of our most dangerous, operating through an assumption of guilt. In quarantine, we are considered infectious until proven safe.
Until Proven Safe tracks the history and future of quarantine around the globe, chasing the story of emergency isolation through time and space--from the crumbling lazarettos of the Mediterranean, built to contain the Black Death, to an experimental Ebola unit in London, and from the hallways of the CDC to closed-door simulations where pharmaceutical execs and epidemiologists prepare for the outbreak of a novel coronavirus.
But the story of quarantine ranges far beyond the history of medical isolation. In Until Proven Safe , the authors tour a nuclear-waste isolation facility beneath the New Mexican desert, see plants stricken with a disease that threatens the world's wheat supply, and meet NASA's Planetary Protection Officer, tasked with saving Earth from extraterrestrial infections. They also introduce us to the corporate tech giants hoping to revolutionize quarantine through surveillance and algorithmic prediction.
We live in a disorienting historical moment that can feel both unprecedented and inevitable; Until Proven Safe helps us make sense of our new reality through a thrillingly reported, thought-provoking exploration of the meaning of freedom, governance, and mutual responsibility.
Reviews (5)
Publisher's Weekly Review
BLDGBLOG blogger Manaugh (A Burglar's Guide to the City) and Gastropod host Twilley take a riveting and timely look at how humanity has protected itself by isolating segments of its populations. Quarantines, they write, have "always been a stimulus for creatively rethinking the built environment," and while the authors cover the response to Covid-19, they also survey the ways animals avoid infecting others, agricultural safeguards against diseases that could decimate food supplies, precautions taken by NASA to not contaminate other planets, and how radioactive nuclear waste can be safely stored for tens of thousands of years. Manaugh and Twilley cull their research into a concise and logical series of recommendations for future public health crises, grounded in a deep appreciation of the human impact of quarantining. Though technological advances in tracking, testing, and containment offer promise for more effective quarantining, the future will likely see more quarantines, and thus will require "a politics and culture of collaboration." The way forward, they write, will require design creativity, legal reforms that ensure "that the authorities making... promises will deliver on them," and imaginatively thinking about quarantine as an experience that allows agency. This thoughtful study couldn't arrive at a better moment. Agent: Nathaniel Jacks, InkWell Management. (July)
Guardian Review
On the first day of Wimbledon, Dame Sarah Gilbert, professor of vaccinology at Oxford's Jenner Institute, was treated to a standing ovation from grateful spectators on a packed Centre Court. Together with her Oxford colleague Catherine Green, Gilbert had delivered the AstraZeneca vaccine against Covid-19 in record time, and tennis fans, enjoying a rare maskless day out in SW19, were keen to show their appreciation. But as Gilbert and Green point out in their new book, Vaxxers, not everyone shares the Centre Court crowd's enthusiasm for vaccines, and as long as the coronavirus continues to mutate and conspiracy theories propagate on social media, their job is not over. It is remarkable that Gilbert, a 59-year-old mother of triplets, and Green, a specialist in vaccine manufacture, found time to write this book, given the considerable technical and logistical hurdles involved in developing a new vaccine from scratch in little under a year. The previous "lab-to-jab" record holder was the mumps vaccine, developed in four years in the 1960s. But because of the difficulty of raising funds for vaccine research and the various regulatory hurdles, it takes 10 years for most new vaccines to be licensed, and even then, a hurried press release or an errant remark by a politician can quickly undo your hard work. Gilbert and Green, rightly, have no time for anti-vaxxers. There is no more cost-effective way of improving the length and quality of someone's life than a vaccine against a nasty disease, they point out. Vaccine hesitancy, however, is a different matter, and it reflects their care and concern that they devote large passages in their book to demystifying their research and putting the risks of vaccination in context. Indeed, Vaxxers can be read as much as a manifesto for the importance of good science communication and an antidote to anti-vax conspiracy theories as a biomedical thriller. In alternating chapters, told from either "Sarah's" or "Cath's" point of view, Gilbert and Green are at pains to point out that they are not "big pharma" but two ordinary people who managed to pull off an extraordinary feat while dealing with the everyday stresses that come with being full-time mums and breadwinners in a notoriously insecure and poorly paid field. For every vaccine that makes it to licensure, there are many that never get beyond proof of concept, let alone to the clinical trial stage. Research groups, like the one Gilbert heads at the Jenner, are like small businesses or charities, with scientists lurching from one project to another on insecure, short-term contracts. Indeed, it is impossible to read Vaxxers without coming away with a newfound respect for Gilbert and Green's ability to juggle multiple tasks while sounding coherent in front of the TV cameras after another sleepless night wondering where the funding for the next stage of their research will come from. And that's before you get to the UK's controversial decision (subsequently vindicated) to extend the interval between the first and second jabs to 12 weeks, or the unfavourable comparisons in the US biotech press between AstraZeneca's efficacy results and those of the Pfizer and Moderna vaccines. Gilbert is understandably sore about the barbs directed against her and her team. "There were days when we seemed to be battling against our employer, or the media, or a swarm of wasps, as well as the virus," she writes. But she never loses sight of the goal of delivering a safe and effective vaccine against Covid. When, on 11 January 2020, the Chinese published the genetic sequence of the coronavirus and Gilbert began designing a vaccine to target the spike protein using a "plug-and-play" technology employing a modified chimp adenovirus, the benchmark for success was anything in excess of 50% efficacy. Yet for all the questions about the optimal dosing regimen (the trials produced the unexpected result that a half dose followed by a full dose generates more antibodies than two full doses), AstraZeneca was able to demonstrate 70% efficacy in trials and 94% effectiveness in the real world - better than Pfizer. Having previously designed vaccines against influenza, Ebola and Mers using the same vaccine platform technology, Gilbert and Green never had any doubt that they would succeed. Their only regret is that due to a lack of funding for a putative "Disease X" in the run-up to the pandemic they weren't able to move even faster. In a charming passage aimed at Bake Off fans, Green describes how making a vaccine against a new disease is a little bit like waiting for a bespoke order for a birthday cake. Since the delivery system is the same, you can expedite the process by preparing the dough and baking the cake beforehand. Then, once you know whose birthday it is, you simply apply the icing with the message, ie the spike protein. The good news is that as the coronavirus continues to mutate, this puts the Jenner Institute and AstraZeneca in a strong position to update their recipe against new variants. The problem is that despite delivering millions of doses on a not-for-profit basis around the world, there are still many countries that have yet to benefit from this bounty or where immunisation rates remain worryingly low. For instance, as British tennis fans were enjoying their strawberries and Pimm's in the sun, in Sydney and Brisbane, Australians were enduring another round of stay-at-home orders in a bid to keep the Delta variant at bay. It was a sobering reminder of the way Covid has divided our world (in Australia only 7% of the population has been immunised against Covid versus 60% in the UK), and how, in the absence of vaccines, the only solution is to employ quarantines. As the academics Geoff Manaugh and Nicola Twilley point out in their brainy but accessible book on the history and future of quarantine, the first quarantine dates to 1377, when Dubrovnik banned travellers from plague-infested areas entering the city. Derived from the Italian word quarantena, meaning 40 days, quarantines are a tried-and-tested means of delaying the arrival of a potentially fatal pathogen. In theory, quarantine works by separating people suspected of sickness from those known to be well. But making this seemingly simple distinction opens worlds of philosophical uncertainty, ethical risk and - as we have seen in India and elsewhere - the abuse of political power. Though it is usually viewed negatively, quarantine can also be a powerful generator of creativity and connection, the more so in the era of Zoom, and should be considered "part of our collective immune system". Yet when it became clear that border closures and quarantines were the only way of buying time until vaccines came on stream, few experts, and few politicians (in the west at least), seemed to have grasped their utility. Manaugh and Twilley suggest this failure was due as much to a lack of imagination as the inability to take note of the many historical examples of the successful application and embrace of quarantines. The result was that rather than employing technology and design solutions to make quarantines more palatable to the populations of advanced democracies in the 21st century, most experts assumed they would be unworkable. In retrospect, this was a mistake. It would also be a mistake in the future, not least because, as Gilbert and Green make clear, Covid-19 is not the last pandemic the world is likely to face and, even with better funding, vaccines will always be playing catch-up with a virus.
Kirkus Review
A captivating survey of the uses and abuses of quarantines, from the days of the Black Death to the lockdowns of Covid-19. Journalists Manaugh and Twilley meld a global view of a timely subject with vividly detailed accounts of quarantines, whether of people or hazardous plants, animals, and chemicals such as nuclear waste. The authors show how--since the emergence of "lazarettos," the quarantine hospitals of medieval Venice and other Adriatic ports--authorities have strived to contain dreaded hazards. Among many others, these have included the bubonic plague, yellow fever, tuberculosis, Ebola, and cholera. Yet some problems resist solutions. "Although the advent of advanced contagion modeling, location tracking, and data mining offer the promise of refining quarantine, rendering it so minimal and precise as to be almost imperceptible," the authors write, "the use of those tools during COVID-19 has demonstrated that, in many ways, effective quarantine has changed remarkably little since its origins during the Black Death." Persistent challenges include the tedium of isolation, the architectural rigors of designing suitable facilities, and the xenophobic use of quarantine "to obstruct the passage of undesirable immigrants at the border and stigmatize those who have already arrived." For such risks, the authors propose fresh, sensible remedies such as a "bill of rights" for the quarantined. But a larger charm of this smart book lies in their ability to bring potentially dry topics to life. They profile the delightfully "obsessive" founder of the Disinfected Mail Study Circle (which tracks epidemics through postal evidence), and, after visiting a greenhouse near London, they note that cacao-plant diseases have contributed to a shrinking global chocolate supply that may lead to a "chocpocalypse." Chocoholics, beware: One study found that in a decade or so, "a Hershey bar may well be as rare and expensive as caviar." An infectiously appealing overview of efforts to contain the potentially infectious. Copyright (c) Kirkus Reviews, used with permission.
Booklist Review
Quarantine. "The very word--foreign, clinical, medieval--inspired fear," write Manaugh and Twilley in their engrossing examination of protective isolation. Surveying six centuries of society's often initial response to epidemics, they deem quarantine a "powerful and dangerous tool." An island near Dubrovnik, NASA, Nebraska, and Venice are a few destinations on the authors' itinerary. The Black Death, cholera, and COVID-19 are some of the infections considered. Quarantine provides a buffer and a delay, offering space and time, between the known (healthy folks) and the dangerous (potentially contagious people). Its complicated nature is adeptly explored, including ethical concerns, legal and moral questions, and enforcement challenges. Risks, uncertainty, security, and architectural design associated with preemptive seclusion are discussed. Descriptions of the many ways mail has been disinfected (grilling, smoking, application of vinegar, processing through weird gadgets) in prior epidemics and lessons on infection-control behavior gleaned from social insects make for fascinating reading. "Quarantine, a solution from the past, is back--and here to stay," the authors warn. In the future, its role will be shaped increasingly by technology and the attitude of citizens.
Library Journal Review
Authors Twilley (co-host of the podcast Gastropod) and Manaugh (A Burglar's Guide to the City) began their research on the practice of quarantine long before the start of the global COVID-19 pandemic, yet they always knew their book would be more than just a history of quarantine. They point out other instances of the practice, including in modern agriculture that depends on quarantine as a means of protection, especially as humans become more dependent on monoculture farming. Space exploration requires quarantine too, so that humans do not destroy other planetary ecosystems by transmitting Earth-based contagions. The global spread of COVID-19 and the subsequent viral flare-ups demonstrate a continuing need for separation and isolation; quarantine is still an effective tool in protecting public health, the authors say. Twilley and Manaugh argue, however, that quarantine's effectiveness must be balanced against historical knowledge and the conditions we see today around diseases like Ebola; they prove that quarantine, when used as a way to protect one's self, family, or society, can also allow the flourishing of racism, xenophobia, and oppression of targeted populations, including the revocation of personal freedoms. This book looks forward to new technologies and legal changes that may alter the way we travel and interact within our own homes to stay safe. VERDICT An informative account for readers interested in public health's impact on historical and current practices in medicine and science.--Rachel M. Minkin, Michigan State Univ. Libs., East Lansing
Table of Contents
Maps | p. vi |
Part I Encountering Uncertainty | |
1 The Coming Quarantine | p. 3 |
Part II Building Quarantine | |
2 The Quarantine Tourist | p. 47 |
3 Postmarks from the Edge | p. 80 |
4 An Extraordinary Power | p. 116 |
5 Alone Together | p. 153 |
Part III Animal, Vegetable, Mineral, Alien | |
6 Biology at the Border | p. 193 |
7 A Million Years of Isolation | p. 244 |
8 All the Planets, All the Time | p. 270 |
Part IV Distance Assistance | |
9 Algorithms of Quarantine | p. 309 |
Epilogue: Until Proven Safe | p. 343 |
Authors' Note | p. 351 |
Sources | p. 353 |
Acknowledgments | p. 379 |
Index | p. 381 |