Of the thousand or so new lessons learned every day in the midst of the coronavirus pandemic, none perhaps is harder to accept than the scientific reluctance to endorse potential therapies and treatments that seem to hold out immediate hope for relief. Take, for example, Donald Trump’s recent promoting of antimalarial drugs that show supposed, if limited, efficacy against COVID-19. Trump’s enthusiasm was instantly recognizable as a con man’s desire to draw a mark’s attention away from the changing nature of the come-on; if you gaslight your listeners with enough energy, they may not be able to turn their eyes away from the new con long enough to see where the old one went.
Still, it’s natural to ask: Wouldn’t it be better to give something that seems to show some promise a chance? The urge to believe so, at such a moment, is human. Trump understands the precise vulnerability of his audience: Isn’t all the procedural stuff really just expert overkill, red tape, bureaucratic delay? So, when Anthony Fauci steps grim-faced to a microphone to tell a reporter, as he did at Trump’s press briefing on Friday, “The information that you’re referring to specifically is anecdotal. It was not done in a controlled clinical trial, so you really can’t make any definitive statement about it,” he can seem the voice not of reason but of bureaucratic caution.
Not surprisingly, Fauci’s caution in this case was swiftly seconded, with regard to the antimalarial drug chloroquine. Gaetan Burgio, a geneticist at the Australian National University, did a particularly crisp analysis in a Twitter thread that, though written very much in sciencespeak, was intelligible to amateurs, and confirmed that the evidence is anecdotal and a clinical trial presumably showing the drug’s efficacy for this application is, at best, half-baked. That doesn’t mean that the evidence is false, just that it’s incomplete. Meanwhile, an enthusiastic supporting document, much circulated on right-wing Web sites, supposedly coming from Stanford Medical School, had nothing to do with Stanford Medical School or any other school. This doesn’t prove that the drug won’t work in some way—who wouldn’t hope that it would? But it shows that we don’t know that it will.
Beneath all this remains the deeper question that many people are grappling with, even if they shun Trump’s bad faith: Why wait for studies when people are suffering and dying now? The answer is a hard one to give, since it seems hard-hearted: if we don’t know what we’re doing, we may do far more harm than good. (Meanwhile, Burgio, and many others, have noted dangerous and potentially lethal chloroquine overdoses.) Plagues and pandemics are huge events affecting enormous populations; we need to battle them not impulsively but with an eye to the future course of the disease. This will save more lives in more places over a longer period of time, scientists tell us, even if it seems cold-blooded now.
The brutal but essential logic of plague science has never been more lucidly dramatized than it was in a now mostly forgotten novel, by the now mostly forgotten American novelist Sinclair Lewis.
Literary reputations have their own evolutionary pressures. This week, there was a hoax involving another novelist, F. Scott Fitzgerald, a contemporary of Lewis’s, whose work, unlike Lewis’s, has proved so hardy that his name and his life are emblematic of the nineteen-twenties generation. The hoax involved a letter that Fitzgerald allegedly wrote in 1920 while he was quarantined in Europe during the Spanish- influenza epidemic. (The hoax was actually a well-meant parody from McSweeney’s, and was readily recognizable as such, because it was too characteristic. When something ticks off every box—in this case, liquor, Zelda, starlight, etc.—it’s almost always a phony. Fitzgerald’s fame made every reader recognize the elements.)
Lewis is mostly unread now both for reasons sound—he was a satirist first and a stylist second, and stylists tend to last after the satirists’ targets have passed—and unsound—he wrote a kind of journalistic fiction that depended less on outré experience than on the passing scene and the issues of the day, which modernist literary taste found fatuous. But, when Trump came to power, Lewis’s 1935 novel, “It Can’t Happen Here,” seemed newly relevant. And, in “Arrowsmith,” a much better novel, from 1925—which propelled Lewis, five years later, to the Nobel Prize in Literature, the first given to any American—he wrote the best American novel we have about plague science. (If anyone doubts the relevance of literature to life, think of the necessity of reading in the past week alone: novels are the condensed history of our lived experience. They are our past made poetic.)
The novel’s protagonist, and namesake, is Martin Arrowsmith, a young Midwestern doctor who, inspired by a German-American immunologist named Max Gottlieb, becomes a research scientist. After many misadventures in academia, including one at a New York institute modelled on the then new Rockefeller Institute, he develops a treatment for plague, called “phage.” When he learns of an outbreak of bubonic plague in the fictitious West Indian island of St. Hubert, he decides to go there to test his medicine. As he goes, his mind and heart are divided in a kind of psychomachia between the science-minded Gottlieb, who tells him, “If I could trust you, Martin, to use the phage with only half your patients and keep the others as controls, under normal hygienic conditions but without the phage, then you could make an absolute determination of its value as complete as what we have of mosquito transmission of yellow fever,” and another mentor, Gustaf Sondelius, a charismatic Swedish apostle of public health who accompanies Arrowsmith and is determined to give the phage to everyone on the island.
Arrowsmith also has a devoted wife, Leora, who, refusing to play the role of the good little wife, insists on going with him to St. Hubert. (Lewis was a much more resolute feminist than any of his more modern-mannered contemporaries.) Lewis has Gottlieb implore him: “I do not make funniness about humanitarianism as I used to; sometimes now I t’ink the vulgar and contentious human race may yet have as much grace and good taste as the cats. But if this is to be, there must be knowledge. So many men, Martin, are kind and neighborly; so few have added to knowledge. You have the chance!”
Once on the island, Arrowsmith struggles to maintain the rigor of his experiment, even as the sheer horror and misery of the plague overwhelms him. “He divided the population into two equal parts.” One half “was injected with plague phage, the other half was left without. He began to succeed. He saw far-off India, with its annual four hundred thousand deaths from plague, saved by his efforts. He heard Max Gottlieb saying, “Martin, you haf done your experiment. I am very glat!”
Sondelius dies, after fighting rats. (“I want you to see how an agnostic can die! I am not afraid, but yoost once more I would like to see Stockholm, and Fifth Avenue on the day the first snow falls and Holy Week at Sevilla. And one good last drunk! . . . Oh, Martin, give my people the phage! Save all of them.”) Then, in one of the most unbearable sequences in American fiction, Leora contracts the plague, by pulling a draw on Martin’s cigarette butt. “She kept away from the flasks of plague germs, but she picked up, because it was his, a half-smoked cigarette and lighted it.” After she dies, a broken Arrowsmith begins to give the phage to everyone on the island, destroying the experiment. The plague does diminish, and he is treated as a hero, but no one can really know what made it go away. Plagues having been known to slacken and die before. Arrowsmith knows that, even as he is lionized, he is ruined: he “thought about what unknown, tight-minded scientists in distant laboratories would say of a man who had had his chance and cast it away. The more they called him the giver of life, the more he felt himself disgraced and a traitor.”
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