written on October 19, 2026, read October 2026
No, this book was certainly not light Sunday-evening-tea-on-the-sofa fare. I recently picked it up as part of a stack of the Reclam books I mentioned before. These are often 200 pages at most, so they are read fairly quickly. Snack-sized, but in this case definitely not fast food.
This book is about triage. In other words, the question “Whom do I save – and how many?”, to repeat the book’s title in slightly shortened form. I find triage a very interesting subject. That is, after all, how the book ended up in the stack.
The question came up with greater urgency in Germany when, during the Covid pandemic, the images from Italy (which shook me deeply) confronted us with the question of how we would deal with such situations.
The TV series The Pitt, which I watched with great enthusiasm, raises this question in two places: on the one hand in the mass casualty event1 in season 1, which shows even a layperson like me many of the questions of triage in practice, and on the other hand in the decisions Dr. Robinavitch had to make about his mentor during the Covid pandemic, in the time before the first season.2
Unfortunately, I find the book’s treatment of Covid rather weak. This last section contains a lot of “would-have-should-have-could-have”, which in my view also oversimplifies some things and, as I see it, loses sight of the book’s own reasoning.
Let me illustrate this with an example: The author argues that it would actually have been imperative to speed up vaccine testing in order to save more people. To this end, he discusses human challenge trials, i.e. deliberately putting test subjects at risk3 in order to arrive at a vaccine as quickly as possible.
That is certainly an argument one can make. At one point, however, the author takes the safety of a vaccine after the first two phases of testing too much for granted. At that stage, all we know is that the vaccine does not immediately kill most people. Or, to put it differently and more accurately: by that point, initial safety data were already available. But they were not yet sufficient to reliably rule out rare side effects, or those that only become apparent later. The quote from David Wallace-Wells that the author uses here – that we had the vaccine all along, because we knew the genetic sequence of the vaccine that was later used – is wrong in this context. “Having” a vaccine means more than merely knowing how it is built; it encompasses everything that comes with it: safety, logistics, production. We had a building block, but we did not have a vaccine.
Far more serious, however, is that the book forgets its own reasoning here: triage is seen, to some extent, as weighing the interests of sick or injured people with differing needs. But isn’t weighing the harm healthy people might suffer from vaccination against the harm the disease causes, at its core, ultimately a kind of triage as well?
Just so there is no misunderstanding: I am not a Covid crank. I have been vaccinated again every year (except in 2025, when I caught Covid myself). I am still one of those people who consider Covid a danger not to be underestimated, even if the risks are no longer quite as great. My personal weighing of “vaccination risks versus protecting my parents, who have by now grown quite old” was very clear-cut. I just think you cannot spend 75 pages arguing very well about the subtleties and complexities of triage and then work with a very broad brush for the last 25 pages. In my view, the book would have deserved another 75 pages to examine the problems of the Covid situation with the same fine pencil.
In the book’s defense, however, it must be said: as far as I know, it was published in 2021, so it was presumably written in the winter of 2020/2021 – before the cerebral venous thromboses and the cases of myocarditis after vaccination became known. On the other hand, it was quite reasonable to assume that a vaccine would also have side effects that could be serious, as with any medication, aspirin included. Or, to stay with vaccines: at the latest since Pandemrix, it was known that risks which are not easy to observe are no mere speculation. Even if the broad brush is understandable, I consider it problematic for the argument in what is otherwise, in my view, a very good text.
PS: I find the book’s title linguistically a bit odd. In English it would read roughly “Whom do I save – and if so, how many?”, and “Whom do I save?” is not a question you can answer with “yes”. I do, however, have an idea from whom he borrowed this phrasing. And for precisely that reason I refrain from mentioning it.
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Or, as it is so “beautifully” called in German: “Massenanfall von Verletzten”, literally a “mass accumulation of injured persons”. ↩
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I am treading a very fine line towards spoilers here. Please forgive me. ↩
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Some of whom would, after all, receive only a placebo in order to demonstrate efficacy. Because of the double blinding, you therefore don’t know whom you are endangering in which way; you only know that you are endangering them. A trial that waits for nature to “do its thing” may take longer, but it avoids this particular moral dilemma – while creating the moral dilemma that arises from the longer wait. But at this point we are back at the distinction between “allowing” and “doing”, which the book mentions several times and which the author, too, considers significant. ↩
This is not a review, and I don't hand out stars either. It is part of my annotated reading list. Whatever first comes to mind when I pick up the book. More about it in this blog post.