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Reviewers largely commend "The Twelve" for its enhanced dynamism, action, and twists compared to its predecessor, making it a quicker and more compelling read for many. The book is praised for its unique blend of apocalyptic body horror, dark science fiction, and fantasy, effectively reimagining established genre tropes with creativity. Many found the world-building to be atmospheric, sensuous, and terrifyingly believable, painting a vivid portrait of humanity in extremis. The narrative is often described as epic and grand, with some appreciating its unconventional structure that revisits the virus's outbreak to expand on events and introduce new perspectives, which deepens the intricate plot strands and landscape. Additionally, the writing style is frequently lauded for its artistry, intellectual complexity, and ability to transcend typical genre boundaries.

Despite its strengths, "The Twelve" faced significant criticism, primarily regarding its complexity and narrative structure. Numerous readers found the book too epic, with an overwhelming number of characters and intersecting plotlines that made it difficult to follow and remember details, especially if not read quickly. The narrative's frequent jumps between different timelines and characters were often perceived as disjointed, leading to confusion and a sense that story threads did not cohere into a satisfying whole. Some felt the pacing became mired in excessive military details in the latter half, while others believed the author relied on improbable coincidences or "made-up" elements to advance the plot. A recurring concern was the portrayal of female characters, with some reviewers expressing strong dissatisfaction over their treatment, finding certain plot points exploitative or limiting to their agency, and a perceived over-reliance on male-centric motivations. The author's prose was also occasionally described as overly verbose, pretentious, or suffering from "author ego overkill."

Overall, "The Twelve" elicits a mixed but generally positive reception, with many acknowledging it as a worthy, albeit sometimes flawed, successor to "The Passage." While some readers were left disappointed and found it a chore to finish, others remained spellbound and eager for the trilogy's conclusion. This book is best suited for readers who enjoyed the intricate world and ambitious scope of the first installment and are prepared for a challenging, multi-layered narrative. It particularly appeals to fans of epic-scale post-apocalyptic stories, horror-sci-fi hybrids, and those who appreciate literary depth within genre fiction. However, those seeking a straightforward, linear plot or less demanding read may find its complexity and character overload frustrating.