Finally, a light at the end of a dark tunnel
In the beginning
We had a nice Christmas holiday with my daughters in New York in 2019. We were planning what we would do after my retirement from the University of Pittsburgh’s School of Public Health after 35 years of service at the end of January, 2020. While browsing the journals, I came across a paper describing a very unusual lethal coronavirus infection in Wuhan, China. By February, I found that thousands of people had died from this infection and it had spread like a fireball in that region and in the surrounding areas, including southeast Asia. In a matter of weeks, we learned that the infection was devastating Europe and the first few cases appeared in Seattle. Being a virologist who worked on HIV for 35 years and encountered other human viral infections, I was still thinking that this would be like the SARS or the Zika virus, which we controlled by adhering to basic Public Health 101 practices, like immediate quarantines for SARS infected people and mosquito control for Zika virus. By the end of February, we realized this was a very unusual coronavirus, one that is highly transmissible and lethal, especially to older people and those with underlying health conditions. By that time, the scientists had isolated the virus, determined its genetic structure and named it SARS-COV-2 and its resulting disease, COVID-19.
Reality starts to set in
We quickly learned that this virus infects all humans regardless of their color, sex, religion or geographical location. In the U.S., the virus disproportionately affected minority groups and older populations with underlying health conditions. The virus also appears to cause recurring health problems, including unusual fatigue, brain fog, temperature irregularities and memory problems, even after recovery from infection. It can also cause blood clots that block capillaries resulting in permanent damage to the lungs, heart and brain. Many who recovered after long hospitalizations faced a long road to full recovery, suffering kidney damage and reduced lung capacity, and requiring extensive physical rehabilitation. Mayo Clinic experts found these longer-term problems can also be evident in people with mild symptoms.
Public health implication
By the end of December, we warned people that future infection and death rate would depend on how we behaved, and how quickly we got vaccinated. Pandemics do not end overnight—they decrease gradually. Compared to the Spanish flu epidemics in 1918, we are doing much better today, because we know what to do. At the height of the epidemic, medical experts and the CDC predicted that wearing masks and maintaining social distancing could curtail coronavirus transmission by 60 to 70 percent and these two deterrents can be almost as effective as the vaccine in controlling the virus. Such an assertion comes from the fact that the early pandemic positivity in New York City of nearly 20 percent dropped to 1 percent after strict adherence to those two public health practices. The same thing happened in Massachusetts, New Jersey and Connecticut. On the other hand, in places where citizens ignored these public health practices, infection rampaged.
Anti-viral therapy and vaccine
At the beginning of the epidemic, I thought that since this virus was not as smart as HIV, we should be able to get an anti-viral drug by early summer. It was not that easy. Fortunately, we did get Gilead’s anti-COVID drug remdesivir, which does not cure, but shortens the hospital stay, and another widely available medicine, dexamethasone, which improves disease progression considerably and decreases the hospital stay for those with the most severe forms of the disease. In November, 2020, we got even better news: Two pharmaceutical companies, Pfizer and Moderna, announced vaccines against COVID that are safe and more than 95 percent effective. Both of these vaccines are approved by the FDA and millions of doses are being distributed. This is a phenomenal scientific and logistical achievement in eight months, considering that it takes an average of five to 10 years to make a vaccine.
At the time of this writing, two more companies with slightly different technologies have reported they will have vaccines ready this year. By early spring to summer, we expect there should be enough vaccine to inoculate most of the U.S. population, with the rest of the globe following by the end of the year.
In the meantime, there is more good news. Two companies, Eli Lily and Regeneron, have developed monoclonal antibodies which, if given early, can increase the chance of survival. These antibodies could serve as an important bridge before the arrival of vaccine. Nine hundred thousand doses of such antibodies are being distributed to all 50 states.
Multi-prong strategy to control the virus
From the preventive perspective, we must continue to follow the public health practices of wearing masks, washing hands frequently and keeping up social distancing. This will reduce the transmissions. Second, broad adoption of the FDA approved vaccine will prevent new infections and thereby block transmission. Preliminary results also indicate the Pfizer and Moderna vaccine could block asymptomatic transmission. We must be vaccinated as soon as possible. Experts say 70 percent of the U.S. population must be vaccinated to achieve the herd immunity so the virus can no longer spread. Based on the scientific and CDC/FDA’s critical evaluation, both Pfizer and Moderna vaccines are safe. And, for those who become infected, monoclonal antibodies should control infection at early stages of infection and anti-COVID drugs remdesivir and dexamethasone can help manage the most severe cases and further progression of the disease.
Final thought: Help is on the way
While we are all stressed from the feeling of isolation, loss of innumerable jobs and loss of loved ones, the good news is that we are not as helpless as we felt last year. We can now see the bright light of hope at the end of the tunnel. The cavalry is here with vaccines and antiviral therapeutics. Until that time, our responsibility remains to hunker down and follow the public health practices of wearing masks, washing hands frequently and keeping up social distancing. We should be kind to our neighbors who are in distress, many of whom have lost jobs or loved ones. Remember the words of Dr. Anthony Fauci, the nation’s highest-ranking infectious disease specialist: During this crisis we must be safe and smart.
With vigilance to public health practice and an effective vaccination program, this horrific disease will remain only in our memory.