Today marks a year since the announcement of the first patient with Covid-19 in the United States. It happened in Washington State, where a man in his 30s who had just returned from a visit to Wuhan, China, started showing symptoms and quickly sought help at a clinic.
Unlike movies or TV, where a sick patient staggers into a hospital waiting room infecting everyone nearby, doctors and public health experts in Washington state were prepared: they carefully monitored what was going on in China and performed exercises to practice what to do when – and not if – an infected patient arrives at your door. This patient was tested, hospitalized and isolated, tracked by contact, treated and eventually released. Although this person became the first patient identified, it was almost certainly not the first case in the country.
Over the past year, a patient has grown exponentially to 24 million confirmed in the United States alone – a number that is certainly just the tip of the iceberg, the cases we know.
The nature of ‘romance’
All those first times make me think about the meaning of the word “romance”. When was the last time that we, as adults and as a society, really experienced something for the first time, or were in a situation for which we had no context?
When we hear about a novel – or new – anything, one of the first things that we, as humans, begin to do is to contextualize or look for similar examples among the things with which we are familiar. We try to understand the contours of this new entity by comparing it with what we already store in our memories and experiences. We look for patterns, similarities, overlaps.
It is human nature. But, very often, this kind of thinking gets in the way.
When this new coronavirus, called SARS-CoV-2, emerged, many scientists, public health officials and doctors – including me – looked to other deadly coronaviruses, such as SARS and MERS, for clues to predict how they would behave. We have also tried to compare it to the seasonal flu virus and previous flu pandemics, such as that caused by the H1N1 subtype, which triggered the 2009 and 1918 pandemics.
I remember delving deeply into it, absorbing all the information I could: reading research articles and unpublished pre-tests; talking to colleagues in China, South Korea, Japan and at my hospital; talking to experts like Dr. Anthony Fauci and global health expert Peter Daszak, whose research was instrumental in understanding the origin and impact of emerging diseases. And I remember, everyone had a theory about some aspect of this new coronavirus – even my mom had a theory.
In the early days, we thought that transmittability from person to person was unlikely, that masks weren’t particularly useful, that it couldn’t be more deadly than flu, that people couldn’t transmit it asymptomatically or over the air. Perhaps we hoped that these things would be true and that the pandemic would not be as devastating as it once was.
But we were wrong. We quickly learned that SARS-CoV-2 was much more deadly than the flu and much more easily transmitted than any of its close cousins, SARS and MERS. We have come to terms with the worrying reality that aerosolized particles and asymptomatic carriers are important factors for their relentless spread.
The point is, I don’t think anyone would have predicted – or wanted to predict – that we would be dealing with a global pandemic of this magnitude a year later. We did not want to face such a bleak future.
Even the way that former President Donald Trump communicated to me that he did not want to panic the American public probably contributed to the problem. But being honest and to the point, and telling people the truth, is sometimes difficult. I deal with it like a doctor all the time. Traumatic brain injury after a car accident on the way to work. This headache: the first sign of a brain tumor. I learned that presenting a problem next to a plan does not alleviate the blow of terrible news, but it can help to mitigate panic, which really serves no purpose. It also makes it much more likely that people will take the problem seriously, rather than simply feeling helpless, which can lead to disbelief and ignore the problem altogether.
If I had known in January of last year that we would still live that Covid captive life and that I would still be conducting interviews in my basement until, say, a vaccine was developed, in many ways it would have been a very difficult pill to swallow. But in at least one way it would have been easier: there would have been a timetable, a timetable for how things should progress – and a tangible ending. The certainty of counting down to zero, as opposed to the inherent ambiguity of counting for what seems like an eternity. We are not as good at counting down as we are at counting down. As painful as it may be, when we count down, we still have an anticipation of an end date.
Pondering the pandemic
Birthdays are also a time to reflect, to look back on this experience and to evaluate what we got and what went wrong.
We got some important things right: we made remarkable progress in the scientific and medical arenas, such as the development of protocols and therapies – both reused and new – for people who fell ill. Most notable of all is that we were able to develop several vaccine candidates and even authorize two with surprising speed.
But we also made too many mistakes – more consequently and tragically, the basic principles of public health, things that are much easier to do, but not so striking: wearing a mask and being physically distant from those who are not at our home. We avoid the cheap mask that falls off easily, but embrace the innovative billion-dollar vaccine that requires a Herculean effort to develop and distribute.
The truth is that, especially for many of us in the developed world, we want science to rescue us – but it cannot rescue us from ourselves; our own human nature. And our human nature is not good at dealing with what it cannot see.
The other day, someone asked me what a great discovery I would like to see for a future pandemic. In addition to the obvious ones – avoiding a future pandemic, developing an effective vaccine, having access to effective drugs, accumulating reliable data – here’s a crazy idea that I would love: fluorescent dye that basically gives the virus a little color. So if someone is infected, you may see a small cloud of shiny green particles coming out of your nose and mouth. Not to scare or disgust people, but because we are much better at handling things that we can tangibly identify than an invisible threat. Trying to make people believe what they can’t see, trying to prove something negative (for example, reliably transmitting all deaths prevented by wearing a mask) has always been the challenge in all preventive medicine.
On the other hand
Looking forward, I am optimistic, talking about medicine. I think that once most of us get vaccinated, SARS-CoV-2 will become like other circulating coronaviruses, an annual nuisance, but not an existential threat.
The United States’ image as a public health leader, however, has been tarnished by last year’s events and its inability to control the pandemic at home. It is a fact, and we cannot use statistics to our advantage: we have 4% of the world population, but 25% of known Covid infections and 20% of deaths. Can the US Centers for Disease Control and Prevention, the nation’s leading public health agency, regain some of the lost prestige at home and abroad? I believe that with a lot of work and time, it can.
But beyond that, the country will be marked psychologically and emotionally for a long time, especially people who have lost family members to Covid-19, the health professionals who have fought relentlessly – sometimes in disbelief or worse – to care for the sick. , of children of all ages who missed a year of school and struggled to catch up, families who lost income from layoffs or suffered other economic catastrophes, owners who had to close their businesses. The list goes on.
I have no doubt that we will overcome this. And hopefully there will be lessons learned, but more importantly, lessons remembered – because those who forget history are doomed to repeat it, and the price we paid as a society during this pandemic is too high to allow it to happen again. The past year has certainly taught us that.
Andrea Kane of CNN Health contributed to this report.