A yr after the Covid disaster started, scientists clarify what we've discovered – and what we've executed unsuitable

Sister Dawn Duran delivers a dose of the Moderna COVID-19 vaccine to Jeremy Coran during the coronavirus disease (COVID-19) outbreak on January 12, 2021 in Pasadena, California, United States.

Mario Anzuoni | Reuters

Exactly a year ago today, the Centers for Disease Control and Prevention confirmed that the first case of a new coronavirus scientist on US soil called 2019-nCoV.

Since then, the country has seen more than 24 million cases and more than 400,000 deaths, according to Johns Hopkins University. A new president takes office, warning that the pandemic will get worse before it gets better.

However, public health experts, doctors, scientists, and industry and government executives say that the past year has taught us a lot about the virus – and how those lessons can be applied to help slow the pandemic now.

What they learned ranged from what they learned about the virus itself and how it spread – remember when we all wiped our food off with Clorox? – Reflections on our own behavior and how it condemns us to ever higher infection rates.

Some, from former member of the National Security Council, Dr. Luciana Borio, and the head of Operation Warp Speed, Moncef Slaoui, emphasize the importance of working with industry early on. Others say the past year proves that the promise of our biomedical technologies can be realized quickly – if only they are funded well enough.

Here are your thoughts.

To the virus

"It's not the winter respiratory virus it's been billed for," said Dr. Paul Offit of the Children's Hospital in Philadelphia. "It's far more far reaching and damaging than that."

Spring predictions of the virus' progress warned that it might resemble the patterns of the 1918 pandemic influenza: a milder first wave followed by a much more deadly second in the fall.

The fall of 2020 ultimately brought with it a feared larger wave of coronavirus cases, but it was not as originally expected after a uniform low through the summer. It peaked at around 76,000 cases in mid-July when the virus spread across Florida, Texas, and Arizona.

At this point, scientists already had an overview of what makes this virus so harmful, experts said, as knowledge developed rapidly in the first few months.

"In early January last year, we were told that there was no human-to-human transmission," said Dr. Megan Ranney from Brown University. "When we noticed it was spreading (person to person) we thought it was spreading like the flu … we thought we had to be worried about droplets and formites."

That changed, said Ranney, "when we weathered that first terrible north-easterly wave."

The fact that the transmission is "more up in the air than originally thought, less superficial than originally thought" has important "implications for prevention advice," said Dr. Carlos del Rio from Emory University. Hence: masks and avoiding large indoor gatherings.

But scientists have also learned that this virus is more difficult than others. The fact that it kills some while silently infecting others is what actually makes it so dangerous, said Dr. Jeremy Faust of Brigham and Women & # 39; s Hospital in Boston.

"On the one hand, asymptomatic transmission has good news: Not everyone gets as sick as we thought," said Faust. "On the other hand, it's so much more difficult to control because people think, 'If I'm fine, I'm fine. I mustn't pose a threat to myself or others.'"

Dr. Leana Wen, former Baltimore health commissioner, said that mindset makes up most of the spread when we are recording an average of nearly 200,000 cases per day.

"There's still some level of magical thinking going on when it comes to people we know and love who aren't in our household," she said. "We think, 'Well this person looks good; I know them, I trust them they wouldn't engage in risky behavior so I'll see them.'"

Because people without symptoms can cause so much spread – more than half, according to the CDC – it's best to "look at everyone as if they could have a coronavirus," Wen said.

About human behavior

"We got the feeling of a changing baseline," said Dr. Michael Osterholm from the University of Minnesota. In April, he said, it felt like the "house was on fire," with 32,000 cases being reported each day. By May there were only about 20,000. "People felt like we flattened the curve, we were done," he said.

By mid-July, this increase through the sun belt had reached a previously unfathomable new high of more than 70,000 cases per day. In early September, cases fell back to 26,000, a number that "was almost as high as the April high, but people were like," Look, that's good, it's under control, "Osterholm said.

In October the upper Midwest began to glow with infection, and "We had nearly 200,000 cases a day for Thanksgiving," he said. At the country's most recent peak, January 8, more than 300,000 cases were reported in a single day.

"Think 300,000 versus 32,000," said Osterholm. "In a period from April to January we went numb to it. Each of them is a changing baseline, and suddenly what happened doesn't seem so bad anymore."

It is part of the human condition to respond in this way in order to "develop a sense of survival". But turning the tide in the pandemic is a key challenge.

Osterholm and Ranney also say they are addressing the structural issues that are putting the brunt of the pandemic on the poor, vulnerable and colored.

"If we develop or implement public health strategies to fight an epidemic, be it structural racism, economic inequality, segregation between high and low income countries, if we do not pay attention to the drivers of people's behavior, we will fail . " Said Ranney. "Even with good science."

Borio, who acted as Covid-19 advisor for the Biden transition along with Osterholm, described the importance of leadership as the most important learning from the past year.

"It has to start at the top," she said. "A divided nation cannot fight a pandemic. Our government, huge and complex, has enormous capabilities, but it is not self-organizing."

But keep politics from doing it as much as you can, added Slaoui, who last week resigned as chief advisor to Operation Warp Speed, the Trump administration that worked hard to develop vaccines and drugs for Covid-19.

"We must never again politicize public health issues," said Slaoui. "I'm sure it cost tens of thousands of lives."

About government and industry

Both Slaoui and Borio, as well as former FDA commissioner Dr. Scott Gottlieb, who is also a CNBC employee and board member of Pfizer and Illumina, said the first year of the pandemic demonstrated the importance of public-private partnerships and how to act on them quickly.

"CDC's refusal to move to commercial laboratories and commercial test kits early on has blinded us to the early spread," said Gottlieb.

The US's ability to detect the virus was hampered in the first few weeks by a test by the CDC that turned out to be flawed.

"The virus has become deeply rooted in our communities," he added. "It was a historic failure."

Borio noted the importance of data systems created by Palantir, gene sequencing partnerships with companies like Illumina, diagnostic testing by Quest and LabCorp, and distribution of vaccines through CVS and Walgreens.

"A truly modern public health system requires a public-private partnership," she said.

However, Borio also stressed the importance of rigor in the regulatory process and the dangers of "early issuance" of emergency approval "before data from adequate and well-controlled studies such as those that have emerged for many of the therapeutics are available."

Hydroxychloroquine, in particular, was a black eye for the Food and Drug Administration, which revoked its emergency use permit for Covid-19 in June after finding it likely to be ineffective.

That, said Borio, "doesn't help the patient."

Slaoui, who oversaw the scientific development of one of the largest public-private partnerships in medical history through Operation Warp Speed, also emphasized the need to conduct better clinical trials. He said at some points over the last year that more than 400 studies have been conducted in the US, most without placebo control, which is considered the gold standard for testing new therapies. Many only took in a handful of patients.

"This is extremely inefficient and comes with high opportunity costs," said Slaoui.

On technology

What well-controlled studies have shown, however, is that "mRNA vaccines work," said Ranney. "The fact that we have not one but two mRNA vaccines that have been used effectively in humans and are both safe and effective in preventing the disease is just huge."

However, according to Borio, they would not have been possible "without early investment by the US government many years ago; these technologies take years to develop."

She called it "the most exciting innovation in vaccine technology in decades".

The outbreak also demonstrated the speed and usefulness of a second technology, vaccines, which use harmless viruses to transport genetic material from the coronavirus to the body's cells to trigger an immune response, Slaoui said. "There are at least two very fast vaccine platforms that vaccines can be developed in months," he added.

"What we missed," he said, "is production capacity and capabilities."

Slaoui said the answer was what he called a biopreparation organization that could develop new vaccines against emerging threats and provide immediate assistance if those threats materialized. He first brought the idea up in 2016 when he was chairman of vaccines at GlaxoSmithKline, and said it didn't catch on, "but we need to revive it now."

Borio cited the appointment of Eric Lander as Biden's best science advisor in a newly elevated position at the cabinet level as a signal of a new era in which science "will be an integral part of policy making".

Offit, an expert in vaccination science, put it very clearly: "We have it in us to make and test a vaccine very quickly," he said, "when we are ready to spend the money."

looking ahead

Despite the lessons of the first year of the Covid-19 pandemic, public health experts warned of a difficult way forward.

"What strikes me the most is how much we don't know yet," said Dr. Kayvon Modjarrad, director of the Emerging Infectious Diseases Division at the Walter Reed Army Institute of Research.

Questions like: How does this virus behave differently from other respiratory viruses? How is it developing? Why does it cause such serious illness in some but asymptomatic in others?

"In science, the first big step in solving one of nature's riddles is understanding how big the riddle is and what questions to ask," Modjarrad said. "We're only getting to that point now."

One of the most pressing challenges is that a variant known as B.1.1.7, which is considered more transmissible than previous forms of the coronavirus, is likely to "take off in the next few weeks to months," Osterholm said. That is, "We could see the worst days of the pandemic ahead of us, even with the vaccine."

One of the most urgent tasks facing the Biden government is managing the distribution of coronavirus vaccines, which has a target of 100 million doses administered in the first 100 days.

However, Osterholm found that at this rate – even if an additional vaccine is released for use that only requires one dose, as Johnson & Johnson & # 39; s expected in the next few months – only about 14% of the US -Population fully vaccinated by the end of April.

Along with an estimated 30% of the population who are already infected and may have immunity, this is less than half of the land protected well into May, "a far cry from any herd immunity," Osterholm said.

"Vaccines don't matter, just vaccinations," added Modjarrad, director of the Emerging Infectious Diseases Division at the Walter Reed Army Institute of Research. "We can't congratulate ourselves too much or declare victory too early."

Dr. Anthony Fauci, the nation's leading infectious disease scientist, said this week he expects the country to reach 75 to 80% of its fall vaccinated population.

"If we do this efficiently from April, May, June, July, August," he told Harvard Business Review hosts on a livestream, "we should have the level of protection we have by early fall." I think we can go back to some form of normalcy. "

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