It is today one year since the first patient with Covid-19 was announced in the United States. It happened in Washington state, where a man in his thirties who had just returned from visiting Wuhan, China, started getting symptoms and quickly sought help at a clinic.
Unlike in the movies or on TV, where a sick patient moves around in a waiting room in the hospital and infects everyone nearby, the doctors and experts in the state of Washington were prepared: they closely monitored what was going on in China and had exercises done to practice what to do when an infected patient – not when a patient arrives at their threshold. This patient was tested, hospitalized and isolated, contact detected, treated and eventually released. Although this person was the first patient identified, he was almost certainly not THE first case in the country.
Over the past year, one patient has grown exponentially to 24 million confirmed in the U.S. alone – a number that is surely just the tip of the iceberg, the cases we know of.
The nature of ‘novel’
All these firsts make me think about the meaning of the word ‘novel’. When was the last time we as adults and as a society really experienced something for the first time or were we in a situation for which we had no context?
When we hear something from a novel – or new – one of the first things we as humans begin to do is to contextualize or look for similar examples among the things we are familiar with. We try to understand the contours of this new entity by comparing it to what we have already stored in our memories and experiences. We are looking for patterns, similarities, overlaps.
This is human nature. But too often that kind of thinking gets in our way.
When this new coronavirus, called SARS-CoV-2, came to light, many scientists, public health officials and doctors – myself included – searched for other deadly coronaviruses, such as SARS and MERS, for clues as to how it would behave. We also tried to compare it with the seasonal flu virus and with flu pandemics in the past, such as those caused by the H1N1 subtype, which offsets both the 2009 and 1918 pandemics.
I remember putting my head deep into this and taking in all the information I could muster: reading research articles and unpublished proofs; talking to colleagues in China, South Korea, Japan and in my hospital; talk to experts like dr. Anthony Fauci and the global health expert Peter Daszak, whose research is the key to understanding the origin and impact of emerging diseases. And I remember, everyone had a theory about some aspect of this new coronavirus – even my mother had a theory.
In the early days, we thought that human-to-human transmission was unlikely, that masks were not particularly useful, that it might not be more deadly than flu, that humans could not spread it asymptomatically or through the air. Maybe we were hoping these things would be true, and the pandemic would not be as devastating as it was.
But we were wrong. We quickly learned that SARS-CoV-2 was much more lethal than flu and much easier to transmit than one of its relatives, SARS and MERS. We have endorsed the sobering reality that aerosolized particles and asymptomatic carriers are the drivers of their relentless distribution.
The point is, I do not think anyone would have predicted – or wanted to predict – that we would be dealing with a global pandemic one year later. We did not want to face such a bleak future.
Even the way former President Donald Trump told me he did not want to panic the American public probably contributed to the problem. But being honest and direct and telling people the truth is sometimes difficult. I deal with it all the time as a doctor. A traumatic brain injury after a car accident on the way to work. That headache: the early sign of a brain tumor. I learned that presenting a problem along with a plan does not alleviate the blow of terrible news, but it can help alleviate the panic, which actually serves no purpose. It also makes it much more likely that people will take the matter seriously rather than just feeling helpless, which can lead to disbelief and completely ignore the problem.
If I had known in January last year that we would still be living this Covid closure life, and that I would still be interviewing from my basement until, for example, a vaccine was developed, it would be a very difficult pill in many ways to swallow. But in at least one way it would have been easier: there would have been a calendar, a timetable for how things should go – and a tangible end. The certainty of a countdown to zero, as opposed to the inherent ambiguity of picking up for what feels like forever. We are not nearly as good at picking up as at counting down. No matter how painful, when we count down, we still have the anticipation of an end date.
Meditating on the pandemic
Birthdays are also the time to reflect, to look back on this experience and to judge what we got right versus what we got wrong.
We have accomplished some great things: we have made remarkable progress in scientific and medical fields, such as the development of protocols and therapies – both reused and new – for people who become ill. Most important of all is that we have managed to develop several vaccine candidates and even authorized two with astonishing speed.
But we also have too many things wrong – the consequent and tragic the basic principles of health, the things that are much easier to do but not so flashy: to wear a mask and stay physically far away from those who are not in our household is not. We avoided the cheap mask that slips easily, yet adopted the billion-dollar breakthrough vaccine that requires a Herculean effort to develop and distribute.
The truth is that we, especially for many of us in the developed world, want science to save us – but it cannot save us from ourselves; our own human nature. And our human nature can not handle well what he can not see.
The other day someone asks me what a major breakthrough I want to see for a future pandemic. Aside from the obvious things – to avoid a future pandemic, to develop an effective vaccine, to have access to effective medicine, to gather reliable data – here’s a crazy idea I would like: fluorescent dye that basically gives the virus just a little color. So if someone is infected, you can see a plume of glowing green particles coming out of their nose and mouth. Not to scare or drive people away, but because we are so much better at dealing with things that we can tangibly identify as an invisible threat. Trying to make people believe in what they cannot see, trying to provide negative evidence (for example, to reliably convey all the deaths that mask wears) has always been the challenge in all preventative medicine.
On the other side
Looking ahead, I am optimistic, medically speaking. I think that once most of us are vaccinated, SARS-CoV-2 like the other coronaviruses will become circulating, an annual nuisance but not an existential threat.
However, the image of the United States as a leader in public health has been tarnished by the events of the past year and the inability to control the pandemic at home. It’s a fact, and we can not turn the statistics to our advantage: we have 4% of the world population, but 25% of the known Covid infections and 20% of the deaths. Can the US Centers for Disease Control and Prevention, the country’s leading public health agency, regain some of its lost prestige at home and abroad? I believe with hard work and time it can.
But beyond that, the country will suffer long psychological and emotional hardships, especially the people who lost relatives to Covid-19, the health workers who fought tirelessly – sometimes in the midst of unbelief or worse – to care for the sick, the children of all ages who lost a year in school and struggled to catch up, the families who lost income due to layoffs or other economic disasters, the owners who had to close their businesses. The list goes on.
I have no doubt that we will get through this. And hopefully lessons will be learned, but more importantly, lessons will be remembered – because those who forget history are doomed to repeat them, and the price we paid as a society during this pandemic is too high to to happen again. Over the past year, we have definitely learned that.
Andrea Kane of CNN Health contributed to this report.