A 30,000-foot look at where we’ve been, where we are now and what the future may hold
When SARS-CoV-2 was named, it was unclear how this virus would impact the world in the months to come. Early fatalities indicated the virus held harmful potential, but it was not suspected to be a pandemic threat. This changed in a matter of weeks, as the virus spread rapidly around the world, infecting and killing people daily.
On Friday, March 13, 2020, COVID-19 was declared a national emergency in the United States. Businesses were forced to work remotely or close, schools adjusted to virtual learning, and masks and social distancing recommendations became the norm. Since then, multiple surges have infected a growing number of people of all age groups and medical histories.
As of mid-January 2021, more than 21 million diagnoses and 358,000 deaths have occurred in the United States alone. Worldwide, nearly 2 million have died from the virus. Despite advances in treating the disease and the rapid vaccine development, the number of cases and casualties continues to grow, but there is hope that the number is beginning to trend downward.
Early Infections and Therapy
Less than two weeks after the WHO proclaimed the presence of the novel coronavirus in Wuhan, China, the first case of COVID-19 was diagnosed in the United States on Jan. 21. By Feb. 10, COVID-19 had already resulted in the more deaths than severe acute respiratory syndrome (SARS) did in 2003.
We knew COVID-19 was causing severe respiratory complications, but we also learned it was not restricted to the respiratory system. It put all organs and systems at risk, including the heart, nervous system, kidneys and skin. Whereas initial findings were that patients with pre-existing medical conditions were at greatest risk for complications, research is now finding that otherwise healthy individuals may suffer residual effects of COVID-19, including psychiatric symptoms such as anxiety and depression, for an indeterminate time.
In an attempt to grapple with the symptoms of COVID-19, early research focused on hydroxychloroquine. Previous research has determined it to be effective and safe for the treatment of malaria and autoimmune diseases. However, hydroxychloroquine has been found to cause dangerous side effects when used otherwise.
In an effort to study hydroxychloroquine’s effectiveness against COVID-19, the FDA approved an Emergency Use Authorization (EUA) of the drug for approximately three months. Within that time period, it did not demonstrate any consistent promise for reducing COVID-19-related symptoms or deaths. The FDA subsequently cancelled its EUA.
The corticosteroids hydrocortisone and dexamethasone, on the other hand, have been found to reduce mortality in severe and critically ill patients. Therefore, these medications are currently recommended treatment, though use of them is contraindicated in those whose COVID-19 is mild or moderate.
Arrival of a Vaccine
In lieu of curative therapy for all subsets of patients and to mitigate the spread of COVID-19, the scientific community performed vigorous research to develop a coronavirus vaccine. As a vaccine to protect against other coronavirus strands had been in development for a decade, the creation of the COVID-19 vaccine was greatly accelerated. Following FDA’s issuance of an EUA on Dec. 11 (Pfizer-BioNTech) and Dec. 18 (Moderna), vaccinations began being administered in mid-December.
As the first wave of vaccination began, logistical issues hampered the process, with hindrances that included lack of resources, miscommunication and the complexity of a nationwide vaccine effort in which the distribution component was left largely to individual states to figure out. Experts suspect that even with widespread vaccination, it may be months or years before spread of the novel coronavirus is under control.
Distribution has not been the only obstacle to widespread vaccination. The efficacy of any vaccine has been heavily scrutinized by certain segments of the population due to misinformed anti-vaccination beliefs and the politicization of efforts to slow the virus, such as wearing face coverings in public and adopting physical isolation and quarantine measures.
This lack of confidence lessens the likelihood that sufficient numbers will receive the vaccine to afford long-term protection against the virus for the population at large. Polls by national news outlets conducted in August 2020, show that 1 in 3 American adults would refuse the vaccine if it were offered to them. Half of the nurses in a single unit of a Texas hospital stated that they would refuse the vaccine, most for political reasons. Should other medical personnel feel the same and if they indicate their preferences to patients, the consequences could be dire.
The potential vaccine side effects only complicates matters. As with other vaccines, the COVID-19 vaccines commonly result in minor symptoms. However, a female healthcare worker in Alaska experienced an anaphylactic reaction and had to be hospitalized. Such stories are rare, but their repetition weakens trust in the vaccine’s safety and efficacy.
Around the same time vaccines were approved, the FDA issued an EUA for an at-home antigen test. Available to the general public, this over-the-counter test enables anyone to perform and evaluate a COVID-19 antigen test at home. As options become simpler and less intrusive, there may be an increase in testing. A positive result may encourage individuals to self-quarantine, which will help slow the spread of coronavirus.
As vaccination is distributed, first to healthcare personnel, frontline workers, the elderly and the chronically ill, there is reason to expect the spread and severity of COVID-19 cases to slow. Recently, new mutations of SARS-CoV-2 make it clear that researchers must continue to seek new protection and treatment options. Additionally, it must remain a priority to overcome skepticism regarding the vaccine in order to enable herd immunity that will serve to protect the most vulnerable. While COVID-19-related challenges facing the medical profession and the U.S. public in 2021 remain grave, the arrival of vaccines brings hope that the final chapters of this story can soon be written.