By Shivanjali Shankaran, MD, Assistant Professor, Division of Infectious Diseases, Rush University Medical Center
As the COVID-19 pandemic spread over the world, taking over our collective global consciousness, I couldn’t help but be reminded of the earliest days of my career as an infectious diseases physician. My fellowship began during another viral pandemic: H1N1 influenza. Every night brought calls to the bedsides of shockingly young patients who were profoundly sick in the ICU. The similarities between 2009 and the current COVID-19 pandemic, however, end there.
Despite being a new strain of influenza that was particularly deadly for young people, H1N1 quickly revealed its secrets to us. We learned early how it spread, how to treat it, and, eventually, how to develop a vaccine for it. The current novel coronavirus however, has offered no such early victories. Much of the spring passed in a blur as healthcare workers across the country struggled to cope with the sick flooding into our hospitals.
The pandemic made it impossible to deny the inequities in our society, with historically marginalized and underserved populations disproportionately represented among those sick and dying. It laid bare how unprepared we were across the world for a disease of this magnitude. As we were racing to get treatment studies up and running, infection control preventionists were working through appropriate ways to cohort patients and protect hospital workers, and our environmental services workers were perfecting safe ways to terminally clean rooms. We learned how the disease spread, as we tried to work out what medications and interventions worked. This collective challenge for our community of healthcare workers was unlike any most of us had experienced. Caring for the patients we were unable to save and speaking with their frantic family members over the phone contrasted dizzyingly with the euphoria of seeing critically sick patients eventually be discharged after weeks on the ventilator. My hospital rang a bell each afternoon as a reminder of those discharges, something that often afforded me a rare moment of uplift in the middle of a punishing day.
Six months on, we have learned more about this complicated virus. We have more information on which treatments don’t work and which may. We know better how to manage patients in the hospital and the complications that can arise with this infection. Having incorporated the lessons learned from the first wave, our community is developing logistical solutions to help us navigate the second one. For instance, my division responsively devised back-up teams to step up as the numbers surge again. Similar preparations are being made in hospitals around the world.
We should have been in a better place. We had a reprieve in summer when numbers went down, but they never went as low as they should have due to factors that are obvious to us all. The politicization of every aspect of this pandemic has exacerbated its harms, and hampered our response. And now we live through déjà vu as we turn to face the headwinds of the second wave.
While we have drugs that help patients with COVID-19, we do not have a cure. Our only true defense is prevention of spread. After forty six million worldwide cases and having lost well over a million humans to this virus, we know what that looks like. Hand washing, masks and social distancing. Hand washing works. Masks work. Social distancing works. We all have to practice all three. While vaccines are studied and a cure is perfected, preventive measures buy us time; they hold death at bay. They allow as many of us as possible to live until our species achieves herd immunity, which, despite media and political disinformation, is only truly obtained via vaccination. Without prevention, uncontrolled spread will burn through us like wildfire. So-called natural infection will cost us untold lives, and many millions more will experience illness and disability. Not only do we have no idea what threshold number of infections gets us to population immunity, we do not even know if such a thing is achievable or long lasting: thus far, we have no reliable understanding of how long immunity will last. What we do know are the myriad complications of this disease. We know that people with even “mild” disease suffer. We know that not only are people sick when acutely unwell, but a significant number are still symptomatic weeks and months after recovery. Uncontrolled spread, allowed in the hope that it will result in herd immunity via natural infection, carries too high a cost for us all, and offers no guarantee that it will bring this pandemic to an end. We must persevere and focus on prevention until a safe and effective vaccine is available to us all.
Multiple large vaccine trials are underway in an unprecedented, coordinated effort to achieve this. These trials must prioritize enrolling people to be truly representative of the population for them to have any impact on the covid-19 pandemic. Researchers and physicians must address historical and ingrained biases and enroll elderly volunteers and people of color, or the vaccines they produce will be inadequate. Once we have effective vaccines whose immunogenicity and effectiveness we fully understand, we come upon yet another hurdle. The vaccines must be made universally available without exception, quickly, and free of charge to all. We cannot allow venality and commerce to be a factor in this time of acute global challenge.
The H1N1 Influenza pandemic of 2009 is estimated to have caused just under 600,000 deaths worldwide. With 1.2 million deaths, of which at least 7,000 have been healthcare workers, this pandemic has far surpassed that. We have moved past a point where it is appropriate to ask if masks are irritating. We must acknowledge the grim reality of our situation and what is to come, and ask instead: what can we do? Wear a mask and socially distance. Our friends, our families, the entire global community depend on each of us taking responsibility for our own part in the fight to end this pandemic