It has been just over six months since the first case of the novel coronavirus was identified on US soil, and across the healthcare industry a huge amount of work has been done to deal with this unprecedented situation. In some areas of the country, the initial impact of the pandemic was appropriately blunted, giving us more time to better understand the virus and its impact on humans and populations. We have learned a tremendous amount about its transmissibility, how it causes disease, and how we can do a better job to help our patients survive. But we are in no way out of the woods.
During the summer, we should have beaten back the virus, constraining it to small outbreaks while we built up defenses like vaccines. Instead, we are heading into the fall and winter with a full-fledged viral forest fire burning across most of America’s South and West. This is the time when we should have been saving up energy and marshalling our resources for the challenges to come during the colder months when people are pushed together indoors. This is not the time to be tired or to give up.
What do we know about COVID-19?
We know that although the SARS-CoV-2 virus and its disease, COVID-19, were hard to pin down, the virus itself is not difficult to kill. In fact, simple preventative measures like good hygiene, handwashing, and mask wearing can dramatically reduce infections. Unfortunately, unlike originally thought, there is a lot of evidence that the virus can be transmitted without the infected person showing any symptoms, making those preventative measures that much more important.
We know that COVID-19 is not just a respiratory illness. The most dangerous complications relate to the vascular effects of the virus and the immune response. We know that although the most severely affected patients are older with underlying health problems; younger, healthier patients can get very sick as well. We know that children are rarely hospitalized, but a small percentage will go on to develop dangerous sequelae that can be life threatening. And we know that there is social and racial disparity driving who gets infected and suffers the most from COVID-19.
We also know a lot more about how to support the treatment of infected patients. Death rates have fallen as doctors have learned how to better oxygenate and support the most severely infected people. Some early treatments, including steroids like dexamethasone and antivirals like remdesivir, have shown effectiveness in reducing the severity of the disease and somewhat speeding recovery. However, we haven’t found a magic cure. Convalescent plasma (taking the antibodies from people who have successfully fought off the virus and giving it to other infected people) is showing promise and will be drawing greater attention, as will treatment with specifically created monoclonal antibodies.
Cautious optimism for a COVID-19 vaccine
Perhaps our greatest progress has been in the rapid development, and now testing, of vaccines against SARS-CoV-2. Out of over a hundred possible candidates, several have entered or are close to entering large-scale final testing. Remarkably, a process that normally should have taken years has been shortened to less than a year.
It is likely that some form of immunity can be induced in at least a subset of the population by the end of the year, with the majority of the country receiving protection by the middle of 2021. There are no guarantees, and we need to overcome any fear about taking the vaccine in order to produce enough population immunity to prevent spread and protect the most vulnerable among us. But it does look like there is light at the end of the tunnel.
