Summing the Past, Predicting the Future of Covid-19
Pandemics leave their remnants in traumas of death and illness. Nurses, doctors, and patients were stunned by the scrambles that the Covid-19 virus produced. Columbia Presbyterian, a thousand bed teaching hospital in upper Manhattan was almost completely converted to emergency rooms to treat gasping Covid patients.
Covid left its effects on joy and civilization with closed schools, museums, and theaters. It destroyed commerce and the human contacts that went with it. Covid-19 did not fall equally and created rage from people whose lives were put on hold. Pandemics have always caused trauma, whether the Black Death that killed a third of Europe in 1347, a diphtheria epidemic that worked its deadly way up the coast of colonial America in the 17th century, or the frequent devastations of smallpox until the 20th century. In 2019, we thought we had disease under better control.
During the pandemic, I wrote a dozen columns that broadly explained the crucial role of public health and how vaccines are made. There are lessons to be learned and we have not seen the last of such events. I discussed the complexity of viruses and how the body controls them through its innate and adaptive immune systems. We covered how vaccines, new and old, are made and tested in clinical trials. We described remarkable new antiviral drugs and monoclonal antibodies and covered the vital role of basic science as a precursor to projects like making a vaccine or a drug. I explained who does research and how research is funded in this and other countries. Mistakes and my predictions that were wrong are noted in brackets. Progress was described in parentheses. There was a lot of progress, and in historical terms it was fast; but not fast enough.
Mistakes are part of the raw material of science. In Anthem, Leonard Cohen sang, “There is a crack in everything. That’s how the light gets in.” Cracks, small inconsistencies that should not occur reveal the unquestioned and unimagined, and the light tells us that there is an opening to the sun, and that we are missing something. Not everyone looks on cracks and light as revelatory. Cracks are anathema to authoritarians because their universe is fully formed; every problem demands a simple explanation, and every disease needs a perfect cure. Dictators do not like to be wrong and do not change their minds. The origins of SARS-CoV-2 Covid in China could have been solved by now if the normal international cooperation of health authorities had been allowed, but it was not. Large lockdowns when a few cases appear is madness when
drugs and vaccines are available. Science in authoritarian societies can be as difficult and dangerous.
Certain aspects of Covid-19 were ignored at the beginning. And that was a mistake. In June and July of 2020, the first reports of long Covid appeared. One in five victims of SARS-CoV-2 had extended symptoms, that reduced the patients to foggy thoughts, exhaustion, muscle fatigue, shortness of breath, and other symptoms. Standard medical tests returned results that were normal, which is frustrating, because physicians do not know what to do and may not pay attention. Current thoughts are that long Covid is an inflammatory response to lingering Covid virus or that small blood clots caused by a virus that is long gone are reducing oxygen delivery to muscles and other tissues. These symptoms usually resolve, but it takes a long time. Chronic Fatigue Syndrome causes similar symptoms, again with normal laboratory test results, so perhaps the answer to one syndrome will improve the prospects of patients with the other. The NIH has made a commitment to support this research. See: A Brief Overview of Long Covid by Erica Spatz, MD. who heads a long Covid Study at the Yale School of Medicine. Paste the title into Google for her article.
Who does this research? I was an Associate Dean of Graduate Students at the Columbia University Medical Center. One of my jobs was to recruit students to our PhD programs, people who had already studied a branch of biology or chemistry. American universities are strong for many reasons, but one is that through the NIH grants or other sources, we can pay Ph.D. students a salary. We teach graduate students more than complex biology and techniques; these subjects include ethics and the responsible conduct of research. Teaching science or any other subject in universities is complicated and we come in for our share of criticism, but the results speak for themselves. A Brief History of the SARS-CoV-2 Pandemic (needs link) should make that clear.