- Since the first COVID-19 cases in the United States were detected about a year ago, the nation and the world have come a long way in understanding the virus.
- Public health experts laud the development of the COVID-19 vaccines as a “Herculean effort” and a “terrific triumph.”
- Challenges remain in addressing misinformation and vaccine hesitancy, grappling with the long-term effects of COVID-19, and preparing for the possibility of a future pandemic.
Roughly a year ago, the first cases of COVID-19 in the United States were detected, and lockdowns and restrictions to stop the spread of the virus were put into place.
Since then the nation and the world have come a long way in understanding the virus, known as SARS-CoV-2, which has claimed the lives of more than 500,000 people in the United States and 2.5 million people across the globe.
Healthline spoke with three infectious disease experts about the biggest lessons we learned over the past year and what our priorities should be as we head into year two of the pandemic.
Preparedness and the importance of public health funding
When COVID-19 first hit the United States in early 2020, scientists were left to grapple with a new virus with little information on how it could be transmitted, prevented, or treated.
“We have a lot of respiratory viruses circulating but they give us a little leeway in terms of not living as long on surfaces, not being as easy to transmit, and not being as aerosol-driven,” said Dr. Colleen Kraft, an infectious disease specialist and associate chief medical officer at Emory University Hospital in Atlanta, Georgia.
“The reason we were so unprepared for COVID-19 was because it was totally brand new. Nobody’s immune system could just blow this off and not transmit it,” Kraft said.
The virus also brought with it a period of chaos that left many wondering how the nation could be so ill-prepared for a public health crisis of that magnitude. The answer, experts say, lies in the defunding of public health systems.
“First and foremost you have to not reduce the support of local, state, and federal public health departments, which of course we’ve been doing for the past 20 years,” said Dr. William Schaffner, professor of medicine in the Division of Infectious Diseases at the Vanderbilt University School of Medicine in Nashville, Tennessee.
Schaffner likened health departments to local fire departments.
“We know we have to have local fire departments even though there aren’t always fires,” he said. “But there are just enough of them that we keep local fire departments intact and they work on not only putting fires out but preventing them. That’s the role of public health departments.”
Dr. Kristin Englund, an infectious disease specialist at the Cleveland Clinic, notes that because of poor public health funding there weren’t enough resources in the places they were needed most.
“When we needed to get testing out into the public and tracing done so that we could try to keep patients who had COVID isolated and keep them from spreading it, we did not have nearly the man and woman power to be able to get that accomplished,” she told Healthline.
“This really brought to the forefront how we need to invest in public health so we have the ability to respond to emergencies like this,” Englund said.
Challenges with public health messaging
Another issue the COVID-19 pandemic brought to light is the importance of effectively communicating public health messages.
Early on in the pandemic, much was unclear about exactly how the virus spreads and how best to avoid transmission. But experts say that's to be expected with the emergence of a new disease.
“Our understanding of a new disease process moves very quickly, and recommendations that are made are going to change,” Englund said.
A prime example is the use of face masks. Early on in the pandemic, the Centers for Disease Control and Prevention (CDC) advised people against it. But by April 2020, it became clear to the scientific community that asymptomatic people could spread the virus and health officials changed their stance.
“I think it’s very easy to point in hindsight and say why weren’t we doing this in the past, but the scientists were not hiding things,” Englund said. “They were simply operating on the very best information they had at the time.
“The goal should be transparency,” she continued, “and to get the information out there as quickly as we can with as much information about why we’re making that decision, but also understand that next week it might change and we can’t apologize for that.”
Schaffner also notes that politicizing the virus and the response to it also brought much confusion and misinformation.
“If the infectious disease community were asked to grade the national response to the COVID-19 pandemic, most of us with a stretch would give it a D,” he said. “It was reluctant and at times downright disdainful of the virus, seemingly not wanting anything to do with it.”
“You have to put the science first,” he continued. “It’s difficult for politicians to be humble, but they have to step back and support the science.”
Developing the COVID-19 vaccines was ‘a real Herculean effort’
Perhaps the biggest milestone in the fight against COVID-19 is the development and emergency use authorization of two vaccines in less than a year with the promise of more ahead.
“That’s something that’s never been done before,” Kraft said. “It’s been a real Herculean effort.”
So far the Food and Drug Administration (FDA) has issued an emergency use authorization for the Pfizer-BioNTech and Moderna COVID-19 vaccines, both of which have an effectiveness rate of around 95 percent.
Johnson & Johnson recently released preliminary results of its vaccine that show it had an overall effectiveness of 66 percent against moderate to severe disease 28 days after vaccination. The company applied for emergency use authorization from the FDA in early February.
Several other vaccines are in various stages of clinical trials.
Schaffner calls this effort a “terrific triumph.”
“It’s important to understand that science behind creating the vaccine has been underway and developing for 15 to 20 years,” he said. “But nonetheless, here in the 21st century we have the scientific capacity such that when a new threat occurs, the brilliant scientists in the laboratory can take this scientific information and apply it to develop diagnostics, therapeutics, and now vaccines that help us fight off this new pandemic virus.”
Additionally, Englund notes that the development of the COVID-19 vaccines was an international effort of scientists across the globe who disseminated important information about the virus as they learned more about it.
“This was not as much a competition but a collaboration in a time of crisis,” she said. “I think it hopefully will allow us to continue to do that as we move forward and we’ll be able to cure a lot more things.”
The evolution of addressing vaccine skepticism and misinformation
A major challenge and priority moving forward, experts say, is addressing the vaccine hesitancy and misinformation that has taken hold in many people and communities across the country.
“Unfortunately, there’s always been a base of anti-vaxxers and folks with some spectrum of vaccine hesitancy and this is highlighting the real problem with that as well,” Englund said.
One of the major reasons often cited for mistrust in the COVID-19 vaccine is the speed at which it was produced.
A recent survey from the Kaiser Family Foundation found that 27 percent of people in the United States said they “probably or definitely would not get a COVID-19 vaccine,” even if it were free and deemed safe by scientists.
The main reasons why people said they were hesitant included worries over side effects and that the vaccine is too new.
“There’s a paradox here because that very skill and talent that allowed us to do this rapidly is met with skepticism by a lot of people,” Schaffner said. “We need to be able to bring people in who are not particularly scientifically literate and make them understand this is a good thing and be comfortable with the notion that we can do this safely. We’re watching this [the vaccine rollout] very carefully and nothing adverse in a serious way has come up.”
Getting this message across may require some creativity, experts say.
“We as a scientific community need to make sure that we’re continuing to get the right information out there into all of the right populations to try to be able to dispel the myths,” Englund said.
“We need to do that in whatever way we can, whether that be talking to folks in libraries or barbershops or speaking with religious leaders so that they can be educated and pass on the information to the folks in their religious centers,” she said.
Kraft also emphasized the importance of empathy and meeting people where they are while communicating with those who are hesitant about getting the vaccine.
“We need to get back remembering that we as individuals are part of humanity and not see each other as nameless clouds of belief systems,” she said. “We are each individuals with complexity who can make choices and need to be treated respectfully. I think we need to increase our humility as we approach these topics and listen to other people and that empathy will go a long way.”
What’s to come: Long-term effects of the virus and the pandemic at large
Another challenge as we look to the second year of the COVID-19 pandemic is the long-term effects the virus has had on individuals who had the disease, as well as the impact on society as a whole.
Englund points to the people who continue to struggle with monthslong COVID-19 symptoms.
“That is going to be so important as it’s going to impact families, the health system, and overall economies because there are going to be a lot of patients who are going to continue to struggle with the long-term impacts of this disease,” she said. “We need to learn so much more about what it is and how we can help our patients.”
The pandemic has also taken a massive toll on the mental health of the nation.
According to a recent report from the Kaiser Family Foundation, about 4 in 10 adults in the United States have reported symptoms of anxiety or depressive condition during the pandemic. That number is up from 1 in 10 adults who reported the same from January to June 2019.
Furthermore, an October 2020 survey from the American Psychological Association found that nearly 1 in 5 adults reported that their mental health was worse than it was at the same time last year.
“This has been a real eye-opener that we need to shore up how we respond to the mental health needs of our country,” Englund said. “Whether it’s having an illness and struggling with that or the isolation people have been experiencing with lockdowns, this has really brought on a lot of anxiety and depression and many people do not have the outlets to be able to get their mental health needs filled.”
She points to the emergence of telemedicine during the pandemic as one strategy to address this gap in care, but notes there's still much more work to be done.
“I think the first thing is to really speak about it and have people in high offices be able to voice the fact that having our children out of schools and trying to learn from home and not being able to socialize and having parents trying to teach their children while also working themselves, that is causing real struggles with our entire world,” Englund said.
“Once we are able to open that discussion, then we can start to find solutions,” she said.
What needs to be done to prepare for ‘inevitable’ future pandemics
The stories last spring of nurses and doctors who used garbage bags as gowns at hospitals because they lacked proper personal protective equipment (PPE) are hard to forget.
“Supply chains were left at the mercy of each individual hospital system and states were outbidding and competing against each other to try and get the equipment and PPE that was needed,” Englund said. “There was not a concerted effort to try to make sure these supplies got to where they were needed most.”
She said the COVID-19 pandemic made it evident that there needs to be centralized control over the ability to help manage that.
“Whether that be through government agencies like FEMA [Federal Emergency Management Agency] or more power with the CDC to be able to direct this, we need to be able to anticipate problems like this in the future and have a much more organized response rather than that early period of chaos where there was a lot more competition and struggling to try to meet the needs of each of the hospitals,” Englund said.
Such preparations are important because future pandemics are “inevitable,” Schaffner said.
“We in public health can predict that just as sure as the sun rises in the east and sets in the west. What we can’t tell you is when, where it will start, and with which virus,” he said.
In addition to COVID-19, Schaffner points to the flu virus, Ebola, Zika, and chikungunya as prime examples in recent years that show how quickly viruses can spread and have deadly consequences.
“We’re a very small world. There are a gazillion viruses out there in the animal population and periodically with our expanding human population moving into territories that are inhabited by the viruses,” Schaffner said. “And with international transportation and the movement of millions of people readily and quickly, there will undoubtedly be future pandemics.”