COVID-19 in the Rearview Mirror: The Glass Half-Full
“I am hopeful that a year from now we will look back at 2021 as another year of scientific discovery and achievement, and the year we tamed the virus.” - Nancy Shute, Editor in Chief, Science Media Group
“This global cooperation is one reason why I see promise in the year ahead—and not only the promise of getting the pandemic under control. I believe the world also has a chance to take concrete steps on one of the other great challenges of our time: climate change.” - Bill Gates
The COVID-19 pandemic made 2020 the deadliest year in U.S. history. Nonetheless, this was also a year of unparalleled achievements in science and public health. The goal of this Germ Gem post is to highlight these advances, which set the stage for a much more hopeful New Year.
Discovery. One year ago (December 2019) a pneumonia outbreak emerged in Wuhan, China. In record time, its cause was discovered and the outbreak was named COVID-19 (standing for coronavirus infectious disease 2019). By January 10, 2020, Professor Yong-Zhen Zhang and his colleagues at Fudan University, Shanghai described the genome of the culprit—a novel coronavirus, called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In short order, this devastating infection spread throughout the world, causing the pandemic we are all living through.
Vaccines. In less than a year’s time since the emergence and discovery of this virus, two safe and highly effective (95%) mRNA vaccines were developed against it. Both vaccines are products of successful partnerships, one between the pharmaceutical giant Pfizer and German biotechnology company BioNTech, and the other between the American biotechnology company Moderna and the National Institutes of Health (NIH). This December, the Food and Drug Administration (FDA) approved both of these vaccines and they are quickly being distributed throughout the U.S.
The development and testing of these mRNA COVID-19 vaccines is unparalleled in the history of medical science. In fact, the journal Science recognized the development and testing of the vaccines at record speed as the 2020’s “Breakthrough of the Year” (Jon Cohen “Shots of Hope,” Science December 18). And if that were not mind-boggling enough, there is more good news: thirteen other pharmaceutical companies have vaccines that have made it into late-stage clinical trials!
In addition to the scientific discoveries leading to these vaccines, practical achievements occurred in providing the necessary infrastructure to manufacture and deliver them. Not to be underestimated is the contribution of government to partnerships with industry (the U.S. government alone anteed up more than $10 billion for what they called ‘Operation Warp Speed’).
Future Developments. COVID-19 is neither the first devastating pandemic to emerge in the past half century nor will it be the last. We are still waiting for vaccines for most of the other emerging pandemics, for example, Middle East Respiratory Syndrome, caused by another coronavirus, as well as infections due to completely different viruses, like HIV (the cause of AIDS), Zika virus, and Nipah virus. In his December 18th article in Nature, “The lightning-fast quest for COVID vaccines—and what it means for other diseases,” Philip Ball discusses the exciting potential of applying these scientific technologies to prevent other infections and even other diseases, such as, cancers.
Prior to the eruption of COVID-19 last December, the greatest fear of many public health experts was the potential for the emergence of an avian influenza strain that could rival that of the influenza A H1N1 strain that killed more than 50 million people globally in 1918-1919. In fact, because of this concern coupled with the enormous annual toll of seasonal influenza, development of a universal flu vaccine—one that would be active against all influenza strains—has long been a top priority of many infectious diseases epidemiologists. Thus, a December 7th report in Nature Medicine of a promising clinical trial of an innovative universal influenza vaccine provides hope that someday the battle against influenza can be won. According to Dan Barouch, director of the Center for Virology and Vaccine Research at Harvard Medical School, the development of the two approved mRNA vaccines for COVID-19 “shows how fast vaccine development can proceed when there is a true global emergency and sufficient resources.”
Treatments for COVID-19 and other diseases. When the COVID-19 pandemic emerged, doctors caring for severely ill patients desperately needed drugs to treat the infection. Prior to COVID-19 the process of identifying and testing of potential therapeutic agents in randomized controlled trials seemed to take forever. But no sooner did the pandemic strike than multicenter clinical trial networks, involving academic institutions, pharmaceutical companies, and governmental organizations (e.g., the NIH, FDA, and World Health Organization [WHO]), sprang up around the world.
One of the first strategies used to find effective treatments was to test drugs that were already approved for similar diseases to see if they were effective in COVID-19. In large part, this strategy proved to be disappointing, despite heroic efforts in coordinating the trials. One exception, however, is dexamethasone, a tried-and-proved steroid with potent anti-inflammatory properties. Through a network called RECOVERY, led by Oxford University, dexamethasone was shown to significantly reduce the mortality of COVID-19. Along with improvements in other medical interventions, it played a major role in the decreased mortality of life-threatening COVID-19. Another optimistic note is that these same clinical trials networks remain poised to test other promising therapies in 2021.
In other news. Relatively few extraordinary breakthroughs in the treatments of diseases other than COVID-19 caught my eye in 2020. (I admit, however, that my interest in infectious diseases biases me when reading the medical literature or the news.) One exception is the publication in the December 5th New England Journal of Medicine of successful CRISPR-Cas9 gene editing in patients with the life-threatening diseases, sickle cell anemia and Beta-thalassemia. The idea behind CRISPR gene editing came from the observation that some bacteria use it to defend themselves against viruses called bacteriophages. (This technology was the subject of two earlier Germ Gem posts.)
Public health. In the early stages of the pandemic, the Center for Disease Control and Prevention (CDC) stumbled in its development of tests for SARS-CoV-2 and in its initial downplaying of the importance of masks in protecting against the transmission of COVID-19. Nonetheless, this venerable institution has now recovered its footing in public health leadership in preventing the spread of SARS-CoV-2. Together with other public health institutions, the CDC ultimately provided the scientific evidence needed to support the use of masks and of social distancing in preventing the spread of COVID-19. The CDC’s guidance will be sorely needed now both in facing the challenges regarding the distribution of the vaccines and also in overcoming mistrust in vaccines, especially among the Black and the Hispanic communities, which have been hit the hardest by this virus.
Improved preparedness. The U.S. was not prepared for this pandemic. When COVID-19 hit in early 2020, the U.S. faced a national health crisis the likes of which it had never before experienced and which it was ill-equipped to deal with. We, as a nation, paid high costs for being unprepared. But on an optimistic note, we also learned some very important things about ourselves and how we, as a species, can and do respond to a global crisis.
We observed the extraordinary selflessness of those employees deemed “essential” who work not only in health care but also at many other jobs in the community providing necessary services so that we as a society can keep functioning. We learned that when the chips are down, countries can pull together and effective public-private partnerships can be formed to prevent and treat emerging pathogens. In the process, we witnessed “big time” the benefits of science and the extraordinary ingenuity of our species. In sum, the most positive lesson we all should have learned from COVID-19 is: where there’s a collective will, there’s a way.