18 Months of the COVID-19 Pandemic – Are We Doing Anything Right?

September 11, 2021 will mark 18 months since the WHO declared the COVID-19 outbreak a pandemic.

A year and a half after the World Health Organization officially declared a pandemic on March 11, 2020, to say Americans are exhausted is an understatement.

I’m an epidemiologist and an internationally recognized science communicator, and I’ve often found myself running between COVID-19 meetings asking, “How did we get here?”

Figuring out the ‘how’ is essential to prepare for the future. In my effort to understand the past 18 months, I’ve found it helpful to categorize the US pandemic journey thus far into five stages: Scramble, Learn, Respond, Test, and Hope.

Scramble: what’s going on?

In early 2020, SARS-CoV-2, the virus that causes COVID-19, hit the United States. The first documented case was a traveler who landed in Seattle on January 15 from Wuhan, China. It was only later that public health officials discovered that SARS-CoV-2 was already spreading through the community.

It wasn’t until March that Americans were forced to take the pandemic seriously, when states began enforcing stay-at-home orders. As citizens struggled to sort out childcare, homeworking and Immunology 101, epidemiologists began responding.

But perhaps a better word is ‘scramble’. The US lacked the public health infrastructure to respond effectively. A chronically underfunded and politicized public health system hampered the country’s real-time response.

Epidemiologists were scrambling and had to rely on volunteers to report public health data nationally because there was no centralized public health data system in the US. Data scientists, like those at Johns Hopkins University, were busy sharing accessible data for decision making. Scientists struggled to develop COVID-19 tests. And everyone struggled to figure out how to communicate the evolving threat of the virus to American lives. From the start, the seeds were sown for a reactive, rather than proactive, approach.

Learn: Are We Doing Something Right?

Once the northeast started to come under control, June 2020 was pretty quiet across the country. Is this done? Perhaps the decline is due to the weather? People started to relax.

Then July struck. In a month’s time, cases in the South were as high as in the Northeast months earlier. The West also began to move. The whack-a-mole game started because there was still no coordinated, national response.

Health departments expanded testing, tracking and surveillance capabilities. A large number of multidisciplinary, academic teams formed to understand COVID-19, from virology at the microscopic level to social implications at the population level.

Now is the time when published, peer-reviewed data on COVID-19 comes in. In less than five months, the scientific literature database Scopus indexed more than 12,000 publications. Researchers began discovering long-term COVID-19 symptoms and figuring out effective protective measures, such as social distancing and wearing a mask. Researchers also learned more about superspreader events and how COVID-19 is transmitted through the air — although this was not officially recognized by the WHO or the Centers for Disease Control and Prevention until about a year later.

As the flood of evidence provided scientists and clinicians with crucial information, a wave of retractions began to emerge, pulling papers with incorrect or unreliable data. This, coupled with a lack of accurate scientific communication from unbiased sources, fueled a concurrent infodemic — an epidemic of misinformation and public health threats that researchers, social media companies and public health officials are still learning to identify, mitigate and deal with.

Reply: Come on, virus!

Then came winter, which turned out to be a perfect storm of pandemic fatigue and vacation travel. This resulted in our largest pandemic wave to date. More than 3,000 people died a day in the US

Fortunately, help was on the way: vaccines. And not just pretty good vaccines — vaccines that blew efficacy out of the water. The Pfizer-BioNTech vaccine was found to have 95% efficacy, well above the 50% threshold. Thanks to more than 500,000 clinical trial volunteers, decades of mRNA research, an estimated $39.5 billion, and fast-moving scientists, the vaccines reached the public in record time. And while the vaccine rollout has been rough, more than 260 million doses were administered in the US by May 2021

However, with vaccines came new challenges: a new battle against misinformation (no, mRNA doesn’t change your DNA) and a battle to understand breakthrough infections.

Meanwhile, new COVID-19 variants came on the scene. Suboptimal genomic surveillance made it difficult to identify where and which variants were spreading. The race between vaccination and the spread of variants had begun. The battle was far from over.

Test: We are tired

The early summer of 2021 was blissful for Americans. The US hit an all-time low in terms of COVID-19 cases. People who had been vaccinated were told to take off their masks, while some unvaccinated people took it carte blanche. More Americans started traveling and going back to work in person.

But then the delta variant knocked on the door. Significantly more transmissible and more serious than the original strain of the coronavirus, it first caused a tsunami of cases in the South that then spread to all corners of the United States.

Unfortunately, pandemic fatigue has become established. And the pandemic is pushing the US response to its limits. It tests the amount of pressure vaccines that can withstand. It tests the capacity of the healthcare system. It tests the resilience of public health and health professionals. It tests scientists’ ability to effectively communicate ever-changing research results. And it is testing the public’s patience as pediatric vaccines undergo clinical trials.

Hope: this will end

Every epidemic curve comes down. And this one will too. But even after it goes down, the pandemic is far from over.

There is one more trauma that needs to be addressed. Families were deprived of decent burials and farewells. Friendships were torn apart by politically charged misinformation and misinformation. Millions of people lost their jobs. And frontline workers are still out of order. A survey of health professionals in the US found that more than half reported symptoms of at least one mental illness from March to April 2021.

The US as a nation will also have to engage in self-reflection. To effectively address the next infectious disease crisis, the US will need to create centralized public health systems and expand genomic surveillance, hospital networks, and testing capabilities. Scientists need to renew the way they communicate science and research in an accessible way so that the CDC can rebuild public trust. And by taking politics out of public health, science may be able to infiltrate echo chambers instead of feeding them.

Americans must prepare so that when the next pandemic hits, everyone will be ready to mount a proactive, effective fight against a common enemy: the virus.

Written by Katelyn Jetelina, assistant professor of epidemiology, University of Texas Health Science Center at Houston.

This article was first published in The Conversation.