It has been three years since the first case of Covid-19 in the United States. What have we learned and what else do we need to understand?


It has been three years since the first case of Covid-19 was diagnosed in the United States on January 20, 2020. Since then, nearly 1.1 million Americans have died from the coronavirus; the United States has reported 102 million cases of Covid, more than any other country, according to Johns Hopkins University. Both figures are likely, according to many health officials, to have been underreported.

There have also been remarkable scientific achievements in our response to the pandemic, not the least of which is the development of the Covid-19 vaccines. But there are still many unanswered questions. To help with thoughts on what we’ve learned and what we need to understand more, I spoke with CNN medical analyst Dr. School of Public Health. She is also the author of “Lifelines: A Doctor’s Journey in the Fight for Public Health”.

CNN: You are a physician who cares for patients, a researcher and professor of public health. What are the key lessons you have learned from the last three years of Covid-19?

Dr AS Leana Wen: There are three main lessons that come to mind. First, we’ve seen how the global scientific community has come together and achieved truly incredible results. Less than a year after Covid-19 was declared a pandemic, we developed, licensed and distributed a vaccine. The scientific community has mobilized on many other aspects of the Covid-19 response, including to identify treatments and improve surveillance tests.

Many of the scientific developments will outlast this pandemic and help with other aspects of our response to infectious disease. For example, the technology behind mRNA vaccines could be used to produce vaccines for other diseases. Wastewater surveillance used to identify and track Covid-19 can be useful for detecting other viruses.

Second, Covid-19 has unmasked many existing crises and magnified them for the world to see. The coronavirus did not create health disparities – these predate the virus – but it exacerbated existing ones.

There have also been many flaws in the public health infrastructure which, while long known to those of us on the ground, have been exposed for all to see. Data systems are not integrated across public health agencies, for example, and city and county health departments are woefully underfunded given their many responsibilities. These stem from the fragmented health care system we have in the United States, as well as the continued lack of investment in local public health agencies.

At the same time, Covid has also shown how crucial public health is. There is a saying that “public health saved your life today, you just don’t know it.” I think many are much more recognizing that public health is essential to prevent problems that can have a major impact on people’s health and well-being.

That said, Covid-19 has occurred during a period of profound division. Virtually every aspect of the pandemic has become politicized and polarized. So, thirdly, there has been rampant disinformation and disinformation which has made responding that much more challenging. We are seeing lasting effects, such as reducing the uptake of routine childhood vaccinations. I am very concerned that public health itself has become politicized in a way that could harm our response to future pandemics.

CNN: You said we learned a lot scientifically. What else do we need to understand about Covid-19?

Wen: At this point in the pandemic, many people have moved away from Covid-19 and no longer see it as a major factor in their daily lives. However, there are millions of Americans vulnerable to serious illness who remain very concerned about the coronavirus. These are people who are immunocompromised, elderly or have multiple underlying diseases. For me, the most important research questions are about these people.

There are some effective antiviral drugs for the treatment of Covid-19, such as Paxlovid. However, some patients are not eligible for Paxlovid and other options are becoming more limited. The US Food and Drug Administration has revoked the authorization for monoclonal antibodies that could treat Covid-19 infection, as they no longer appear effective against the new circulating variants. The FDA also recently stated that the preventive antibody Evusheld may be ineffective against some variants, including the XBB.1.5 variant which is currently dominant in the United States.

It should be an urgent priority to focus on developing better treatments for the people most vulnerable to severe COVID-19 disease. I also hope there will be much more investment in finding better vaccines. The vaccines we have are excellent at protecting against serious disease, which is very important. However, they are not very effective at preventing infection.

The ideal vaccine would be more effective at reducing infection and targeting the virus broadly so that you’re not always trying to anticipate which variant will develop next, and then trying to find a vaccine that works against that variant. For example, research is ongoing into nasal vaccines and pan-coronavirus vaccines. I hope these efforts are accelerated.

CNN: We’re learning more about Long Covid, but is this an area that needs more research?

Wen: Absolutely. We know that many people have persistent symptoms after a Covid-19 infection. According to a large Israeli study, most symptoms resolve within the first year after infection for people with mild disease. However, there are some who have long-lasting symptoms, such as fatigue, headaches, palpitations and shortness of breath, that are so debilitating that they can no longer work.

There’s a lot we still don’t know about long Covid. The most important thing is how to treat patients who have it. The physiological mechanisms behind what is causing their lingering symptoms are also unclear, along with how common they are.

There are currently long waits to get into specialist clinics that treat this condition, so much more training needs to be done for general practitioners and other doctors who are likely to end up being the primary healthcare providers for many people suffering from long Covid .

CNN: What do you expect to happen in the next year around Covid-19?

Wen: Right now, China is experiencing a massive surge in cases. It is the latest major country to have enforced a strict zero-Covid policy, and now that policy has been overturned. Once infection numbers in China stabilize, Covid-19 will likely become endemic there, as it has become in most other parts of the world.

There will, no doubt, be new variations that arise. We need to keep them under control and monitor accordingly to see if they are more lethal and/or evade the effectiveness of existing vaccines. The key, as I said before, is to develop vaccines that can cover the variants more broadly.

And we must once again remember that while many people got back to life before the pandemic, others did not. In the coming year of Covid-19, I believe the focus needs to be much more specific to these people who need our help the most. For example, we should target recalls and treatment to those who are most vulnerable.

Finally, there should be a much greater effort to rebuild our public health infrastructure. This is long overdue. Doing so is critical not only to preparing for the next pandemic but also to improving the health and well-being of all Americans.

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