People who worked on pandemic preparedness anticipated the Great Toilet Paper Shortage of spring 2020. But many other things about the #Covid-19 pandemic have come as a surprise. I've chronicled some of them. https://t.co/yLtEtNM5cA
— Helen Branswell ???? (@HelenBranswell) December 27, 2022
Here’s a separate post, for the people who didn’t have time to read the link in my latest Covid Update Friday morning. Helen Branswell has been one of my go-to sources for pandemic information over the last three years:
People who study infectious diseases and who work in public health have long known a bad pandemic would one day come.
They knew such an event would overwhelm hospitals, strain supply chains, and place stresses on society that we would be ill-equipped to meet. Countries like the United States have for decades prepared to respond to such a crisis.
But despite all the planning, the Covid-19 pandemic has, in myriad ways, not played out as expected. Three years after the first reports of a novel virus emerged from China, these experts admit that the microbe and the world’s response to it have continuously deviated from their forecasts.
In the hope that important lessons for next time can be found in the things we didn’t anticipate this time, STAT asked 23 experts what had surprised them the most about the pandemic.
The TL;DR version: We have a lot of learning left to do.
Containment can buy time
… After China successfully slowed the spread of the new virus with draconian measures limiting individuals’ movements, many countries instituted some versions of what came to be known as “lockdown.” In some cases the actions were too late or too inefficiently implemented to make a big difference. But a number of countries deployed these measures with significant success; New Zealand, Australia, Singapore, South Korea, and Japan, among others, lost far fewer lives than peer nations. And of course China, where the pandemic began, kept Covid largely at bay until very recently, albeit with restrictions that would not be accepted in other parts of the world.
The WHO pandemic flu response plan is being updated to incorporate what was learned about containment efforts during Covid. Cowling said it won’t advise long-term efforts to try to stop a new pandemic virus, but “temporary containment to buy time, actually, I think some places will consider.”…
How variable the illness was
Covid has killed millions around the world, including more than 1 million in the United States. But some people who have been infected have no symptoms at all. Others have the equivalent of a head cold.
Some patterns are intuitive. Many of the deaths have been in people in their 70s, 80s, and beyond. Many have been in people with chronic health conditions that undermine their ability to fight off the infection.
But sometimes the variability of the illness makes little sense, a fact that has surprised Deepta Bhattacharya, professor of immunology at the University of Arizona College of Medicine…
How quickly people could be reinfected
While an ever-dwindling number of people have not yet experienced a Covid infection, some have been infected several times. For some, the interval between Covid bouts is amazingly short.
“Anecdotally, I know several instances where infections occurred, the infection resolved clinically, and then the person became symptomatic again with SARS-CoV-2 positivity a few weeks after the initial infection,” said Stanley Perlman, a longtime coronavirus researcher at the University of Iowa…
The biggest surprise, hands down: How the virus has evolved
… Coronaviruses don’t change very quickly, they aren’t as mutable as, say, influenza viruses, those experts said. In fact, the spike protein on the virus’ exterior, the one that attaches to human cells and triggers infection, cannot change too much without losing its ability to infect, they assured the rest of us.
That was the dogma. Then came the variants: Alpha, Beta, Delta, and Omicron, with its mind-boggling array of mutations. Since it emerged in late 2021, Omicron has splintered into a seemingly endless succession of subvariants, which continue to mutate and evade immunity induced by prior infection and immunization…
The susceptibility of the public to charlatans
… The Covid pandemic has been a field day for quacks and crooks. They’ve made a killing.
It is ever thus, some would surely say. But Bieniasz has been stunned by the degree to which a not-small portion of the population has been taken in by hucksters — and by the inability of the scientific community to break that spell.
“The sort of willingness of Joe Public to listen to anybody with a large Twitter following has just shocked and appalled me,” Bieniasz said. He sees this as a consequence of a huge loss of trust in the scientific community.
The reverberations of this loss of trust continue, even though the acute phase of the pandemic appears to be subsiding…
Covid vaccines — so many surprises
For quite a few of the people interviewed for this article, the speed with which Covid vaccines were developed was truly unexpected. Ran Balicer, director of Israel’s Clalit Research Institute, encapsulated that view: “Vaccine(s) ready, tested, and launched in under a year.”
For others, the surprise was how effective the vaccines were. “I was on the Pfizer DSMB” — the data and safety monitoring board, a group of independent experts that oversees a clinical trial — “and was one of the people that unblinded that study the first time and saw the 95% efficacy. Basically it just brought tears to my eyes,” said Kathryn Edwards, a professor of pediatrics and vice-chair for clinical research at Vanderbilt University…
Perhaps the biggest vaccines surprise, though, was the speed at which gobsmacking amounts of vaccine were produced. Billions and billions of doses in the first year of production alone.
Hatchett has spent nearly two decades working on pandemic preparedness. The past three years have held few surprises for him. But he marveled at what he called “this truly miraculous scaling of production.”…
How long the damn thing has lasted
Pandemics are rare occurrences; fewer than a handful have happened in the age of modern virology, when laboratories could provide detailed knowledge of what was causing the illness and how that pathogen was evolving.
The pandemics that have been recorded have mainly been caused by flu. And in the recorded flu pandemics, there was generally a wave or two — sometimes, in some places three — and then humans and the new virus reached a detente. The new flu virus settled into causing seasonal flu activity, not pandemic flu.
A lot of people STAT spoke to thought that was the way this pandemic would play out. They didn’t anticipate that we’d be where we are now, with waves of transmission still occurring at various points in the year, rather than during the winter, as is the way of most respiratory pathogens…
The panic-neglect cycle persists
Over the past couple of decades, the world has gone through a number of big disease scares. SARS-1. The H1N1 flu pandemic. MERS. Zika. Ebola. With each, the world raced to respond.
And each time, as the panic eased, neglect kicked in. Rather than recognizing these events as warnings that longer-term investments and structural changes were needed to safeguard the globe against the next one, the world moved on. As it appears to be doing now.
“We’ve seen in other epidemics this happening,” said Berkley, the Gavi CEO. “But you kind of thought with this one, it was so global, it was so big that I would not have expected it to have happened so quickly.”…
I haven’t even included all the *headers* from this long, informative piece. If you’ve got some downtime over this weekend, I would highly recommend reading the whole thing!