2021: The war against COVID-19 will continue
COVID-19 would have been named COVID-20, if it weren’t for Dr. Li Wenliang, Chinese ophthalmologist who bravely posted a description of the “new” disease to warn other doctors on Dec. 30, 2019.
That was before the police demanded it be withdrawn and before he tragically died of the disease, a few weeks later at age 33. Though in retrospect the new virus was clearly spreading around the globe even before then, still, it was 2020 that defined the pandemic that so devastated the world.
Even as this virus continues to ravage us and decimate societies around the world, even as a new more transmissible strain (B.1.1.7) appears to be emerging that could accelerate the pandemic, it is important to pause briefly as a new year begins to marvel at how much scientists have been able to accomplish in such a short period of time.
We learned about prevention, as multiple population studies demonstrated that masking works, especially when combined with social distancing, restricting travel and staying away from large gatherings. Countries like Taiwan, Singapore, Australia, Hong Kong and New Zealand utilized these strategies effectively, whereas Europe, the UK and the United States (with the exception of Vermont) failed miserably, in part because of poor messaging, political divisiveness, fear-mongering and inconsistent compliance.
We learned last spring that COVID-19 is really two diseases in one: first, the virus itself; second, the inflammation it causes — inflammation on the inside of blood vessels, which affects not just the lungs but also the heart, the kidneys and sometimes the brain and nerves. This inflammation is more common in the elderly, the obese and those with underlying conditions including diabetes, heart and lung disease. We learned, much to the surprise of many, that dexamethasone has an impact in decreasing the inflammation late in the course of the disease, that anticoagulants are often helpful and that ECMO (where the blood is reoxygenated outside the body) can keep people alive when ventilators alone are not enough.
Early in the illness, the antiviral drug remdesivir has been shown to be mildly to moderately effective, and monoclonal antibodies have decreased viral load with some effect on the severity of illness.
There is some preliminary evidence that zinc, vitamin D, the antacid Pepcid and even the overly politicized hydroxychloroquine could play a role and reduce symptoms, though none of this is fully proven.
We still don’t know exactly why COVID-19 affects some people more severely than others, but Dr. Francis Collins, one of the top geneticists in the world and director of the National Institutes of Health (NIH), told me that he believes variation in a body’s use of its own interferon to fight the virus may vary from one person to the next and be partly responsible for the difference in symptom severity from one patient to the next.
But the biggest accomplishment in the one-year war against COVID-19 by far has been the development of highly effective and safe vaccines. These vaccines deliver the virus’s protein by different mechanisms to induce an immune response. They rely on the latest technologies, from the Messenger RNA of the Pfizer/BioNTech and Moderna vaccines, which provokes the body’s dendritic cells to make the virus’s spike proteins and launch a robust immune response, to the deactivated adenovirus vaccines carrying the genetic SARS-CoV-2 payload of the Johnson & Johnson and Oxford/AstraZeneca (chimp adenovirus) vaccines, to the protein based vaccine (where the virus’s protein is grown in insect cells) of Novavax.
Much of this technology has been studied on different and related viruses (including SARS, MERS and Ebola), but never before has vaccine science come to bear on a virus that threatened us all so quickly and so effectively.
One year after Wenliang’s dire and prophetic warning, I and other health care workers bared our arms for the shot in the first major battle back — a battle in the war against COVID-19, which Operation Warp Speed’s chief operating officer, four-star Gen. Gus Perna aptly compared to D-Day.
Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent and author of the new book, “COVID; the Politics of Fear and the Power of Science.