An ongoing dialogue on HIV/AIDS, infectious diseases,
March 22nd, 2022
What Have We Learned from the Pandemic So Far?
The title slide of an upcoming talk. You can see I’ve made great progress.
Dear Readers,
I need your help.
Recently one of my colleagues reached out and asked if I could give a talk to his research group.
“Just give one of your canned Covid talks,” he said.
Ha.
Needless to say — but I will say it anyway — he’s not an ID doctor. Otherwise he’d know that, as I’ve said before, talks on COVID-19 become outdated as soon as you click the little save button (it’s a floppy disk icon) on your PowerPoint program.
As a result, there’s no such thing as a “canned Covid talk” because you need to update them constantly. The field is constantly changing.
(Small aside here — how long will that particular save icon be up there at the top of Microsoft Office programs? After all, people stopped using floppy disks in the late 1990s. My crack research team revealed that companies completely stopped making them over a decade ago.)
How quickly do these COVID talks become outdated? Much faster than floppy disks. I’ve lectured multiple times on COVID-19 over the past 2 years, to a variety of medical and non-medical learners, and thought it might be interesting to see what a talk looked like just 6 months ago, back in September 2021 — an eternity in COVID time.
(I’ve done talks since then, too, but let’s look at 6 months ago for the full effect.)
It included these obsolete topics that one would be hard-pressed to include in a talk today:
- The Delta variant — see you later!
- The monoclonals casirivimab plus imdevimab and bamlanivimab plus etesevimab — remember those? Can you pronounce them yet? If not, you’re probably spared having to learn.
- The debate about whether remdesivir works — not much of a debate anymore, provided it’s started early enough.
- The latest on baricitinib — now a widely accepted tocilizumab alternative.
No mention of nirmatrelvir or molnupiravir or PINETREE or Evusheld or bebtelovimab or interferon lambda. And definitely no Omicron, that was our “gift” during the holiday season, 2021.
It did include the FDA’s admonition on ivermectin, always good for a few chuckles:
https://twitter.com/US_FDA/status/1429050070243192839?s=20&t=Y2xezMoy7Zau9zJpt1YX9A
That one never gets old, and might stick around for a while in upcoming talks.
Frustrated by the constant churning of content in these COVID talks, I offered my colleague a somewhat different topic, namely:
COVID-19: Lessons Learned (So Far)
… which is why I’m reaching out to you, loyal readers of this site, for help. In a classic case of “be careful what you wish for,” I now realize that this is a gargantuan topic, one spanning pretty much every discipline under the sun. A comprehensive review would take hours (not 50 minutes, with 10 minutes for questions). Frankly, it’s a good topic for an entire PhD thesis.
Overwhelmed, I’ve already checked in on social media — here’s one great response, from Dr. Darcy Wooten:
Life is short, pandemics help expose structural inequalities, rigorous science matters, politicizing medicine is harmful, and vaccines are amazing. In our darkest hours we must hold on to hope. We must keep going.
Impressive what some people can do within the 280 character limit on Twitter! I offered her the opportunity to give the talk in my place, but she declined. Quite understandable — she lives in San Diego, a long way from the Longwood Medical Area. Plus, it’s still freezing here in Boston.
But seriously — what would you include in a talk with this title?
Let me know in the comments. And you can go longer than 280 characters.
32 Responses to “What Have We Learned from the Pandemic So Far?”
Paul E. Sax, MD
Contributing Editor
NEJM Journal Watch
Infectious Diseases
Biography | Disclosures | Summaries
Learn more about HIV and ID Observations.
NEJM Journal Watch — Recent Infectious Disease Articles- HIV Primary Care Guidance: Updates for 2024
- Simultaneous vs. Sequential Administration of COVID-19 and Influenza Vaccines
- Observations from ID and Beyond: Musings About a Bruising and an ID Link-o-Rama
- The Bad with the Good: Donor-to-Recipient Transmission of Bartonella quintana
- A Promising Novel Treatment for Progressive Multifocal Leukoencephalopathy
Non medical lesson learned from this pandemic-supply chains matter and outsourcing hurts and need more production capacity for anything from masks/gowns to APIs, testing supplies etc. in the country.
Get back in love with ID
Understand really the meaning of ONE HEALTH
You don’t mention what research this group is doing – but off the top of my head, unless this group has some sort of very specialized area that they’d like updated, I think I’d sort “what we’ve learned” into updates on:
1. Know thy enemy: how the virus spreads, what it does to the people it infects, how it ups its game (variants), with emphasis on what we’ve learned that we’re not acting on yet (think ventilation, UVC sanitizing as examples – although since this was well known in 1918, maybe ventilation doesn’t count as an update? – or maybe it does now that we’ve shown that SARS-CoV-2 is yet another airborne illness that takes advantage of poor ventilation)
2. Stuff I can do to reduce my risk of getting sick (acute or chronic) or dying (thus also protecting the health care system) – again, being sure to mention what we’ve learned that we’re not acting on yet; e,g, what about correcting suboptimal vitamin D levels before infection? (using at least daily D3 or adequate sun exposure – the longer the dosing interval, the less effective) – or effect of correcting other nutritional deficiencies linked to susceptibility to viral infections?
3. Stuff I can do to reduce the risk of other people getting sick or dying (and thus also protecting the health care system)
4. Stuff society can do to reduce the risk of the virus infecting people, making people sick, and killing people (I’d use the Haddon matrix as the template here – challenge the audience to fill in the squares, you can get some great ideas when people get going. I find the Haddon matrix is a very powerful tool for identifying how inequities act to increase illness and death.)
And as part of all of the above, what we don’t know that would be very helpful to know (research needs), how we can get better at sorting out strong from weak research findings, and how do we support research on cheap & cheerful but safe and effective intervention that are not patentable and/or profitable?
Plus judicious use of stories to make the theory real –
This sounds as though it could be a really lively session – how long do you have?
Okay, I’ll stop now . . . .
What I have learned during the COVID-19 pandemic:
Truth is not a matter of opinion.
In the long run, humility is more effective than bravado.
Globally, faith actors carry great influence. They can be immovable obstacles or powerful allies. Therefore it is best to engage them early in the game rather than having to play catch-up later.
Even so-called “mild” infections can cause debilitating “long COVID” symptoms, most of which we have no good understanding of and/or treatment for. And people can get “mild” infections, even if they are vaccinated, boostered and do everything else science tells us will lessen the risk of getting an infection.
“It’s like a weather alert. Right now, the skies are sunny and bright, and we hope they stay that way,” Michael Osterholm, PhD, director of the University of Minnesota’s Center for Infectious Disease Research and Policy, told CNN.
“But we could have some bad weather by evening,” he said. “We just don’t know.”
What more can I say?
Above all else, humility that something invisible to the naked eye—something we need an electron microscope to see—can bring the world to its knees. It happened before COVID and, in all likelihood, will happen again.
Playing poker in person is 90% more fun than playing on-line.
From Nature news: “Lessons from the COVID data wizards” has some thoughtful considerations.
Nature 603, 564-567 (2022)
doi: https://doi.org/10.1038/d41586-022-00792-2
Our FACS count machine counting CD4 is still working happily away with it’s floppy discs.
We are terribly unprepared for pandemics as a country. Also, if China closes down a city, go buy masks and prepare. (which I think is happening again…)
We continue to take care of patients under changing conditions. [stolen from another source, but here you go]
That one epidemic that was present prior to the pandemic, namely obesity, needs to be our most important focus in trying to limit the harms in the next pandemic. We need to eat better and exercise more frequently and improve the overall health of our country as obesity and overall poor health related to poor diet and a lack of exercise played a tremendous role in the severity of this pandemic.
Finally, a better understanding of aerosols!
We have learned that many forms of outpatient care can be provided via telemedicine in a way that improves access for many without sacrificing quality. In particular, we learned that patients with opioid use disorder can safely and effectively initiate treatment with buprenorphine (a life-saving yet overly restricted medication) via telemedicine–WITHOUT having to see a provider in person before starting. This COVID-era exception to FDA regulations has not lead to the adverse ramifications that some may have feared, and advocates hope this low-barrier approach stays in place.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7833481/
Those of us >65 for whom IM vaccinations are precluded, (AcqVWD), still live in a social minefield. Any general discussion should remind people of the continued need for an oral vaccine and the existence of our group. I am one cough away from disaster as are many of the immuno-compromised. One city in China shuts down and we back to square one as was noted earlier in this thread.
I wish that more influential people would be talking about the needs of Long Covid patients, and the long term sequelae of the pandemic. Many patients with PASC cannot work, have difficulties accessing care, are unable to pay their bills and afraid of what the future looks like. It is a depressing, disheartening and demoralizing experience to have a “new illness”. We cannot move on without concrete fiscal help and science. We need a national task force on Long Covid.
Science is a stepchild to people’s beliefs. The mistrust of our society towards authority and government has rendered logic and data to the periphery of individual expression. I am challenged to believe that many people no live by any golden rule. And….vaccines work.
Already mentioned once, I would like to share my take on the Obesity and Diabetes epidemic that preceded the Covid -19 Pandemic is one of the main factors for severe illness, death and chronic problems with Covid -19 infection. From my small corner of the world I see this as a consequence of our economic model and legislation. Both emphasize and allow the effective marketing of food that make people sick as well as virtual entertainment that foster sedentary behaviors, while decreasing the capability and power of the consumer to make choices that will help them be healthier. it is both a problem of the individual but mainly a problem of a predatory system that feeds on the pain and suffering of the consumer.
The other pandemic that preceded Covid-19 is in the area of Behavioral Health. My pediatric practice has transformed into a depression and anxiety treatment one. Our young people are in so much pain and their parents do not know what to do, schools do not know what to do, neither health and behavioral health providers.
we need to change the way we deal with Behavioral Health. The current system has failed for a long time and the current pandemic made it more obvious.
1) Masks reduce transmission of airborne viruses, including SARS-CoV-2, and should be recommended even when supplies are limited. Supply chain concerns should not drive infection control recommendations.
2) Misinformation kills. Science discovered an amazingly safe and effective vaccine yet half of America won’t take it because they are misinformed and/or misunderstand the risks and benefits of vaccination.
3) Remdesivir is an effective drug when given early on in the disease course but most healthcare systems cannot figure out how to give an IV antiviral to an outpatient daily x 3.
The average citizen is very much unaware of how the natural course of all things medical evolve. I’m still surprised by how suspicious some patients are of the way things in general change and evolve with the pandemic. I guess I shouldn’t be since as a student (many years ago…) I had a lightbulb moment where I realized that I wasn’t going to learn everything I needed to know in a textbook because (thankfully) what we know is constantly changing. For most people, medical things in general are a great mystery, and I could see how that would raise suspicions when “we’re told one thing one day, then the opposite the next” as I unfortunately still hear too often. Like most things both pre- and post-2020, I find that explaining things in simple terms can be reassuring for someone, even the fact that for those in the medical community all the changes are not unexpected. Sure, not everyone chooses to trust or believe me (I live in FL, after all), but I know I’ve been able to get through to some. Let’s work on building rapport with our patients so that when they have genuine questions or concerns they will come to us instead of social media, unqualified yet well-meaning friends, and podcast hosts.
This may have been known before like many of the “lessons”, but pandemic again highlighted the difference in results between observational studies and well done RCT’s.
I have treated 40+ of my friends in the very early stages of Covid 19 using low dosages of doxycycline as an MMP9 inhibitor. Where did I get the idea? My grandfather was in the used furniture business and during the summer I use to deliver and set up the furniture. One day he visited me on the job telling me that you are supposed to remove the old junk before you bring in the new stuff.
I figured that the single-stranded RNA would have to use all the proteases it could get its little spike protein around. however, By using doxycycline as an inhibitor of MMP9 the virus would not, could not take over the cells’ machinery for reproduction. There simply was not enough room.
You might look at:
SARS-CoV2. https://aaushi.info/A55949
Covid-19. https://aaushi.info/A57084
SARS Cov2 epidemiology. https://aaushi.info/A56691
SARS Cov2 laboratory. https://aaushi.info/A56964
common cold vs influenza vs Covid-19. https://aaushi.info/A57414
SARS Cov2 management. https://aaushi.info/A56690
COVID-19 vaccine. https://aaushi.info/A56502
Covid-19 vaccine booster. https://aaushi.info/A57312
long Covid-19. long Covid-19
COVID-19: multisystem inflammatory syndrome. https://aaushi.info/A56575
mRNA vaccines are cool! Just wait for the next for the next more virulent pandemic to recognize their charm.
The FDA bureaucracy needs to be upgraded to approve diagnostic studies earlier during a pandemic.
The CDC funding and authority need to be protected from politicians who may circumvent the science for their own political agenda.
Just like in war, we need to have to design specific strategies for specific situations and anticipate a well executed exit strategy.
As a retired cardiothoracic surgeon, I believe I have no place to comment on COVID, but as an 87year-old human who has survived many epidemics, endemics and several pandemics in Hong Kong I believe I do have something to say. I agreed totally with Dr. Sax that often anything we say today will be outdated to-morrow.
Yes, the virus keeps evolving from alfa to omicron, and so does the phenotype of the illness and the treatment and vaccination seem never be able to catch up with it. But certain principles have not changed, such as isolation, social distancing, masking, sanitation, building up individual health with property rest and nutrition, and cooperation of all parties involved.
Last year, I wrote for a journal and said that new mutations are capable of writing off our apparent success and before it passed through peer review the omicron variant proved my point. This year, I wrote for the same journal that one historical lesson is that epidemics and wars often go together. The article is still under review and Ukraine is already on fire. Certain principles do not get outdated.
1) Vaccine inequality and 2) vaccine hesitancy in resource rich country
I am currently living in Hong Kong and the current 5th wave is causing havoc especially among nursing home residents who are mostly not vaccinated.
Vaccine clearly works. Looks at the statistics from the HK Public Health.
https://www.covidvaccine.gov.hk/pdf/death_analysis.pdf
3) role of media in sensationalizing side effects of vaccine in the early days. We hardly hear about vaccine side effects now a days
What did we learn about face masks? Politics and mental comfort aside, they did not seem to stop the spread of this disease in any appreciable way. We saw teams of healthcare workers go out in groups after having “just one little” celebration or lunch together. Same with spread through family, friends , church groups, work groups. The masking studies show the effectiveness, however, in application, we watched as the virus ran it’s course being stopped primarily by vaccines and treatment medications. Should this information be applied to the next pandemic? Are these observations incorrect? Is it time to put away the facemasks?
How do we try to convince the non takers to get the vaccine?
What works, if anything?
A lie is halfway around the world before the truth gets out of bed in the morning. Millions of people were convinced not to take the most effective, safest vaccine ever produced. The mRNA vaccines leading the pack in effectiveness and safety. My questions for my fellow physicians are these: What can be done to counteract the flood of misinformation and the resulting tragic toll of hundreds of thousands of unnecessary illness and death? Do we need a ‘unified command’ in messaging to avoid conflicts? How can people be convinced a pandemic is always a moving target and recommendations change with time? What’s lacking in how we teach science and the scientific
method?