Dr. Sanjay Gupta: The United States’ one-year coronavirus checkup

We have entered the era of coronavirus anniversaries.

Today marks one year since the announcement of the first patient with Covid-19 in the United States. It happened in Washington state, where a male in his 30s who had just returned from visiting Wuhan, China, started experiencing symptoms and quickly sought help at a clinic.

Unlike in the movies or on TV, where a sick patient staggers into a hospital waiting room infecting everyone nearby, the doctors and public health experts in Washington state were prepared: They had been carefully monitoring what was going on in China and had been running drills to practice what to do when — not if — an infected patient arrived at their doorstep. This patient was tested, hospitalized and isolated, contact-traced, treated and eventually released. Even though this person became the first patient identified, he was almost certainly not THE first case in the country.

Over the course of the last year, one patient has grown exponentially into 24 million confirmed in the US alone — a number that is surely only the tip of the iceberg, the cases we know about.

Anniversaries are important and meaningful to us. They’re a way of marking the passage of time and noting historical events, delineating the Before and After. And with the start of our second year dealing with this novel coronavirus, which almost exactly coincides with the start of 2021, we will be noting many more Firsts of the Covid-19 Pandemic: the first complete lockdown of a city, Wuhan (1/23); the first time the World Health Organization declared coronavirus a “public health emergency of international concern” (1/30); the first death outside of mainland China (2/2); the introduction of the name “Covid-19” — the disease caused by the novel coronavirus — into the popular lexicon (2/11); the first known US death (2/29)– although health officials would later amend that milestone (2/6). And I’ll never forget March 9, the first time I, on CNN, used the word “pandemic” to describe what was happening. Two days later, WHO did the same.

The nature of ‘novel’

All these firsts make me think about the significance of the word “novel.” When was the last time we, as adults and as a society, truly experienced anything for the first time, or have been in a situation for which we had no context?

When we hear of a novel — or new — anything, one of the first things we, as humans, start doing is contextualizing or looking for similar examples among the things we are familiar with. We try to understand the contours of this new entity by comparing it to what we already have stored in our memories and experiences. We look for patterns, similarities, overlap.

It’s human nature. But, too often, that sort of thinking gets in our way.

When this novel coronavirus, called SARS-CoV-2, emerged, many scientists, public health officials and doctors — myself included — looked to other deadly coronaviruses, such as SARS and MERS, for clues to predict how it would behave. We also tried to compare it to the seasonal influenza virus and to past flu pandemics, like the one caused by the H1N1 subtype, which set off both the 2009 and the 1918 pandemics.

I remember putting my head down deep into this, taking in all the information I could: reading research papers and unpublished pre-proofs; talking to colleagues in China, South Korea, Japan and at my hospital; talking to experts like Dr. Anthony Fauci and global health expert Peter Daszak, whose research has been key to understanding the origin and impact of emerging diseases. And I remember, everybody had a theory about some aspect of this novel coronavirus — even my mother had a theory.

In the earliest days, we thought human-to-human transmissibility was unlikely, that masks weren’t particularly helpful, that it might not be deadlier than the flu, that people couldn’t spread it asymptomatically or through the air. Maybe we hoped these things would be true, and the pandemic wouldn’t be as devastating as it has been.

But we were wrong. We quickly learned that SARS-CoV-2 was much deadlier than the flu, and much more easily transmissible than either of its close cousins, SARS and MERS. We came to terms with the sobering reality that aerosolized particles and asymptomatic carriers are significant drivers of its relentless spread.

The point is, I don’t think anyone would have predicted — or wanted to predict — we’d be dealing with a global pandemic of this magnitude one year later. We didn’t want to face such a grim future.

Even the way former President Donald Trump communicated to me that he didn’t want to panic the American public likely contributed to the problem. But being honest and direct, and telling people the truth, is sometimes hard. I deal with this as a doctor all the time. A traumatic brain injury after a car accident on the way to work. That headache: the early sign of a brain tumor. I have learned that presenting a problem alongside a plan doesn’t soften the blow of terrible news, but it can help mitigate the panic, which really serves no purpose. It also makes it much more likely people will take the issue seriously, rather than simply feeling helpless, which can lead to disbelief and ignoring the problem altogether.

If I had known in January of last year that we’d still be living this Covid lockdown life, and that I’d still be conducting interviews from my basement until, say, a vaccine was developed, in many ways it would have been a very difficult pill to swallow. But in at least one way it would have been easier: There would be a calendar, a timetable, about how things should progress — and a tangible end. The certainty of a countdown to zero, as opposed to the inherent ambiguity of counting up for what feels like forever. We’re not nearly as good at counting up as we are at counting down. However painful, when we countdown, we still have the anticipation of an end date.

Pondering the pandemic

Anniversaries are also a time to reflect, to look back on this experience and assess what we got right versus what we got wrong.

We got a few big things right: We made remarkable progress in scientific and medical arenas, like developing protocols and therapeutics — both repurposed and new — for people who got sick. Most notable of all, we managed to develop several vaccine candidates and even authorized two with astonishing speed.

But we also got too many things wrong — most consequentially and tragically the public health basics, the things that are far easier to do but not as flashy: wearing a mask and staying physically distanced from those not in our household. We eschewed the inexpensive mask that slips on easily, yet embraced the billion-dollar breakthrough vaccine that takes a Herculean effort to develop and distribute.

The truth is, especially for many of us in the developed world, we want science to rescue us — but it can’t rescue us from ourselves; our own human nature. And our human nature is not good at dealing with what it can’t see.

The other day, someone asked me what big breakthrough I would like to see for a future pandemic. Aside from the obvious ones — avoiding a future pandemic, developing an effective vaccine, having access to effective medications, amassing reliable data—here’s a crazy idea I would love: fluorescent dye that basically gives the virus just a little bit of color. So if someone is infected, you could see a little plume of glowing green particles coming out of their nose and mouth. Not to scare people or gross them out, but because we are so much better at dealing with things that we can tangibly identify than an invisible threat. Trying to get people to believe in what they can’t see, trying to prove a negative (for example, reliably conveying all the deaths mask-wearing prevented) has always been the challenge in all preventive medicine.

On the other side

Looking forward, I am optimistic, medically-speaking. I think once most of us are vaccinated, SARS-CoV-2 will become like the other circulating coronaviruses, an annual nuisance but not an existential threat.

The image of the United States as a public health leader, however, has been tarnished by the events of the last year and its inability to control the pandemic at home. It’s a fact, and we can’t spin the statistics to our advantage: We have 4% of the world’s population but 25% of known Covid infections and 20% of deaths. Can the US Centers for Disease Control and Prevention, the country’s premier public health agency, regain some of its lost prestige domestically and abroad? I believe with hard work and time, it can.

But beyond that, the country will be scarred psychologically and emotionally for a long time, especially the people who have lost family members to Covid-19, the health care workers who fought tirelessly — sometimes in the face of disbelief or worse — to care for the sick, the children of all ages who lost a year of school and struggled to catch up, the families who lost income from layoffs or suffered other economic catastrophes, the owners who had to shutter their businesses. The list goes on.

I have no doubt we will get through this. And hopefully there will be lessons learned, but more importantly, lessons remembered — because those who forget history are doomed to repeat it, and the price we’ve paid as a society during this pandemic is too high to let that happen again. This past year has most certainly taught us that.