6 months later, the COVID-19 pandemic ‘is not done with us’
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The novel coronavirus outbreak was first reported on Dec. 31, 2019, in Wuhan, China. Within a month, the virus had spread to Italy, the United States and Germany.
Six months into what became a global pandemic, cases of COVID-19 have surpassed 9 million. A virtual press conference held recently by Johns Hopkins Medicine reflected on the developments of the past 6 months.
Topics ranged from contact tracing of the virus to its impact on children and the disproportionate burden on communities of color. As several states begin the process of reopening, researchers continue to work to better understand clinical characteristics of COVID-19 and the impact of containment measures. The search for an effective vaccine is also ongoing.
“Scientists around the world are leaving no stone unturned in order to gain a deeper understanding of SARS-CoV-2, the virus that causes COVID-19, and come up with remedies,” Gitanjali Pai, MD, AAHIVS, an infectious disease physician at Memorial Hospital and Physicians’ Clinic in Stilwell, Oklahoma, and an Infectious Disease News Editorial Board Member, told Healio. “New information is pouring [in] by the minute.”
COVID-19 and children
During the press conference Aaron M. Milstone, MD, MHS, professor of pediatric infectious diseases and epidemiology and associate hospital epidemiologist at Johns Hopkins Medicine, said that recognition of multisystem inflammatory syndrome (MIS-C) associated with COVID-19 in children has been one of the major developments regarding the way in which the virus manifests.
“This clinical presentation has reframed thinking about the risk of COVID-19 to children,” Milstone told Healio. “Hopefully, parents take a bit more of a pause before thinking their kids are not at risk for COVID-19.”
In New York, research that examined MIS-C showed 60% of children with the syndrome tested positive for SARS-CoV-2 infection and 40% had antibodies specific to the coronavirus, which causes COVID-19. Recent WHO data also suggest that indirect impacts from the pandemic, like the suspension of health services, may have a greater impact on the health of women and children than deaths from the virus itself.
“The good news is that the children infected with COVID-19 are faring better than adults. It is also heartening that parents have recognized the need to keep children emotionally healthy in times of quarantine,” Pai said. “But the caveat is that all the factors affecting children are still not known. Children are vulnerable. We must raise the index of suspicion where children are involved.”
Impact on communities of color
Sherita H. Golden, MD, MHS, vice president and chief diversity officer and professor of medicine at Johns Hopkins Medicine, noted the disproportionate impact of the virus on Black, Latino and Native American communities during the press conference. She said that COVID-19 death rates in the United States are 62 per 100,000 persons in Blacks and 36 per 100,000 persons in Native Americans compared with the estimate of 26 per 100,000 persons in whites.
“There is a burden of comorbidities that African Americans have, including. higher rates of diabetes, hypertension, cardiovascular disease and lung disease. At the beginning of the pandemic, there was really a focus on that: ‘These are the reasons for differences in mortality,’” Golden said. “But I think we have to step back and say, ‘Why are there these differences in mortality?’”
Golden continued by emphasizing that distrust of the medical system within these communities, largely due to unethical experiments from history such as the Tuskegee syphilis experiment, may contribute to the high mortality rates. She also said that the closures of medical schools in 1910 created an ongoing shortage of Black physicians who can advocate for their own, further exacerbating these issues.
“It’s really important to recognize that while we have a public health and a civil rights crisis going on simultaneously, we have to be responsible in implementing the best public health practices,” Golden said.
Vaccination
Both public and private institutions have worked to create potential vaccine candidates throughout the pandemic, with 13 currently under clinical evaluation and 129 in the preclinical phase.
“As we open up the country, and with easing of social distancing measures, children need to be protected from the possibility of a higher risk for communicable, and preventable, disease spread. We must focus even more on protecting our children via immunization,” Pai said.
Additionally, WHO recently reported that the virus’s impact on routine vaccination systems may put 80 million children at risk for missed vaccinations.
Containment measures
Research throughout the COVID-19 outbreak has shown that social distancing reduces case counts in the general public, as well as high-risk groups like transplant recipients. However, delayed pandemic response measures and testing issues have left the U.S. with the highest case count in the world.
“Unlike in countries like Singapore and South Korea, control measures in the United States did not take off in earnest as soon as the first case was detected,” Pai said. “In hindsight, complacency did us in. The shortage of [personal protective equipment], a scarcity of equipment, delays in ramping up testing, social distancing failures, a lack of consistent and regular communication and an absence of community engagement all led to an exponential increase in the number of cases.”
During the Johns Hopkins press conference, Crystal Watson, DrPH, MPH, senior scholar and assistant professor at Johns Hopkins Center for Health Security, emphasized the importance contact tracing throughout the pandemic.
“This is a way to manage the spread of the virus on a case-by-case level,” she said. “This capacity is needed to break the chains of transmission.”
A recent small study of 37 asymptomatic patients with COVID-19 published in Nature Medicine suggests antibodies for the virus may only last only 2 months, which may impact virus mitigation efforts. Limited testing capacity has been a particularly salient issue in the U.S. throughout the pandemic, with access to rapid diagnostic tests varying between states. Watson said that current surges in case counts indicate that contact tracing capacity must be improved before the fall and suggested a “massive workforce upgrade” as a potential solution to this issue.
In addition, the public and the health care workforce must remain vigilant, according to Pai, who emphasized that the pandemic is not yet over.
“We can’t afford to lose the fight with COVID-19,” Pai said. “At the same time, we have to get back to our normal lives fast. The epidemiology of COVID-19 is unfolding very slowly. We think we are done with the pandemic, but the pandemic is not done with us. Caution and precaution are the name of the game.”
References:
- Johns Hopkins. Coronavirus resource center. https://coronavirus.jhu.edu/map.html. Accessed June 23, 2020.
- Long Q, et al. Nat Med. 2020;doi:10.1038/s41591-020-0965-6.
- WHO. Draft landscape of COVID-19 candidate vaccines. https://www.who.int/who-documents-detail/draft-landscape-of-covid-19-candidate-vaccines. Accessed May 27, 2020.
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