7 Hard and Crucial Lessons of Covid-19
An invisible virus exposes critical blind spots in science and society. But will we learn?
Plaguing the world for more than a year, the coronavirus has forced reckonings in everything from scientific understanding to heart-wrenching inequities in health care and the economy. Given the human tendency to ignore history, here, for the record, are seven vital lessons we can take from the Covid-19 pandemic, which could start benefiting us now and for generations to come.
1. Virus science just underwent a paradigm shift
Sanitizing groceries and drowning our homes with bleach was wrongheaded, in hindsight. That early advice reflected an outdated view of how the coronavirus, influenza, and other respiratory viruses spread, some of it based on experiments done in the 1930s.
Combining expertise in atmospheric chemistry, aerosol physics, and disease transmission, a few often-ignored scientists were pointing out many months ago how SARS-CoV-2, the Covid-causing coronavirus, really gets around:
“The main mode of transmission is through the air, by breathing in aerosols that contain the virus,” explains one of those experts, Jose-Luis Jimenez, PhD, a chemistry professor at the University of Colorado, Boulder. “There are zero cases where the virus has been shown to transmit [via] a surface.”
(Other researchers have echoed the absence of any documented cases of surface transmission. It may have happened, but it’s clearly not the most common means.)
Unfortunately, Jimenez and other virus-transmission experts complain, the World Health Organization and U.S. Centers for Disease Control and Prevention have been slow to acknowledge the outsized role of airborne spread and to translate what leading experts have been saying since last spring into loud and clear advice.
“Millions of people have been infected because we emphasized defending ourselves against a mode of transmission that’s minor (surfaces) while ignoring the major one (air),” Jimenez tells Elemental. “Going forward, we need to realize that most or all respiratory viruses likely transmit through the air in the same way as SARS-CoV-2, and we need to prepare for the next pandemic or the seasonal flu [by] building on this paradigm shift on how transmission works.”
So while hand-washing remains important for protection against disease in general and may help with Covid, we now know that masks, distancing, air filtration, and ventilation are the key ways to lower the risk of coronavirus infections in homes, businesses, schools, or anywhere people gather.
2. We were not prepared for this
Covid-19 has killed more Americans than any conflict since the Civil War. Yet the agencies that research and defend against disease are underfunded, scientists argue. The Department of Defense’s budget is about $700 billion. The annual budget for the National Institutes of Health, which oversees the CDC, the Food and Drug Administration, and other health agencies, is around $40 billion — lower than it was nearly two decades ago. Meanwhile, state budgets and staffing aimed at battling health emergencies have been slashed over the past dozen years.
Yet trillions of federal dollars are now being spent to deal with the disastrous health and economic fallouts of inadequate pandemic preparation and response.
“The amount of money we have spent and lost during Covid-19 is greater than we would spend for a war,” points out Krutika Kuppalli, MD, an assistant professor of infectious diseases at the Medical University of South Carolina. “Yet infectious-diseases research is not funded nearly at the level that our Department of Defense is funded because people do not conceptualize the destruction from outbreaks on the level of a war.”
The United States lacked masks, gowns, and other necessary equipment. There was no system in place for widespread disease testing, contact tracing, or rapid vaccine distribution. Meanwhile, the entire U.S. health care system was (and remains) riddled with social inequities and segmented policies that left it woefully unprepared to react properly to the threat, communicate consistently to the public, and treat the sick.
Kuppalli is one of many infectious-disease experts that view this debacle as a warm-up for next time — when an even deadlier new pathogen promises to rear its ugly pandemic head.
“We need to have local, state, and national stockpiles of essential resources such as personal protective equipment, medications, and other supplies,” she says. “We also need to fund infectious-diseases research and pandemic response consistently and not be reactive to these outbreaks.”
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3. Viruses will exploit every opportunity we give them
Who knew the novel coronavirus would be so infectious and deadly, that it could evolve, resurge multiple times, learn to evade treatments and vaccines, and plague humanity for more than a year? Well, lots of scientists did. And per their expectations, clearly stated in spring 2020, the coronavirus didn’t magically disappear. Instead, it took full advantage of patchwork, stop-and-start, often ostrich-level prevention strategies in the United States and elsewhere.
“What can happen will happen in the permissible environment afforded to the virus in the U.S. and other countries,” says Mark Cameron, PhD, an immunologist and medical researcher in the School of Medicine at Case Western Reserve University in Ohio.
History is poised to repeat sooner than anyone would wish, Cameron and other experts fear. The pace of new cases has bottomed out at troublingly high levels, new variants are more infectious, in some cases deadlier, and prone to at least partially evade existing treatments and vaccines. With states lifting mask mandates and other mitigation strategies long before vaccinations approach helpful herd-immunity numbers, there is “plenty of opportunity” for the coronavirus to resurge yet again, Cameron says.
“We should know better by now,” he tells me. “Understanding what can happen is our best opportunity to prevent what will happen.”
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4. Novel viruses should never be taken lightly, by anyone
This one you probably know by heart: The coronavirus is highly infectious yet often causes no symptoms, hitching stealthy rides in unwitting incubators of all ages. Young people don’t die at high rates — though more than 300 children and teens have succumbed — but it’s clear they contribute to transmission.
That much we know. But there is much we’re still learning.
In addition to the staggering death toll, the virus also causes inexplicable “long Covid” symptoms, ranging from fatigue, “brain fog,” and gastrointestinal issues to anxiety and depression, typically with no identifiable cause or obvious medical markers. People across all age groups are suffering for months after infection, says Francis Collins, MD, director of the NIH. Just one example: 13-year-old Madilyn Dayton, once an active athlete, can now barely stay awake for her school Zoom classes, running on half her former energy six months after catching Covid.
“We do not know yet the magnitude of the problem,” Collins says, “but given the number of individuals of all ages who have been or will be infected with SARS-CoV-2, the coronavirus that causes Covid-19, the public health impact could be profound.”
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5. In-school learning is a foundation of our society
Few pandemic mitigation efforts proved more disruptive to society than school closures, which debilitated normal family function and forced working parents into the stressful and often impossible roles of substitute teacher or daycare provider. Yet in many states, schools were shuttered while the pathogenic petri dishes otherwise known as bars, restaurants, and gyms remained open, to the great consternation of scientists who know how to end a pandemic.
One tragic result: a disproportionately negative impact on women.
Since the start of the pandemic, nearly 500,000 more women than men have left the U.S. workforce, whether due to layoffs or because they’ve shouldered the bulk of the increased burden for childcare. Countless more women have reduced their work hours and missed out on advancement opportunities.
“The U.S. economy has always been hard on women, impacted by gender bias, a pronounced wage gap, and societal norms,” notes Michelle Williams, dean of Harvard T.H. Chan School of Public Health. “The pandemic has done epic damage to the progress women have made in the workforce over the past few decades.”
Children are suffering, too. School closures leave millions of kids without a square meal and the social support they rely on, fueling increases in anxiety and depression. With less-effective online education, Covid-era kids will make less money throughout life compared to children of other generations, a factor that will drag on the entire economy for decades to come.
6. Social inequities are widespread, debilitating, deadly, and enduring
Because of extreme disparities in access to health insurance and health care and other systemic disadvantages, people of color are disproportionately susceptible to contracting Covid-19, and then more likely to die from it. Already, the pandemic has shaved off three years of life expectancy for U.S. Latinos and two years for Black people, yet just 0.68 years for white Americans.
Health is inextricably linked with economics.
“Black and Brown people have not only suffered disproportionately from the disease itself but have also been hit especially hard economically,” Williams says by email. “This collision of medical, economic, and societal crises should force a reckoning across all industries and sectors, which must now confront the real costs (including economic and otherwise) of inequity. As a society, we must work toward a common goal of eradicating racial and gender disparities across the board.”
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7. We have two economies
Americans who’ve struggled to pay bills on poverty-level wages, lost their jobs amid the pandemic, struggled to get adequate health care with no health insurance, and been forced to trudge off to their essential jobs with or without good PPE, find little solace in the recent record highs in the stock market.
“Poor and low-wealth people have always known that they were among the least-valued people in society, often toiling away in near invisibility,” says Christopher Hayes, PhD, a labor historian at Rutgers School of Management and Labor Relations. “They always knew they were one illness or financial demand away from ruin. They always knew those low-wage, low-prestige jobs often come with substantial physical risks.”
The solutions for protecting essential workers and lifting them out of poverty are obvious, if politically unpopular.
“People need living wages and guaranteed health care that, if not free, is reasonably priced,” Hayes says. “I know what it’s like to live without both, and to expect things to be that way indefinitely. It’s a brutal way of life.”
That brutal way of life cascades generationally. The already cavernous wealth gap between white and Black families has widened during the pandemic, with related financial and health challenges that will last a generation and beyond. One analysis, based on historical effects of recessions, projects more than a million American deaths over the next 20 years due to Covid-related financial hardship and stress, with disproportionate effects for women and people of color.
Amid all the doom, gloom, and exhausting frustration, there are signs of hope. The $1.9 trillion relief package passed by Congress is projected to cut poverty by a third. Williams calls it “the most significant piece of public health legislation in a generation” and says it could have a major impact on health care infrastructure and affordable health insurance.
“We need to make these investments permanent ones and we need buy-in from business to make similar investments in the social determinants of health,” she says. “These investments, above all, will work to lessen or eliminate our country’s two-tiered economy.”
The nation’s policymakers now have access to ample knowledge and awareness in medical science, psychology, sociology, and economics to prevent future catastrophic pandemics and lessen the physical and financial blow from any health crisis.
But here’s the trillion-dollar question:
“What will we do with it, now that we all seem to know, and how long will we remember?” Hayes asks. “I can see a future in which all of this fades back into the background as the pandemic recedes.”
Like Hayes, we should all certainly hope not.