Covid assessment: A physician looks back

"We got it right and we got it wrong."

December, 2020. A physician warned us:

   "Our hospitals, doctors, and nurses are at the breaking point. Clinicians are angry and frustrated at reckless virus- spreaders who whine about masks. 

     Will you agree not to get treated if you get COVID?"

In the first months of the Covid pandemic America's medical community and public health authorities were feeling their way. Something big was happening. People were dying, but we weren't clear yet what it was, how it was spread, who was at risk, whether there were long-term consequences after the original Covid infection, and what were the tradeoffs between infection control and business-as-usual personal freedom. 

College classmate Eliot Nierman, M.D., is back with a view of our medical response to Covid, now with the perspective of time. His prior post got widespread circulation by readers of this blog. It warned that the country's hospitals were filling up with people who weren't taking Covid seriously enough. He recently retired from his long career as a Professor of Clinical Medicine at the University of Pennsylvania Medical School.  

Guest Post by Eliot Nierman

We got it right and we got it wrong.

Science is messy. Discoveries and making use of knowledge is not a straight path. It is full of twists and turns, dead ends, wrong moves and reversals. For the first time I am aware of, the general public got to view this confusing reality first hand with the miracle that was the scientific and medical response to Covid. Why do I say miracle when there were mistakes and so many died? Millions of lives were saved due to discoveries and advances in treatments that usually take years and decades but with Covid only took weeks and months. 

In 1976, when I was a medical intern in Philadelphia, there was a severe outbreak of a respiratory disease amongst a group at a Legionnaire’s convention. Even though it was caused by a bacteria which is much easier to discover than a virus, it took six months to identify the causative bacteria, a previously unrecognized bacteria that had in retrospect caused outbreaks at least 20 years earlier in the 1950s! AIDS was first clinically observed in the U.S. in 1981. The cause was unknown. It was not even initially known if it was an infection. The virus that causes HIV was isolated two years later. It was not until 1985 that there was agreement that the virus isolated by different researchers was the same and the cause of AIDS. Unfortunately, as is the case with Covid and global warming, there is “HIV denialism” and conspiracy theories. As in the case with Legionnaire’s, in retrospect there were previous unrecognized AIDS cases at least as early as 1959 in the Belgian Congo and in the 1960’s in the U.S.! In 1985, the first test for HIV was developed and in 1987, the first antiretroviral drug, AZT, that partially treated HIV became available. In 1995, effective treatment with highly active antiretroviral therapy became available. There is still no vaccine for AIDs.

Covid was first identified in China in December, 2019. The virus was identified in January, 2020 and tests were developed within a couple of months. The previously existing antiviral drug Remdesevir was found to be of value in severely ill patients in 2020. Vaccines were first available in December, 2020. In 2021 an oral antiviral protease inhibitor, Paxlovid became available. What had previously taken years was accomplished in about a year or even less. Amazingly fast and an incredible success story!

The initial approach to Covid was epidemiological, an attempt to prevent the medical system from being overwhelmed. This was successful in saving lives --  as shown in comparison to the Swedish approach to not have restrictions --  and in keeping the medical system from being overwhelmed. However there was a huge economic and social cost. Mistakes were made in terms of initial recommendations to not wear masks (in part to save them for medical personnel) and then to recommend wearing them outside. Fortunately our economy now seems to have largely recovered except for some continued mild inflation. In the past couple of months, U.S. mortality rate finally decreased back to pre-Covid levels, i.e., no excess Covid deaths. 

2020

The biggest mistake was the prolonged overemphasis on remote schooling. Children have been much less vulnerable to Covid and have been shown to not be major vectors in the spread of Covid. This was recognized early enough in the pandemic that the damage should have been limited by changing to in-person-schooling-with-masks much earlier. Unfortunately, politics and vested interest groups prevented the earlier implementation of more enlightened approaches and the cost in lost learning as measured on reading and math tests has been huge. The other big tragedy has been the conspiracy theories and the politicization of vaccination resulting in hundreds of thousands lives lost that should have been saved. We physicians met way too many severely ill unvaccinated patients who asked to be vaccinated, sadly when it was too late to have any benefit.

Science is objective and nonpartisan  We have all greatly benefitted from the advancements due to it even when it challenged what we thought was how the world worked. When we try to pick and choose conclusions based on our beliefs, we lose those benefits and return society back to the times when ill-humors caused disease and blood-letting was the treatment  Anyone who wants that approach is welcome to it. Just don’t expect the rest of us to suffer with you.

 

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