Amesh Adalja, Rupali Limaye, Jeffrey Shaman and Brian Wahl all know SARS-CoV-2, the virus that causes COVID, inside and out.
Adalja, an ER doctor and biosecurity specialist, saw this pandemic coming back in 2018 when he headed a report called The Characteristics of Pandemic Pathogens. It states, “The most probable naturally occurring [global catastrophic biological risk]–level threat that humans face is from a respiratory-borne RNA virus.”
The warning, he says, was mostly unheeded. “After that report was published, I suspect, it ended up in a lot of desk drawers in Washington, [D.C.], gathering dust.”
When the pandemic hit, Adalja, who has often appeared in the media since, saw the reaction change. “One reporter told me she got goose bumps watching my interview in 2018, so I think there was some appreciation after the fact,” he adds.
In early 2020 Shaman was able to start tracking the burgeoning pandemic using data scraped from inside China’s health-reporting system and from mobile phone information. That research enabled an early revelation that was stark—and undeniable. “It was clear to us was that it behaved like a common respiratory virus and that there was absolutely no stopping this thing,” he says. “There were all these avenues for the virus to get around by people who didn’t know they had it—and, you know, once the genie has left the bottle that way, there’s no controlling it.”
Shaman and his research group have since created a veritable mountain of COVID-19 projections, which they supply to multiple federal and state agencies and make publicly available.
Wahl is an epidemiologist and public health specialist who has been based in India for more than a decade. He saw the dreaded “second wave” of COVID, fueled by the Delta variant, from the ground there. And, he says, the trauma and speed of that spread actually created an opening for increased vaccine acceptance. “Following second wave in India, we saw vaccination in the country really pick up steam—and so vaccination has been increasing over time,” Wahl says.
Back in the U.S., vaccine hesitance, even in the face of successively more contagious variants, such as Delta and then Omicron, has been tougher to combat. Limaye seemed preternaturally prepared to take up the challenge from the start of the pandemic here. “I looked at vaccine hesitancy before COVID for about five or six years,” she says.
And since the pandemic began, Limaye figures she has spoken directly—intimately and personally—to 3,000 people who are vaccine-hesitant. Her takeaway? “Those conversations can be really challenging, as you can imagine—people are very emotional about vaccines and their decisions,” she says. But even after all of those conversations, Limaye remains hopeful, if guardedly so. “I think there is a way forward that we can get through to people and get them to embrace science again,” she says.
Amesh Adalja: The coronavirus pandemic has changed the world by showing people what a pandemic can do in the 21st century, when we have vaccines antibiotics science—we still can have a very disruptive infectious disease emergency something that many people didn’t think was possible because the 2009 H1N1 influenza pandemic wasn’t that severe but I think when you look back at SARS CoV-2 it really shows how devastating a pandemic can be even with all the tools that we have.
Rupali Limaye: The coronavirus pandemic has changed the world by illustrating a number of inequities. These are social economic as well as health inequities, not only globally but here in the United States. They were always there and i think what happened with COVID is they essentially brought it to the surface. It really indicated how much inequity we were already seeing but that we weren’t really fixing through structural interventions.
Jeffrey Shaman: The coronavirus pandemic changed the world by reminding much of the world that infectious diseases remain a threat and are not just simply something that happens to other people.
Brian Wahl: The coronavirus pandemic has changed the world by reminding us that we are interconnected and that it is important to address infectious diseases to address health emergencies everywhere in order to protect individuals everywhere.
The coronavirus pandemic has changed science by bringing together multiple domains within the scientific effort to address a pressing human challenge. The number of lives that this virus has affected has been tremendous, but it has also catalyzed collaboration coordination within the scientific community in really meaningful ways that hopefully we’ll be able to maintain in years and decades to come.
Limaye: The Coronavirus pandemic has changed science by illustrating the power of vaccines, in my opinion. And what I mean by that is that it’s really incredible that we were able to get a safe and an effective product to the market within about a year. So it really shows i think the power of science and what can be done when we can put investments in resources when there is a priority pandemic occurring.
Adalja: The coronavirus pandemic has changed science by showing how important it is to be fast, to be quick, to be able to get countermeasures developed in a time that can actually change a trajectory of a pandemic. In the past, when we thought about what would be the rate -limiting step in a pandemic it would be getting the vaccines, but that’s not the case now. We were able to get vaccines within a year, antivirals within a year.
All of that shows that science has really accelerated to the point where it can provide tools at a breakneck speed. It’s just now the issue of getting people to utilize those tools.
Shaman: Our ability—and this is less science and more people—our ability to have an evidence-based approach to taking on this pandemic was fraught. And that’s not to say that we needed to recognize that the virus was a threat
and do x, y, and z.
There is legitimate debate about lots of issues, like how much you close the economy how much pain and suffering that’s going to cause, are you going to do more harm by what you do than what you don’t do? Those are legitimate things but you know, demonizing mask wearing, down playing vaccination, putting in place policies that fires or penalizes people for trying to implement public health measures—you know things of that nature have all emerged and they’re just part of the current cultural and political climate in the US certainly and we see it in other places, as
well. So it’s not unique to the United States—in the way that something that is disruptive, that none of us want to have in our presence, results in some people wanting to tackle it some people running away from it some people wanting to deliberately ignore it so that other agenda can be fulfilled.
Science just got entrained into all that. It became another type of information that could be used by pundits or politicians or policy makers or businesses to shape an agenda that they had. One thing that is i think troubling for many of us that work in science is that there has been an increase in anti-science sentiment.
Limaye: There have been changing public health recommendations, simply because they have reflected the data. We see that as progress as scientists. I think the public sees that as scientists don’t know what they’re doing. This has led to a distrust in health care systems, which is also impacted vaccine uptake, as well.
Adalja: There’s always been misinformation any time there’s been an infectious disease emergency. For example, during the the polio outbreaks in the 1940s there was disinformation on the radio saying there was going to be kids in body bags if they got the polio vaccine.
So that’s something that we’ve seen before, but what’s different now is you’ve got this voice what I call “the voice of the dark ages” utilizing the Internet, which is much faster than radio or print or or just pamphlets. And that is really hard to combat. That information can spread very, very quickly, very fast just like a virus does. And the general public has swallowed a lot using social media that is very hard to untangle out of their minds.
So, in many ways, it’s become more frustrating at this stage of the pandemic because what we’re seeing are self-inflicted illnesses. They’re all vaccine preventable illnesses. We’re seeing people take actions that actually put their own community hospitals into crisis.
That makes it much much different than when you’re dealing with it back in 2020 when there’s no vaccine and everybody’s sort of helpless trying to do the best they can. Now we see this being willful, or at least I see it as being willful, where you’ve got this great technology that that can save lives but people just choose not to take that technology, and then also then choose to come to the hospital and crush the hospital.
Wahl: We’ve understood how the virus spreads and we’ve learned a lot about the virus in a very short amount of time, however, we still have a hard time in in modeling human behavior and and policies. I’ve always believed in the power of public health and the importance of epidemiology.
I’ve been frustrated over the last two years by the response to science and the response to public health, however, it’s only reinforced my resolve to focus on contributing to good science to helping to communicate good science and to ultimately protecting the health of of individuals around the world.
Shaman: You know, the question is how many more tricks does it have in its bag? Can another variant emerge that’s similarly dissimilar to everything else that’s appeared or has the virus fully explored that space and is only going to make mild variants of omicron delta beta and alpha from now on, in which case our exposure to it is going to confer a lot of protection and we could expect that it will be milder and milder going forward.
Or is something new and radical going to emerge again that’s highly immune evasive the way omicron was that we don’t know. And that is going to determine whether or not in 2022 we’re going to have another two, three waves of this thing that are going to be disruptive again the way omicron is, or it’s going to settle into a pattern that’s more benign and less disruptive.
That’s the the question that we’re trying to answer—you know, what is the endemic pattern are we getting there how much more capacity and surprises does this virus have in store for us?
Limaye: I think the path forward is ensuring that public health institutions, the healthcare system acts in a way that really builds trust. There’s several ways this can be done. I think the first is being very clear and being much more communicative about what the response is including what we’re asking people to do. You know one I think misstep
throughout this whole pandemic was the absence of regular even daily types of briefings from the CDC
or even the administration. I think that would have gone a long way. So that’s one.
I think the second piece that we need to look at is thinking about what are the different messengers that we can use
to really promote the health of the public. We’ve traditionally defaulted to clinicians or public health scientists to really deliver the message, and the key thing that we’ve learned here during this pandemic, particularly in regards to reducing disparities related to vaccine uptake, is that we need to leverage different messengers.
So that can be community leaders. Those can be religious leaders, for example, and other people in the community that aren’t necessarily connected to the public health or the health care system.
I think the third thing that we can do is kind of bring it back with regards to science literacy—figure out ways in which that we can use that within the educational system, starting at a younger age so that people are more interested in science but are also less fearful.
I would say of science and that would also help I think, you know, in terms of moving the needle forward, so that we are more transparent and that there’s more trust in public health, as well as the health care system.
Adalja: So the path forward is to teach people how to risk calculate, and for too long during this pandemic we went to this abstinence-only approach. And, from HIV from Hepatitis-C from injection drug use, we know that abstinence only doesn’t work because people will still take those risks and you need to do what’s called harm reduction.
Now it’s become increasingly easier with vaccines, monoclonal antibodies, rapid diagnostic tests, anti-virals—all of that has made it easier to do. But the path forward has always been we have to adapt to this new threat we can’t cease living. And I think that’s something that was hard for people to accept back in in march of 2020.
But I think increasingly now they see that is the only path forward, and we’ve seen the follies of going kind of going through “COVID Zero”—that this wasn’t something that was a biologically plausible goal, and I think that stunted people’s ability to risk calculate. And that’s why people are having a hard time now realizing with the Omicron variant that this is the new normal, and I think if we would have articulated that I think we would have be in a better situation where people understand that they’re going to have to learn how to make risk calculations.
And I think that’s the path forward—is using the tools that science and medicine have given us to make this
a much more manageable infection that people can deal with in their everyday life the way they deal with other respiratory viruses.
For me my path forward is to continue doing this because there is not an end to pandemic threats. I want to understand how other respiratory viruses circulate; what other respiratory viruses could be pandemic threats; how to be more proactive with our medical countermeasure development; are there ways to harness the knowledge we have of virus families to move medical countermeasures, drugs vaccines, monoclonal antibodies, kind of pre-position them for the next pandemic?
The other aspect I’m really interested in is the fact that there was a great improvement in our diagnostic capacity during COVID-19, one of which is home testing. We have home tests now for COVID-19. Why don’t we have home tests for flu and group-A strep? i envision this world where people in their kitchen have kind of like a toaster oven device where they can put a swab in it and know what virus they have. And then link to telemedicine so they can get a prescription for Tamiflu or antibiotics because they’ve got strep throat or a COVID antiviral.
I think there is this opportunity to really revolutionize medicine and epidemiology by using home tests, and i think we’re just on the cusp of that. And I think we’ve got to keep the momentum going. So I’m also going to be working on trying to understand what the value is of home test and what what the future could be.