Scholarly Perspectives on COVID-19, Part 1: “This Was Only a Matter of Time”
June 23, 2020
- CDC Image Library, ID# 23311.
In retrospect, December 2019 seems like an altogether different era now. For most of the U.S. population, at least, those were the halcyon days when students were doggedly completing final exams and papers, teachers were grading and looking forward to winter break, shoppers were checking off gift lists online and in stores, the faithful were making pilgrimages to holy sites, families were crisscrossing states and oceans to visit loved ones, football fans were celebrating the NFL playoffs, tourists were crowding into theaters on and off Broadway, crafters were selling their wares at holiday bazaars, farmers were repairing their equipment, and friends were meeting up for peppermint and eggnog lattés.
On New Year’s Eve, meanwhile, the China Country Office of the World Health Organization (WHO) received reports that a cluster of pneumonia cases had presented in the city of Wuhan, in Hubei Province—place names that have since become ominously familiar but were then still unknown to many Americans. Six days later, the cause of the illness was still obscure, but by January 7, 2020, scientists in China had already isolated the pathogen and shared its full genetic sequence with the global scientific community. They identified it as a novel coronavirus (2019-nCoV).
Combining visual metaphor and perhaps not a little irony, coronaviruses are named for their crown- or halo-like appearance when peered at through an electron microscope; corona in Latin denotes an honorific garland worn on the head or else a halo encircling a celestial body, such as the sun. The pathogens, of which there are currently four main types known to affect humans, were first characterized in 1965 and are the source of mild to serious upper respiratory syndromes; some coronaviruses, for example, are known to cause the common cold (as do more than 200 other viruses, such as rhinoviruses). This newest coronavirus, however, had within a week caused 44 patients to seek in-hospital care, with 11 reported as severely ill.
Back in Georgetown, Texas, microbiologist Martín Gonzalez was just one Southwestern scientist who was carefully following updates on the epidemic as news emerged each day in the popular media and within the scholarly community. A novel virus is always cause for keen interest among researchers and healthcare practitioners alike, certainly, but it’s not necessarily a source of surprise. After all, in reflecting on the long history of human disease, researchers started predicting a pandemic like COVID-19 decades ago and more recently in articles such as “The Next Plague Is Coming; Is America Ready?” by science journalist Ed Yong and in the 2020 Netflix documentary series Pandemic: How to Prevent an Outbreak (whose first episode, Gonzalez says, is “the one to watch” if you want an accessible explanation of how a global disease affects communities, how researchers and healthcare providers approach them, and how difficult it is to develop vaccines).
“With all the past epidemics and pandemics that we’ve seen, this was only a matter of time,” Gonzalez says. “I think most people in the sciences realized this was the case.”
A crash course in virology and epidemiology
Gonzalez was teaching microbiology in January. On the first day of class, he posed the same question he asks at the beginning of every lecture: “Has anybody heard anything going on in science?” That day, he received a lot of blank stares; his students, like most people across the nation, had not yet started paying attention to the 2019-nCoV coverage, blissfully unaware of how the virus and the disease it causes would soon take center stage during classroom discussions and, of course, disrupt their very lives. But Gonzalez knew that the virus was one to watch: the first case of a 2019-nCoV infection in the U.S. was confirmed on January 20, in Snohomish County, Washington; by the end of the same month, the infected were numbering nearly 10,000 in at least 21 countries, and the WHO had declared a “public health emergency of international concern.” So he asked his students to start sharing the latest information at the top of each class meeting.
It didn’t take long, he says, “for students to start realizing that this was going to be much bigger than we originally thought.”
On February 11, 2020, the International Committee on Taxonomy of Viruses (ICTV) announced that, given the genetic relationship between the novel coronavirus and the coronavirus responsible for the 2003 outbreak of SARS, the new pathogen would be named severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2. The same day, the WHO christened the disease caused by SARS-CoV-2 coronavirus disease 2019, or COVID-19.
Meanwhile, Gonzalez and his students discussed how viruses, the smallest of all microbes, consist of DNA or RNA surrounded by a protein coat called a capsid and sometimes, as with SARS-CoV-2, by a lipid envelope that can be dissolved with soap, thereby destroying the entire particle (TL;DR? wash those hands!). They knew how viruses attach to the plasma membranes of living host cells and hack the cell’s mechanisms to replicate before detaching and invading other cells, usually destroying those cells, damaging tissues, and sickening or even killing the host organism. They discussed how viruses spread through the human population in many ways. For example, some can be passed on by skin-to-skin contact. Others can be transmitted via contaminated surfaces (disinfect those countertops!). They can spread through exposure to others’ bodily fluids and secretions, such as through sharing needles, sexual contact, or coughing and sneezing (again, wash those hands! but also wear masks to keep from infecting others!). And viruses can be carried by vectors, or disease-bearing organisms, such as mosquitoes, fleas, or bats, the last of which may have served as a reservoir for SARS-CoV-2 before it jumped to an intermediate host and then eventually infected humans—who are also possible vectors.
“It was a great learning experience,” Gonzalez reflects.
But he noticed that as the days went by, his students began expressing frustration about the governmental and public responses to the outbreak. By late February, the number of confirmed cases of COVID-19 had topped approximately 84,000 in at least 56 countries, and the death toll had climbed to 3,900, but many nations, including the U.S., were slow to react and failed to implement a unified, strategic approach to testing and prevention based on classic epidemiological models.
Gonzalez’s students wanted to know why. “And I told them, ‘We can talk about politics, but I have no idea why we’re approaching this the way we are,’” he remembers.
They also wondered aloud whether the novel coronavirus was something to be worried about considering comparisons that were being drawn between COVID-19 and seasonal influenza. Gonzalez’s response was to remind them of the flu’s grave statistics: the Centers for Disease Control and Prevention (CDC), for example, estimates that in the U.S. in 2016–2017 alone, 29 million people contracted symptoms of the seasonal flu, with 14 million seeking medical care, 500,000 requiring hospitalization, and 38,000 dying. Moreover, many people worldwide have developed immunity to seasonal flu strains, and flu vaccines exist to combat infection. By contrast, although mortality rates are impossible to confirm while an epidemic or pandemic is ongoing, the risk of death from COVID-19 appears to be higher than that from the flu. In addition, it remains unclear even now whether those who have survived COVID-19 have developed immunity, how long that immunity lasts, when a safe vaccine will be available, and when a large enough swathe of the global population will be inoculated to develop herd immunity.
Gonzalez says that his students “became more educated in all this. They became aware of the power of knowledge. And they became aware of the stress of knowledge.”
The diseases of misinformation and inadequate response
Given the store of knowledge scientists have developed based on previous epidemics, including the more recent outbreaks of coronavirus-caused diseases such as SARS (in 2003) and MERS (Middle East respiratory syndrome, in 2012), you would think that we would have been more prepared and known how to respond more quickly. And countries such as Taiwan, New Zealand, Costa Rica, Iceland, Norway, and Denmark have been highly successful in limiting both infection and mortality because they relied on science, prioritized public health, coordinated responses among institutions, acted swiftly, and garnered the trust and cooperation of its citizens.
But elsewhere, as in the U.S., Gonzalez says, it’s been clear we haven’t learned the lessons of past outbreaks. A significant etiology of the chaotic and ineffective response has been misinformation, and he believes that platforms such as Nextdoor, Facebook, Twitter are just some of the vectors to blame for the spread of false or misleading information. “One of the things that concerns me is we’re very much a social-media society now,” he explains. “Social media can be an incredible tool to get your message out, but if your message is filled with misinformation, it’s devastating to the cause… . Lives are at stake here.”
“Social media can be an incredible tool to get your message out, but if your message is filled with misinformation, it’s devastating to the cause… . Lives are at stake here.”
Ironically, one flagrant inaccuracy Gonzalez saw floating about was a comment about vaccines in which the poster opined that “‘scientists were lying.’” Understandably, Gonzalez had to refrain from responding, and he now limits his media diet to reporting by the CDC and the BBC, the British news channel. “I haven’t checked it recently, but I can imagine my blood pressure is up a little bit,” he laughs.
In the absence of accurate and clear communication—not to mention the lack of other standard epidemiological strategies, including widespread reliable testing, quick diagnosis and quarantine, and contact tracing and isolation—the U.S. federal response to the disaster has been, well, disastrous. The most glaring symptom of this failure is that the country’s tally of infections and deaths far surpasses that of any other country: on May 24, the U.S. exceeded 1.6 million confirmed cases and 100,000 deaths, and at the time of this publication, a day shy of one month later, that death toll has risen to 120,225, with well more than 2.29 million confirmed cases. Another complication of the U.S.’s messy response has been a host of avoidable draconian interventions with wide-ranging impacts on human behavior and the economy, such as social distancing, stay-at-home mandates, and school and business closures—sacrifices that became necessary to “flatten the curve” (i.e., reduce the number of infections to prevent overburdening the healthcare system) but would also lead to upheaval in the lives and learning of Southwestern’s own staff, faculty, and students.
But one other adverse effect of the lack of a coordinated national response has been a shortage of life-saving medical supplies. States, for example, were left to compete for ventilators, and healthcare providers were forced to reuse or go without personal protective equipment (PPE), jeopardizing the lives of the very people who can actually treat the disease. “I think what is most frustrating is we’re putting people on the frontlines of this pandemic in danger,” Gonzalez shares. He felt so strongly about the supply crisis, in fact, that he broached to his colleagues in the Biology Department a way they could help. “I said, ‘We have all these gloves we’re not going to be using because we’re not having labs or classes, and we have a good stock, so we can donate them!’” he recalls. The biology faculty consulted with Southwestern’s administration, and their colleagues in the Chemistry Department volunteered to donate their equipment as well. “It’s one of those things where you’re saying, ‘I shouldn’t have to be doing this, but we’re doing it,’” Gonzalez adds.
Positive outcomes and outlooks
Despite his and his students’ deep concerns about the way the COVID-19 pandemic has been handled, Gonzalez saw some glimmers of positivity and hope when stay-at-home orders were in effect—from the community wanting to support local restaurants by ordering takeout and neighbors offering to pick up items from the grocery store to help protect those who are greater risk of developing serious illness, such as those 65 years and older or those with underlying medical conditions, such as diabetes, heart disease, or compromised immunity. “From that standpoint, it’s been very uplifting for me,” he says. “Some of the community is wanting to make a difference and looking to help.”
He also celebrates the many breakthroughs of his STEM colleagues around the world, who have worked tirelessly in the past few months to advance knowledge of COVID-19 —and over the years and decades to improve our learning about infectious diseases more broadly. He loves seeing publications such as Nature encouraging scientists to share their latest findings “to expand our understanding and build this knowledge base.” And he looks forward to discoveries that might be just around the corner, such as a universal vaccine that provides long-term immunization against all influenza types or a platform vaccine, long advocated by National Institute of Allergy and Infectious Diseases Director Anthony Fauci, which would enable researchers to begin the first phase of clinical trials for new vaccines within months rather than years. “You have no idea how much pride I had when it was less than two weeks after [the COVID-19 pandemic] started rolling that the global scientific community came out with a genetic sequence for [SARS-CoV-2],” he says excitedly. “That’s why I fell in love with science: it’s truly a community. When we publish papers, we police each other by doing peer review, and people will try to reproduce some of your results. We’ve been doing this for a long time, and it’s worked. I’ve been really happy with that.”
“You have no idea how much pride I had when it was less than two weeks after [the COVID-19 pandemic] started rolling that the global scientific community came out with a genetic sequence for [SARS-CoV-2].”
Gonzalez says that we still have much to learn about SARS-CoV-2 and COVID-19, but even after the current pandemic ends, we cannot be complacent going forward; instead, we must apply the lessons of yesterday and today. “We can look at some of the earliest Old World infectious diseases—things like dengue fever, yellow fever, and malaria. It took something like 300 years for those three diseases to be found on most places on this planet,” he explains. “And then you look at the global society we are now and look at some of these new emerging infectious diseases, such as West Nile virus, Zika virus, and Chinkungunya virus. It’s taken them less than 16 years to be found pretty much on a very large percentage of this Earth.”
Moreover, Gonzalez adds, we have yet to fully comprehend the many twists and turns of infectious disease. For example, how might climate change accelerate or exacerbate the spread of such illnesses? When will the next single mutation in a known virus enable the sudden transmission of the pathogen from animals to humans, as was the case of SARS-Co-V-2? We were fortunate that the coronavirus that causes MERS, a disease with a 35% case–fatality rate, did not easily transfer between human beings, but what if a more robust MERS-CoV-2 were to emerge? And what if Ebola—a fast-spreading disease with quickly manifesting symptoms and a shocking mortality rate as high as 90% in some WHO estimates—were suddenly contagious when carriers were asymptomatic (i.e., not exhibiting symptoms)?
“We need to be prepared for this,” he asserts. “This is not something where we can sit there and say, ‘As soon as this starts happening, we’ll jump.’ We need to be working at this right now.”
However, scientific discovery and innovation require opportunity and resources—including both money and time. The media’s pursuit of big stories and eye-catching headlines might suggest that scientific progress happens by leaps and bounds within days or weeks; the anxious public may be impatient for answers about a public-health crisis that is shaping individual lives. Nevertheless, good science requires time: time for research and development, time for experimentation and failure, time for correcting errors and replicating results, and time for collaboration and peer review. “Yes, [scientists] can figure it out, but it takes time,” Gonzalez says. “Science is not ‘do one experiment and have a result.’ It just didn’t work that way. I wish it did!” he laughs.
And with the COVID-19 pandemic, that scientific progress is actually happening fairly quickly, regardless of what naysayers might think or say. But because of the relatively rapid pace of research on SARS-CoV-2 and COVID-19, scientific findings and recommendations shared with the public can change, sometimes in the course of just weeks. After all, scientists are constantly expanding on previous work, discovering new phenomena, and drawing conclusions from the latest evidence. Their work can also be misinterpreted and misreported—accidentally or intentionally—by journalists, pundits, and social-media frequenters. And in a heightened atmosphere characterized by fear of the unknown and suspicion of the very science we should be relying on, Gonzalez knows moving forward will require “a lot of education.”
“As I’ve always said, trust the science,” he says. “The science will police itself and will let you know if there’s something you shouldn’t be listening to.”
Gonzalez will continue urging his students to use the communication skills they’ve gained at Southwestern to share their scientific knowledge with their families, friends, and communities.
In the meantime, Gonzalez will continue urging his students to use the communication skills they’ve gained at Southwestern to share their scientific knowledge with their families, friends, and communities. It’s a practice that he hopes will prevent his students from caving to fear, will keep their circle of connections informed, and will ensure the health and safety of their loved ones. Says Gonzalez, “That’s the one thing I’ve really told my students: ‘Whether this [pandemic] was going on or not, you’re going to be part of a community, and there are times when a community requires a voice of reason. Your job is to go out there, use what you’ve learned, and bring that voice.’ I hope they do it; I really do.”
- The Centers for Disease Control and Prevention (CDC), Coronavirus (COVID-19)
- Johns Hopkins University & Medicine, Coronavirus Resource Center, World Map, and Animated Maps
- JSTOR, A Science Reader for COVID-19
- The New England Journal of Medicine, COVID-19 resources collection
- The New York Times, The Coronavirus Outbreak
- The Smithsonian National Museum of Natural History, Outbreak: Epidemics in a Connected World
- The World Health Organization (WHO), Coronavirus Disease (COVID-19) Pandemic