“It has to be the flu.”
Jana Shaw had been sick before. After she was diagnosed with rheumatoid arthritis at 18 months old and prescribed immunosuppressants ever since, her life had been punctuated by bouts of illness. But this seemed worse, almost the sickest she’d ever felt. The body aches alone made her cry out. Her fever raged. She struggled to breathe.
Her doctor tested her for flu. Negative. Later, when she didn’t get better, she tested again. Negative.
“I’m stumped,” she remembers her doctor saying.
Shaw had caught whatever it was from her dad, a traveling salesman who became sick after a domestic trip. Her grandmother, who was 91 at the time and lived with them, fell ill, too.
It was mid-January 2020. The Centers for Disease Control and Prevention would confirm the first COVID-19 case in the U.S. on Jan. 20.
Two years later, Shaw doesn’t know if what she caught was COVID-19, though she suspects it was. For her family and the world, that spring was a season of questions, not answers.
“Everyone wanted certainty where there was no certainty, myself included,” said Dr. Jo Anna Leuck, an emergency medicine physician and assistant dean of curriculum at the TCU School of Medicine.
Now, as a new year brings caseloads that far eclipse previous peaks, and as COVID-19 deaths in the U.S. approach 850,000, Leuck said she’s felt a sense of deja vu. “It does feel somewhat like it did (in 2020), right? We went to spring break, and then we never came back.”
But this time, amid ongoing uncertainties, answers exist. The novel coronavirus, and whom it affects and how, and what can be done about it, is not the enigma it once was. “We really are further along,” she said.
We understand the virus better.
Diana Cervantes was teaching an infectious disease epidemiology course at The University of North Texas Health Science Center when she heard murmurs of a virus wending through China. She discussed the news with her students.
“We just talked about, what are the aspects of a virus that make it an effective and efficient virus?” she said.
An infectious disease epidemiologist herself, Cervantes was watching how the virus spread: whether people with mild symptoms or without symptoms could transmit it, how they did so, and if the virus could create what she calls a “sustained transmission chain” from person to person. Those characteristics would help determine if the virus would “fizzle” or become a pandemic.
In late January, the CDC confirmed that the new coronavirus — which would soon be named SARS-CoV-2 — had spread from person to person in the U.S. Within months, the CDC would theorize how the virus predominantly spread: through respiratory droplets between people in close contact with each other. (These droplets, typically too small to see, are responsible for your glasses fogging up while you’re wearing a mask.)
Two years later, that understanding remains.
Furthermore, a person with COVID-19 can be contagious two days before symptoms appear, but can spread COVID-19 even when asymptomatic. This characteristic enables the virus to transmit more effectively, because people spread it without knowing they’re infected, Cervantes said.
We know which protections work against it.
Like Shaw’s doctor, Leuck couldn’t quite put her finger on why some of her patients were so ill in early 2020. Leuck is an emergency medicine physician at Texas Health Harris Methodist Hospital in Fort Worth.
“I remember working a shift in late February, and thinking, ‘This is so weird. It seems like everybody’s got the flu and pneumonia,’ but nobody was testing positive for the flu. And we just didn’t know,” she said. “I really think that that was COVID, even then.”
The high caseloads she’s seeing because of the omicron variant feel reminiscent of those early months. This time around, though, she’s feeling “much more hopeful.”
“The vaccine has changed everything,” Leuck said.
The U.S. Food and Drug Administration authorized the Pfizer vaccine for emergency use on Dec. 11, 2020, nine months to the day after the World Health Organization declared COVID-19 a pandemic. The Moderna vaccine received the same authorization a week later.
Thirteen months later, nearly 208 million people in the U.S. — more than 60% of the total population — are fully vaccinated. More than one-third of those people have also received a booster dose.
Anyone 5 and up can be vaccinated; anyone 12 and up can be boosted.
“I will never cease to be impressed with how quickly we were able to use some existing research and technology and come up with what really has proven to be a safe and effective vaccine,” Leuck said.
The vaccine and booster don’t keep everyone from contracting COVID-19, but they protect people from “the sick that matters,” she said: the sort of sick that requires intensive hospital care.
In Texas, for example, people who were fully vaccinated were 45 times less likely to become infected with COVID-19 than people who weren’t vaccinated in the first nine months of 2021, according to a report from the Texas Department of State Health Services. During the same time period, people who were fully vaccinated were 40 times less likely to die from COVID-19 than people who weren’t vaccinated.
In March 2020, for example, the CDC said only people who were sick or caregivers needed to wear a mask. On April 3, 2020, however, the messaging changed: “Everyone should wear a cloth face cover when they have to go out in public, for example to the grocery store or to pick up other necessities.”
“Masking has been so central to this pandemic,” Cervantes, with the Health Science Center, said.
But the accumulation of scientific evidence supporting masks didn’t happen quickly. “It took time,” she said. “It takes time.”
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We’ve made strides in treatments.
The development of treatments for people with COVID-19 has likewise required patience. When the pandemic began, “there was very literally no known treatment,” Leuck said.
As early as March 2020, the FDA authorized various treatments that made headlines, including hydroxychloroquine, a drug for malaria that former president Donald Trump touted (and whose emergency use authorization the FDA later revoked); remdesivir, the first COVID-19 treatment to gain full FDA approval; and sotrovimab, a monoclonal antibody treatment that, so far, seems to still work against the omicron variant.
Other potential treatments, like ivermectin, a drug used to treat parasites, gained popularity — and scrutiny. (A preprint study that suggested ivermectin could reduce COVID-19 death rates by over 90% was withdrawn in July 2021.) Both the CDC and the FDA recommend against taking ivermectin to treat COVID-19.
The FDA authorized three therapeutics in December 2021: two treatment pills, one from Pfizer and one from Merck, and a monoclonal antibody therapy called Evusheld, meant to prevent COVID-19 infection.
Clinical care, too, has come a long way. Patients hospitalized for COVID-19 fare well with steroids like dexamethasone and supplemental oxygen, Leuck said. The COVID-19 Treatment Guidelines Panel has further recommendations for the treatment of hospitalized patients, depending on their level of severity.
While these developments “don’t make (COVID-19) snap-of-the-fingers go away, we are at a much better place than when this pandemic started,” she said.
When Jana Shaw fell ill in early 2020, she used an inhaler and slept. (During her waking moments, she binged Gilmore Girls.) Two weeks passed before she began to improve. Her grandma struggled to get out of bed. Her dad, who has cancer, had a lingering cough.
All three of them have increased risk for severe COVID-19 illness, and all three healed from whatever it was they caught. After her doctor gave her the go-ahead, Shaw received the vaccine and booster. Doing so gave her a sense of security she hadn’t felt in a long time.
“It is still scary,” she said, “but — I’m not in the medical field — but it seems like they have a better handle than they did in March (2020).”
For Cervantes, the onslaught of data about COVID-19 has been a triumph and a challenge. The pace and scope of information has outstripped the scientific community’s ability to quickly sift and interpret it, she said.
“It’s small steps,” she said. “It’s progress and not perfection.”
For Leuck, one central question lingers. She wonders what a new normal might look like, one that addresses but isn’t dictated by this virus: “How do we keep living — with COVID — but then also be able to pivot when we have spikes like we’re having now?”
Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.