One pandemic year later, what’s next?

A city the density of Atlanta or Milwaukee, over a half-million strong, tragically has been wiped from the face of America’s future. Thousands of businesses disappeared, never to return. Millions remained out of work or hardly strayed out of their home, for work or play.

A dose or two of hope, however, arrived near the end of the pandemic’s first year in the form of not one, not two, but three record-breaking vaccines for the dreaded, unseen virus that causes COVID-19.

So where do we go from here, in the second year in these times of coronavirus?

As we mark the one-year anniversary today of the World Health Organization first declaring a global COVID-19 pandemic, Washington University in St. Louis experts, including from its School of Medicine, look both back and ahead.

Variants will require ‘boosters’; will historic shot-making continue?

“Never forgetting the tragic loss of more than a half-million Americans, the past 12 months have witnessed the remarkable discovery, development and distribution of vaccines based largely upon new or unproven technologies. Consider the time needed merely to identify a novel pathogen and begin testing vaccines against it. This span has historically been measured in decades or centuries, with measles holding the recent record, progressing from discovery to testing in just over 10 years. To put this amazing achievement in perspective, the time that elapsed from the identification of SARS-CoV2 until the first vaccine trial occurred in as many weeks.

“Just as remarkable is the fact that the clinical trials for these vaccines were executed with unprecedented efficiency, with three safe and effective vaccines authorized within one year; an achievement that many – including myself – felt impossible months ago. Yet all of this pales in comparison with the final outcome: safe vaccines that block the most dangerous forms of COVID-19. These outcomes have surpassed expectations and reflect an amazing cooperation amongst scientists, physicians, regulators all around the world. From a personal standpoint, I transitioned from merely analyzing clinical trials to volunteering in one. This experience conveyed a new view of our work at the Center for Research Innovation in Biotechnology (CRIB) at Washington University.

“This work is nowhere near completion, though. The rapid and widespread transmission of COVID-19 is creating new variants that will challenge and confound vaccines and treatment. Mutation is a particular specialty of viruses, and SARS-CoV2 is no exception. Given the virus has largely run amok for the past year, these variants could erode the efficiency of vaccines deployed and will likely require updated ‘boosters’ to ensure the hot embers of COVID-19 do not flare into renewed conflagrations.

“Yet, we can rest assured that the amazing scientific and medical momentum achieved over the past 12 months will not abate. Better still, the experiences of the past year may facilitate new and equally exciting opportunities to prevent and treat future microbial pathogens as well as longstanding microbial nemeses and many cancers.”

Michael Kinch, PhD, associate vice chancellor and director of the Centers for Research Innovation in Biotechnology (CRIB) and Drug Discovery (CDD).

Race, religion and the vaccine

“The rate of vaccination amongst African American communities is significantly lower than the general public. This is concerning as African Americans comprise a high concentration of frontline jobs, that is employment that requires in-person labor.

“African Americans, for actual historical reasons, have cited distrust of the medical profession as one reason for their hesitancy to be vaccinated.

“However, several cities and states including Tallahassee, Philadelphia and Toledo, Ohio, have experienced significant success educating, testing and vaccinating African Americans within faith communities. This success draws upon the historic and current role Black faith communities specifically and Black activist groups more broadly have played in social-service delivery, especially regarding health and banking. The reality of the social authority of Black clerics also contributes to such success.”

Lerone Martin, PhD, director of American Culture Studies in Arts & Sciences and associate professor of religion and politics in the Danforth Center on Religion and Politics

Vaccinate, mitigate, remove emotion – still, trying path lies ahead

“Having millions of doses of three fully tested, safe and effective vaccines within 12 months of a pandemic virus first being identified is mind-boggling. And over the past year, we have learned that human connection is precious and dearly missed when it is taken away; rational decision-making based on scientific evidence is difficult during a pandemic and that we often make decisions based on emotion; and systemic racism is real and can have direct large-scale detrimental effects on health.

“Most challenging in the past year has been watching a mounting death toll in the face of reluctance to consistently message and model the behaviors that would have averted many deaths. A major challenge in the next six months will be navigating how to emerge from the pandemic safely. Some will ditch mitigation measures too quickly and others will cling to them for psychological safety beyond the duration they are needed. How do we factor into the reality that vaccinated individuals have less, but not zero, risk when not everybody has yet had a chance to be vaccinated? How will requiring proof of vaccination further lead to inequities?”

Steven Lawrence, MD, infectious disease expert, who studies how to better understand the natural history, impact and mitigation of potentially large-scale infectious disease outbreaks

Curtain pulled back on public health funding, inequities

“The pandemic placed a bright spotlight on public health. It was at the same time gratifying to see higher visibility for public health and recognition of its ability to make a difference in the daily lives of our population … but also troubling to observe our underinvestment in public health.

“The pandemic pulled back the curtain on inequities in society that are in need of immediate attention. We also have seen how the ever-changing information ecosystem affects public health. For example, due in part to a rise in disinformation and heavy use of social media, we now know that false information spreads up to six times more quickly than accurate information.

“There are multiple windows of opportunity to create a brighter future for public health – allowing us to be more prepared for the next public health challenge. First, we need to elect, appoint and cultivate leaders who support evidence-informed policy making. Next, we need to reinvest in public health practice. Without this investment, a new discovery – e.g., the COVID-19 vaccines – will not be deployed effectively and efficiently, with a well-defined and -funded vaccination campaign. Third, we need to address health and social justice issues across society – we will not achieve population health until we have justice in all sectors, including transportation, education, employment, economics and law enforcement.

“And, finally, we need to identify and teach the critical new skills for the future public health practitioner – issues such as crisis management and communication, policy advocacy and systems thinking.”

Ross Brownson, PhD, the Steven H. and Susan U. Lipstein Distinguished Professor of Public Health

Due to our tattered fabric, ‘we may have to live with (this) forever’

“We’ve learned that it is entirely possible to not only flatten the curve, but end the pandemic through modifying behavior. But you have to have the right mobilization and social and economic fabric to do so – and we did not.

“The fact that this epidemic may not come to a close, with emergent COVID variants circulating, is something we may have to live with forever. The world will have a hard time accepting that.”

Elvin Geng, MD, epidemiologist and an infectious diseases physician. During the pandemic, he helped to develop a platform to track information about local transmission that officials needed to make public health decisions.

Nurse practitioner Marsha Johnson (second from left, attending physician Rachel McDonald, MD, and other members of the COVID-19 care team talk outside of a patient room in the Barnes Jewish Hospital ICU, Nov. 5, 2020. (Matt Miller/Washington University)

School closures ‘sideline’ working mothers

“Our research shows schools are a vital source of care for young children, and without full-time, in-person instruction, mothers have been sidelined from the labor force. The longer these conditions remain in place, the more difficult it may be for mothers to fully recover from prolonged spells of non-employment, resulting in reduced occupational opportunities and lifetime earnings.

“Without more support from fathers, employers and the government, something had to give under this unsustainable pressure. What seems to be giving is mothers’ employment.

“This is an injustice with long-term consequences for mothers’ job prospects and economic stability. These are not personal problems, but deeply political issues that require policy interventions. Well-funded and evidence-based reopening plans are necessary to allow children to return to school face-to-face, and to allow parents to engage in paid work.

“Now, more than ever, it is crucial that federal and state governments invest in expanding the public care infrastructure for children of all ages.”

Caitlyn Collins, PhD, assistant professor of sociology in Arts & Sciences and study co-author

How to cope with pandemic anniversary emotions

“People have shared so many different feelings: loss, loneliness, hopelessness, anxiety, depression, boredom, frustration. A lot of us are feeling these things, but for some people they are much more intense, especially for those who have lost access to people or activities that have helped them manage difficult feelings in the past.

“Over the past year, the boundaries between our home lives and our professional lives have changed. During quarantine, we may have attended meetings from our living room or taught class from a bedroom. Email communications have multiplied exponentially because we don’t run into people in the hallways or break rooms like we used to. The expectations for constant work engagement have soared. I think this will be hard to roll back.

“This shared nature of this vulnerability could, in theory, be a source of solidarity and strength. And for some people it has been. Unfortunately, it has also brought out some of the uglier dimensions of our society, as public health measures became deeply politicized and a zero-sum mentality prevailed. Younger generations have watched all of this unfold.”

Rebecca Lester, PhD, professor of sociocultural anthropology in Arts & Sciences

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