2020 – The Good and the Bad

There is no doubt that 2020 will be remembered as an extraordinary year, mostly because of the worst pandemic in a century. Worldwide the pandemic has infected more than 78 million people with more than 1.7 million deaths. In the US there have been more than 18 million infections and more than 321,000 deaths, which is almost certainly an underestimate. As the year comes to a close the pandemic is far from over – we are in the middle of the third and largest wave, which will likely get a boost from holiday gatherings, and with a long winter yet to come.

The pandemic has exposed the best and worst of humanity, and highlights just about everything that we deal with at Science-Based Medicine. Let me start with the good news. The emergence of a novel coronavirus, SARS-CoV-2, which causes COVID-19, was partly a scientific challenge to the world. At the end of 2019 there was an outbreak of an infectious respiratory illness in Wuhan, China, with the first 4 cases being identified on December 29^th. By January 9^th the WHO announced the outbreak of a possible coronavirus illness in the region, beginning travel advisories. By January 12^th the virus itself was isolated from epithelial cells taken from infected patients. On January 24, the Chinese scientists who identified the virus published a complete genomic sequence in the NEJM.

In less than a month from the first warning that a respiratory illness of unknown origin was possibly identified in a hospital in Wuhan, we had the complete genetic sequence of the responsible virus. Amazingly, with the genetic sequence in hand, it took Moderna just 2 days to develop a vaccine. It may be frustrating to know that we have had an effective vaccine against the pandemic the entire time, but we only know that in hindsight. The months were spent testing the vaccine for safety and efficacy, in an expedited process, but still it takes time. Meanwhile many other vaccines were in development as well. By the end of 2020 we now have more than 50 vaccines in development around the world, with several at least preliminarily approved. In the US the Moderna vaccine and another mRNA vaccine from Pfizer-BioNTech have EUA’s and are being distributed, with more than 2 million doses already given.

We do have to marvel at that timeline – in less than a year we went from an unknown novel infectious illness to multiple effective vaccines being distributed. In the future that timeline could be further compressed. Once the mRNA vaccine platform is proven safe and effective, the clinical trial phase can be further streamlined. Again – the vaccine itself existed within two days, we just need to decide how much testing is necessary prior to distribution.

During this time we also learned a great deal about the virus and the disease it causes. Within the first six months there were over 23 thousand scientific papers published about the pandemic. We learned about the typical course of the disease, best practice for treatment, vulnerable populations, and developed some therapeutics. The illness case fatality rate has been decreasing due to this improving knowledge. We also learned how the virus spreads and how to prevent it. I think by any measure we have to consider the scientific response to the challenge of this pandemic a stunning success.

We can also consider the professional response – how did the medical community handle the challenge of being swamped with cases of a new and serious illness? There, too, I think the robustness and professionalism of the medical community came through. Healthcare workers calmly risked their lives to treat patients. Hospitals rapidly developed new protocols to minimize spread. Intensive care units had to make do at times with insufficient resources. Overall, it was a heroic effort that saved numerous lives and helped contain this pandemic. In one estimate, by September in the US more than 1,700 healthcare workers died from COVID-19.

From a political perspective, the response of governments to the challenge of the pandemic was mixed. Some countries did well, while others failed. The US, unfortunately, did worse that most comparable nations, with a too-little-too-late response in almost every area. We had too little PPE (personal protection equipment) which contributed to the healthcare worker and other frontline worker fatalities. We had too little testing and contact tracing. We lacked a coherent national strategy, or clear mandates coming from the top that the public should wear masks and socially distance, with blatant public violations by some leaders. We wasted a shutdown which only delayed the spread, by failing to combine it with adequate testing and therefore were not able to calibrate the reopening optimally.

The COVID pandemic also provoked a parallel pandemic of misinformation, conspiracy theories, and pseudoscience. This was entirely predictable, especially by those engaged with science communication focused on countering pseudoscience. Of course, magic CAM treatments came out of the woodwork. The anti-vaxxers started opposing COVID vaccines before they even existed. And there were the pandemic deniers – denying that masks work, downplaying the severity of COVID, or denying the pandemic altogether.

In all, the pandemic served as a giant example of “what’s the harm” when it comes to medical pseudoscience. Allowing conspiracy theories, lack of trust in experts and professionals, anti-science attitudes, and pseudoscience to simmer in a society has demonstrable harm. One such harm is that it weakens our ability to respond to a challenge like the pandemic. It’s impossible to calculate how many excess deaths there have been as a result, but it is plausible (looking at other countries with a more optimal response) that the US could have kept pandemic deaths to less than 100,000 with a more coordinated response. This means that (again, we cannot prove what would have happened, but it is plausible) over 200,000 excess deaths occurred (so far) because of our bungled response, which was due to a failure to properly listen to the experts and follow their advice.

The pandemic highlighted both the growing power of our advancing science, and the harm of rejecting science and expertise for conspiracy theories and pseudoscience. I doubt we will collectively learn this lesson, but at least we will do our best to point it out whenever we can.