On Jan. 19, 2020, a 35-year-old man showed up at an urgent-care clinic in Washington State, complaining of a cough and fever — symptoms that would soon worsen into what presented like a serious case of pneumonia. He’d just returned from Wuhan, China, where he had family. This man was the first U.S. case of Covid-19. “We in the virology community had a serious ‘I think we’re fucked’ moment in the first weeks of February 2020,” says Eric Bortz, a University of Alaska-Anchorage virologist and public-health expert. The first Covid death in the U.S. is a matter of debate. In the early days of the pandemic, many doctors and medical examiners struggled to pin deaths on the newly-identified virus. But attributing deaths to Covid got easier as cases piled up.
That was more than two years ago, and now a million Americans are dead from the SARS-CoV-2 virus. After several successive waves of infections from a series of variants of the basic pathogen, as well as a historic effort to develop new vaccines and therapies, cases and deaths are dropping almost everywhere. Covid is finally getting closer to “endemicity”— that is, the point where many officials consider it a manageable problem without major restrictions on schools, businesses and travel.
But the possibility of endemicity doesn’t mean we did our best — with nearly a million dead, and untold millions more suffering Long Covid after effects, it’s something that will continue to haunt our country. Looking back at 30 months of uncertainty, social disruption, scientific triumph and political mismanagement, it’s clear we could have done a lot better to contain the virus, treat the disease it causes and prepare for whatever virus might follow SARS-CoV-2. Our biggest failure: communicating accurate information, responsibly, and in a way people can use.
Sloppy messaging from health experts and government officials, exacerbated by rampant–and sometimes deliberate–misinformation not only prolonged the current pandemic, it’s already undermined our response to the next pandemic, by seeding skepticism of good science and public-health policy in the minds of millions of under-informed Americans.
Misinformation Derailed Vaccination
Mere weeks into the pandemic, loose coalitions of the world’s leading vaccine-designers, biggest pharmaceutical firms, and richest governments had formed parallel efforts to develop new vaccines specifically for Covid. Beijing’s Sinovac Biotech Life Sciences got there first, with a simple, two-dose “killed-virus” vaccine that the Chinese government authorized starting in August 2020. That December, Moderna and Pfizer-BioNTech had their two-dose mRNA vaccines approved, and soon after came Johnson and Johnson’s.
“The United States’ singular success with Covid-19 undoubtedly is the development of mRNA vaccines in record time,” says Lawrence Gostin, a Georgetown University global-health expert. “The public-private partnership that brought the world this historic scientific technology has been transformational.”
At first, things looked good: in the spring of 2021, Americans got vaccinated at a rapid clip, with a record 4.5 million U.S. residents getting jabbed on April 1. The country seemed to be on track to reach the Biden administration’s goal of getting 70 percent of adults at least partially vaccinated by July 4.
Then things got messy. Vaccination uptake stalled out as the ranks of anti-vaxxers swelled. The country missed the July 4 deadline by four months. Families with kids under five, who had wrongly been assured early on that their children weren’t as susceptible to the disease, didn’t even have the option to immunize their kids, leaving them effective hostages to the unwilling masses.
“The sad reality is that there is a significant number of Americans who do not appear to be able to wrap their minds around the potential severity of the infection with the coronavirus that causes Covid-19,” says Bortz. “Misinformation has been rife, and it’s damaging.”
At every turn, the government failed to break the misinformation cycle. And at times, official fumbling made the information problem worse. “We didn’t communicate this vaccine as well as we could’ve — and kept inadvertently damning it,” says Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia.
For starters, the government and scientific community never clearly addressed the false claim that the vaccines don’t help prevent the spread of Covid even when they do reduce the severity of infection. “Very early, we created the misperception that if you’re vaccinated and had mild illness, or unvaccinated and had mild illness, you’re equally contagious,” Offit says. “That’s wrong. It also damned the vaccines.”
By the time the Biden administration took over from Trump in 2021, the politicization of the vaccine had already firmly taken hold.
“While the general public is to be commended for doing their part to be safe, a major concern has been the degree of vaccine-hesitancy and unwillingness to engage in protective behaviors such as wearing face masks and social-distancing by many,” says Anthony Alberg, a University of South Carolina epidemiologist. “Attempts by leaders, including former president Trump, to turn these into political rather than public-health issues has exacerbated these issues.”
Mishandling of Variants
A surge of infections in the summer and early fall of 2021, attributed to the deadlier Delta variant, was just a preview of even worse things to come. The new Omicron lineage reached the U.S. in late November. Omicron evolved to be less virulent than Delta, explained John Swartzberg, a professor emeritus of infectious diseases and vaccinology at the University of California-Berkeley’s School of Public Health.
But the new lineage’s sky-high transmissibility more than made up for its overall mildness. Experts described the basic Omicron lineage–BA.1 following by BA.2 and others–as the most contagious respiratory virus they’d ever seen. Its sublineages were ever more contagious. “BA.2 is somewhere between 30 percent and 80 percent more transmissible than BA.1,” Swartzberg said.
Cases skyrocketed, dragging hospitalizations and deaths higher, too–and prompting the FDA to begin authorizing booster shots of the leading vaccines.
The majority of Americans were protected by some combination of natural immunity–the antibodies and T-cells left over from past infection–and vaccination. For them, Omicron usually registered as a bad cold or a case of the flu. New antiviral drugs, including Pfizer’s at-home Covid pill paxlovid, reduced the risk of death following infection, including in those rare symptomatic cases in the vaccinated.
But kids under five still weren’t eligible for the vaccines, and 20 percent of U.S. adults–50 million people–refused to get jabbed under any circumstances. One branch of government was on their side. In a shocking act of anti-science judicial activism in January, the U.S. Supreme Court struck down a rule from the U.S. Occupational Safety and Health Administration requiring employers with a hundred or more workers to mandate vaccines or weekly testing.
With Omicron’s arrival, Covid has become a pandemic of the unvaccinated. Most Americans are protected against the worst outcomes. For them, a new kind of normal is possible at minimal risk. It’s no surprise then, that in February the last big states with major Covid restrictions began lifting them. Following a series of court orders by right-wing federal judges this spring, there were almost no restrictions left anywhere in the U.S.
Like it or not, the country is moving closer to “endemicity,” that point where a disease is always present but manageable at a cost many people consider acceptable. For the unvaccinated millions, however, endemicity could still be very, very dangerous. SARS-CoV-2 isn’t going anywhere. New lineages are coming. Most of us should be fine. A lot of us might not be.
Nervously Looking Forward
That gap between the vaxxed and unvaxxed wasn’t inevitable. Clearer and more forceful messaging might have convinced a few million more Americans to get vaccinated–and saved the lives of thousands of them.
Now it’s too late for them, and experts worry what might come next. There will be other pandemics in future, perhaps caused by one of the dozens of dangerous coronaviruses that are present in animal populations–they’re “zoonotic,” to borrow a scientific term — but haven’t yet made the leap to the human species. “I think that we should really be looking at the idea of ‘nightmare’ viruses in terms of zoonotic viruses that we have yet to encounter,” said Stephanie James, the head of a Covid testing lab at Regis University in Colorado. “The combination of climate change, population density and urban expansion is worrisome because I think we will continue to see novel viruses with the capacity to cause human disease. I think we need to continue to be cognizant of this and prepared for the next viral pandemic.”
Lucky for us, the same basic technology that helped us quickly develop a vaccine for SARS-CoV-2 could help us whip a new jab for, say, SARS-CoV-3. MRNA technology is inherently flexible. Plug in new genetic information and you’ve got a whole new vaccine. The current pandemic blessed us with the technology to get ahead of the next pandemic, thanks to world-class collaboration between government, science and industry.
“In addition to our frontline healthcare workers, the other unsung heroes of the pandemic response are the myriad scientists working in public health departments, universities, hospital labs and the biotechnology sector, who have built the foundation and advanced the molecular technology for vaccines, diagnostics and therapies,” Bortz said. “This infrastructure will help mitigate the next pandemic and must be supported vigorously.”
But the current pandemic also cursed us with a bigger, angier anti-vaxx minority that also has key allies in local and state government, the U.S. Congress and — most worryingly — a rogue Supreme Court that is less concerned with the law and public health than with handing “wins” to a right-wing fringe. “The Court is eviscerating the very ability of the federal government to protect Americans,” Gostin said in a statement. “The justices are overturning decades of precedent upholding federal public-health powers.”
When, not if, the next pandemic strikes, scientists should be able to whip up a new vaccine in just a few months. But tens of millions of Americans will be inclined to reject the jab outright. And a lot of them could die as a result.
Delivering a lifesaving public-health message through a fog of impassioned bullshit could require major reforms, says Jeffrey Klausner, a professor of medicine and public health at USC. “If there are places like West Point and Annapolis to train military leaders, similar places should exist to train public-health professionals.”
That kind of change could be hard and expensive, but it’s also necessary. “We need to build public trust in public health agencies,” Gostin said. “Disinformation was a huge problem with Covid-19, so finding ways to ensure more scientifically accurate information, especially in social media, is vitally important.”