Short Wave - Reflections On Coronavirus A Year In

Episode Date: March 18, 2021

It's been about a year since the World Health Organization declared the coronavirus a pandemic. The world has learned a lot in that time — about how the virus spreads, who is at heightened risk and how the disease progresses. Today, Maddie walks us through some of these big lessons.Reach the show by emailing [e-mail] pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

You're listening to Shortwave from NPR. Hey, everybody. Emily Kwong here with Maddie Safaya. Hi, Maddie. Hi, Emily. So last week marked one year since the World Health Organization declared the coronavirus a pandemic. COVID-19 cases in more than 100 other countries are rising. Here in the U.S., a thousand people are now confirmed with the virus. At least 30 have died. Dr. Anthony Fauci told Congress today it's going to get worse. In the U.S., those first reported cases were on the West Coast, and soon we had the outbreak in New York. Medical staff have been describing warlike conditions in hospitals. More than 6,000 people have died throughout New York State, most of them in New York City. The start of this pandemic was so painful, and I remember wondering how bad it was going to get, and then the virus started to pop up everywhere.

And at that time, we didn't really know that much. Like, that's right, yeah. how people even got the virus. We're still working out how much is it by human, human transmission, and how much is it by surface? How deadly it would become, what all the symptoms were. Yeah, in the early months, we were learning so much so quickly, but also not quickly enough, if that makes any sense. It does. I mean, we really have learned a lot over this last year at tremendous cost. Yeah.

And so I think one way to honor that loss is to really. reflect on those lessons and actually make use of what we've learned. Because, Emily, we are not done with this pandemic yet. Nope. So today on the show, we look back at this last year and talk about some of the big lessons we've learned along the way. This is Shortwave, the Daily Science podcast from NPR. Okay, Emily, we have learned way more than we can cover in one show. So today we're going to focus on three areas. how people get it, who's getting it, and what this disease looks like, because our understanding of those has changed a lot over the last year. It has. Okay, let's start with how people get it. Tell me about that. Sure. So I talked with Lindsay Marr about this because she studies how viruses behave in the air.

She's a professor of civil and environmental engineering at Virginia Tech. And she described our understanding of transmission in the beginning of the pandemic like this. There was a lot of, I think, attempt to keep people from panicking. And so to kind of downplay the spread of it and to really focus on transmission at close contact. And then there was a lot of talk about contaminated surfaces. Yeah, I remember this. In the beginning of the pandemic, I was panic buying disinfecting wipes, texting relatives about wiping down their groceries, that kind of thing. Yeah, we know now that contaminated surfaces aren't playing a big role.

in transmission. And when we did talk about person-to-person transmission, it was overwhelmingly focused on droplets expelled when we cough or sneeze to a lesser extent, breathe. They generally fall to the ground quickly because they have some weight to them. That's where a lot of the six feet guidance comes from. Yeah, the idea being that those droplets can fly and land on surfaces and contaminate them or land on someone else's mouth or nose. Right. But, you know, Lindsay would argue that a lot, if not most transmission, comes from even smaller particles. Those that fly farther than droplets and they hang out longer in the air. Those we call aerosols.

And sometimes that type of spread is referred to as airborne transmission. There's a higher burden of proof for acceptance of that. And so kind of over the, you know, I guess the World Health Organization around March or so kind of came out said COVID-19 is not airborne, and yet I suspected otherwise. And then the evidence started coming out. There were outbreaks that could pretty much only be explained by aerosol transmission, super spreader events where a few people can get a lot of people sick are best explained by aerosols. And this buildup of evidence led Lindsay and more than 200 other scientists to sign a letter in July

to the World Health Organization saying, hey, this type of transmission needs. to be recognized. They kind of responded and said, oh, okay, maybe in special circumstances, like when you have a poorly ventilated indoor environment and infected people around. Well, it turns out that many public spaces, indoor spaces, are poorly ventilated and have lots of people around. Yeah, that's a lot of indoor spaces. So where are we now with it? Because I know the WHO and CDC do acknowledge today that aerosol transmission can happen, though they say it is pretty rare. Right. That's basically what. where we are now. Okay, but how much does this distinction between how much transmission is through droplets and aerosols really matter? Well, Lindsay argues it's already made a difference. I think because we

haven't come to terms really with aerosol transmission and it's important, or maybe we've only done that recently, the initial messages that went out are what people kind of latched on to, which was, oh, you don't need a mask, wash your hands, wipe down your groceries, these are the things we should be worried about. And I have to say here, Emily, the scientists focused on aerosols do think those bigger droplets play a role. They're just saying that aerosols are playing a way bigger role than is being acknowledged. Gotcha. And the idea here is if we did acknowledge it, you know, instead of workplaces spending the majority of their money on hand sanitizer and sketching out these six-foot-apart spaces, maybe they would put more focus on vamping up ventilation, airflow and masking.

This is a really important shift in our understanding of transmission. Yeah, and coming to terms with how this disease spreads is crucial because how it spreads impacts who gets it. You know, we know this virus spreads really well indoors, especially in crowded living or working conditions. Places where racial and ethnic minorities are more likely to live and work. And that was another huge lesson we learned this year. This virus does not impact everyone equally. We've seen lots of communities hit pretty hard in these little pockets. And on the national level, Native American, Alaska Native, Black, Latinx, and Hispanic people have been disproportionately impacted by COVID.

Yeah. And for people who've been paying attention to socioeconomic and health care inequities in this country, this came as no surprise. Right. Because early on, I remember people saying, this virus doesn't discriminate. Right. remember that? Yeah, absolutely. That was out there. But the U.S. health care system, housing market, workforce, those institutions surely do discriminate.

Right. And the virus amplified those already existing disparities. Yeah. I mean, I remember when I was working with Rebecca, one of the producers on our show, on a story early on about COVID in a neighborhood in San Francisco called the Mission District. 95% of the people who were getting sick were Hispanic or Latin X, even though they only made up about half of the population. As someone who works in the hospital, the disparities were evident, I think, from the beginning. But I think we had not looked within the community, and this was more stark than I expected.

That's Dr. Karina Marquez of UCSF talking to us back in May. And I just remember looking at the data from that study, and being stunned. I mean, these were people living or working in more or less the same place, but having very different experiences. I mean, almost everyone who tested positive couldn't work from home. Same goes for people making less than $50,000 a year. Their experiences and sort of the social determinants of health, I think, are also vastly different, which kind of when you look at some of the other factors like income or whether you need to work or whether you're an essential worker, how many people you live with those things all are very different.

Those trends turned out to be true throughout the U.S. And those disparities go beyond just getting the virus. The CDC reports that Alaska Natives and Native Americans are about three and a half times more likely to be hospitalized than white people. And that's similar for black, Hispanic, and Latinx people as well. People in those groups are also more likely to die from COVID. Yeah. There's so much work to be done in this area. Yeah.

Absolutely. So we've talked about how people are getting COVID, who's getting it. And I want to get to your third point, which is how the disease plays out. Because in the early months, there was a lot of coverage focusing on how the serious COVID cases required hospitalization, even ventilators. Some people didn't make it and some did. And it was almost this binary between death and recovery. Yeah. I mean, that's how it felt to me definitely in the beginning. But, you know, what we learned over this last year is that there is that there is a number of. a huge range in what this disease looks like in people who get it. I mean, one of the most concerning things about this coronavirus is that people are contagious for days before symptoms show up or symptoms never show up. And, you know, that happens, like with the flu, for example, but not to this degree or scale. Yeah. And this is one of the reasons why it became clear that masks are really important. Right. Because you don't necessarily know who is sick. Exactly. But As time went on, it became clear in cases where people do get symptoms.

The disease can really vary from person to person. And in some cases, people with COVID take a long time to feel totally better. Their symptoms stick around. We anticipated that our ICU patients would have protracted symptoms. What we didn't anticipate was just the sheer burden of patients who were not critically ill, who went on to have protracted symptoms. And so, yeah, I mean, it was both surprising, And not surprising. It's not surprising in that we know that viral syndrome and other infectious diseases can lead to syndromes like this. But I think what was most striking is just the scale.

That's George Alba. He's a pulmonary and critical care doc at Massachusetts General Hospital. And he's talking about patients experiencing post-acute COVID. Patients often refer to this as long-COVID or sometimes call themselves long-haulers. Right. These are people reporting symptoms for months and months. And in many cases, it's not clear with long-haulers. exactly what's causing these symptoms, whether the virus is still active or it's just their immune system kind of up in arms. Yeah. George helps run a recovery coronavirus clinic. And I asked him, just, you know, describe some of the symptoms for me. And I just want you to hear this list, Emily, because people have trouble sleeping. They feel like their sleep is non-restorative. Shortness of breath and exercise intolerance, kind of inability to do the same level of physical activity

that they were before. Some people have a resting faster heart rate than they did before their infection. People can experience joint pains among women who I've cared for with post-acute COVID hair loss is one of the more significant things. In the acute setting, you can have changes to taste and smell. Just the sheer scale of this disease is really surprising. Does George know how many people are experiencing these long-term symptoms? So that is a big question, Emily.

And doctor after my own heart, he made it very clear to me that there are caveats in these data. They're preliminary and prone to sample bias. But he said best estimate is that about 10% of all patients who have had COVID develop symptoms beyond one month. And about 2% have symptoms for more than three months. Three months. I mean, 2% mine sounds small, but with how many cases there have been. That's millions of. people. Yeah, and, and you know, Dr. Alwell said most of his patients do eventually get better.

That's good. But there can be huge economic impacts on families. And again, that impact is not felt equally. He says that in recovery from critical illness, like patients that have been in the ICU, there are longstanding disparities. And we have no reason to believe that will be different for post-acute COVID. Certainly in the patients that I have helped care for are that they're more likely to not be able to get back into the workforce, that the financial toxicity is certainly more significant for racial and ethnic minorities. And of the patients that I have cared for who have developed housing instability, it is exclusive to patients who are racial and ethnic minorities thus far. So I asked him, what do we need to do about this? And he said there needs to be way more investment

in community-centered and led health care. To be able to make sure that the patients who were seeing, who we saw most impacted by the pandemic or actually getting the post-acute care that they need. Absolutely. And I know how you feel about community-informed health care and psychom. So this all sounds pretty good to me. Yeah, of course. I mean, this year, I think we saw the power communities can have

when they work together and actually have the resources they need, whether it's the scientific community coming together to develop a safe and effective vaccine in record time. Or, you know, we talked about the Mission District Study earlier. It was community leaders who really made that possible. Right. I mean, it was long COVID patients who were the ones that said, hey, these symptoms are not going away. We need doctors to believe and acknowledge us. Exactly. So, you know, what I hope the big lesson that we take from COVID is, yes, acknowledging these systemic inequities and discrimination that have made communities vulnerable and for the first time actually addressing those and also acknowledging the power, the role some of these communities have

already played in actually making that transformation. Maddie, just listening to you has helped me really process the past here in a lot of ways. So thank you for staying up on the science and wrapping your arms around everything we've gone through. This has been a really, really good look back. That is very kind, Emily Kwong. I appreciate you. I appreciate you too.

This episode was produced by Rebecca Ramirez. edited by Giselle Grayson and fact-checked by Rasha Airet. Stacey Abbott was the audio engineer. Special thanks to Ariela Zabedi and Leah Dinella. I'm Emily Kwong. And I'm Maddie Safaya. Thanks for listening to Shortwave from NPR. On NPR's Consider This Podcast,

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