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Pandemic Year 1

By Shannon Lee

It’s hard to believe that we are already past or just about to hit a number of one-year milestones as regards the COVID-19 pandemic: -Jan. 30, 2020: The World Health Organization listed the outbreak as a Public Health Emergency of Global Concern -Jan. 21, 2020: The CDC reported the first official travel-related case in this country -Jan. 28, 2020: California’s first official cases were diagnosed (it’s now clear the virus was here prior to that time) -Feb. 28, 2020: The first official death from COVID-19 was recorded (eventually amended to earlier in February after post-mortem testing confirmed earlier cases) -March 11, 2020: Epidemic upgraded to Global Pandemic When I first wrote about the pandemic for the Kenwood Press, it was March 29, 2020. There were 718,685 reported cases globally, with 33,881 deaths. In the United States, there were 139,675 cases and 2,436 deaths. All eyes at that moment were firmly on a monumental unfolding health crisis in Italy.

After nearly a year, our United States numbers are numbingly higher (27.9 million cases and 494,051 deaths) but there are multiple vaccines available, an incredible achievement of medical research, testing is relatively available, and our treatments of the disease have improved greatly. As I mentioned back in March 2020, it is predicted in epidemiology that outcomes will be worst at the beginning of any pandemic, and therefore death rates (or Case Fatality Rates, CFR) will improve as the pandemic rolls on, with the caveat that all bets are off if the healthcare infrastructure is overwhelmed. Dropping CFRs have come to pass and are easiest to see when contrasting early-hit states compared to the statistics overall. In total, New York state has seen 45,957 deaths out of 1,568,881 cases, a CFR of 2.92. New Jersey has seen 22,721 deaths out of 758,450 cases, a CFR of 2.99. Compare those numbers to the current overall national CFR of 1.77 or to California’s CFR of 1.37 (i.e., 1.37% of California’s known cases have resulted in death), and you can see the dropping CFR due to better outcomes.

Those are the numbers, but what about the science language we’ve all been exposed to in the past year? A year ago, many terms were used regularly only by healthcare researchers and epidemiologists; now they are on the news almost every night. Here are a few to highlight and perhaps clarify.

Morbidity vs. Mortality

Epidemiologists studying outcomes of disease do not just focus on death but also on the pain and suffering and loss of normal daily life activities caused by a disease. Mortality is the death statistic; morbidity is the combination of all negative outcomes of the disease course that do not involve death. This could include everything from days lost from work due to fatigue all the way to permanent paralysis. Mortality from COVID-19 seems to be in the realm of 1-2%. It is comparatively good that this particular coronavirus only manifests with this level of mortality. Two other 21st century coronavirus outbreaks, SARS and MERS, showed mortalities of 9% and 35%, respectively. For comparison, seasonal flu fluctuates but is on average about 0.1%. Morbidity from COVID-19 is hard to pin down (because we are still firmly in the pandemic) but there is a recognized larger-than-typical set of post-viral sufferers from this virus. These people are being labeled “Long-Haulers” and their symptoms are diverse: from brain fog and loss of hair all the way to diagnosable medical conditions such as POTS, CFS/ME, and onset diabetes (this is not an exhaustive list). Impacts of prolonged hospitalizations, long-term organ damage due to treatments and the viral infection, and this collective “Long COVID” phenomenon will be part of the morbidity consideration.

Transmission

In acquired disease, transmission refers to the method by which the pathogen travels from one host to the next. Droplet transmission is the transfer of small pathogens in respiratory liquid droplets. Aerosol transmission is similar, but the size is smaller and they stay in the surrounding air for longer. Measles is a much more infectious virus and is a great example of aerosol transmission. Influenza viruses are droplet transmission. The current coronavirus appears to be predominantly droplet-transmitted, but studies are still working through potentials of aerosol transmission and several new variants do appear to be more infectious, which may suggest easier transmission. The combination of definitive droplet transmission and the mortality/morbidity concerns accounts for why there was an early health directive regarding mask wearing for this pandemic.

Monoclonal antibody (MA)

This term became popular in the news around the time that former President Trump was hospitalized for COVID-19. MAs are laboratory manufactured antibodies that are used in treatment to help the patient’s immune system fight off an infection. In November 2020 two MAs, casirivimab and imdevimab, were cleared for Emergency Use Authorization (EUA) for treating COVID-19 pa- tients (granted to Regeneron Pharmaceuticals, Inc.). These MAs were created specific to the novel virus and target the spike protein on the virus’ surface. These drugs were approved for use in early disease stage patients who had a strong potential to progress to severe COVID.

Shannon Lee, PhD, is a Glen Ellen resident and an instructor in the Biology Department at Sonoma State University. She has been a science educator for 20 years, having taught previously at UCLA and California State University Northridge. This science column was written on the evening of Feb. 19th with all data coming in as of the reports for that date. This is a swiftly changing situation. The case and morbidity data referenced herein was obtained from The New York Times online interactive coronavirus database.

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