Helen Branswell of STAT News, one of the best science writers around, interviewed a whole bunch of scientists and public health experts about what surprised them about the COVID pandemic. It’s fascinating. Some of them were surprised by things like the supply chain breakdown or the eerie quiet of the streets during the early days. With others it was the virus itself. You need to read the whole thing, but I’ve excerpted a few of the findings below:
The biggest surprise, hands down: How the virus has evolved
In the early days of the pandemic, before the new virus had a name, people who had studied coronaviruses offered reassuring predictions about the stability of the virus, which has implications for how often people might be reinfected and how frequently vaccines would need to be updated.
Coronaviruses don’t change very quickly, they aren’t as mutable as, say, influenza viruses, those experts said. In fact, the spike protein on the virus’ exterior, the one that attaches to human cells and triggers infection, cannot change too much without losing its ability to infect, they assured the rest of us.
That was the dogma. Then came the variants: Alpha, Beta, Delta, and Omicron, with its mind-boggling array of mutations. Since it emerged in late 2021, Omicron has splintered into a seemingly endless succession of subvariants, which continue to mutate and evade immunity induced by prior infection and immunization.
Many of the people STAT interviewed cited SARS-CoV-2’s evolution as their biggest surprise of the pandemic. “It’s been wild, in my view,” said Marion Koopmans, head of virology at Erasmus Medical Center in Rotterdam, the Netherlands.
Anthony Fauci, retiring head of the National Institute of Allergy and Infectious Diseases, also listed it as his number 1 surprise. “What has surprised me most about Covid is the continual evolution of new variants leading to an unprecedented persistence of the pandemic phase over three years,” he said.
Michael Diamond, a viral immunologist at Washington University, scoffed when he recalled the early proclamations about the virus’ inability to mutate much. “At some point we’re going to run out of mutational space. Well, we haven’t run out of that yet, which was surprising to us, I think, that the virus is still flexible enough to be able to accommodate these mutations. And not only do that, but increase transmissibility and increase immune escape concurrently.”
The erroneous prediction was predicated on what, after the fact, was clearly a flawed idea — that the evolutionary rate seen when a virus was moving through a totally naïve population would remain the evolutionary rate when the virus faced the challenge of infecting people who had some vaccine- or infection-acquired immunity, said Paul Bieniasz, a virologist at Rockefeller University.
Bieniasz was surprised by the role immunocompromised people — people who, once they contracted Covid, could not shake the infection for weeks, sometimes months — played in driving evolution of the virus. That phenomenon is believed to be responsible for another of the surprises about SARS-2 evolution. Most viruses evolve in a stepwise fashion known as “drift,” adding change after change to an existing strain. But some of the Covid variants look more like old versions of the virus were hyper mutated, possibly in a persistently infected person. When those viruses started to spread, they replaced the viruses that had been circulating. The Alpha, Beta, Gamma and Omicron variants of concern are examples of this type of evolution, called saltation, Thomas Peacock and colleagues wrote in a preprint article posted in late November.
“The reality is that SARS-CoV-2 had a much greater capacity for adaptation than I expected,” said Vineet Menachery, a coronavirus expert at the University of Texas Medical Branch. “While this fact was exacerbated by slow uptake and delivery of vaccines, the truth is that the sheer amount of virus and replication provide enough replication cycles to … select for mutations that provided fitness and immune evasion advantages.”
Covid vaccines — so many surprises
For quite a few of the people interviewed for this article, the speed with which Covid vaccines were developed was truly unexpected. Ran Balicer, director of Israel’s Clalit Research Institute, encapsulated that view: “Vaccine(s) ready, tested, and launched in under a year.” For others, the surprise was how effective the vaccines were. “I was on the Pfizer DSMB” — the data and safety monitoring board, a group of independent experts who oversee a clinical trial — “and was one of the people that unblinded that study the first time and saw the 95% efficacy. Basically it just brought tears to my eyes,” said Kathryn Edwards, a professor of pediatrics and vice-chair for clinical research at Vanderbilt University.
Still others were stunned at how many vaccine development attempts were successful. Hatchett is now the CEO of the Coalition for Epidemic Preparedness Innovations (CEPI), an organization whose mission is to spur development of vaccines for diseases that can trigger dangerous epidemics or pandemics, vaccines for which there isn’t a market — until suddenly there is. He thought there would be a Covid vaccine within 12 to 18 months of the start of the pandemic; in fact, the first vaccines were ready in 11 months. But historically, only about 1 in 10 vaccine projects succeeds. Hatchett figured that would be the case here too.
Instead, Covid vaccine after Covid vaccine worked. Old-school inactivated vaccines, the foundation of China’s vaccination effort. New messenger RNA vaccines like Pfizer’s and Moderna’s. Recombinant protein vaccines like the one made by Novavax. Viral-vectored vaccines, like the AstraZeneca and Johnson & Johnson jabs. True, there were a few failures, but far fewer than anyone anticipated. Hatchett puts it down to investments in vaccinology.
Not all the vaccine surprises were positive
For all the wondrous surprises related to the vaccines, some were disappointing.
They have been potent protectors against the worst of Covid, cutting hospitalizations and deaths dramatically. But protection against infection declines rapidly over a course of a few months — at least with the mRNA vaccines. “Going from 95% to negligible in terms of transmission in the time window in which that has occurred — that’s pretty dramatic,” said Bieniasz, the Rockefeller University virologist.
Vaccine hesitancy and rejection has been a growing problem for years, but before the pandemic, the scale of the problem in the United States was still relatively small. The vast majority of parents vaccinated their kids against childhood diseases.
And in the early days of the vaccine rollout, when supplies were tight, people jostled and misrepresented themselves and called in favors to try to get to the front of the line faster. But anti-vax forces mobilized to attack the new vaccines. Rumors flew that they attacked testicles and altered fertility. A surprising level of distrust took hold. As vaccine supplies began to swell, demand began to evaporate.
Messonnier knew all about vaccine hesitancy. But even she was taken aback by how quickly “must have” turned to “meh.”
“I expected people to see vaccines as they did at the end of 2020, as being the thing that was going to save us, the thing that was going to get life back to normal. And that moment when folks felt that way just passed so quickly,” said Messonnier, who is now dean of the Gillings School of Global Public Health at the University of North Carolina.
Claire Hannan, too, was surprised by how fleeting the keen-to-get-vaccine moment was. Hannan is the executive director of the Association of Immunization Managers, which represents leaders of state, local, and territorial immunization programs — the people who oversee the efforts to turn vaccines in vials into vaccinations in arms.
The last couple of years have been extraordinarily busy for Hannan and her members.
“The initial surge in demand and the craziness and the logistics and all of the challenges and the lack of funding and lack of staffing — expected all of that,” she said. “It was what came after that that surprised me.’’
What came after wasn’t a surprise to those of us who follow politics. We knew that half the country had signed on to a cult and that the cult leader was a self-serving con man. Still, I suppose there was some hope that people would sober up one the morgues filled up.
They didn’t:
The susceptibility of the public to charlatans
First it was a malaria drug, hydroxychloroquine. Then it was ivermectin, a drug used to eliminate parasitic worms. Heavenly silver. Bleach. Ultraviolet light. Urine therapy. The list goes on.
The Covid pandemic has been a field day for quacks and crooks. They’ve made a killing.
It is ever thus, some would surely say. But Bieniasz has been stunned by the degree to which a not-small portion of the population has been taken in by hucksters — and by the inability of the scientific community to break that spell.
“The sort of willingness of Joe Public to listen to anybody with a large Twitter following has just shocked and appalled me,” Bieniasz said. He sees this as a consequence of a huge loss of trust in the scientific community.
The reverberations of this loss of trust continue, even though the acute phase of the pandemic appears to be subsiding.
Malia Jones, an assistant professor in community and environmental sociology at the University of Wisconsin-Madison, studies vaccine hesitancy and rejection. She spoke to parents this autumn who refused to get their kids vaccinated against flu. The reason? A rumor that the government is bottling Covid vaccine in flu vaccine vials to surreptitiously increase Covid vaccination rates among kids.
“What? Imagine the coordination it would take to pull that off. It’s just impossible,” she sputtered. “And illegal, and a lot of other stuff, too. But also just really implausible. It’s not the way the world works.”
So much for pulling together in a crisis
It turns out that a crisis can further polarize highly polarized nations.
“I think I naively would have predicted that it would have brought everyone together, because in the early days you felt that sense of ‘we’re all in it together,’” said Messonnier. Instead, the country cleaved into the people who were concerned about Covid and keen to reduce its spread and the people who thought the cure — school closures and the like — was substantially worse than the disease.
The fights were vicious, deepening existing divides.
“We had seen fierce arguments in the past about the nature of responses and tensions between business and public health. All of that’s structural. It’s part of the problem. But the extent to which it became associated with political identities was surprising and disappointing,” Hatchett said.
Farrar, the new WHO chief scientist, agreed. “The politicization of public health has surprised me — that wearing a mask became a political statement.”
The politicization and polarization of public health measures has hurt vaccine uptake, said Rupali Limaye, director of behavioral and implementation science at the International Vaccine Access Center at Johns Hopkins University. “It is clear that polarization has led to more extreme beliefs and has hampered our ability to speak with those that may have differing views,” she said. “My hope is that we can dial down the politicization through building back trust in health institutions, as we will need to navigate this for disease control in the future.”
There’s a lot more at the link including some pretty severe criticisms of the public health apparatus, the government agencies and scientists themselves. We have to hope that these lessons won’t be forgotten before the inevitable next pandemic.
Update: Just as an aside, among the January 6th transcripts that were released today is this outrageous excerpt about Jared Kushner:
That isn’t a surprise. He is a sociopath which raises the question: what lessons have we learned about electing sociopaths to high office?