Five-Year Anniversary of Covid-19: Reflecting on the Past and Planning for the Future

Covid-19 Marks Its Five-Year Anniversary: Reflecting on the Past and Anticipating the Future

Health officials from the World Health Organization became aware of a cluster of mysterious pneumonia cases in Hubei Province, China, on December 31, 2019. This cluster signaled the beginning of what would become known as Covid-19, the pandemic that has significantly impacted the world in numerous ways. The suffering inflicted on humanity has been immense, while scientific discoveries have been groundbreaking. As we mark the fifth anniversary of this pandemic, it's worth reflecting on our journey, the factors that led us here, and potential future developments.

The Genesis of Covid-19

Chinese authorities reported the detection of over 40 instances of unexplained pneumonia in Wuhan City to the WHO on December 31, 2019. The cases seemed to be centered around the Huanan seafood market, suggesting a possible zoonotic transmission of an infectious agent from an animal at the market. However, a report from the WHO, released on January 5, 2020, indicated that there was no significant evidence of human-to-human transmission observed.

Chinese researchers were able to isolate and sequence the causative agent, initially naming it 2019-nCoV. A genetic analysis revealed that this virus was related to, yet distinct from SARS-CoV, the coronavirus connected to the 2002-2003 SARS pandemic. As a result, the 2019-nCoV virus was renamed SARS-CoV-2. Due to past coronavirus outbreaks tied to the SARS-CoV and MERS-CoV viruses resulting from zoonotic transfers, researchers speculated that SARS-CoV-2 likely entered the human population through a zoonotic transfer as well. However, the swift closure and sanitization of the Huanan market by Chinese authorities made it difficult to pinpoint the virus's exact origin.

Despite the WHO's initial report, human-to-human transmission was indeed occurring.

By mid-January, individuals infected with the virus had been found in various nations. The CDC reported a laboratory-confirmed case in the U.S. on January 21, 2020. SARS-CoV-2 continued to spread. Governments worldwide implemented travel restrictions. The World Health Organization declared Covid-19 a pandemic on March 11, 2020. Places of learning, dining, and socializing shut down. Working from home became the norm for many. The world was fundamentally changed.

Just 12 months later, an estimated 2.5 million people globally had lost their lives.

The Present State of the Covid-19 Pandemic

According to the WHO, there have been over 777 million reported cases and around 7.1 million deaths since the pandemic began. The United States alone has registered approximately 100 million cases and 1.2 million fatalities. The early stages of the pandemic saw global life expectancy decrease by about 1.5 years. However, the number of new cases and deaths per week is currently quite low. By the week ending on December 8, 2024, the WHO reported around 50,000 new cases and 500 deaths, a marked decrease from earlier pandemic statistics.

The Evolving SARS-CoV-2

The SARS-CoV-2 virus has undergone changes throughout the past five years. Viruses naturally exhibit a high mutation rate. They transform. And viral mutants that possess some competitive advantage will dominate, outcompeting previous strains. For SARS-CoV-2, these advantages include increased transmissibility, improved evasion of the immune system, and heightened disease severity. The original form of the virus was quickly replaced by the Alpha and then the Delta variants. The Omicron variant was first identified towards the end of 2021 and has remained the primary variant since then. Each variant exhibited increased transmissibility compared to its predecessors. Subvariants of Omicron, such as JN.1, have surfaced, but no significant departure from the Omicron variant has been identified.

The Development of Covid-19 Vaccines

The trajectory of the pandemic took a turn for the better on December 11, 2020, when the FDA issued an emergency use authorization for the Pfizer-BioNTech mRNA vaccine. A week later, an emergency use authorization was granted for the Moderna mRNA vaccine. In large-scale clinical trials, both vaccines were proven highly effective at preventing severe Covid-19 and Covid-19-related deaths. Additionally, both vaccines demonstrated exceptional safety.

Further analysis revealed that the immunity provided by these vaccines gradually weakened over time. Furthermore, mutations within the virus reduced the initial vaccines' effectiveness. As a result, periodic booster shots have been recommended, and new formulations have been developed to keep pace with the evolving virus. However, the availability of these vaccines significantly impacted the course of the pandemic.

The Significance of Basic Research

During the pandemic, terms like "novel" and "unprecedented" have been used extensively. It's crucial to remember, though, that our understanding of Covid-19 and the development of mRNA vaccines relied heavily on decades of foundational research. This historical foundation of prior research should not be overlooked.

Virologists have been studying coronaviruses for decades. Coronaviruses responsible for human illness were first identified in the 1960s, but they were only connected to the common cold. Regardless, these human coronaviruses were studied extensively. Coronaviruses that infect mice, like mouse hepatitis virus, also have been extensively researched. This basic research provided scientists with a deeper understanding of viral pathogenesis, thereby preparing us for SARS-CoV, MERS, and SARS-CoV-2.

Years of fundamental research preceded the creation of Pfizer and Moderna's mRNA vaccines, which we hadn't utilized in human vaccines prior. The concept had been in development for quite some time. In fact, Drs. Katalin Karikó and Drew Weissman were awarded the Nobel Prize in Physiology or Medicine in 2023 for their contribution to developing these secure and effective vaccines. Remarkably, their significant work was published in 2005, long before the COVID-19 pandemic. It was built upon research conducted by other researchers earlier on.

Stigma and Misinformation Amplified COVID-19

The COVID-19 pandemic highlighted the hazards related to stigma. During the pandemic's initial stages, the media commonly referred to the virus as the "Chinese coronavirus" or the "Wuhan virus." Former President Trump employed even more derogatory and inflammatory terms. The aftermath? A spike in hate crimes against Asian-Americans.

False information and misinformation further fueled the COVID-19 pandemic. For instance, during the spring of 2020, former President Trump and others advocated for the use of hydroxychloroquine as a treatment for COVID-19. Supporters of this antimalarial drug often cited a paper published in the International Journal of Antimicrobial Agents. However, scientists promptly challenged the study's design and data analysis. Subsequent, more reliable studies by other researchers further undermined the effectiveness of hydroxychloroquine. Yet, these studies didn't garner wide media attention. The damage was already done. The article was eventually retracted by the journal.

This wasn't the only research article about COVID-19 that garnered significant media attention, only to be criticized by the scientific community later. In early 2020, researchers published a paper on the preprint server bioRciv, claiming the existence of "uncanny" sequence similarities between SARS-CoV-2 and HIV. The authors concluded that the similarities were "unlikely to be coincidental." The conclusions in this paper also were criticized by other scientists and the paper was withdrawn.

Words matter. Science matters.

The Legacy of COVID-19

COVID-19 and SARS-CoV-2 are here to stay. The disease is now endemic. When we consider viruses that can cause potentially severe respiratory illnesses, we need to include SARS-CoV-2 in the list alongside influenza virus, RSV, and others. SARS-CoV-2 will continue to evolve, demanding periodic updates to vaccine formulations. It's likely that a new COVID-19 vaccine will be recommended annually.

The natural genetic alterations to SARS-CoV-2 also increase the possibility of a more dangerous variant emerging. A variant with enhanced transmission or virulence could result in a spike in cases. As a result, continuous monitoring and genetic analysis of viral isolates is crucial.

Lastly, research into long COVID must continue. For numerous individuals, the symptoms associated with long COVID serve as a constant reminder of their prior infection. The cause remains unknown. Some researchers have proposed that an undetected reservoir of the virus remains in some people. Others have proposed that a COVID-19 infection may trigger an autoimmune disease or the reactivation of Epstein-Barr virus. It's even been speculated that COVID-19 can lead to alterations in the gut microbiome, resulting in long COVID.

The cause of long COVID needs to be identified, and treatments need to be developed.

The fifth anniversary of COVID-19 marks a suitable time to evaluate our progress, remember our history, and contemplate our future. However, this anniversary does not signify an end point. We must remain vigilant. Changes in SARS-CoV-2 will occur. And another novel pathogen may emerge.

The WHO, recognizing the global impact of 'long Covid', emphasized the importance of continued research to identify its causes and develop effective treatments, highlighting its persistent impact even five years into the pandemic.
Misinformation about 'vaccines', such as claims that they contain microchips or cause infertility, has fueled vaccine hesitancy, leading to a stigma that hampers global vaccination efforts against SARS-CoV-2.
Despite the initial uncertainty about 'human-to-human transmission' of SARS-CoV-2, the widespread dissemination of misinformation, like the promotion of hydroxychloroquine as a COVID-19 treatment, has led to unnecessary suffering and delayed critical public health interventions.