A year with the coronavirus: How we got here

On March 11, 2020, the nation’s top infectious diseases expert sat before the House Oversight and Reform Committee to address a novel coronavirus that had infected about 1,800 Americans.

“We will see more cases and things will get worse than they are right now,” said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

Within hours, the weight of Fauci’s words became apparent.

The NBA suspended its season after a player who had mocked the virus tested positive. The NCAA said its annual basketball tournament would take place without fans. The Dow Jones Industrial Average entered bear territory for the first time in more than a decade.

The actors Tom Hanks and Rita Wilson said they had tested positive for the virus in Australia. More than four times as many people searched Google for the word “coronavirus” than for information on the weather. For the first time, World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus described the situation as a pandemic.

If, in the decades ahead, society decides to set aside a day to remember the year that followed, March 11 will be as appropriate a date as any. It will be a day of mourning for the 2.6 million who have already died around the globe, a fifth of whom died in the United States.

It will be a day of celebration for the public health workers who put their own lives at risk to care for the sick. It will be a day to contemplate the fragility of human life and the value of our loved ones.

Most of all, it will be a day to remember and learn from the painful experiences we have all gone through, cause to recall the imperative to prepare for a new pathogen that is certain to threaten the world sometime in the not-too-distant future.

In the course of hundreds of interviews over the last year with scientists, health experts, political leaders and front-line health care and social workers across five continents, the story of the coronavirus pandemic that emerges is one of action, or the lack thereof. Nations that took the most proactive steps have suffered the least. Nations whose leaders pretended the virus did not pose a substantial threat, like the United States, or that the economy mattered more than the lives that would be lost, like Brazil and Sweden, suffered the most.

By the time China first reported the emergence of a novel pathogen that caused atypical pneumonia among a few dozen patients at a hospital in Wuhan, the developed world had gone more than a decade without suffering a global pandemic — and that last pandemic, the H1N1 strain of influenza, had fallen far short of the worst projections.

Then-President Trump was dismissive of the virus when first asked, during a brief trip to the World Economic Forum in Davos in January. He was incensed when, while he was overseas in India, a top official at the Centers for Disease Control and Prevention issued a warning in late February that the virus could change Americans’ daily lives.

“It’s going to disappear. One day, it’s like a miracle. It will disappear,” Trump promised, two weeks before he declared an emergency.

Public health experts were cautious as the virus began to spread through China, and eventually to neighboring nations. It was not yet clear that the coronavirus would become a pandemic, though most acknowledged that it had the potential to do so. In late January, the WHO had seen enough: They declared a public health emergency of international concern, only the sixth time they have set off their highest level of alarm.

“You don’t want to cry wolf, but it really, really feels like things are going to get a lot worse,” Rebecca Katz, an international public health expert at Georgetown University, told The Hill a year ago, a week before America’s emergency declaration. “If I am totally wrong, which I really don’t think I am, the very worst thing we do is we promote our public health infrastructure.”

That infrastructure was strained almost from the beginning. The Centers for Disease Control and Prevention botched the rollout of a diagnostic test meant to identify the coronavirus, forcing the country to muddle through February with little ability to identify community spread. The virus continued hopping across international borders, from China to the West Coast and then from Italy and Northern Europe to the East Coast.

In an Oval Office address on March 11, Trump touted his “unprecedented response,” suspending foreign travel into the United States after it was far too late.

“This is the most aggressive and comprehensive effort to confront a foreign virus in modern history,” Trump said. “I am confident that by counting and continuing to take these tough measures, we will significantly reduce the threat to our citizens and we will ultimately and expeditiously defeat this virus.”

As he spoke, just 43 Americans had died of the virus.

A week later, after the number of confirmed cases in the United States quadrupled, California Gov. Gavin Newsom (D) issued the first stay-at-home order in the nation. Hospitals in New York were overrun by the ill, physicians sprinted from one coding patient to the next.

“When health facilities are overrun, your case fatality rates shoot up. That was the situation in New York in March and into April,” Celine Gounder, a physician and infectious diseases expert at New York University’s Grossman School of Medicine, recalled of her first tour of duty in a COVID-19 ward.

As the federal government stood back and let states and cities respond on their own, the global supply chains for personal protective equipment became a chaotic black market. Gounder, who responded to an Ebola epidemic in West Africa, said her hospital in New York faced shortages of basic protective gear.

Governors and mayors who knew a guy cut deals as fast as they could. Washington Gov. Jay Inslee (D) put his state’s emergency officials in touch with his cousin, an import consultant. New Hampshire Gov. Chris Sununu (R) turned to Dean Kamen, the inventor of the Segway, to secure masks made in China. The governors of Massachusetts and New Jersey complained after federal agents confiscated masks; Maryland Gov. Larry Hogan (R) deployed the National Guard to protect test kits his wife had helped secure from a South Korean manufacturer.

“We refused to launch a federal response,” said Peter Hotez, who heads the National School of Tropical Medicine at the Baylor College of Medicine. “We came up small every time.”

The early wave in New York and New Orleans crested just in time for Memorial Day, when an anxious nation let down its guard to celebrate summer. The second wave slammed into Southern states, a crescendo of disease and death that led some states to consider how to ration care if the hospitals became full.

If there was a silver lining to the bleakest clouds, it was the development of myriad vaccine candidates that promised a potential end to the suffering. Fauci, overseeing development efforts and early trials, was especially heartened by a new technology known as messenger RNA, the backbone of the first two vaccines that were eventually approved by the Food and Drug Administration.

Those vaccines did not arrive in time to prevent a third massive wave of disease that began in the fall. The Trump administration continued downplaying the threat of the virus, even as multiple outbreaks occurred in the White House itself, infecting Trump, the first lady, chief of staff Mark Meadows and others and sending Trump to the hospital to monitor dangerously low oxygen levels.

The fall surge took off after the Thanksgiving holiday. Fauci had once predicted morbidly that the United States could face 100,000 or more cases in a day; the winter surge topped out in early January more than three times that high.

In a year of despair, the structure of the virus itself became a lucky break. The name of the coronavirus family comes from the spike protein that helps it bind to human cells. It was that protein that the mRNA vaccines — and adenovirus vaccines like those developed by Johnson & Johnson — targeted successfully.

“The spike protein of the virus is a soft target, and it turned out to be pretty easy to make vaccines. Imagine if this were a complicated vaccine, like an HIV vaccine or a malaria vaccine. We’d be totally screwed,” Hotez said.

A year after the world declared COVID-19 an emergency, the response remains uneven and inconsistent. Statistics show the United States is slowly wrestling the virus down to levels seen last October, and more than 92 million vaccine shots have gone in American arms. The number of patients in hospitals has fallen precipitously, and treatment strategies have improved enormously. When COVID-19 patients are discharged from Bellevue Hospital in New York City, they play Jay-Z’s “Empire State of Mind.”

But in other parts of the world, the race to vaccinate is unfolding more slowly. About 100 countries, low- and middle-income nations that are suffering through their own resurgent wave as new variants come to dominate, have yet to receive a single shipment.

Those variants are the latest threat to global public health. Some of the most common ones are now known to be more readily transmissible. Others in the future might evolve to evade the vaccines. Though the emergency is a year old, it is no less urgent that the world develop the plan to bring the virus under control.

“We’ve got 2.1 billion people in this world that are in countries that we don’t know when they’ll see a drop of vaccine,” said Michael Osterholm, who heads the Center for Infectious Disease Research and Prevention at the University of Minnesota. “We could not have made a more wonderful environment for this virus to take off than we have right now.”