Here’s what we know about the coronavirus

We don’t really know when the novel coronavirus first began infecting people. But as we turn a page on our calendars into June, it is fair to say that SARS-CoV-2 has been with us now for a full six months. In that time, many reporters and editors of the health and science desk at The New York Times have shifted our journalistic focus as we have sought to tell the story of the coronavirus pandemic. While much remains unknown and mysterious after six months, there are some things we’re pretty sure of. These are some of those insights.

A Crisis Exposes Systemic Defects

The United States knows how to fight wars.

But, as the past few months have shown, the American response to pathogens can easily become a shambles — even though they kill more Americans than many wars have.

We have no viral Pentagon.

The Centers for Disease Control and Prevention is more of an FBI for outbreak investigations than a war machine. For years — under both the Obama and Trump administrations — its leaders have had to seek clearance for almost every utterance.

Dr. Anthony S. Fauci, the most prominent of the doctors advising the coronavirus task force, is actually the head of a research institute, the National Institute for Allergy and Infectious Disease, rather than of the medical equivalent of a combat battalion.

The Surgeon General is essentially an admiral without a crew. He dispenses health warnings and recommendations, but the Public Health Services Commissioned Corps, which reports to him, are only about 6,500 strong, and many members have other jobs, often at the CDC.

Almost all the front-line troops — the contact tracers, the laboratory technicians, the epidemiologists, the staff in state and city hospitals — are paid by state and local health departments whose budgets have shriveled for years. These soldiers are led by 50 commanders, in the form of governors, and with that many in charge, it is amazing that any response moves forward.

The rest of the response is in the hands of thousands of private militias — hospitals, insurers, doctors, nurses, respiratory technicians, pharmacists and so on, all of whom have individual employers. Within limits, they can do what they want. When they cannot get something they need from overseas they are largely powerless without federal logistical help.

As war does to defeated nations, pandemics expose the weaknesses of their systems.

Our patchwork and uncoordinated response has produced more than 100,000 deaths — surely we can do better.

“The superpowers have their priorities all wrong,” Dr. Michael Ryan, the head of the WHO’s emergencies program, said recently.

“They spend billions on missiles and submarines, and on fighting terrorism, and pennies on viruses. You can start peace talks with your enemy. You can change your policies to lessen the threat of terrorism,” he added. “But you cannot negotiate with a virus, and we know that new threats are coming along every year.”


Face Coverings Offer Protection

The debate over whether Americans should wear face masks to control coronavirus transmission has been settled. Although public health authorities gave confusing and often contradictory advice in the early months of the pandemic, most experts now agree that if everyone wears a mask, individuals protect one another.

Researchers know that even simple masks can effectively stop droplets spewing from an infected wearer’s nose or mouth. In a study published in April in Nature, scientists showed that when people who are infected with influenza, rhinovirus or a mild cold-causing coronavirus wore a mask, it blocked nearly 100% of the viral droplets they exhaled, as well as some tiny aerosol particles.

Still, mask wearing remains uneven in many parts of the United States. But governments and businesses are beginning to require, or at least recommend, that masks be worn in many public settings.

There is also growing evidence that some kinds of masks may protect you from other people’s germs. High-grade N95 masks are cleared by federal public health agencies because they filter out at least 95% of particles that are 0.3 microns in diameter when properly worn. One study showed that N95s were able to capture more than 90% of viral particles, even if the particles were about one-fifth the size of a coronavirus. Other studies have shown that flat, blue surgical masks block between 50-80% of particles, whereas cloth masks block 10-30% of tiny particles.

“Wearing a mask is better than nothing,” said Dr. Robert Atmar, an infectious disease specialist at Baylor College of Medicine. Because the coronavirus typically infects people by entering their body through the mouth and nose, covering these areas can act as the first line of defense against the virus, he said.

Donning a face covering is also likely to prevent you from touching your face, which is another way the coronavirus can be transmitted from contaminated surfaces to unsuspecting individuals. And when combined with hand washing and other protective measures, such as social distancing, masks help reduce the transmission of disease, Atmar said.


Many Signs Something’s Not Right

COVID-19 is a viral respiratory illness. Many early descriptions of symptoms focused on patients being short of breath and eventually being placed on ventilators. But the virus does not confine its assault to the lungs, and doctors have identified a number of symptoms and syndromes associated with it.

In some patients, the virus propels the immune system into overdrive, causing the lungs to fill with fluid and damaging multiple organs, including the brain, heart, kidneys and liver.

The first symptoms of an infection are usually a cough and shortness of breath. But in April the CDC added to the list of early signs sore throat, fever, chills and muscle aches. Gastrointestinal upset, such as diarrhea and nausea, has also been observed.

Another telltale sign of infection may be a sudden, profound diminution of one’s sense of smell and taste.

Teenagers and young adults in some cases have developed painful red and purple lesions on the fingers and toes, but few other serious symptoms.

Severe disease leads to pneumonia and acute respiratory distress syndrome. The blood oxygen levels plummet, and patients may get supplemental oxygen or be placed on a ventilator to help them breathe.

But even without lung impairment, the disease can cause injury to the kidneys, heart or liver. Critically ill patients are prone to developing dangerous blood clots in the legs and the lungs. In rare cases, the disease triggers ischemic strokes that block the arteries supplying blood to the brain, or brain impairments, such as altered mental status or encephalopathy.

Death can result from heart failure, kidney failure, multiple organ failure, respiratory distress or shock.


Tempering Hopes About a Vaccine

The idea is simplicity itself: If enough of the population has antibodies to the novel coronavirus, the virus will hit too many dead ends to continue infecting people. That is herd immunity.

And that is the great hope for a vaccine. But it may not happen, even if a vaccine becomes available, as experience with flu vaccines shows.

Dr. Paul Offit of Children’s Hospital of Philadelphia and the University of Pennsylvania noted that while vaccines eliminated measles, rubella and smallpox and almost eliminated polio in the United States, vaccines against influenza and whooping cough have not stopped outbreaks. (With some parents declining measles vaccines, that disease is coming back.)

Influenza and whooping cough have spread, even after enough people in a community have been vaccinated to, in theory, stop the diseases. That’s because the antibodies that protect people against viruses infecting mucosal surfaces like the lining of the nose tend to be short-lived.

Vaccines against respiratory diseases are, at best, modestly effective, agreed Dr. Arnold Monto of the University of Michigan,

Since the coronavirus usually starts by infecting the respiratory system, Monto suspects that a COVID-19 vaccine would have a similar effect to a flu vaccine — it will reduce the incidence of the disease and make it less severe on average, but it will not make COVID-19 go away.

He would like the virus to disappear, of course, but a vaccine that reduces the disease’s spread and severity is a lot better than nothing.

“As an older person, what I want is not to end up on a respirator,” Monto said.


How Long Can This Keep Going On?

Summer is almost here, states are reopening and new coronavirus cases are declining or, at least, holding steady in many parts of the United States. At least 100 scientific teams around the world are racing to develop a vaccine.

That’s about it for the good news.

The virus has shown no sign of going away: We will be in this pandemic era for the long haul, likely a year or more. The masks, the social distancing, the fretful hand-washing, the aching withdrawal from friends and family — those steps are still the best hope of staying well, and will be for some time to come.

“This virus just may become another endemic virus in our communities, and this virus may never go away,” Dr. Mike Ryan, the executive director of the World Health Organization’s health emergencies program, warned last month. Some scientists think that the longer we live with the virus, the milder its effects will become, but that remains to be seen.

Predictions that millions of doses of a vaccine may be available by the end of this year may be too rosy. No vaccine has ever been created that fast.

The disease would be less frightening if there were a treatment that could cure it or, at least, prevent severe illness. But there is not. Remdesivir, the eagerly awaited antiviral drug? “Modest” benefit is the highest mark experts give it.

Which brings us back to masks and social distancing, which have come to feel quite antisocial. If only we could go back to life the way it used to be.

We cannot. Not yet. There are just enough wild cards with this disease — perfectly healthy adults and children who inexplicably become very, very sick — that no one can afford to be cavalier about catching it.

About 35% of infected people have no symptoms at all, so if they are out and about, they could unknowingly infect other people.

Enormous questions loom. Can workplaces be made safe? What about trains, subways, airplanes, school buses? How many people can work from home? When would it be safe to reopen schools? How do you get a 6-year-old with the attention span of a squirrel to socially distance?

The bottom line: Wear a mask, keep your distance. When the time comes in the fall, get a flu shot, to protect yourself from one respiratory disease you can avoid and to help keep emergency rooms and urgent care from being overwhelmed. Hope for a treatment, a cure, a vaccine. Be patient. We have to pace ourselves. If there’s such a thing as a disease marathon, this is it.


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