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This week marks two pandemic “anniversaries” — the World Health Organization declared the coronavirus outbreak a pandemic on March 11, 2020, and former President Trump declared it a national emergency two days later.

Tragically, there have been more than a half million deaths in the United States and more than 2.6 million globally since then.

To mark these dates, I asked a range of people, from clinicians on the frontlines to virus watchers, vaccine makers, and public health specialists, to share their answers to this question: What was the moment last year when you realized we were in real trouble?

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David Quammen: About 10 years ago
Helen Branswell: An unsettling interview
Ugur Sahin: Reading a paper in The Lancet
Jennifer Doudna: It seemed like this virus might be different
Paul Stoffels: Standing on the streets of Davos at the World Economic Forum
Juliette Kayyem: My calendar entry for Feb. 23: Cancel
Antonio Dájer: We were on our own
Sandro Galea: I realized just how unprepared the U.S. was for the looming crisis
Uché Blackstock: March 11: From a theoretical problem for me to a real one
Margot Kushel: Homeless people were going to be hit hard
Jaclyn O’Halloran: A decision to leave hospital nursing

 

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By David Quammen: The “moment last year” when I realized the world was in real trouble occurred about 10 years ago.

I was finishing work on my book “Spillover: Animal Infections and the Next Human Pandemic.” I had asked some of the smartest infectious disease scientists I knew these questions: Will there be a Next Big One, a pandemic of infection that sweeps the globe and kills millions of people? If so, what will it look like?

The consensus of what they told me, which I published in the book in 2012, was this: Yes, there will be a Next Big One. It will be caused by a virus new to humans that has emerged from a wild animal. That virus could well be an influenza or a coronavirus; the wild animal could well be a rodent, a primate, or a bat; and the spillover could well occur in or near a “wet market” in some country where wildlife is sold as food amid other food products and where an infected person might easily reach an internationally connected airport. We can’t say when this will happen, but it will happen.

The moment last year when I realized, more immediately, that the world could be in real trouble was on Jan. 13, 2020, when I was reading an email from the disease reporting service ProMED, about the cluster of atypical pneumonias in the city of Wuhan, and I saw for the first time, on the subject line and in the text, the words “novel coronavirus.”

David Quammen is a freelance writer and author of “Spillover: Animal Infections and the Next Human Pandemic” (W.W. Norton, 2012).

By Helen Branswell: On the evening of Jan. 24, 2020, I conducted one of the most unsettling interviews of my career.

I was talking with Trevor Bedford, a computational biologist at the Fred Hutchinson Cancer Research Center in Seattle. He had been using genetic sequence data to chart the spread of the SARS-CoV-2 virus that had apparently emerged in China in December 2019. The first case detected in the United States had been reported three days earlier, though the infected man had actually returned to the country on Jan. 15 after traveling to Wuhan, China, where the outbreak is believed to have begun.

People in Bedford’s field were using a rule of thumb to estimate how many cases of what came to be known as Covid-19 were outside of China. This was at a time when tests were just being developed to detect the new infection. Each case detected outside China, they estimated, represented about 500 exported cases. When we started speaking, Bedford thought there were a total of 13 exported cases around the world.

No, I told him. That number is now 29.

“Jesus!” he said.

“Did you just say ‘Jesus?'” I asked.

He got audibly flustered, calculating on the fly how much bigger this thing had, in that instant, become. His evident alarm was contagious.

“If it’s not contained shortly, I think we are looking at a pandemic,” Trevor said. He was right.

Helen Branswell is a senior writer covering infectious diseases and global health for STAT.

By Ugur Sahin: Toward the end of January 2020, I was sitting at the computer late at night with a cup of tea reading an article in The Lancet. It described severe cases of an illness caused by a new virus, SARS-CoV-2, which met all the criteria for a pandemic virus: It was highly contagious, some infected people did not show symptoms, and the virus spread quickly within families. In addition, it belonged to the family of coronaviruses, which had already caused major problems during the first severe acute respiratory disease (SARS) epidemic 18 years ago. At that time, a pandemic was barely averted.

Today we are much more mobile. Wuhan is a city with more than 10 million inhabitants that is well-connected to the rest of the world. On reading the article, it became clear to me that this outbreak would not be limited to China. When I saw the pattern, I thought: This is going to become a huge problem.

Ugur Sahin is the co-founder and CEO of BioNTech.

By Jennifer Doudna: In February, as we started to hear more and more about the novel coronavirus, it seemed like this virus might be different, but it was still vague, distant. Everything changed in quick succession in mid-March.

On March 9th, U.C. Berkeley, where I work, announced that it would be switching to remote learning. Later that week, my son Andy, who was a senior in high school at the time, was planning to attend a regional robotics competition in Fresno, and we had to make the call: should he go when things could change at any moment? We put him on the train with the immediate sense that it was the wrong decision.

Things did change, and quickly. The WHO declared that COVID-19 had become a global pandemic. In the middle of the night, my husband and I decided that we needed to drive to Fresno without delay. When you’re driving three hours across California in the dark of night to pick up your child because of a fast-moving pandemic, it’s impossible to miss that the world had suddenly entered a dangerous period.

Not surprisingly, Andy wasn’t thrilled that we showed up to bring him home, but he agreed to come. As we were leaving, we received confirmation that we had made the right call: Andy got a text saying that the robotics event had been cancelled and everyone had to return home immediately.

The next day, on March 13th, I held a meeting with my colleagues at the Innovative Genomics Institute to discuss how we could respond. We had a choice: go home and wait this out, or step up and use our expertise to help our local community. One day later, we started working on launching a clinical testing lab at the IGI, something none of us as research scientists had ever imagined doing. One year later, we have run over 200,000 tests for the UC Berkeley campus and underserved communities in the Bay Area, and we’ll keep going as long as we’re needed.

Jennifer Doudna is a professor of chemistry and professor of biochemistry and molecular biology at the University of California, Berkeley and co-winner of the 2020 Nobel Prize in Chemistry.

By Paul Stoffels: In January 2020, as I stood on the streets of Davos at the World Economic Forum, I knew that we were in trouble. We had heard for the first time that a novel coronavirus had emerged that was more infectious than other coronaviruses, and that the first person-to-person transmission had occurred in Wuhan, China.

That’s when my company — and others — realized we needed to get going.

The coronavirus sequence had just been published, and I called our team in the Netherlands and asked them to start working on a vaccine. The team was ahead of me: they told me they had already started working on a vaccine.

As someone who has been on the front lines of HIV and Ebola epidemics, I was troubled by the potential for this new virus to have world-wide implications. The global health community had been trying to sound the alarm for many years about the need for more investment in pandemic preparedness. We didn’t know the specific virus that would be the cause, but we were not wrong about the lack of global preparedness to deal with a pandemic.

Based on my experience with HIV and Ebola, I strongly believed that a vaccine would be the critical tool needed to stop Covid-19. A year later, I’m incredibly proud of the accomplishments of our team and others. Although the fight against Covid-19 is not over, we must harness the many difficult lessons from this pandemic to ensure there is proactive, coordinated action to be better prepared for the next infectious disease threat.

Paul Stoffels is an infectious disease physician, and chief scientific officer and vice chair of the executive committee of Johnson & Johnson.

By Juliette Kayyem: Reading Helen Branswell’s Jan. 4, 2020, article in STAT about a “mystery pneumonia outbreak” in China gave me a sense of unease. As a reporter, Branswell had to write what she was reporting, but even she gave a hint that something wasn’t right. I’m an analyst, so I get to analyze. And I thought, “Something’s very wrong with this because China is still claiming there have been no deaths.” China wouldn’t be so nervous about this outbreak unless it was really bad.

I started to prepare then. Given my work teaching and advising in homeland security and preparedness planning, my house is pretty ready for the unexpected: extra water, food, medicines, paper products stored downstairs, and the like. But I started to get extras of the basics. I told family and friends to do same; tried to reach audiences by Twitter or CNN, making long tweet storms of what people should do. But I couldn’t truly put into action the enormity of what was coming until I was sitting on a beach in a foreign country around Feb. 20. I was on a surfing trip with one of my sons and it just hit me: We need to get home and stay home. I’m pretty organized about schedules and the entry in my calendar — I still have it here — for Sunday, Feb. 23, 2020, is “cancel.” That was it. The entire entry. And so I canceled everything: work trips, vacations, life as I had known it.

It wasn’t until March 8 that I was able to put into complete words what I knew was unfolding. I got a call from my friend Dante Ramos, a senior editor at The Atlantic, who had noticed that a tweet of mine was, as he said, “atypically panicked.” He asked if I would write about what I was thinking. I said to him, “This is going to be bad.” We worked on the piece and he asked me about a headline. I remember pausing and then saying, “America, you have no idea what’s about to happen,” which was close to the article’s headline.

Juliette Kayyem is faculty chair of the Homeland Security Program at Harvard’s Kennedy School of Government, a former Department of Homeland Security official under President Barack Obama, and author of “Security Mom.”

By Antonio Dájer: During the first week of March 2020, the New York City emergency department I work in had its first patient with suspected Covid-19. At the time, getting approval for a Covid-19 test took hours of telephone negotiation with the city’s health department. The test — it took two days to come back — was positive.

As I heard the result being announced, a wave of fear unlike any I’d felt in 25 years as an emergency physician burned through my chest.

During the H1N1 outbreak in 2009, the pros at the NYC Department of Health and Mental Hygiene had masterfully directed the city’s response. This time they were absent. The politicians had grabbed the microphones.

Worse, the U.S. had no Covid-19 tests, having declined to use the World Health Organization’s version and squandered the month of February, failing to develop its own. We had seen on our TVs what was happening in Wuhan and Italy. That morning in early March my colleagues and I sensed the Covid tsunami — rendered invisible by our testing and leadership fiascos — barreling toward us.

We were on our own. The politicians did not lock down New York City for another 16 excruciating days. And then the world caved in.

Antonio Dájer is an emergency physician in New York City and a columnist for Discover magazine.

By Sandro Galea: Given my work in public health, the possibility of an outbreak like Covid-19 happening has never been far from my mind. In many ways, the pandemic was deeply predictable. We did not know when such an outbreak would occur but we could reasonably assume that one would emerge sooner or later.

In public talks on epidemiology, I have often used Ebola and SARS as examples of the interconnectedness of health, reflecting how contagion spreads in the modern world. So when the first signs of trouble emerged in Wuhan, like many in my field I watched with concern. With the rapid global spread in February 2020, it was apparent we faced a serious problem, as I wrote at the time.

But what was perhaps most on my mind was an awareness of just how unprepared the U.S. was for the looming crisis. We were vulnerable on two fronts: First was the erratic, polarizing approach of the Trump administration. Its failures to lead effectively in the moment were all the more problematic for coming at the end of three years of systematic disinvestment in the policies and institutions that support health. Then there was our country’s broader failure to address the socioeconomic conditions that have kept our public’s health mediocre. From opioids to obesity, gun violence, and socioeconomic inequality, our health is not where it should be — and it is worse for vulnerable, marginalized communities.

As the pandemic unfolded, it soon became clear that the heaviest burden would fall on communities already suffering from poor health, as a consequence of their marginalization. So, my sense that our health was in trouble really emerged long before the novel coronavirus ever entered our consciousness. It emerged with my earliest exposure to public health, when I first learned of our collective poor health and the disparities that characterize it. It means that whenever disaster strikes, no matter what form it takes, it will be exploit the health gaps in our society, becoming exponentially worse in the process. Sadly, this is exactly what we have seen with Covid-19, and it is what we will see with the next contagion if we do not address the challenges this pandemic has exposed.

Sandro Galea is a physician and dean of the Boston University School of Public Health. The Healthiest Goldfish features his weekly thoughts on public health.

By Uché Blackstock: Toward the end of February 2020, urgent care organizations like the one I work for were seeing the end of a busy flu season. The volume of patients had started declining and clinicians like me were finally getting a chance to breathe.

Then, on the morning of March 11, 2020, I received an email from my organization and coronavirus went from a theoretical problem for me to a real one. The email laid out that all providers would be required to wear full personal protective equipment (PPE) for their entire 12-hour shifts: gloves, gown, eye protection, and N95 mask. There were rare occasions that required full PPE and I had not been in any of them since I was in medical school in the early 2000s, when I was on my surgery clinical rotation.

At the time, I don’t think I had yet seen any patients with Covid-19 symptoms. We were given a quick primer on what to look for: flu-like symptoms plus travel to an endemic area, like China, Italy, or Iran. We didn’t yet know yet that a significant number of people infected with coronavirus displayed no symptoms, or that they may have never been outside of the United States.

I remember masking and gowning up at the beginning of that shift totally unaware of what was to come and feeling a sense of dread.

Uché Blackstock, M.D., is an emergency physician in New York City and the founder and CEO of Advancing Health Equity.

By Margot Kushel: I can be a bit of a worry wart: my kids make fun of me that I like to prepare for every type of disaster. But the news out of China in late January 2020 scared me.

From years of studying health inequities and working with people affected by racism and social exclusion, I was pretty cleared eyed that homeless people were going to be hit hard by the looming pandemic.

In mid-February, I read a paper published in a small journal by Dr. Stephen Hwang, an expert in homelessness, on how Toronto tried to protect its homeless population during the SARS outbreak in 2003. One of their strategies was to move people with SARS from crowded shelters to hotels.

That paper helped inform my work to protect the homeless from Covid-19, including the development of what became Project Roomkey, which provided non-congregate shelter (hotel rooms and trailers) for people at highest risk of death from Covid who were homeless, as well as a system of isolation and quarantine units for those who were diagnosed but didn’t need hospitalization or those who were exposed.

Pandemics thrive on inequality, on structural racism, on all the divisions that we have. That meant the U.S. was a set up for a terrible outcome with Covid-19. There was no way for fancy health care to overcome racism and deeply embedded structural inequalities, such as lack of affordable housing, poor protection for workers, and xenophobia. I am so thrilled with the vaccines and, in many ways, their development can be seen as a towering achievement. But watching the vaccines roll out — where those most affected by Covid-19 have been the least likely to get vaccines — feels unsurprising and infuriating.

Margot Kushel is a professor of medicine in the Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Trauma Center and director of the UCSF Center for Vulnerable Populations.

By Jaclyn O’Halloran: Last March, as Covid-19 began its initial onslaught in the U.S., I remember the eerie calm that pervaded the hospital I worked in as a nurse, the swift recession of water before a crashing wave. Administrators worked chaotically to prepare frontline staff and allay our growing fears as we heard the horrors from the frontlines of Italy. My peers and I mentally prepared for the battle to come and built each other up in military-like fashion as best we could.

During this time, a seasoned nurse I had worked closely with made the decision to stop working at patients’ bedsides. I remember feeling gutted and angry and even, selfishly, betrayed by her actions. How could she leave us at the eleventh hour?

I later realized that moment would have greater significance not only on my career but on health care itself. Watching an experienced nurse leave the work she had loved doing for years should have served as a warning for what was to come. But it took living and working through the first wave of Covid-19 for me to realize how troubled the U.S. health care system is. The ripple effects will linger for years to come.

Little did I know then that just a few months after my colleague made her decision to stop working at the hospital, I would do the same thing. I switched to a nursing specialty — hospice — that aligns more with my values as a caregiver. That decision, however, was replete with feelings of doubt, guilt, and failure.

I now know how challenging and difficult it must have been for that experienced nurse to leave her job a year ago. The past year with Covid-19 taught me the importance of quality of life, something that must be cherished above all else, but is sadly often dismissed for health care workers today.

Jaclyn O’Halloran is a registered nurse who works in Massachusetts.

  • The moments came:

    (1) March 2003 – SARS. I was following the daily (hourly) reports out of the Prince of Wales Hospital in Hong Kong over the weekend. Toronto had not been hit, yet. Hong Kong did not look good. Went in early and purchased a four month supply of masks and respirators for my Department first thing that Monday morning with hospital funds – “I know there are patients, the patients will have to wait” – as the national hospital supply system was selling out. Purchased an identical number of same with my own funds, figuring that the hospital administrator would likely confiscate my Department supply for the rest of the hospital if things got bad and I would still be able to provide Department backup from my own supply. Always have a Plan B. 😉 Have stored those materials in the top of a household closet ever since. All in perfect unopened condition when the current Pandemic hit – elastic and all. ~18 years later.

    January 30, 2020 – just looked at my emails – this is when I sent out the first email alerts to friends and family – photographs from Wuhan and suggestions for action – reinforced by telephone conversations. Those who took these matters seriously hit their local hardware stores for respirators, goggles and such. These sold out quickly. Plus the Dollar stores for 60%-70% ethanol hand sanitizer – the usual places ran out quickly, but the Dollar Store clientele got the message last.

    Ignored most messaging from the WHO, the U.S Surgeon General, and the CDC – a lot appeared to be nonsense – except to do the opposite. Fauci made some sense – by February 8 or earlier. Nancy Messonnier made perfect sense – a little late in the game – February 25 – then disappeared into a Black Hole, never to be seen again.

    Supplied family, friends and neighbors with masks, respirators, goggles, sanitizer, knowledge and virtual hand-holding. Care packages in the mail. None of the 21 have come down with the Novel Coronavirus – knock on wood.

    My concern has hardly been with Novel Coronavirus mortality – that is very real, true, but your odds are pretty good unless they aren’t – you know who you are.

    My concern – from the beginning – has been largely in regard to possible chronic sequelae. Now that may be nothing much to worry about – or it may be huge.

    Or it may be anything in between.

    Time will tell us what Time wants us to know.

  • I believe I acquired COVID 19 Dec 14, 2019 in a town in MX. On Dec 21, I felt the first symptoms just before boarding an aircraft to Philadelphia, PA. All the symptoms were there. An elderly friend that I spent New Years day with died of what I probably gave him by the third week of January. On Dec 14, I lunched adjacent to a large (maybe 12 people) gathering of Chinese tourists. My wife and son also acquired the illness from me. Unfortunately, I left for a business trip, along with my son, who was still actively ill, on January 10 and drove across the US. By then I may not have been contagious, although my son probably was.

  • I had heard something about a virus in Wuhan in early January.
    So, I pulled the preprints of the papers in the Lancet and NEJM.
    It was sickening. While I was still reading the papers, I could clearly see what was going to happen. This was, I think, January 9, 2020.
    Called a bunch of people in the BioMed industry, called the local Congress-Critter. Everybody thought I was nuts.
    I suppose that this is part of the pattern of a major epidemic.

  • I went back and looked at my emails and realized that on December 31st, 2019, I had read an article in the South China Post about a mysterious pneumonia-like illness in Wuhan and had forwarded it on to friends of mine who had been doing virus surveillance in bats and pigs in China and in the Wuhan area. I said in my email, “I don’t like the sounds of this and I hope this doesn’t portend for what 2020 has in store for us. Happy New Year.” When I raise this, my colleagues all say I jinxed us.

  • When one of my bosses returned January 1st from vacation in Hawaii – developed a respiratory illness that was mis-diagnosed as strep-throat, and was deathly ill for 2 weeks I connected that with all the news from around the world. China does not without a very serious reason abruptly put 57 million people in lock-down … Chinese go to Hawaii too …. and then mid-January my pharmacy background told me “this is it”. So I prepped (dentist, eye-doctor, yearly medical check-up, lab-work, meds supply, masks), warned friends and family, wrote articles that I guess got ignored, and started isolation March 7, about 2 weeks before my country went into lock-down. My friends picked up the masks I had put on my porch for them, my kids took my warnings too lightly, but I knew all their scepticism would fade. Global travel had continued much too long (Jan, Feb, half of March), super-spreader Carnivals were still held in Feb (Italy, the Netherlands, Brazil, etc), an international dental convention became a logical super-spreader event (Feb). Vast numbers of people fell ill – totally avoidable had national leaders had the smarts and courage to ACT much sooner and much more agressively protective. This pandemic is exacerbated by failing leaders in a lot of countries. Those nations where life is normal again acted strongly, correctly and immediately. China’s economy is off the charts with all the on-line orders, there is a crippling shortage of shipping containers from there to anywhere else in the world. The whole world suffers, while the First Ignorant Deniers are now living it up. Of course the WHO’s trip to that secretive country would not delivery anything meaningful. There is a lot wrong with this reality check.

  • Not really an expert. But around January 11-15 2020 the reports of a spreading “novel coronavirus” in China with flu like symptoms causing serious pneumonia in patients had me thinking only one thing – Flu Pandemic of 1918(which had lasted from 1917 until around 1922).

    It had been around 100 years since that “big one”, which had occurred 30 years after a previous major global pandemic of a flu like disease which had killed millions(during the 1880’s – suspected to have been a coronavirus). The human species was overdue for a new pandemic, and the population in some places had quadrupled in size in 100 years. People were more mobile than in 1918, a virus could spread between continents within hours instead of weeks. There were also more potential victims as a result.

    I began thinking what they were going to call “it”, the new disease, I thought perhaps RCD-219, Human Respiratory Coronavirus Disease 2019. COVID-19 was in fact chosen later with SARS-CoV-2(I was thinking HRCV-219) by I believe the WHO.

    I began wearing masks (and gloves all the time) everyday at work and at public locations by March 5. I looked like a hypochondriac but soon many started doing the same.

  • Around New Years, we started seeing Facebook posts from friends in Taiwan and mainland China about mandatory masks, a few lockdowns here and there. Red flag went up considering how much world travel occurs every single day and the apparent lack of concern in the US. By end of January we were discussing what we might have to do to keep my husband’s business up and running in a pandemic. People thought we were nuts. And then the rest of the year happened.

  • The moment came for me the first week of March, when I was planning to attend a conference at the Allen Brain Institute. I got an email saying the event was canceled due to the coronavirus. I thought, ‘huh. A conference organized by and serving biomedical scientists made what must have been a very expensive and likely unpopular decision to cancel at the last minute. This is bad.’

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