Three months ago Tuesday, the U.S. confirmed the nation's first case of what was then called the "novel" coronavirus – a Washington state man in his 30s who had recently returned from Wuhan, China, the epicenter of a seemingly distant illness that had killed six people.
"What's transpired since then has really gone beyond what anyone could imagine," said Dr. Jay Cook, chief medical officer at Providence Regional Medical Center Everett, which received the first patient. "And the story's still playing out."
Now, there are almost 2.5 million confirmed COVID-19 cases worldwide, and the U.S. is reporting more cases than any other country. Lives have been turned upside down – particularly among communities disproportionately impacted by the outbreak – and more than 40,000 in the U.S. have died.
About 14% of the U.S. workforce has filed for unemployment. Thousands of small businesses are on the brink. Gas is selling for under $1 a gallon in more than a dozen states. And President Donald Trump has signed the largest stimulus package in U.S. history.
We're holding "Happy Birthday" signs from afar and camping out in lawn chairs outside nursing homes. We're saying wedding vows over Zoom and on sidewalks. Prom dresses are gathering dust. Graduation ceremonies are going virtual. We're dumping milk, smashing eggs and burying onions. We're standing 6 feet away at the checkout line – and may need to be standing even farther.
During a season of religious celebrations of resurrection, liberation and community, many Americans have turned inward to pray and reflect. Pastors across the nation celebrated Easter Mass before empty pews and crowded parking lots. Many marked Passover with solitary Seders. Mosques were expected to be closed for Ramadan.
For many, this has been a time of grieving.
"It’s almost like an eternity," said Marshall Hatch, senior pastor at Chicago's New Mount Pilgrim Missionary Baptist Church.
Over the past month, Hatch has taken four trips to the same West Side cemetery to bury friends and family members who died after contracting COVID-19 – first his pastor, then a parishioner, his sister and his best friend of 45 years.
"I haven’t done all of my crying yet," Hatch said. "At some point, we’re going to come through this nightmare, and we’re going to have a chance to reflect on those who were lost. I almost feel like I have to wait until it’s over to figure out who did not survive the pandemic of 2020."
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What we have learned
If there's a silver lining to this suffering, it’s what we’re learning from this outbreak, said Greg Poland, a Mayo Clinic infectious diseases expert who has been working 14- to 16-hour days for months on end.
"The canvas that we call COVID-19 was blank 14 weeks ago. It’s been an amazing thing to see the amount of knowledge that has been generated. It has never before been done in human history," Poland said.
In just a few months, we've genetically sequenced the virus, identified risk factors and initiated drug tests, Poland said. We've learned that social distancing can help bend the curve, that we can work and educate from a distance, that telehealth can help decrease costs and increase access, that doctors and nurses can effectively work across state borders.
That preparedness is the key to saving lives, he said.
"We've learned that something that happened in a city that most people have never heard of can be inside the U.S. within 24 or 36 hours," Poland said. "We’ve learned how interconnected our global economy really is. We’ve learned that, in the context of medications, we’ve probably inappropriately outsourced too much of that."
We've also been stripped of our deniability, Poland said. The COVID-19 virus is the third coronavirus to emerge in the past 18 years, following Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome. "We dare not be unprepared next time," Poland said. "Because there will be coronavirus four and five."
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Some of what we initially thought about the coronavirus was wrong, too. Scientists studying the genetics of the virus have concluded that people were spreading the virus in New York as early as late January, and that it came mostly from Europe, not Asia.
The CDC has estimated that about 1 in 4 people infected with the coronavirus may be asymptomatic. The federal government has adjusted its guidance on face masks, suggesting that the general public should be wearing them after all.
Where we went wrong, what is next
We've also learned that, in some ways, we've failed.
"I've been looking at where testing went awry," Dr. Michael Mina, an epidemiologist and immunologist at Harvard School of Public Health and Harvard Medical School. "The first element initially was the lack of formal recognition by the federal government that this was a problem. We ended up in a situation where no testing was really available."
The U.S. was slow to ramp up coronavirus testing nationwide. The CDC initially limited who should be tested for the virus and shipped flawed test kits to state and county public health labs. Hospital and private commercial labs did not get the Food and Drug Administration’s regulatory green light until the end of February.
Now, the U.S. is conducting more than 100,000 tests per day, but some say that's still not enough to start reopening the country. "Overall, the testing capacity still remains well below what it needs to be," Mina said. "If we want to use testing in a way that’s going to allow everyone to go back to work, we’re going to need robust testing at workplaces."
We're entering a new phase of the outbreak, Mina said – the era of serological testing, which measures the amount of antibodies in blood. The body develops antibodies when responding to an infection. Typically, antibodies prevent reinfection and make it harder to spread the virus. By testing for the presence of antibodies, researchers can determine whether someone has had the virus in the past.
It's possible that many people may have been infected with the coronavirus but didn't test positive through a nose or throat swab test, which helps determine whether someone is currently infected. Many people have been asymptomatic – or didn't know they were inflected.
"I don't think we’ve come close to picking up 1 in 10 (infected) people. Using antibodies – those are going to be the watershed moments. That will tell us about the prevalence, and the true mortality. And that will help paint the picture of what we do next as a society," Mina said. "Some of the most interesting things we’ll find out are going to happen in the next couple weeks."
If serological tests reveal that a large percentage of people in a city or state have antibodies, researchers might determine there is enough herd immunity to protect those who haven't contracted the virus. That would mean people could return to work and to society.
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Many questions still remain
There's still a lot we don't understand about COVID-19. How did the virus originate? Why are men so much more severely affected than women? Why are children minimally affected? DoCOVID-19 antibodies really offer protection and, if so, how much? For how long? Is it enough to prevent further spread?
"We don't know if this virus will result in sterilizing immunity – that, if I breathe in the virus, my body just entirely kills it off before it has the chance to replicate. Seasonal viruses don't usually lead to that, or to lifelong immunity," Mina said.
Some experts have already projected four different scenarios for how the current crisis will impact society for years to come. Best case scenario? The pandemic is a passing storm. Worst case? The virus proves impossible to contain and spreads in long-lasting waves around the globe.
Will we see the rise of immunization certificates – documentation verifying a person is immune to the virus that causes COVID-19? Temperature screening checkpoints? A fundamental reordering of society?
"We have an incredible opportunity to envision a future that is better than the normal we had before the pandemic," Hatch said. "The best way to move forward would be to understand that these (are) inequities we need to correct. Because we now have the unmistakable evidence that this isolation, segregation of opportunity left us all more vulnerable. Communities in the margins become pockets of transmission that leave everybody more vulnerable."
At Providence Hospital, Cook has seen nearly 200 coronavirus patients since the nation's first case arrived there. His team is preparing for an influx of patients with significant medical conditions that have been left unaddressed during theoutbreak. They're also getting ready for a possible second wave of COVID-19 cases.
"The whole world is in turmoil," Cook said. "Life may not be exactly the same, but don’t get so discouraged in the short term. I am confident that we will get through this. We have the potential to do better on the other side."