A COVID-19 retrospective

I’m summarizing here for myself and anyone else interested, my best estimations about COVID-19 (Covid) from all the science I have seen and personal experiences through the past few years. I hope this can be a good refresher in the future when this episode is inevitably brought up and everyone’s personal opinions might have clouded the nuances of its evolution. These are my personal opinions informed by the best knowledge I could gather from science.

About me: biotech major, and a biomedical engineering PhD, no other medical degree. I’m not an expert in these topics by any professional standard. I did however spend a decade in wetlabs and know a thing or two about sterile technique, but that’s it. I have read a few hundred scientific publications about Covid, however.

Before we begin: according to me, masking works, vaccines work and vaccine mandates were warranted. Only the details are up to debate below. I spent inordinate sums of money and effort protecting myself and my family from this disease and was successful in doing so (while still traveling internationally and going on with life as normally as possible). I masked up with N95s from the beginning till March 2023. Got vaxxed with 3 booster shots over the years.

  • In the initial months of the pandemic it was truly difficult to determine the true mode of transmission of the virus or what the precautions to take should have been.
  • Given what we knew worked for SARS and other epidemics, however, recommending masking was absolutely a good call. N95 masks were always a better option than regular masks, notwithstanding the contradictory back and forth perpetuated by CDC and WHO.
  • The fundamental reason why COVID was so effective as a pandemic was because the virus was infectious BEFORE becoming symptomatic. This completely derailed all prior protocols and caught regulators flat footed unless they were truly objective and were ready to follow the data in moments’ notice (which few really did).
  • Social distancing was an acceptable precaution for maybe the first few months of the pandemic until we had limited data on transmissibility and particle sizes. This practice should have then been abandoned. As it became clear that the particle sizes of relevance to Covid (which likely changed for delta and omicron) were small enough to be able to infect anyone in a closed circulation environment, it didn’t make any sense to continue this precaution and instead we should have focused on more stringent avoidance of such environments altogether.
  • Carefully designed Ventilation was likely the only way one could have avoided Covid in any closed space without a mask yet it was not used as a solution in any country or organization on a consistent basis.
  • A good fraction of people were just fairly immune to Covid pre-Delta (unless they were exposed to insane viral loads like in a hospital ward). This likely compounded our misunderstanding of what worked and didn’t work precautions-wise.
  • Mask effectiveness summary:

    • With proper adherence, surgical/cloth masks were of some help for pre-Delta. For Delta, N95 was a minimum requirement to reasonably avoid infection. For later versions of omicron, even N95s were likely not sufficient if you weren’t vaccinated, and likely would have required P100 + covering of mucosal membranes (goggles for your eyes) for reasonably guaranteed protection.
    • Proper adherence meant never removing the mask in a closed space, even for a second. The moment this rule was violated, all bets were off though if kept to a bare minimum it likely helped with varying results.
    • The only folks who likely followed something close to proper adherence were the practitioners in the Covid wards of developed countries. Even doctors and scientists not directly treating Covid patients did not follow strict adherence.
  • Covid deadliness and mechanism summary:

    • The deadliness of Covid pre-omicron (especially Delta), was fundamentally likely due to its propensity to form synctia, i.e., cell-cell fusions - the viral proteins somehow mediated fusion between cells, even between the epithelial cells and immune cells. While synctia formation is observed in other viral infections, it played an important role in making pre-omicron Covid deadly. This was new, and we were unable to target any pathway to help treat it.
    • Omicron does not cause synctia and hence became a fundamentally different disease, the nuance of which is lost on most discussions and even scientific studies where no differentiation efforts are made to categorize this distinction. We will likely never study well the role synctia formation played in the deadliness of early Covid due to this.
  • Vaccines absolutely worked; until later omicron strains, any rare side effects of the vaccines including mRNA vaccines were worth it. As of May 2023, however, it’s not clear if the vaccine is any more useful than a flu shot is. But given the potentially riskier side effects of mRNA vaccines, the vaccines themselves being less similar to the evolving strains, and the relatively small window where they’re very effective (a few months), it’s perfectly valid to not want to get vaccinated with any more booster shots unless you’re in a high risk population.
  • With each subsequent predominant strain of omicron, the virus became more contagious (likely becoming the most contagious respiratory virus in circulation) but also less symptomatic/deadly. As of 2023, it’s no worse than a typical flu strain.
  • Remdesivir didn’t help much. Ivermectin did not work at all. Antibody therapies likely worked for Delta. No opinion on paxlovid.
  • Why did COVID become so polarizing? A combination of the following practices eroded any confidence a good fraction of the public has on expert knowledge and hence led to people taking their fate into their own hands.

    • Poor CDC and WHO leadership: Everyone looked up to them for level headed consistent guidance and leadership. Yet they gave the opposite. Mismanaged, inconsistent, self-contradictory and hypocritical are the only adjectives that come to mind.
    • The ruthless unpredictability of it all: Countries that did strict lockdowns ended up still getting wave after wave. Some events were superspreaders, others were not, with no clear rhyme or reason.
    • It was still a mild disease for most people. Except for a brief period of the Delta wave, most who got the disease only had relatively mild symptoms which eroded the seriousness of it all.
    • Hypocrisy: It’s not up to debate that pretty much everyone in the world ended up following the rules in some way or another that anyone with basic reaonsing skills would consider hypocritical. It’s human nature to lose confidence in a system one perceived as hypocritical. Examples:

      • Requiring masks to enter a restaurant but only to then remove it once you’re seated.
      • Requiring masks but saying surgical masks are fine even after considerable evidence emerged showing they were not very effective at preventing Delta/omicron infections.
      • Fauci and other thought leaders removed masks for press briefings in closed spaces with people clearly fairly close to them (even if they were still in compliance with social distancing rules).
      • Celebrities and politicians touting the rules while regular folks were penalized for doing the same.
    • Ego: time and again agencies, politicians and thought leaders continued to recommend rules against logic and the most recent scientific/observational evidence just because their earlier recommendation might look wrong otherwise. Example: China doubled down on Sinovac even after it became clear it didn’t work, and countless Chinese lives were lost when the disease eventually found its way into the country (thank Lord it was not-as-deadly omicron).
    • Useless security theater: measuring temperature when there was no proven clear relevance to early Covid positivity (most people were infectious days before such symptoms); banning gatherings in open windy places like beaches when there was no real evidence the virus could spread there; disinfecting every surface even after it became clear fomites were not a primary mechanism of transmission.
    • Politicians undermining good practices: For a bit, everyone across the political spectrum looked up to Trump. In rare cases they even did the right thing (like having daily briefings). But his initial sowing of doubt on the recommendations was enough to set the stage.
    • Preexisting lack of confidence in the medical system: Let’s not forget that vaccine denial was already a large problem in developed nations and suddenly the entire population, not just moms, had to make decisions on this topic.

Topics I have not formed conclusions on yet:

  • It’s unclear what lockdowns were the most productive, if any. Countries on all sides of this topic fared well and worse with minimal patterns. Countries that succeeded for years without massive outbreaks paid the price when it eventually got into their population.
  • Flatten the curve? Did that even make sense? No idea.
  • How bad was it for kids? What was done correctly and what could have been better?

Interesting recollections from the early stages of the pandemic:

  • I remember reading in March 2020, a handbook that was released from China. It was so methodical and thoughtful given how little we knew. I wonder how we regressed from that to how the pandemic evolved eventually. I wonder what we could do in the future to avoid the same mistake.
  • When the pandemic begun, in April, I estimated to my mother that the worst-case scenario is that this disease might kill 1 in 100 people in countries like India. Based on personal experiences and knowledge (and how much India likely underreported deaths), this number was not very far off from reality. 1 in 100 people.

Long-term physical issues of Covid still taunt many of the people I know and care about; it's clear that this disease has changed the fundamental rates of most common causes of deaths in humans. We can only wait and see what this means in the long-term.

Children around the world have collectively and unanimously been put through the most unprecedented break in normalcy since World War II (even WWII likely did not affect the world in its entirety this much). It will be fascinating to see how this generation grows up and what effect this experience has on their adult lives and the decisions they make for humanity.

I hope someone more qualified can write a better summary than this, and if they do, I’ll happily link them here. Or change the statements above as and when there emerged clear evidence warranting it. Here’s to hoping these are lessons we don’t need again anytime in the future.

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