Covid-19 Pandemic.pdf

HISTORY OF MEDICINE AND PANDEMICS Dima Karam Fall 2023 COVID-19 Milestones These lectures offer insights into medicine’s past, ask what has shaped contemporary medicine, highlighting the evolution in medical theory, understandings of how the body works, how disease occurs and advances in treatment...

HISTORY OF MEDICINE AND PANDEMICS Dima Karam Fall 2023 COVID-19 Milestones These lectures offer insights into medicine’s past, ask what has shaped contemporary medicine, highlighting the evolution in medical theory, understandings of how the body works, how disease occurs and advances in treatment. The course will also address essential medical breakthroughs so that you have a firm general grasp of major advances in the history of medicine. We will follow a chronological order to cover the following periods: Session 1: Session 4: ★ classical antiquity Covid-19 timeline: Pandemic of modern times ★ arab and medieval medicine Session 2: Session 5: ★ early modern Globalization, disease transmission & health ★ 20th and 21st century medicine Session 3: Session 6: ★ History of the most marking pandemics Future frontiers in medicine Learning outcomes On successfully completing the lectures you will be able to: 1. Understand and demonstrate the broad sweep of medicine’s development throughout history, and possess the skills needed to understand evaluate, contextualise and communicate effectively your knowledge of medical history. 2. Demonstrate knowledge in essential medical breakthroughs throughout history and most modern pandemics 3. Engage with the underlying issues associated with the evolution of how disease and health were understood throughout history, to gain an ability to evaluate and interpret these changes within their specific historical context 4. Be able to contextualise medical advances and pandemics within the state of science at a particular period to be able to project what future developments may bring to the practice and project a physician’s role in that context History of medicine Part 4 Covid-19 Timeline: Pandemic of modern times The World Shuts Down Around the World The Race for a Vaccine Covid-19 Pandemic visualized Covid-19 Timeline: Pandemic of modern times ★ The outbreak of COVID-19 infectious respiratory disease triggered one of the deadliest pandemics in modern history. ★ Leading up to May 5, 2023, when the WHO officially downgraded its “national emergency” status, the COVID-19 pandemic claimed nearly 7 million lives worldwide. ★ In the United States, deaths from COVID-19 eclipsed 1.1 million, nearly twice the American death toll from the 1918 flu pandemic. ★ The pandemic also took a heavy toll economically, politically and psychologically, revealing deep divisions in the way that people around the world viewed the role of government in a public health crisis, particularly vaccine mandates. ★ The full effects of the COVID-19 pandemic will reverberate for decades. A New Virus Breaks Out in Wuhan, China ★ In December 2019, the China office of the World Health Organization (WHO) received news of an isolated outbreak of a pneumonia-like virus in the city of Wuhan. The virus caused high fevers and shortness of breath, and the cases seemed connected to the Huanan Seafood Wholesale Market in Wuhan ★ After testing samples, the WHO identified it as a novel type of coronavirus similar to the deadly SARS virus that swept through Asia from 2002-2004. The WHO named this new strain SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2). ★ Where, exactly, the novel virus originated is hotly debated. There are two leading theories. One is that the virus jumped from animals to humans, possibly carried by infected animals sold at the Wuhan market in late 2019. A second theory is that the virus escaped from the Wuhan Institute of Virology, a research lab that was studying coronaviruses. U.S. intelligence agencies maintain that both origin stories are “plausible.”  The First COVID-19 Cases in America The WHO hoped that the virus outbreak would be contained to Wuhan, but by mid-January 2020 infections were reported in Thailand, Japan and Korea, all from people who had traveled to China. On February 11, 2020, the WHO released a new name for the disease causing the deadly outbreak: Coronavirus Disease 2019 or COVID-19. By mid-March 2020, all 50 U.S. states had reported at least one positive case of COVID-19, and nearly all of the new infections were caused by “community spread,” not by people who contracted the disease while traveling abroad. At the same time, COVID-19 had spread to 114 countries worldwide, killing more than 4,000 people and infecting hundreds of thousands more. On March 11, the WHO made it official and declared COVID-19 a pandemic. The World Shuts Down ★ Pandemics are expected in a globally interconnected world, so emergency plans were in place. In the United States, health officials at the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) set in motion a national response plan developed for flu pandemics. ★ Country by country, government officials took emergency measures to encourage “social distancing,” one of the many new terms that became part of the COVID-19 vocabulary. Travel was restricted. Schools were closed. With the exception of “essential workers,” all offices and businesses were shuttered. By early April 2020, more than 316 million Americans were under a shelter-in-place or stay-at-home order.  The World Shuts Down ★ With more than 1,000 deaths and nearly 100,000 cases, it was clear by April 2020 that COVID-19 was highly contagious and virulent. What wasn’t clear, even to public health officials, was how individuals could best protect themselves from COVID-19. ★ In the early weeks of the outbreak, the CDC discouraged people from buying face masks, because officials feared a shortage of masks for doctors and hospital workers. ★ By April 2020, the CDC revised its recommendations, encouraging people to wear masks in public, to socially distance and to wash hands frequently. ★ President Donald Trump undercut the CDC recommendations by emphasizing that masking was voluntary and vowing not to wear a mask himself. This was just the beginning of the political divisions that hobbled the COVID-19 response in America. Around the World DEC. 31 Chinese authorities treated dozens of cases of pneumonia of unknown cause. JAN. 11 China reported its first death: a regular customer at the market in Wuhan JAN. 20 Other countries, including the United States, confirmed cases. JAN. 23 Wuhan, a city of more than 11 million, was cut off by the Chinese authorities. JAN. 30 The W.H.O. declared a global health emergency. FEB. 14 France announced the first coronavirus death in Europe: elderly Chinese tourist FEB. 23 Italy saw a major surge in cases: Europe faces its first major outbreak. In the Lombardy region, officials locked down 10 towns after a cluster of cases, seals off its hard-hit northern regions of Lombardy and Veneto FEB. 24 Iran emerged as a second focus point. Kuwait, Bahrain, Oman and Iraq record their first cases, Around the World FEB 26 Infections outside China outnumber those there for the first time. Italy and Iran emerge as new epicenters. MARCH 6 The number of infected people exceeds 100,000 globally. Deaths top 3,400 MARCH 10 “The whole of Italy is closed now,” headline in newspapers after Rome imposes the most severe controls on a Western nation since World War Two. MARCH 14 France and Spain join Italy in imposing lockdowns on tens of millions of people, and other countries extend entry bans to try to stop the spreading virus. MARCH 17 The E.U. barred most travelers from outside the bloc. Around the World MARCH 19 Italy’s death toll overtakes China. The virus has spread to more than 170 countries. MARCH 26 The United States led the world in confirmed cases. APRIL 2 Global cases shoot past 1 million as deaths soar in the United States and western Europe. Killing at least 51,000. and millions lose their jobs. In just a few weeks, the pandemic put nearly 10 million Americans out of work, APRIL 23 Trump says scientists should explore whether injecting disinfectant might help COVID-19 patients, horrifying medical professionals who worry that some people will poison themselves with bleach. APRIL 26 The global death toll surpassed 200,000. APRIL 30 Airlines announced rules requiring face masks. Around the World AUG. 1 The U.S. saw July cases more than double the total of any other month. AUG. 16 The C.D.C. began developing a plan to distribute a coronavirus vaccine. AUG. 18 Universities that reopened soon began moving classes online. SEPT. 28 Global deaths reached 1 million. In the 10 months since a mysterious pneumonia began striking residents of Wuhan, China, Covid-19 had killed more than one million people worldwide DEC. 2 The U.K. approved Pfizer’s coronavirus vaccine. Britain gave emergency authorization on Dec. 2 to Pfizer’s coronavirus vaccine, leaping ahead of the United States DEC. 11 The F.D.A. approved a vaccine by Pfizer. DEC. 18 The F.D.A. approved Moderna’s Covid vaccine.  Financial Markets Collapse ★ Business closures and stay-at-home orders gutted the U.S. economy. The unemployment rate skyrocketed, particularly in the service sector (restaurant and other retail workers). By May 2020, the U.S. unemployment rate reached 14.7 percent, the highest jobless rate since the Great Depression. ★ All across America, households felt the pinch of lost jobs and lower wages. Food insecurity reached a peak by December 2020 with 30 million American adults—a full 14 percent—reporting that their families didn’t get enough to eat in the past week.  The Race for a Vaccine ★ A new vaccine typically takes 10 to 15 years to develop and test, but the world couldn’t wait that long for a COVID-19 vaccine. The U.S. Department of Health and Human Services (HHS) under the Trump administration launched “Operation Warp Speed,” a public-private partnership which provided billions of dollars in upfront funding to pharmaceutical companies to rapidly develop vaccines and conduct clinical trials. ★ The first clinical trial for a COVID-19 vaccine was announced on March 16, 2020, only days after the WHO officially classified COVID-19 as a pandemic. The vaccines developed by Moderna and Pfizer were the first ever to employ messenger RNA, a breakthrough technology. After large-scale clinical trials, both vaccines were found to be greater than 95 percent effective against infection with COVID-19. The Race for a Vaccine ★ A nurse from New York officially became the first American to receive a COVID-19 vaccine on December 14, 2020. Ten days later, more than 1 million vaccines had been administered, starting with healthcare workers and elderly residents of nursing homes. As the months rolled on, vaccine availability was expanded to all American adults, and then to teenagers and all school-age children. ★ By the end of the pandemic in early 2023, more than 670 million doses of COVID-19 vaccines had been administered in the United States at a rate of 203 doses per 100 people. Approximately 80 percent of the U.S. population received at least one COVID-19 shot, but vaccination rates were markedly lower among Black, Hispanic and Native Americans.  COVID-19 Deaths Heaviest Among Elderly and People of Color ★ Of the more than 1.1 million COVID deaths in the United States, 75 percent were individuals who were 65 or older. A full 93 percent of American COVID-19 victims were 50 or older. Throughout the emergence of COVID-19 variants and the vaccine rollouts, older Americans remained the most at-risk for being hospitalized and ultimately dying from the disease. ★ Black, Hispanic and Native Americans were also at a statistically higher risk of developing life-threatening COVID-19 systems and succumbing to the disease. The COVID-19 pandemic shined light on the health disparities between racial and ethnic groups driven by systemic racism and lower access to healthcare. ★ Mental health also worsened during the COVID-19 pandemic. The anxiety of contracting the disease, and the stresses of being unemployed or confined at home, led to unprecedented numbers of Americans reporting feelings of depression and suicidal ideation.  A Time of Social & Political Upheaval ★ In the United States, the three long years of the COVID-19 pandemic paralleled a time of heightened political contention and social upheaval. ★ Because so many Americans were out of work or home from school due to COVID-19 shutdowns, unprecedented numbers of people from all walks of life took to the streets to demand reforms. ★ Instead of banding together to slow the spread of the disease, Americans became sharply divided along political lines in their opinions of masking requirements, vaccines and social distancing. In general, politically liberal Americans supported vaccine mandates and wearing masks in public, while politically conservative Americans chafed against public health mandates, prompting “mask wars” and anti-vaxx protests.  Covid-19 Timeline: Yale medicine COVID-19 and related vaccine development and research 1984 Paul A. Krieg, Ph.D., Douglas A. Melton, Ph.D., Tom Maniatis, Ph.D., and Michael Green, Ph.D. and colleagues at Harvard University use a synthesized RNA enzyme to make biologically active messenger RNA (mRNA) in a lab. A similar process is still used today to make synthetic mRNA. Drs. Krieg and Melton use synthetic mRNA to study gene function and activity. Other researchers also study RNA. 1987 Robert W. Malone, M.D., M.S. mixes mRNA with fat droplets. He discovers that when human cells are added to this mixture, they absorb the mRNA and make proteins. Dr. Malone also finds that frog embryos absorb mRNA. These experiments are considered early steps in the eventual development of mRNA-based COVID-19 vaccines.  COVID-19 and related vaccine development and research 1990s Researchers test mRNA as a treatment in rats and as an influenza and cancer vaccine in mice. 2000s Several researchers study mRNA treatments or vaccines. But since mRNA is easy to damage and expensive to produce, many researchers can’t get funding to pursue this work and so the research often wasn’t pursued. 2005 Katalin Kariko, Ph.D., and Drew Weissman, M.D., Ph.D., discover that modifying synthetic mRNA keeps the immune system from attacking the mRNA. This discovery moves mRNA vaccine research forward.  COVID-19 and related vaccine development and research 2010s Many researchers study mRNA treatments or vaccines. 2019 A new coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is found in China. The SARS-CoV-2 virus causes coronavirus disease 2019 (COVID-19). WHO will declare the COVID-19 outbreak a pandemic in 2020. WHO and CDC issue recommendations for preventing and treating COVID-19. By January 2021, COVID-19 will cause about 2.5 million deaths worldwide. 2020 Many COVID-19 vaccine clinical trials are in process. Researchers take what was previously learned from vaccine studies of SARS-CoV, MERS-CoV and other viruses to develop vaccines that prevent COVID-19. Researchers also study COVID-19 symptoms, long-term effects, diagnostic tests, antibody tests, treatments and drugs. COVID-19 and related vaccine development and research COVID-19 vaccines ★ The FDA gives emergency use authorization to two mRNA COVID-19 vaccines, the Pfizer-BioNTech and the Moderna COVID-19 vaccines. Because there is an urgent need for COVID-19 vaccines and the FDA’s vaccine approval process can take months to years, the FDA first gave emergency use authorization to COVID-19 vaccines based on less data than is normally required. The data must show that the vaccines are safe and effective before the FDA can give emergency use authorization or approval. Vaccines have gone through — and continue to go through — extensive safety monitoring. Millions of COVID-19 vaccines have been given since December 2020. 2021 ★ The FDA gives emergency use authorization to the Janssen/Johnson & Johnson COVID-19 vaccine. The FDA approves the Pfizer-BioNTech COVID-19 vaccine, now called Comirnaty, to prevent COVID-19 in people age 16 and older. The FDA also authorizes the Pfizer-BioNTech vaccine for children ages 5 through 15. Researchers continue to study and develop several other COVID-19 vaccines. Many COVID-19 vaccines are in clinical trials. COVID-19 and related vaccine development and research 2022 ★ The FDA approves the Moderna COVID-19 vaccine, now called Spikevax, to prevent COVID-19 in people age 18 and older. The FDA approves the Moderna vaccine for children age 6 months to age 17. The FDA has also authorized the Novavax COVID-19, adjuvanted vaccine to prevent COVID-19 in people age 12 and older. Further readings: o Coronavirus timeline: Tracking the critical moments of Covid-19 https://www.nbcnews.com/health/health-news/coronavirus-timeline-tracking-crit ical-moments-covid-19-n1154341 o Covid-19-pandemic-timeline: Milestones Around the World https://www.nm.org/healthbeat/medical-advances/new-therapies-and-drug-trials /covid-19-pandemic-timeline o Our Pandemic Year—A COVID-19 Timeline https://www.yalemedicine.org/news/covid-timeline o Long Covid https://www.yalemedicine.org/conditions/long-covid-post-acute-sequelae-of-sars- cov-2-infection-pasc o WHO Covid-19 Dashboard https://covid19.who.int/ o Covid-19 Data Explorer https://ourworldindata.org/grapher/cumulative-covid-deaths-region WHO Coronavirus (COVID-19) Dashboard WHO Coronavirus (COVID-19) Dashboard