Many of us are eager to say goodbye to 2020 and hello to 2021. For good reason. This past year brought the frightening mystery of the novel coronavirus. And with vaccines close to approval, but none readily available, there's a second wave, surging numbers, and some long months ahead dealing with COVID-19 and its fallout. Here's what we've learned about the virus, where we stand now, and what we can expect in the future.

What we've learned

"Back in late February, there was a lot we didn't understand about the virus," Summit Health Chief Medical Officer, NY Region Dr. Dan Frogel says. "Our resources on the diagnostic side were short and limited, and on the therapeutic side they didn't exist at all."

Since then, we have learned much about how the virus spreads, how to avoid infection, who is at risk for more serious illness, and how to manage patients better. Physicians quickly learned that aggressive mechanical interventions like putting patients on a ventilator were less helpful than assumed. "We went back to just oxygen support and old drugs like steroids, and patients responded better," Dr. Frogel says.

How the virus spreads

Researchers and physicians have discovered how the novel coronavirus spreads: Infected droplets expelled from the mouth of an infected person received by another person. The risk is highest when we are indoors, close to others, generally within six feet, and unmasked. "There are some reports of aerosol spread," Summit Health's internal medicine doctor Kriya Patel, MD says. "But the degree of this type of spread is unknown. We also don't know how long smaller droplets remain in the air." What we do know is that talking, singing, coughing, and sneezing can spread the virus further than normal breathing.

There is also some evidence that the virus has mutated and become more contagious than it originally was. We now know that people are most contagious starting two days before their symptoms start until about five days into their illness.

How to avoid getting infected

“The basic plan is to avoid getting infected particles into our respiratory tract,” say Dr. Patel. Here are some simple steps we can all take to reduce our risk:

• Wear a mask any time you are around people who you do not live with
• Keep a physical distance of six feet from others
• Avoid crowds, particularly when indoors
• Wash your hands or use hand sanitizer frequently, especially before eating or touching your face
• Stay away from anyone who does not feel well

And she adds that “following all of these steps greatly reduces your risk compared to following only some of them.”

What are the symptoms of COVID-19?

While COVID-19 can cause many of the symptoms caused by common colds and the flu, we have also found symptoms of coronavirus that differ from other illnesses, for instance, accompaniment of loss of smell and taste.

Common symptoms of COVID-19 include:

• Fatigue
• Cough
• Congestion or shortness of breath
• Loss of taste or smell
• Headache
• Body aches
• Diarrhea
• Nausea
• Chest or abdominal pain

Some people have no symptoms at all. Others have one or any combination of the symptoms listed above. A small percent of people will experience more severe disease that can lead to pneumonia, low oxygen level, blood clots, or internal organ damage.

And while most people with mild or moderate illness recover fully, Dr. Patel says that "COVID-19 can sometimes result in prolonged illness, even in young adults and children without underlying chronic medical conditions." Symptoms that may persist in "long COVID” cases include fatigue, lack of energy, confusion, trouble concentrating or brain fog, or persistence of any of the initial symptoms they had.

What are the risk factors for getting sick?

We know that many patients will have mild or no symptoms. Centers for Disease Control and Prevention (CDC) says that about 81% of cases range from mild to moderate, and 19% from severe to critical. But it's difficult to estimate how many people are walking around with the virus, given that many are asymptomatic. The data suggests that number is higher than you might think. That's why, Dr. Patel says, it's especially important for high-risk individuals to remain cautious, especially those who are older or those who have underlying co-morbidities such as:

• Diabetes
• Obesity
• Chronic obstructive pulmonary disease
• Chronic heart disease
• Hypertension
• Immune disorders or taking medications that can affect the immune system

Testing

Dr. Frogel says that lockdown helped people learn mitigating measures, but as society opened back up, numbers rose again. At the same time, however, "testing capabilities became more robust, and we were able to track, trace, and isolate. Early detection has helped us reduce spread and monitor positive patients closely.”

However, as the rates of infection are rising so is the demand for testing and this could again overwhelm our capability to evaluate everyone at risk. “So while we recommend that anyone who has symptoms be evaluated for testing, the best thing to do is minimize your risk so you don’t increase your risk of exposure by coming in for a test.”

If you do end up having close contact with an infected person, you should quarantine and not go to work or school. Close contact is defined as being within six feet for more than 15 minutes. You may consider getting tested at day 5-7, but remember that you must quarantine for 7-10 days even if you are negative.  

Looking ahead to treatments

With remdesivir and dexamethasone approved for severely ill patients, we are seeing better outcomes. In addition, other therapies—antivirals, convalescent plasma, monoclonal antibodies, and immunomodulators—are being studied in various trials for patients with milder illness who are at risk for getting sicker. 

Vaccines - the light at the end of the tunnel

Possibly the best news is that more than 100 COVID-19 vaccines are in development, with 40 or so currently in clinical evaluation stages. The news changes daily, but already several have proven to be safe and effective, and one will soon be delivered to state health departments.

“The problem now is mostly logistics,” Dr. Frogel says, with production and administration the two key problems to solve. Still, he's confident that after widespread vaccine availability, "the next real wave will be milder, and the one after, and then we won't get one at all."

Help for people of all races and ethnicities

We know that COVID-19 has disproportionately impacted Black, Latinx, Native Americans, and other minority communities. Often these communities have less access to testing and medical care. Vaccine trials have made active efforts to include people of all races and ethnicities for testing of safety and effectiveness. As we look to a time in the near future when vaccination will be available to the general public, it will be essential to ensure equal access for those at highest risk regardless of race or ethnicity. 

We cannot let our guard down

With new treatments and vaccines around the corner, Dr. Frogel’s real concerns are more immediate, related to both mitigating spread during the winter and fighting against human nature. To get through the next few months, he suggests that you do a real quarantine if you become exposed to a person with known COVID-19.  Even if you test negative, you must stay away from others for the full recommended quarantine period. "It takes up to 14 days for symptoms to develop," he says. "It may seem like a long time, but plenty of people under quarantine do wind up testing positive."

In addition:

• Follow mask mandates. Always keep your mask on when you are around others who do not live with you.
• Limit holiday gatherings to household members only.
• Obey curfews.
• Continue to practice good hand hygiene.
• Decrease social contact wherever possible.
• If you have symptoms seek medical care.
• If you have no symptoms but had close contact with a person with COVID, consider getting tested at day 5-7 rather than right away to increase accuracy.  Remember, regardless of test results you must quarantine for the full recommended period.
• If you have no symptoms, consider test or retest at drive-through centers to ease the burden on urgent care clinics.
   

In short, be honest with yourself and your caregiver if you've had contact with a carrier. And don't let down your guard. We're all tired of the pandemic and overjoyed about the promise and potential of therapeutics and vaccines. But as with all viruses, there unfortunately may never be a cure. The good news is we are close to controlling this pandemic with increased understanding of the disease and the promising vaccines and therapeutics on the horizon.