The COVID-19 pandemic blindsided nearly every country in the world – By the end of February news of the outbreak had hit media, but the World Health Organization still had it classified as an epidemic. The Trump administration learned of the outbreak in January and halted all travel to and from China.
On February 28th the World Health Organization raised the global risk level to “Very High”. Most countries had yet to see a single case, and so, classified their risk to be very low – this quickly changed as soon as the first case appeared in each country (the first case is indicative of an outbreak that has already established itself, the beginning of a wave). Some multinational companies had started to restrict travel at this point, but no government travel restrictions were yet in place. Airlines were offering free changes to flights to, from or via China, South Korea and Italy (locations of known outbreaks at the time). On February 29th the U.S. increased travel restrictions for South Korea, Italy and Iran, but the virus had already spread to many other countries where no restrictions were being put in place. The first case in Nigeria was reported on February 27th, and by September, 7 different lineages of the virus had been identified by Nigerian scientists as circulating in the region.
On March 1st China announced 573 new positive cases, and by March 5th masks and hand sanitizers were difficult to find in Toronto being sold out in stores and online – people began panic buying, which later proved to compromise supply for medical workers. New York City began quarantining thousands of people at the same time California declared a state of emergency. New York would later prove to have one of the highest death tolls.
In March we understood that COVID-19 can be transmitted by direct contact with infected humans or animals by inhaling airborne particles when an infected person speaks, coughs or sneezes (infection can also occur via the eyes); or by direct contact with a contaminated surface (and then touching your eyes or mouth). By March 6th there were reports of symptomatic people travelling on flights or public transit systems, yet no precautions were being taken (no one was wearing masks yet). One of the worst outbreaks occurred on a cruise ship – the Grand Princess, and guidelines for diagnostic testing were being announced.
By March 9th it was apparent how quickly the virus was spreading – doubling in numbers every few days. Italy imposed a month-long lockdown of 60 million people in response to the crisis (+9,000 cases at that point). Multiple states in the U.S. declared a state of emergency by March 9th, and Netanyahu announced a two-week quarantine on all travellers entering Israel. The incubation period of the virus was still unknown at this point, estimated to be 5.1 days (later shown to be 1-14 days). It was also known in March that the virus could stay airborne and infect people who are in an enclosed space even if they are 4.5 metres apart. The World Health Organization did not admit the virus was airborne until July 30th. People began working from home while other people died of COVID-19 alone, in hospitals. Signs began to emerge in March that re-infection was possible, and that any immunity gleaned from an initial infection would not last (an indication that it could be like the common cold).
On March 11th the World Health Organization officially declared the COVID-19 outbreak a pandemic; at this point the virus was already overwhelming healthcare systems due to lack of supplies, staff and appropriate facilities. Governments around the world and the IMF announced billions of dollars of funding for the pandemic response. On March 11th, the U.S. had approximately 1,000 cases. President Trump suspended all travel from Europe for 30 days and the NBA and NHL suspended their season. It was expected that we would see a much larger number of infections in late stages in the U.S. than Canada due to the lack of a free healthcare system and other social support systems.
By March 12th the pandemic was forcing museums, companies and schools to shut down when there were reports of a case, and major events and conferences were being cancelled worldwide. Testing was still being reserved for hospitalized patients, and not for anyone who thought they may have been exposed. By March 13th the U.S. declared a national emergency (unlocking over $50B in funds), and the U.S.-Canada border was closed. By March 15th, the worst hit countries had a few thousand cases each (with the exception of Italy which had +24,700 at this time); other countries such as Belgium, Denmark, Japan, Canada, Australia and Israel had between 150-900 cases – one month later Canada (April 12th) would see 24,292 cases. New York closed all schools, Spain implemented a 15-day lockdown, and Canada advised non-essential travel should be avoided. The UK and Switzerland at the time were taking no measures to combat the virus. By March 16th Canada closed its borders to all international travellers, gatherings in the U.S. were limited to 10 people, and vaccine development was underway.
Toronto declared a state of emergency on March 23rd as reports of young people in the U.S. becoming extremely sick began to emerge. Ventilators were in short supply and hospitals began sterilizing and re-using masks. Mass layoffs began in some companies in March, with other companies hiring large numbers of people as a result of people’s change in behaviour (e.g. Amazon). Italy called in their army to help with the bodies. The Spanish military discovered dead bodies in nursing homes (people abandoned and left to die). Studies in March revealed that being male is a risk factor, and that a sudden loss of smell could be a sign of infection.
At the end of March the Canadian government introduced the Canada Emergency Response Benefit and President Trump sent stimulus cheques to American citizens. As more provinces and states declared a state of emergency, shortages of PPE in hospitals became more common. Stress on health workers and health officials was extreme, with reports of suicide from being unable to cope. In the worst hit countries, patients were being transferred to other locations due to a shortage of beds and makeshift hospitals were set up. It was also apparent in March that measures would need to be taken to help tenants pay rent, so that businesses and people could stay in place and be best positioned for a quick recovery (the federal government would later announce the Canada Emergency Commercial Rent Assistance program in April). In March, Ontario closed all schools until May (which would later be pushed to September). The U.S. was able to source ventilators quickly to meet demand and would later send some to other countries to aid with their response.
By April, deaths in long-term care homes worldwide began to rapidly increase and governments were scrambling to source and distribute PPE. By this time it was known that the virus could be spread through aerosols through the air, but health guidelines remained unchanged. Some cities were having trouble keeping up with cremations, a problem seen worldwide. Gilead donated their drug, Remdesivir for treatment against COVID-19 and various drug and vaccine candidate studies were well underway. It was also in April where reports of second infections began to emerge (in Wuhan), and suspicions that people who had ‘recovered’ were actually still infectious. Whether immunity was possible or not was a question that would continue to baffle scientists for months, with real-time studies being conducted on various populations (notably, Iceland). Cases in the U.S. at this point had increased steadily, comprising 30% of cases worldwide. Interstate transmission of the virus in the U.S., and limited travel restrictions exacerbated the spread. It was also in April that the UK shifted its strategy, almost immediately after Boris Johnson was released from the hospital after battling the virus. A strong campaign by Canada’s federal government to have PPE made in Canada also began, which later proved to be a success.
Common symptoms of COVID-19 started to become apparent and included: pink eye, loss of smell, fever, chills, headaches, indigestion, skin rashes and manifestations, and lesions on the toes; this list would grow much longer in the months that followed.
On April 14th, Ontario extended its state of emergency an additional 28 days, and the World Health Organization acknowledged that COVID-19 was much deadlier than the flu. Stock markets were disrupted and oil prices plunged into negative territory. Crops were going to waste due to lack of orders and some areas had to ration food. Ontario also called in the military for assistance with outbreaks in its long-term care homes. More outbreaks were being seen at meat processing plants, but the source of infection remained unclear. People began dying at home. As more research and studies were being conducted, more potential therapeutics were discovered, and research fast-tracked.
By May, social distancing measures were proving to be very effective, and perhaps led people to believe that the pandemic was ending. In the U.S., more than half of states began re-opening (only to “pause” their re-openings in the weeks and months that followed due to surges in cases). China also experienced a resurgence of cases and went into another lockdown, testing 11 million people at the same time, and while Italy began re-opening bars and cafes, Brazil’s outbreak was just beginning. A study with hamsters showed that masks were highly effective at reducing transmission, a critical discovery since it was predicted that COVID-19 might be around “forever”. By May it was also apparent that COVID-19 was not just a respiratory disease, with the ability to infect multiple organs including the brain. Distribution of Remdesivir was also a problem in May (distribution problems were later addressed by the Trump Administration and the Department of Defense). COVID-19 had altered human behaviour worldwide so much that pollution levels dropped dramatically and AI machine learning systems became confused. It was also in May that reports of immune-boosting drugs might help in reducing severity of symptoms (vitamins C, D, Iron, etc.).
Countries that experienced the worst outbreaks were often mulled with anti-science sentiments, with 1 in 5 adults in the UK believing COVID-19 is a hoax, and similar sentiments expressed by large populations in the United States. In May, governments began pledging billions for vaccine development, and at the end of May, the World Health Organization agreed to an independent probe of its response to the pandemic at a time when there was still no consensus on reporting. Going to the grocery store became a risky activity. More longer-term symptoms of COVID-19 emerged including reduced lung capacity and neurological damage among previously healthy people. In May, Remdesivir was also officially announced as an effective treatment and federal scientists published their data. It was also discovered that the virus is still evolving, which made it more infectious (but not more deadly). At the end of May, Japan had lifted its state of emergency completely to criticism that it was too early. Two weeks after Wisconsin, USA re-opened, there were a record number of cases and deaths in the area. The outbreak in Brazil was now out of control, and entry to the U.S. from Brazil was restricted indefinitely.
By June 2020, large-scale protests were occurring in the U.S. despite the pandemic, and reports of super-spreaders causing large outbreaks caused concern for protestors. It was also apparent in June that severity of symptoms is tied to genetic factors, in addition to socio-economic factors that result in increased exposure/risk. A study backed by the World Health Organization showed that masks were effective at reducing transmission up to 85%.
At the end of June, it was discovered that a cheap steroid, Dexamethasone, was highly effective at reducing the death rate, and 500,000 courses of Remdesivir were purchased by the U.S. for treatment. Where restrictions were lifted, cases rose, and cities were forced back into lockdown. High-level government officials worldwide were testing positive. Guidelines for re-opening were released by the federal government at the end of June, and temperature screening became mandatory at airports. The World Bank predicted that COVID-19 would cause a recession worse than the 2009 financial crisis.
By July, the rate of infection began accelerating worldwide and the pandemic was shown to cause an 18% rise in deaths in the United States. Mass layoffs continued worldwide and Hong Kong was hit with a third wave. In July, the World Health Organization was still resisting claims that the virus is airborne. Large social gatherings were taking place given the nice weather, which would later result in increases in cases (spikes) and indoor events were found to be much more dangerous than outdoor events. Laws were enforced and those who disobeyed quarantine laws in Canada were charged. On July 13th there were approximately 13,226,236 cases worldwide and President Trump was pictured wearing a face mask for the first time. In July, Jair Bolsonaro tested positive and Brazil closed its beaches until a vaccine becomes available. Half of people surveyed in the U.S. who tested positive didn’t know where they got infected, and more reports of untraceable cases were seen worldwide. Males, older adults, racial and ethnic minorities and those with underlying conditions were established as being high-risk.
A ‘comprehensive review’ conducted in July also revealed COVID-19’s effects outside of the lungs which included blood clots, inflammation, auto-immune disorders, heart attacks, kidney failure and neurological effects. Other and indirect afflictions from the pandemic also include psychological trauma, and domestic abuse. Chinese doctors began helping other countries, putting into practice what they learned from their own outbreak. Human trials of vaccines also began in July. Calls for equal-access to vaccines were made by world leaders including Justin Trudeau and Jacinda Ardern. The second-wave of infections in the U.S. saw younger patients than the first wave. On July 22nd, President Trump held a press conference where he announced multiple effective therapeutics for COVID-19 patients including Remdesivir, blood thinners and steroids. At the end of July, Remdesivir was officially approved for use in Canada and 160 vaccines were under development worldwide. President Trump announced he would reduce the cost of prescription drugs up to 50%.
On July 30th, the World Health Organization (finally) and formally recognized the SARS-CoV-2 virus as airborne. Those who had recovered from COVID-19 were encouraged by President Trump to donate plasma to help existing patients recover more quickly. At the end of July it was also discovered that children can be just as infectious, despite only having mild symptoms.
By August the virus had reached virtually every country in the world and vaccine development became a focus. Management of the pandemic in the U.S. and Canada was hindered by separation of jurisdictions (confusion as to who is responsible – whether it should be states and provinces, or the federal governments). Contact tracing was not aggressive enough in the U.S., and the virus quickly became difficult to manage. People in Ontario are not happy with provincial re-opening plans.
At the end of August, major cities looked like ghost towns and governments were looking to accelerate vaccine development. Hundreds of thousands of children had tested positive in July and August in the U.S. and schools that re-opened were sending children home after dozens of students tested positive within the first few days.
By September, long-term symptoms and cases of reinfection were discovered, Dexamethasone became a widely-used treatment, and plasma treatments were authorized by the FDA after a push by President Trump. Bars and nightclubs were closed in Iowa due to spikes and the U.S.-Canada border remained closed. Plans for re-opening in Ontario have gone ahead despite a high number of active infections, with children returning to school and employees returning to work. The number of cases in Ontario continues to rise and the federal government has declared Canada has entered its second wave. In September, the CDC also reversed its testing guidelines, urging anyone who may have been exposed to be tested. The U.S. federal government has told states to prepare for vaccine distribution in late October.
Remdesivir is currently the only ‘official’ drug approved for treating patients in the early/intermediate stages which has been shown to reduce the duration of symptoms (improving lung function) by four days and reducing the risk of death.
Dexamethasone is a commonly available steroid that can dampen the immune response (cytokine storm), reducing the number of deaths for severe cases.
Common Indigestion Drugs and Muscle Relaxants for symptoms in mild cases.
Iron Supplements may help with weakness/fatigue.
Heparin and blood thinners can prevent lethal blood clots (and thus potentially strokes), and ease headaches at all stages of infection.
Plasma Transfusions from a recovered patient can reduce the duration of symptoms in mild cases.
Antibody ‘pack’ from Regeneron
Sedatives (propofol, dexmedetomidine, etomidate and ketamine).
Analgesics (morphine, fentanyl and hydromorphone).
Pain medications (ketamine, lorazepam, morphine, hydromorphone and fentanyl).
Paralytics and other drugs for those on ventilators.
Ventilators and ECMO Machines
Prone Ventilation can help patients who are on a ventilator, physically opening airways to allow for more oxygen absorption (use of inversion tables should be explored). This has a risk of nerve damage.
Lung Transplants are used in some cases where a patient’s lungs have been severely damaged (and a donor’s lungs are available).
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