ON DECEMBER 11, 2019, a bat coronavirus made its debut in Wuhan, China. Soon, hundreds of people were hospitalized with pneumonia caused by a virus called SARS-CoV-2. Before the virus left China, more than 4,000 people had died from a disease called Covid. No one was immune. The world was a blank slate.
By January 2020, scientists had isolated the virus and cracked its genetic code. It was now possible to make a vaccine.
In March 2020, the World Health Organization (WHO) declared that the virus sweeping across the globe was officially a pandemic. By that point, 12,000 people had died. In May 2020, after more than 200,000 people in the United States had died from Covid, President Donald Trump announced the creation of Operation Warp Speed, in which the federal government would provide $11 billion to pharmaceutical companies to speed up the development of a vaccine.
In December 2020, after two million people had died from Covid worldwide, the Food and Drug Administration (FDA) authorized vaccines made by Pfizer and Moderna through a streamlined process called Emergency Use Authorization (EUA). Both vaccines contained modified messenger RNA (or mRNA), a novel vaccine technology. Although these mRNA vaccines had been tested in more than 70,000 people—and found to be highly effective—the less stringent EUA approval process, and the breakneck speed with which these vaccines were produced, caused many Americans to worry that corners had been cut—or, worse, that safety guidelines had been ignored. (I am the co-inventor of a rotavirus vaccine, which took 26 years to develop and test. The first Covid vaccines were developed and tested in 11 months.)
In January 2021, after more than 500,000 Americans had died from Covid, Joseph Biden was sworn in as the 46th president of the United States. His administration immediately began mass-producing, mass-distributing, and mass-administering vaccines. Because health systems in the United States weren’t geared toward mass-vaccinating adults, this was no easy task. On the day that President Biden was inaugurated, health care workers were vaccinating a million Americans every day. One month later, in February 2021, 1.5 million; in March, 2.5 million; in April, 3.5 million. A remarkable accomplishment.
By June 2023, about 96 percent of the U.S. population, including more than 90 percent of children, had been vaccinated, naturally infected, or both. No longer were hospitals overrun with Covid patients. The original goal of Covid vaccines, which was to prevent serious infections—to keep people out of hospitals, out of intensive care units, and out of morgues—had been reached. Most Americans returned to life as before. In an interview on 60 Minutes, President Biden said, “The pandemic is over. We still have a problem with Covid. We’re still doing a lot of work on it. But the pandemic is over.”
Was President Biden right?
One definition of a pandemic is that it changes the way we live, work, and play. An epidemic doesn’t. Influenza is a perfect example. Two years before SARS-CoV-2 entered the United States, influenza caused 800,000 hospitalizations and 60,000 deaths. Yearly influenza epidemics don’t change the way we live. We don’t mask, social distance, isolate, quarantine, restrict travel, shutter schools, close businesses, or test to see if we’re infected. If we did, we could dramatically reduce the suffering, hospitalization, and death caused every year by influenza. Indeed, in 2020, when we did all those things to control Covid, influenza virtually disappeared from the United States, as did several other winter respiratory viruses.
We are now at the point where we have accepted the disease and death caused by Covid, as we do with influenza. One thing, however, is certain: SARS-CoV-2 isn’t going away. The virus will continue to circulate throughout the world, continue to generate new variants that are more contagious and immune resistant, and continue to cause harm for decades, if not centuries to come—much as has been the case with influenza since the mid-1300s.
PEOPLE ARE NOW throwing away their masks, gathering in indoor settings, attending large sporting events and concerts, using public transportation, going to movies, and getting back to life as normal. We cannot, however, forget that nine million people in this country, because they have weakened immune systems, cannot be vaccinated successfully. Or that about four million babies are born every year in the United States who are susceptible to the virus. Or that tens of millions of Americans are so elderly or have health conditions that are so debilitating that even a mild infection can be life threatening. Also, although Covid vaccines are highly effective at preventing severe disease, they aren’t particularly effective at preventing mild disease or eliminating transmission, which will continue to occur even if everyone in the world is vaccinated and even if the virus never creates variants.
How will we live with Covid now while continuing to protect those who are most vulnerable? Do we still need to test and wear masks? Do young children need to be vaccinated? Do Covid vaccine mandates have any place in a post-pandemic world?
THIS BOOK IS ABOUT where we’ve been and where we’re going.
In 2020, I was an attending physician in the Division of Infectious Diseases at the Children’s Hospital of Philadelphia when Covid overwhelmed our institution, like many others. I saw children struggling to breathe. I saw parents crying as children were taken to the intensive care unit and mechanically ventilated. And I saw children die. As was the case for so many of us who worked in hospitals, the experience was crushing.
Also in 2020, I was asked by Dr. Francis Collins, head of the National Institutes of Health (NIH), to be part of a group that advised pharmaceutical companies on how to best construct and test Covid vaccines. And I have been a voting member on the FDA’s vaccine advisory committee since 2017. Because of my role on these committees, I was often asked to appear on network news programs on CNN, MSNBC, and Fox News, as well as on morning shows on CBS, NBC, and ABC, to explain events that were unfolding in real time. I was frequently quoted in the media, and like many in my position, I felt an enormous responsibility to get things right.
As the pandemic progressed, however, we found that we weren’t always right, because our decisions were often based on incomplete information. At times, we would give conflicting recommendations, and as a result, many Americans lost faith in both the institutions and the individuals responsible for guiding us out of this pandemic. In 2022, a Pew Research Center survey found that only 29 percent of adults said they had a great deal of confidence in medical scientists to act in the public’s interest. That same year, an NBC News poll found that trust in the Centers for Disease Control and Prevention (CDC) had fallen from 69 percent at the beginning of the pandemic to 44 percent two years later.
In the pages that follow, I invite you behind the scenes to learn as we learned—and will no doubt continue to learn—as SARS-CoV-2 joins the pantheon of other winter respiratory viruses like influenza and respiratory syncytial virus (RSV) that collectively cause hundreds of thousands of hospitalizations and tens of thousands of deaths in the United States every year. We’ll trace the rise of Covid conspiracy theories, and how they could endanger our response to future pandemics. And finally, we’ll explore how to better protect ourselves and our children against new pathogens. A companion website will provide additional resources and links to the latest science and recommendations.
Our journey will start at the beginning. How and where did this deadly virus originate?