by Dr. Saralyn Mark, AMWA Covid-19 Lead
“We do not know the duration nor the durability of the immune response to natural infection nor to the vaccine.”
I’ve lost track of the number of times that I made this statement since the start of the Covid-19 pandemic. It aligns with my belief that health and scientific communication should follow the “C’s” –clear, consistent with the facts as we know them, and coordinated among all stakeholders.
Yet, communication during this pandemic would not even deserve a C grade. Why did something that should have been so basic, go so wrong?
I think the answer lies in what we have seen in the various hearings and briefings which took place in June. . One just needs to watch the House and Senate hearings on the origin of Covid-19 and the public health response to understand. In June, the public observed political theater on Capitol Hill filled with accusations, incendiary comments, and linguistic gymnastics along with a chorus of scientific interpretation and reflection which may have blended into the cacophony of harsh voices.
What was particularly jarring was the dramatic and overt politicalization of science and medicine—an anathema to the basic tenets of professions which embody neutrality and open mindedness. I recall during one of my first interviews, as the American Medical Women’s Association Covid-19 lead, with a cable news network during the early days of the pandemic. I was asked to comment on a statement made by a senator regarding the political nature of this outbreak.
It was dispiriting to have to state that the SARS Cov-2 virus didn’t care about political parties or nationalities—all of humanity (and some animals) across the globe were fair game to be infected and the window was closing fast. Images out of China and Italy were a harbinger of what was going to hit our shores. This was not a time for political debate. Sadly, our nation could never get beyond political divisiveness around this outbreak. Mitigation measures, medications, vaccines, closures-all became fodder. Along the way, some pearls of knowledge, such as its aerosolized mode of transmission, leaked through the air of distrust, fear and anger, but it was difficult to grasp. Often the public became fixated on what they first heard and who was the messenger rather than on the evolving data. The polarization got further entrenched as the pandemic wore on.
The goals of these congressional hearings in the House and Senate are important, not only to help us understand how we got to this point, but hopefully, how to prevent future public health disasters. But, we just we can’t seem to help ourselves. It appeared that many questions or statements (including valid ones) had to take a divisive tone-to win a point which just further divides a nation already traumatized by too much death and chronic illness.
We shouldn’t ignore that these hearings can play a critical role. I would hope that the public tuned in to hear not just political barbs, but answers to questions underlying the origins of this diabolical virus and the lessons learned for pandemic preparedness. For example, it was fascinating and sobering to learn more about the genetic makeup of a virus that has killed over 25 million people and impacted hundreds of millions suffering from Long Covid worldwide.
There are 7 species of coronaviruses. Four species are identified with the common cold and the other 3 with its lethal cousins (SARS Cov-1, MERS, SARS CoV-2). What sets these 3 species apart from the other 4 which generally cause mild and self-limiting cold-like symptoms? Were the 4 strains initially more deadly, but mutated to be less pathogenic? If so, what drove this evolution and over what period of time? If SARS CoV-2 originated in a lab, would this evolution ever happen? This is one reason why it’s important to understand its origin.
Generally, in nature, viruses don’t persist if they continue to kill their hosts or make them too ill to go out in public and spread their virions. Viruses need hosts for replication and dispersal—the ultimate embodiment of ‘going viral’.
As usual, the most controversial questions regarding viral origin-lab verses natural-morphed into a political discourse during the congressional hearings. It’s a bit ironic in that gain-of-function research definitions and policies have changed over several administrations. However, it does not change the fact that with this type of research, humans are playing with fire. And just like a bonfire, it has to be contained or it can become a wild fire. Bottom line is that all labs around the globe need independent oversight and enhanced lab security. However, as we’ve seen with the challenges to develop and adopt the World Health Organization’s pandemic preparedness treaty, universal lab security, transparency and oversight will probably never happen.
Though I appreciate the value in understanding the potential pathogenicity of viruses, I’m not a proponent of gain-of-function research at this time. I don’t believe that the global scientific community can currently conduct it at a biosafety/biosecurity level necessary to protect lab employees and the public at large. I wonder how much the public understood the discussion around gain-of-function research or did they just tune out exhausted by the continuous rancor?
Fortunately, we can learn from an outstanding briefing that also took place in June. No, it was not another congressional hearing, but a National Academy of Sciences, Engineering and Medicine briefing on Long Covid. It provided a brilliant example of how to engage the public from the start by providing information in a cogent and relatable manner from trusted sources.
Over a thousand interviews were conducted with scientists, clinicians, policy makers and patient advocates. The presentations from these stakeholders were clear, consistent with the facts as we know them and coordinated. Everyone agreed that symptoms need to persist for at least 3 months post-acute infection if the date is known, there are no diagnostic tests or biomarkers, it’s a diagnosis of inclusion, there is asymptomatic transmission, and it’s needs to simply be called Long Covid. From the start, they emphasized that messages will evolve as the data evolves.
Novel communication for a novel virus. It can be done.
About the Author
Saralyn Mark, M.D., the American Medical Women’s Association’s COVID-19 lead, is the founder of SolaMed Solutions LLC, and iGIANT (Impact of Gender/Sex on Innovation and Novel Technologies). She is the author of Stellar Medicine: A Journey Through the Universe of Women’s Health and a former senior medical and policy adviser to the White House, the Department of Health and Human Services and NASA.
Sources:
https://oversight.house.gov/hearing/a-hearing-with-dr-anthony-fauci/ (House hearing)
https://thehill.com/policy/healthcare/4728292-covid-19-origins-hearing-theories/ (Senate hearing)
https://www.hsgac.senate.gov/wp-content/uploads/Testimony-Ebright-2024-06-18.pdf (Lab Origin)
https://www.asbmb.org/asbmb-today/policy/112121/gain-of-function-research-all-in-the-eye-of-the-be (Gain-of-Function Overview)
https://www.politico.com/news/2024/06/02/fauci-covid-research-investigative-panel-00161109 (Tabak Testimony-Defn of Gof)
https://www.forbes.com/sites/stevensalzberg/2023/04/17/what-is-gain-of-function-research-and-why-should-it-be-banned/?sh=14d0513249dc (Gain-of-Function Defn)
https://commonslibrary.parliament.uk/research-briefings/cbp-9550/ (WHO pandemic plan)
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00410-0/fulltext (WHO treaty challenges)
https://www.nationalacademies.org/our-work/examining-the-working-definition-for-long-covid (NASEM Report on Long Covid)