San Francisco Chronicle - (Sunday)
How virus has forever changed us
Despite vaccines, it’s likely to be a chronic threat
Stacy Allegro began to feel the symptoms on March 16, the same day, one year ago, that seven Bay Area health officers announced the first shelterinplace order in the United States. It was the day that the coronavirus pandemic officially, and in some ways permanently, upended our lives.
The order issued that Monday morning was as shocking and inconceivable as it was expected, after two weeks of climbing cases and amid a growing dread that swept across the region. Public health officials had been issuing increasingly dire warnings and restrictions on behavior, but still, shutting down was “a
seismic shift in our thinking,” said Dr. Grant Colfax, the director of public health for San Francisco.
By the end of that week, the entire state had locked down to quell what would become the first surge of the pandemic. And Allegro, a 59yearold Novato resident, had joined the unenviable club of firstwave victims of COVID19 — then a mysterious new respiratory disease just beginning to carve its deadly path across the world.
As of March 16, 2020, five COVID19 deaths had been reported in the Bay Area. A year later, more than 5,500 have died. In that time, the virus has shifted dramatically in our collective estimation — from a poorly understood and dangerously underestimated threat to a germ we are slowly, reluctantly, learning to live with.
Eliminating the coronavirus, we now understand, may not be possible. The Bay Area and the rest of the world will have to adapt to it, and the virus to us, over the coming years — maybe for generations, maybe forever. Few understand how the virus has and will continue to shape our lives better than those who were infected early — like Allegro, who fainted shortly after she arrived in the emergency room at Kaiser San Rafael Medical Center, 10 days after her symptoms appeared. She woke up in intensive care surrounded by doctors and nurses in hazmat suits, feeling like she was in a scene from a science fiction movie.
She survived her brawl with the coronavirus, but didn’t come out unscathed. The illness damaged her vocal cords, leaving her with the raspy timbre of Katharine Hepburn, she likes to say. The effects on her mental health are in some ways more distressing. She gets depressed. She’s terrified of getting sick again. She’s convinced the virus aged her, and she worries she’ll never fully recover.
Her experience is a reflection of what’s happening across the Bay Area as we creep toward what could be the end of the pandemic. The early days defined by sharp panic and unsettling uncertainty have settled into fatigue and melancholy along the slow road to recovery, even as hope bubbles up.
“It’s like a grieving process, but everybody is at a different place in the process,” Allegro said. “Some people are angry or scared or in disbelief or denial. The line between being OK and not OK is very thin for a lot of us.”
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Grief and all its related complications are to be expected after the abrupt, traumatic transformation of our lives over the past year, public health experts say. First people strug
gled to understand the nature of the threat. A pandemic of this scale seemed inconceivable except to those few who had long braced for it.
Even after it breached U.S. shores and spread fast across the country, many experts saw a chance to beat it back with lockdowns and aggressive case management. There wasn’t much talk about the longterm future; people were left with the impression that “flattening the curve” meant wiping our hands of the virus.
Now, it’s understood the virus probably will become endemic, a chronic threat as familiar to us as influenza or whooping cough or, if we’re lucky, something less common like measles.
“Will we be living with it? Yes. But can we live with it successfully? Absolutely,” Dr. Mark Ghaly, secretary of California Health and Human Services, said in an interview.
Vaccinations, he said, will prevent most hospitalizations and deaths from COVID19, making the coronavirus something with which we can learn to coexist, like dozens of other pathogens.
Ghaly and other state and local officials who led California’s pandemic response say they are finally coming to understand how to manage this virus, while striking the fragile balance between keeping people alive and letting people actually live — seeing loved ones, going to work safely, enjoying a meal in a restaurant. Getting to this place has been fraught and at times confounding.
“I think about how when you prepare for a game or a match you watch game film, you try to understand your opponent. There’s no game film on coronavirus,” Ghaly said. “We’re taping it now. And it’s going to be a while before we have a complete sense of what it does.” When the virus emerged in late 2019, many experts failed to recognize the threat it would become. Most mistakenly thought that, at worst, the world was facing a contagion like the virus that caused SARS. That 2003 outbreak killed fewer than 800 people worldwide, none in the United States.
This new coronavirus was sneakier and much tougher to control. And experts made a second misjudgment: They thought the world — or at least the United States, with its infectious disease expertise and public health infrastructure — would ward off a fullblown pandemic. They couldn’t imagine a response so mismanaged that half a million Americans would be dead in a year.
“It wasn’t just a case of incompetence, it was a case of sabotaging the public health effort, and that surprised me,” said Dr. Robert Siegel, a Stanford virologist. “I thought this virus was serious, but I believed the U.S. would mount the appropriate response and control it. I don’t know anybody who could have guessed we’d be where we are now.”
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Siegel said he has been appalled but not surprised by society’s tendency to “normalize” the virus and the extraordinary damage it has done as the year has progressed. But he expects this process will continue.
“I don’t think it will go away,” he said. “I think it’ll just become background noise, like cancer deaths and traffic deaths.”
Indeed, a consistent challenge of the pandemic has been getting people to appreciate the deadly threat posed by something that may still feel intangible or far away. While many have lost family members and loved ones, many others don’t know anyone who died of COVID19, or even someone who became seriously ill.
They’ve experienced the virus instead as a haunting — a shadowy, incomprehensible presence that’s left a wake of economic chaos and emotional devastation.
“Most of the public was stuck at home and wasn’t experiencing the pandemic except in this virtual way,” said Martha Lincoln, a medical anthropologist at San Francisco State University.
That made it hard for many
people to grasp the severity of the public health crisis, even as the case counts and death tolls mounted, even as images flashed on their TVs and phones of hospitals overrun by patients. They struggled to understand their grief and to come to terms with all the ways their lives changed while they were cooped up inside, isolated, afraid and frustrated.
Culturally, Americans may have been poorly prepared to face the demands of a pandemic, Lincoln said. That was especially true under the authority of former President Donald Trump, whose management of the pandemic at times leaned on denial and neglect. But even in the liberal Bay Area, “magical thinking” about the pandemic’s threat has been problematic.
“The culture of denialism and rugged individualism in the United States is really, really entrenched,” Lincoln said. “And that makes people optimistic in ways that sometimes are not very realistic.”
Yet that’s just one narrative of the pandemic.
More than 410,000 people in the Bay Area have been infected, and for them and their families, the threat could not be normalized. Nor could the way that the virus exploited deep inequities in the region and across the nation; the burden of disease has largely fallen on communities of color — on Black and brown essential workers and the people they live with, who had no choice but to continue going about their lives while others huddled safely at home.
They felt the brunt of disease as well as the economic fallout, as the stock market rewarded wealthy investors by soaring to new highs.
“We saw it in the first week after shelterinplace — hundreds of people lost their jobs and came to us. We were in for a tsunami, and we knew it,” said Christopher Gil of the Mission Economic Development Agency, which serves lowincome and immigrant Latinos.
A year later, his team is still doing “triage,” even as people are starting to feel hopeful about recovery.
“This pandemic, I can’t imagine anybody that it hasn’t in some way been a challenge. But I don’t think people realize how much of a challenge there was in this community,” Gil said. “It’s just two different worlds.”
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Looking back now, Colfax, the San Francisco health director, said several moments along the course of the pandemic strike him as momentous.
The first reports of overwhelmed hospitals in Italy, the early rampage of the virus through a Washington state nursing home
— these registered as harbingers of what could happen in San Francisco, signaling to Colfax that he needed to act fast.
He gets emotional when he recalls the moment he realized the first shelterinplace order was working — that San Francisco had driven back the surge with the blunt tools of social distancing and masking. Even if it was too late to wipe out the virus entirely, it could be controlled, and that was a relief. “And the moment I read about the first vaccine results — I’m a scientist, and it still felt like a miracle,” Colfax said. “Going to Zuckerberg (San Francisco General) Hospital and having the first health care providers get their first vaccine — of many surreal moments, that was just incredible. I’ll never forget it.”
For someone who had grown up in the shadow of the AIDS epidemic, who as a public health scientist had witnessed the repeated failures of a vaccine to stop HIV, just finding a way out was remarkable.
The swift emergence of the vaccines represented, too, that not everything about this pandemic year was terrible.
“If there’s anything we’ve learned, it’s the capacity of this whole pandemic to surprise us,” said Dr. Robert Wachter, head of the UCSF Department of Medicine. “I’m tilting more and more optimistically lately, and my fear is the surprises are almost all negative. But the biggest surprise? The unbelievable vaccine story.
“The probability this thing goes away by 2022 and we never hear from it again is close to zero,” he said. “But the pandemic ends eventually.” What does the end mean, though? What will it look like? According to experts, it will be a slowmoving series of images: a few thousand fans at a baseball opening game in April, kids in summer school classrooms, maybe even a concert in the fall, in a venue at half capacity.
Some things won’t ever go back to normal; others probably shouldn’t. Why not, Gil asked, use the pandemic to transform health care, make it more equitable and accessible? Why not harness it to drive policy that stabilizes public health and provides better support for lowincome families?
Previous pandemics have resulted in lifealtering, and lifesaving, cultural changes. In the past year, almost no one died of the flu in part because of the precautions in place to stop the coronavirus. If people stay home when they’re sick and wear masks on BART as a result of this pandemic, maybe it’s OK if we never quite get back to normal.
“People’s kids haven’t been sick in a year. I haven’t woken up with a sore throat and thought I was coming down with something in a year. That’s great,” said Dr. Jahan Fahimi, an emergency room doctor at UCSF. “There are certain types of behaviors and activities that I think will be forever changed. And it’s kind of healthier.”