First thoughts and first 100 days

Someone asked me if I took immediate notice when I heard of an outbreak of a new coronavirus which later would be named SARS-CoV-2, the cause of COVID-19. I replied with a quick “yes”. I don’t know what date I first heard about the outbreak of a new pneumonia-like illness of unknown etiology in China, but looking back at my activity on Twitter I see that I first tweeted about it on January 4th. On that date I tweeted a story from the South China Morning Post reporting 44 cases of a mysterious “viral pneumonia outbreak.” January 4th was just four days after the Chinese government had first reported a cluster of pneumonia cases in Wuhan on December 31st, three days after the Huanan Seafood Wholesale Market closed on New Year’s Day, seven days before the first death was reported on January 11th and sixteen days before the first-identified case in the U.S. in my home-state of Washington on January 20th. All of this was likely 4–6 weeks after the virus first jumped from an animal into a human host. I’ve read a couple of stories claiming to identify “patient zero,” the South China Morning Post reporting that a 55-year-old Hubei resident had been sickened on November 17th and news.com.au reporting patient zero was a 57-year-old seafood merchant at the Huanan market who became ill on December 10th. I take all of these reports with a grain of salt but they are interesting to read. Looking back even further, it is thought that the virus came to humans through an “intermediate host,” an animal species in which the virus does not normally circulate but which is susceptible to the virus. The reason why it is thought that the virus likely came through an intermediate host is because SARS-CoV-2 is very closely related to coronaviruses that circulate in horseshoe bats with >96% genetic similarity to a virus called BatCoV RaTG13. These bats are likely the “reservoir” of SARS-CoV-2 or very closely-related viruses and it is among these bats where the virus normally circulates and where it likely has been present for a very long time. There have been no documented cases of spread of coronaviruses directly from bats to humans, these bats were hibernating around Wuhan when the outbreak began and bats were not sold at the Huanan market — therefore, most likely, the virus came to humans through an intermediate host. Previous outbreaks of novel coronaviruses (SARS — Severe Acute Respiratory Syndrome and MERS — Middle East Respiratory Syndrome) are also thought to have originally come from bats through intermediate hosts — SARS through palm civets and MERS through dromedary camels. Various possible intermediate hosts of SARS-CoV-2 have been suggested — anything from snakes to pangolins but I have not seen any definitive evidence identifying the intermediate host of the virus.

The cause of what would later be called COVID-19 was not actually identified as a coronavirus until January 7th. When I first heard that the cause was a coronavirus my thoughts certainly turned immediately to SARS and MERS, the two other novel coronaviruses in recent history with outbreaks occurring in 2002–2003 and 2014–2015, respectively. On January 7th, before a fatality had even been reported, I probably thought that this new coronavirus was a much less severe version of SARS or MERS which technically would have been correct. Unfortunately we would later find out that this virus can be deadly and is much more capable of sustained transmission between humans compared to SARS and MERS. The death toll from COVID-19 would surpass the death toll from SARS on February 9th. Just before the weekend we got Alex moved up to Colorado the Iranian and Italian outbreaks would begin, on February 19th and February 21st. Wednesday, February 26th inaugurated likely the strangest Lent that any of us have experienced. When we entered the whirlwind of March I still was expecting to soon be deployed, expecting that I would likely eventually be caring for patients with COVID-19, but not in the U.S. Within weeks I was seeing my first COVID-19 patients not in a foreign land but close to the city I had called home for years.

Today is 100 days since China reported the beginnings of the current pandemic. When I formed my first impressions of this virus I could not have imagined the global crisis and the unprecedented alterations to daily life we are now experiencing. Today is also Maundy Thursday, the day when Christians celebrate Christ’s Last Supper and prepare to enter into the Triduum, the three holiest days of the Church Year — Good Friday, Holy Saturday and Easter Sunday. Not being in church on this day, perhaps more than any other, underscores for me what most of the world is suffering through at this moment. Maundy Thursday is a very physical celebration. It is a time when we may have our feet washed and, in turn, wash the feet of another, in imitation of Christ’s actions on the night of his Last Supper. It is also the celebration of an intimate meal between friends, when they ate from the same dish, when the beloved disciple leaned on Jesus’ bosom. All of this seems so foreign and so impossible now in this age of distancing. But as Queen Elizabeth II so elegantly stated last Sunday, “We will meet again.”