At the beginning of last year, we knew pretty much nothing about the virus that would come to rule our lives for most of 2020. A mystery virus linked to pneumonia was reported in Wuhan, China in December 2019. In early January, the U.S. confirmed its first cases of the unnamed illness, and we maintained watchful vigilance until the World Health Organization (W.H.O.) declared a state of emergency on January 30. After that, things moved quickly, and the illness finally received a name; 'CO' for 'corona,' 'VI' for 'virus,' and 'D' for disease, thus COVID-19 was coined. Since then, our lives have changed dramatically. However we have come a long way since those first reports, so we are taking a look back at all the things we have learned this year about COVID-19, and a look ahead to what we still need to do to beat this horrific illness.

How it spreads:

When cases first skyrocketed in the United States, disinfectant wipes began to fly off the shelves. This was because it was originally believed that the virus could survive for long periods of time on a surface, making that an easy way for it to spread. Months later, we now know that, though the virus can live for hours on materials, the primary source of transmission is droplets from our respiratory system that travel through the air. This is why mask wearing became mandatory in most communities. This was also when the Centers for Disease Control and Prevention (CDC) established a recommendation for social distancing, requesting people to stay at least six feet apart since that is as far as the droplets could travel. 

Later, we learned that COVID-19 may also secondarily be spread by airborne transmission. So, the smaller respiratory droplets exhaled when people breath, talk or sing may linger in the air for minutes or hours, posing a risk to others who are more than six feet away or even after a person has left the space. 

How contagious it is:

When it was first detected, it was thought that the mysterious virus didn’t easily transmit from person to person. Then it was found that an infected person would, on average, spread to one or two other individuals. As we learned more about how it was transmitted, it became clear that one infected person could cause a ripple effect that could infect hundreds. 

The idea that you had to have symptoms to spread the new coronavirus was one that was adapted from other coronaviruses we had seen before, namely SARS and MERS. However, we soon learned that unlike SARS and MERS which only infect the lung cells, this virus can infect cells in the nose and throat, so people can transmit it to others before feeling sick.

What the symptoms are: 

Earliest reports of the illness warned against a high fever, shortness of breath and a cough. Now the list of symptoms has greatly expanded to include loss of taste and smell, fatigue, headache, diarrhea, vomiting and body aches, just to name a few. It has also been discovered that some carriers are asymptomatic, so though they have the virus they may not experience any symptoms at all. 

Who is at risk:

It was originally reported that people over 65 or with a chronic condition were at the highest risk for developing severe symptoms. Many believed that children were mostly immune to COVID-19. However, we now know that COVID-19 is not selective. Though age and chronic conditions can be risk factors, anyone can contract the disease and have severe symptoms. In addition, racial disparities have become apparent, with Black, Latinx and Indigenous people contracting and dying from COVID-19 at higher rates. 

How it should be treated:

There has been a lot of speculation about how to repel the virus. Reports of mouthwash, disinfectants, steroids and other home remedies have been found not only to be ineffective but potentially dangerous. In the beginning, we were learning on the fly, so patients were quick to go to the emergency room and doctors were quick to put patients on ventilators. Now that we have more experience with the coronavirus, hospitals have settled on a core set of treatments, although a cure is still forthcoming. In addition, we have learned that milder cases can mostly clear up on their own after about two weeks if symptoms are monitored and treated while the sickness runs its course. During this time, it is essential that the sick individual stay self-quarantined. 

How to get tested:

In the early days, because testing kits were scarce, most hospitals were only testing patients who were experiencing multiple symptoms. Now, getting a coronavirus test has become much easier, with most testing sites being open to all individuals regardless of symptoms. In addition, an at-home coronavirus test has been developed to make getting results even easier. 

Similarly, the tests themselves have changed. The main method is a viral test which includes nasal swabbing. Recently, saliva testing is becoming more common because it is less uncomfortable. In addition, antibody testing is also available and involves taking and testing a blood sample to determine if there was a past infection.

What recovery looks like:

In the beginning, we questioned if you contracted COVID-19 and recovered, were you then protected from a second infection? Though we do have a test that can detect the antibodies in the blood, we still do not know if they provide protection, and for how long, from getting infected again. In fact, there have been reports of people contracting the disease for a second time. 

Also concerning, though millions of Americans have recovered from COVID-19, the long-term effects are still a mystery. We are now discovering that many people who were diagnosed weeks or months ago are experiencing lingering or new symptoms. Termed ‘long-haulers’ for experiencing post-COVID long-term symptoms, even people who were not hospitalized and who had mild illness may be experiencing longer-term symptoms. 

Creating a vaccine:

Because this is an entirely new virus, when we realized the severity, it became a global collaborative to create a vaccine. There is currently no vaccine approved by the Food and Drug Administration (FDA) to prevent COVID-19. The FDA has granted Emergency Use Authorization for the first supply of manufactured vaccines prioritizing those most at risk. It is expected that a vaccine for general distribution will be available to all adults in 2021.

Stay Informed:

Medical discoveries continue to grow our knowledge base and allow us to improve how we prevent and treat COVID-19. You can count on the American Lung Association to provide science-based information to help you navigate the latest research and guidelines.  Learn more at Lung.org/COVID-19.


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