With nearly 870,000 deaths caused worldwide by COVID-19, experts are looking forward to stopping the virus—and looking backward, studying what lessons we have learned from the past. In a new essay in the journal Cell, Dr. Anthony Fauci—the nation's leading infectious disease expert—and David M. Morens chronicle "Emerging Pandemic Diseases: How We Got to COVID-19"—and reveal how COVID is spread and why it's so important to contain it, for our generation and future ones. Read on to see what they found, and to ensure your health and the health of others, don't miss these Sure Signs You've Already Had Coronavirus.1 On How COVID-19 Spreads—and Where You're Most Likely to Catch It "SARS-CoV-2 is transmitted via hands and fomites, respiratory droplets and aerosol, including transmission by superspreading events where large numbers of individuals are infected by a single person, almost invariably in closed crowded settings.' This is why Dr. Fauci has long been saying: "Avoid crowds."2 On Why the Virus is So Brutal"Unimagined just a few short months ago, the ongoing COVID-19 pandemic has upended our entire planet, quickly challenging past assumptions and future certainties. It possesses simultaneously three characteristics that have allowed it to render an historic assault on the human species, triggering a virtual global 'lockdown' as the only weapon against uncontrolled spread. It combines the characteristics of being a virus that to our knowledge has never before infected humans in a sustained manner, together with its extraordinary efficiency in transmitting from person to person and its relatively high level of morbidity and mortality, especially among seniors and those with underlying co-morbidities. It indeed is the perfect storm of an emerging infectious disease."3 On Why We Must Take Control of the Virus "First, in the immediate sense, it is important to mitigate spread of infection, illness, and death. Second, it is critical to prevent the persistence of microbes that may lead to additional emergences that are cumulatively as deadly, or more so, than the original emergences. That viral genetic descendants of the 1918 influenza pandemic virus are still causing seasonal outbreaks throughout the world, and still killing cumulatively millions of people a century later, is a powerful reminder that single disease emergences can have consequences beyond immediate morbidity and mortality. In the ancient ongoing struggle between microbes and man, genetically more adaptable microbes have the upper hand in consistently surprising us and often catching us unprepared."4 On What We Know About COVID"As COVID-19 is caused by a novel virus (SARS-CoV-2) producing a spectrum of disease whose clinical, pathologic, and epidemiologic patterns have never before been observed, we are gaining insights only incrementally. At some time in the future we will be better able to compare and contrast COVID-19 to other important emerging diseases; however, at this time we are still just entering a steep learning curve that will surely keep surprising us as we struggle to control what is already among the deadliest pandemics of the past century."5 On How—Scientifically—the Virus Spreads"SARS-CoV and SARS-CoV-2 enter cells via ACE-2 receptors, found on lung alveolar epithelial cells, gastrointestinal enterocytes, arterial and venous endothelial cells, and arterial smooth muscle cells, among other cell types, which explains the excretion of SARS-CoV-2 and potential transmission via the respiratory and enteric routes. With regard to the latter, although SARS-CoV-2 infects cells of the gastrointestinal tract, fecal transmission has not to date been implicated in significant person-to-person viral spread."6 On How to Limit Future Pandemics"Living in greater harmony with nature will require changes in human behavior as well as other radical changes that may take decades to achieve: rebuilding the infrastructures of human existence, from cities to homes to workplaces, to water and sewer systems, to recreational and gatherings venues. In such a transformation we will need to prioritize changes in those human behaviors that constitute risks for the emergence of infectious diseases. Chief among them are reducing crowding at home, work, and in public places as well as minimizing environmental perturbations such as deforestation, intense urbanization, and intensive animal farming. Equally important are ending global poverty, improving sanitation and hygiene, and reducing unsafe exposure to animals, so that humans and potential human pathogens have limited opportunities for contact."7 The Doctors' Conclusion is We Must Live in 'Creative Harmony' With Nature"There is nothing new about this situation, except that we now live in a human-dominated world in which our increasingly extreme alterations of the environment induce increasingly extreme backlashes from nature….We remain at risk for the foreseeable future. COVID-19 is among the most vivid wake-up calls in over a century. It should force us to begin to think in earnest and collectively about living in more thoughtful and creative harmony with nature, even as we plan for nature's inevitable, and always unexpected, surprises."8 How You Can Avoid COVID-19As for yourself, do everything you can to prevent getting—and spreading—COVID-19 in the first place: Mask up, get tested if you think you have coronavirus, avoid crowds (and bars, and house parties), practice social distancing, only run essential errands, wash your hands regularly, disinfect frequently touched surfaces, and to get through this pandemic at your healthiest, once again don't miss these Sure Signs You've Already Had Coronavirus.
