On January 26 last year, the Arizona Department of Health Services confirmed what more and more scientists and medical experts worry about: A 26-year-old man at Arizona State University tested positive for the virus, and the virus did not even have a name. At the time, This virus, which hardly involves most American citizens, is called the novel coronavirus.
The news caused panic among some students because the state was working to isolate the man and test his direct contacts. For most people, life goes on as usual, but this situation will change within a few weeks.
COVID-19 has arrived in Arizona.
Within a few weeks, Josh Labelle, executive director of the Institute of Biodesign at Arizona State University, began to sound the alarm that the virus could become a bigger problem. He was not the only one: Throughout February, scientists and experts in Arizona became increasingly worried and began to prepare for a possible epidemic.
"At the time, none of us really understood the scale and scope of this incident," Labelle said.
No one expected how bad things would get.
Stephanie Jackson, senior vice president of HonorHealth, said: "I never dreamed that Arizona would be so bad. It's embarrassing."
Since the first case, more than 727,000 Arizonans have been infected with COVID-19 and more than 12,200 have died. The United States has been grappling with quarantine, business and school closures, hospital overloads, supply shortages, test backlogs and anti-mask protests.
Through all this, scientists and medical staff work around the clock to take care of critically ill patients and fight the virus.
"We are exhausted," Jackson said, "every minute we are reacting to something that we can barely control."
Many people, including Jackson, hope that vaccines are a way to get rid of the pandemic, but it is expected that there is still a long way to go in the future. After witnessing problems with testing and other public health measures, some people worry that the introduction of vaccines will be clumsy, confusing and inefficient.
These concerns are not unfounded: The slow rollout of the Arizona vaccine has drawn criticism from Governor Doug Ducey and elderly residents who cannot make appointments easily.
As the first year enters the second year, health care and science leaders hope that the state can learn from the mistakes of the past and build on its success.
The first COVID-19 case in Arizona did not cause the spread of the disease. The person who tested positive had just returned from the Wuhan area of China, and he reported that he had been in contact with a patient.
David Engelthaler, director of the infectious disease department at the Flagstaff Institute for Translational Genomics, said that despite "there are a lot of opportunities for transmission," the student has never infected anyone else.
Although the person tested positive within 18 days of diagnosis, 10 high-risk contacts (including one close contact) never tested positive, and no other cases in the state were genetically traced to him.
"In general, the early cases did not cause a large-scale outbreak," Engeltal said. "They usually fail."
From mid-February to late March, the virus was reintroduced into the state at least 11 times. Engelthaler said genetic analysis showed that most of these cases originated from European virus strains, and some were introduced through domestic travel in other states in the United States.
"I think the nature of this beast has changed," he said. "We didn't really see the effect of this virus until those strains from Europe reached the United States and reached Arizona."
He said that by March, the state was trying to shut down the virus through strict public health guidelines, but the virus continued to spread. He believes this is because the European strain carries an important early mutation that makes the virus easier to spread.
Engelthaler said mutations like this and the virus variants in the UK and South Africa show why genetic monitoring of viruses is important. Although the state was initially monitoring the virus, funding for genetic monitoring ran out last fall and has only now begun to increase.
He said: "I think many people overemphasize the differences between public policy and the politics surrounding this issue, and don't pay enough attention to the virus."
As the vaccine is promoted nationwide, HonorHealth executive Jackson said that the possibility that mutations hinder the vaccine or cause the further spread of COVID-19 worries her.
She said: "The most important thing we can do now is to make the vaccine spread faster than the virus. We may surge again in March or April, and we need to be prepared for this."
TGen started to develop genetic tests to screen for COVID-19 in January, and by mid-February, LaBaer said he had started discussions with ASU management for large-scale COVID-19 testing.
"One thing we know is that if this is going to be a serious epidemic, we need a way to test it," Labelle said.
Initially, only test kits distributed by the Centers for Disease Control could be used for testing. However, the early test kits that were introduced to state laboratories were improperly handled due to flaws in the test, resulting in test delays.
"We don't even have a way to test it," Jackson said, explaining that each test must pass the county health department's requirements. "In the beginning, we only tested patients with a history of travel to China."
The FDA issued new guidance on February 29, allowing federally certified laboratories to perform additional tests.
By mid-March, TGen began testing, and ASU had assembled hundreds of test kits. The university had hoped to open a drive-through test site before the end of this month. Other national laboratories hope to follow suit.
A big challenge is the lack of supply. Finding the required swabs and substances prevents many test sites from starting or testing large numbers of people. When the test first started, Labelle said there were only a few thousand swabs in the state.
Richard Gray, chief executive of the Mayo Clinic in Arizona, said this shortage forced hospitals to be creative. Mayo started using 3D printed cotton swabs for its test suite.
There is also a shortage of personal protective equipment for medical staff, which has led Dignity Health to start 3D printing its own masks and design reusable protective clothing. Although the hospital has found an innovative solution, Keith Frey, chief medical officer of Dignity Health in Arizona, said that the shortage of supply has brought important lessons for the future.
"We may hope that next time we have better inventory and be better prepared," he said.
Initial efforts also focused on testing symptomatic patients, but Gray hopes that the state will also focus on testing asymptomatic patients.
Gray said: "If we test a wide range of people, it may help in the early stages," and explained that it can prevent the asymptomatic spread of the disease.
Mayo and others focus on swab-based tests, while the University of Arizona is committed to developing the state's first COVID-19 antibody test. These tests can determine whether a person has been infected with the virus. But after about a month, it became clear that “this is not the test everyone wants,” said Michael Dake, senior vice president of health sciences at UA.
The university later switched to providing rapid swab-based tests, but Dake believes that the uncertainty illustrates how disconnected the deployment of COVID-19 tests statewide and nationwide.
"If we have some directions, blueprints and guidelines that are more uniform across counties and states, it will be very helpful," he said. "Obviously we never got it."
Testing required: This is a list of COVID-19 tests available in the Phoenix area and online
Now, with UA and the entire Arizona offering multiple forms of testing, Dake believes that the state can handle testing well. But Dyke said that he still sees the same unorganized pattern with the current vaccination plan, where "ordinary citizens can only try to fend for themselves."
He is hopeful that the newly elected Biden administration will enact a more coordinated and streamlined vaccination effort.
Information about wearing masks is also confusing. In March, due to concerns about insufficient supply of medical-grade masks, officials only recommended masks to health workers and infected persons. Experts are also not sure how the virus spreads and whether the masks are effective. The researchers later learned that the gradual spread of the virus is possible, and masks can help prevent the spread.
"In hindsight, can we recommend people to use cloth masks from the beginning because they are in short supply? Does this help? Yes," Gray said.
On the contrary, the flip-flops on the mask information reduced the public’s trust in health officials, which may be part of the reason for the birth of the anti-mask movement.
Andrew Badley, head of the COVID-19 working group at the Mayo Clinic, also believes that poor public health infrastructure has caused delays in testing and treatment. He said that the introduction of remdesivir and monoclonal antibodies and other therapies did not allow people to get treatment easily and fairly.
"Our public health infrastructure is not optimal," he said. "And I think we know we need to improve it."
Despite the challenges, Badley believes that the country has gone further than he expected in fighting the virus. He said the rapid pace of vaccine development is "remarkable", especially considering that there are still no vaccines available for many other diseases.
Gray said the new mRNA technology behind the vaccine will have a lasting impact and can be used to help fight other diseases in the future. He is proud of the innovation and progress of the healthcare industry in 2020.
"In the healthcare field, we are not necessarily known for rapid innovation and change, but we have indeed entered a whole new field," he said. "The changes that we thought might take a few years to happen happened in a few days."
He said that in addition to new vaccine technologies, the pandemic has also promoted the development of home disease detection and telemedicine.
Valleywise Health Chief Clinical Officer Michael White said that another success of the past year has come from the improvement of COVID-19 patient care. This includes determining that the patient should be in the prone position, the ventilator should be the last resource, and progress in finding effective treatments.
"We still don't have a cure, but we know some methods that help shorten the length of hospital stay, such as dexamethasone or steroids," White said.
Promising treatments also include laboratory-made antibodies called monoclonal antibodies. Mayo Hospital Medical Director Alyssa Chapital said that even during the COVID-19 surge in Arizona in July and during the holidays, these advancements have allowed Mayo Clinic to take care of patients.
Since January, she has been tracking major developments and changes in the pandemic-so far, the log has 19 pages. On June 25th, her diary wrote "25 patients hit, a record high".
She said that since then, the hospital has received as many as 135 patients at one time.
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In Banner Health, the state's largest healthcare system, the burden on patients is even higher. Chief Clinical Officer Marjorie Bessel said that in the past year, the hospital system has taken care of more than 55,000 COVID-19 patients, of which more than 5,000 had to be intubated.
Bessel said: "I was surprised at what we were able to handle... it must be beyond what we thought we should do."
Chapital said that one of the most important developments enabling hospitals to respond to the surge in COVID-19 cases is the establishment of a collaborative communication network between private individuals and public health agencies across the state.
"I am very proud of the way Arizona responded," she said. “People can always pick on the country’s problems, but we can start working with public health authorities and other hospitals relatively quickly.”
This allows the hospital to more evenly distribute the burden of patients and provide excess equipment to the organizations in need.
"We really work together to solve this problem because we don't want any of us to be left behind," Frey said.
Both Chapital and Frey hope this collaboration will continue even after the pandemic. Chapital said that the speed of work and the elimination of bureaucratic tapes may help advance the treatment of other diseases in the future.
"There is no reason it takes eight to ten years to get a drug approved by the FDA," she said.
Experts say that the biggest challenge now will be to vaccinate people quickly and fairly until people get herd immunity. Cara Christ, director of the Arizona Department of Health Services, said that vaccines will be the way out of the current crisis and she encourages people to get vaccinated as soon as they meet the conditions.
At the same time, she urged people to follow public health guidelines to reduce the risk of contracting this disease.
Although the vaccine is being launched, Bessel said that there are now an "astounding number of patients" in hospitals, and the current surge will take longer to recover due to the lack of statewide mitigation measures to stop the spread of the disease. She also expects the arrival of new virus strains, such as the first discovered variant in the UK, to make recovery more difficult.
"This will be a long recovery, indeed," Bessel said. "It will take many, many months to recover from it."
She added that recovery will require national policies and public actions guided by science.
This year may prove to be a turning point in the fight against COVID-19, but even if herd immunity is achieved, medical staff will still be busy.
COVID-19 "travelers" who continue to show symptoms after the initial illness period or need rehabilitation services after lying on a hospital bed for a few months will be taxed on resources.
"We are likely to put pressure on rehabilitation facilities," Budley said.
Health care workers also need to deal with the backlog of surgeries and other non-essential care, which was delayed when the hospital was overwhelmed by COVID-19 cases. Although classified as non-essential, Chapital stated that these services are still necessary.
Bessel said that vaccination rates for other diseases are now declining as well as vaccination rates for other preventive care.
Health care officials have not set a clear date when herd immunity will be reached and the virus may be contained.
"We are learning about this virus every day, and this virus is challenging us," Christ said.
Although it is too early to say that the full impact of the virus mutation is too early, Engeltal said his theory is that this virus may evolve to be more contagious but less severe, just like other types that cause the common cold. Same as the coronavirus.
"Unfortunately, this means that the virus will not disappear-it will continue to exist, and we will see it seasonally," he reasoned. "But the advantage of doing so may be that the mortality rate will be much lower."
Like many people who are hopeful about vaccines, Dyke initially believed that life could return to normal in the third quarter of 2021.
"But we don't know yet," he said. "Things are very smooth."
LaBaer said that even now, ASU will continue to adjust its daily plans based on the virus and supply shortages.
Chapital said she has given up trying to predict what will happen next or when the pandemic will end. She hopes that this country will never return to what it used to be.
"Things will never be the same," she said, "but everything will be fine."
Amanda Morris covers all fields of biological sciences, including healthcare, technology, new research, and the environment. Send her tips, story ideas, or dog memes to amorris@gannett.com, and follow her on Twitter @amandamomorris for the latest bioscience updates.
The independent reporting of the biological sciences in Arizona was funded by the Flynn Foundation.
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