COVID and 2020:
An extraordinary year for science
The coronavirus pandemic shaped the year in research — from vaccines and treatments to campus shutdowns and virtual meetings.
By Ewen Callaway, Heidi Ledford, Giuliana Viglione, Traci Watson, & Alexandra Witze.
One event dominated in 2020: a deadly and previously unknown virus wreaked havoc across the globe, killing more than 1.5 million people, infecting many more and causing economic devastation. And although there were other newsworthy research developments in 2020, the pandemic set the course of science to an extraordinary degree.
The speed of the coronavirus’s spread has been matched only by the pace of scientific insights. Almost as soon as SARS-CoV-2 was discovered, research groups worldwide started probing its biology, while others developed diagnostic tests or investigated public-health measures to control it. Scientists also raced to find treatments and create vaccines that could bring the pandemic under control. “We’ve never progressed so fast with any other infectious agent,” says virologist Theodora Hatziioannou at the Rockefeller University in New York City.
But, as it has with almost everyone, the pandemic has also affected researchers’ working and personal lives. Many of those who do not study the virus or its impact have had their projects delayed, careers put on hold and research funding disrupted.
A new virus
In January, less than a month after reports first emerged that a mysterious respiratory illness was striking people in the Chinese city of Wuhan, the country’s researchers had identified the cause: a new coronavirus1, soon to be named SARS-CoV-2. By 11 January, a Chinese–Australian team had posted the virus’s genetic sequence online. Soon afterwards, scientists made another key, yet alarming, discovery: the virus could pass between people.
Electron micrograph of a SARS-CoV-2 particle, covered in spike proteins. Credit: National Infection Service/SPL
Electron micrograph of a SARS-CoV-2 particle, covered in spike proteins. Credit: National Infection Service/SPL
By February, researchers had worked out that the virus latches on to a receptor called ACE22, a protein found on the surfaces of cells in many organs, including the lungs and gut. That abundance of targets might help to explain the devastating breadth of COVID-19’s symptoms, which range from pneumonia to diarrhoea and strokes3. The virus grabs ACE2 at least ten times as tightly as does SARS-CoV, the related coronavirus that caused a deadly outbreak of respiratory disease in 2003. Scientists think this could partly explain SARS-CoV-2’s infectiousness.
By March, some scientists were suggesting that tiny virus-laden ‘aerosols’, which can linger in the air for long periods, play a part in transmission. But not all researchers agreed, and it took some governments and public-health organizations months to adapt to the evidence that this was one way that the virus spread. Researchers have also learnt that people can spread the disease before developing symptoms. Without controls, roughly half of all SARS-CoV-2 transmission starts with infected people who have not yet had symptoms, according to an analysis published last month4.
Perhaps the biggest outstanding mystery surrounding the virus’s biology is where it came from. Strong evidence suggests that it originated in bats, and probably passed to humans through an intermediate animal. A number of animal species are susceptible to SARS-CoV-2 infection, including cats and mink. In September, the World Health Organization (WHO) formed a scientific team to investigate the animal origin of the pandemic, starting its search in China and expanding elsewhere. US President Donald Trump and others have claimed, without substantive evidence, that a Chinese laboratory released SARS-CoV-2, but most scientists think that is highly unlikely.
Control attempts: successes and failures
From the pandemic’s earliest days, epidemiologists have rushed to develop models to predict the virus’s spread — and suggest what public-health measures could help to control it. In the absence of vaccines or treatments, officials worldwide have relied on what are known as non-pharmaceutical interventions, such as lockdowns. In January, officials in Wuhan showed how quickly shutting down almost every aspect of daily life could contain the virus. Much of the world followed, with similar restrictions on movement.
Many countries restricted people’s movements to control outbreaks. Credit: Aly Song/Reuters
Many countries restricted people’s movements to control outbreaks. Credit: Aly Song/Reuters
But the economic impact of lockdowns was swift and severe, which led many countries to open up before the virus was under control. Uncertainty early in the pandemic about whether the virus was airborne led to debate about the benefits of wearing face masks, which became politicized — particularly in the United States. Meanwhile, conspiracy theories, misinformation and sketchy science spread almost as fast as the virus. These included discussions about the merits of letting the virus run its course instead of controlling it.
Epidemiologists advised that mass testing for SARS-CoV-2 was the way out of the crisis. But in many countries, shortages of kits and reagents for the standard tests, which use a technique called PCR, created bottlenecks. This spurred research groups worldwide to start devising new rapid tests, including those based on the gene-editing tool CRISPR and fast antigen tests, which could help with diagnosing diseases that emerge in future.
Countries that quashed viral spread early, such as Vietnam, Taiwan and Thailand, used a combination of approaches, including full lockdowns, widespread testing, mask-wearing mandates and digital contact tracing. In Singapore, New Zealand and Iceland, aggressive test-and-trace programmes, combined with stringent isolation measures, helped to almost eliminate the virus, enabling life to return to near normal.
The common thread in these success stories is governments’ willingness to act quickly and decisively, says Caitlin Rivers, an epidemiologist at Johns Hopkins University in Baltimore, Maryland. “Those early and aggressive actions really helped to slow transmission.”
But in many countries, officials were slow to act, ignored scientific advice or struggled to ramp up testing. The result was an uptick in infections that led to a second wave. And across the United States and Western Europe, COVID-19 infections and deaths are now surging once more.
Speedy vaccines
Amid the chaos, a historic scientific effort has given the world vaccines against a disease that humanity wasn’t even aware of a year ago. COVID-19 vaccines have been developed and tested with breathtaking speed. At the last count, in November, the WHO said there were more than 200 in development, roughly 50 of which are in various stages of clinical trials. They use a dizzying array of approaches, from old-school inoculation with chemically inactivated SARS-CoV-2 virus to newer technologies that have never before yielded licensed vaccines.
Results from large efficacy trials have showed that vaccines developed by pharmaceutical company Pfizer and German biotechnology firm BioNTech; US biotechnology company Moderna; and pharmaceutical company AstraZeneca and the University of Oxford, UK, effectively prevent COVID-19. In the past month, regulators in the United Kingdom and the United States have issued emergency authorization for Pfizer’s vaccine, allowing its widespread use, and regulators in the European Union are expected to make their decision in the coming weeks. Vaccines developed in China and Russia had already been approved, but before final-stage testing in people had been completed.
Pfizer and Moderna’s vaccines seem to be around 95% effective at preventing COVID-19, whereas the efficacy of AstraZeneca and Oxford’s remains uncertain. Important questions linger: how well do vaccines prevent severe disease, especially in older people, and how long does protection last? And scientists still don’t know whether vaccines will stop people from spreading the virus; many vaccines for other illnesses don’t.
Vulnerable residents in Kampala received food deliveries during Uganda’s lockdown. Credit: Sumy Sadurni/AFP/Getty
Vulnerable residents in Kampala received food deliveries during Uganda’s lockdown. Credit: Sumy Sadurni/AFP/Getty
For vaccines to do their job, they need to reach those who need them most. Rich countries, including the United States, the United Kingdom, members of the European Union and Japan have pre-purchased billions of doses of numerous vaccines. An effort to procure vaccines for low- and middle-income countries has gained support from many wealthy countries — notably not the United States — but its success is not certain. There are myriad hurdles in making and delivering vaccines; for example, Pfizer’s needs to be kept at −70 °C, which will pose problems in areas of the world without the infrastructure for cold storage. More difficulties are sure to emerge.
Treatments, old and new
Vaccines alone are unlikely to end the pandemic, given the logistics of deploying jabs — which might be needed periodically — to the global population. “The only way out of this pandemic is the combination of vaccines and therapeutics,” says Lennie Derde, an intensive-care physician at the University Medical Centre Utrecht in the Netherlands.
Researchers have raced to test a slew of potential treatments, with mixed success. Some candidates — including the malaria drug hydroxychloroquine, and a cocktail of two HIV drugs — showed initial promise in small clinical trials and observational studies, but later failed to show benefits in larger, randomized controlled studies5,6 in people hospitalized with COVID-19.
Hospitals in some countries have been overwhelmed during the pandemic. Credit: Irfan Khan/Polaris/eyevine
Hospitals in some countries have been overwhelmed during the pandemic. Credit: Irfan Khan/Polaris/eyevine
In April, researchers running a large clinical trial announced that an antiviral drug called remdesivir reduced the length of hospital stays for people with COVID-19, but later studies found that the drug did not significantly reduce deaths. In November, the World Health Organization advised against using it.
Potential COVID-19 treatments became heavily politicized in some regions, with leaders in the United States, India, China and Latin America touting unproven therapies, including hydroxychloroquine. A few regulators issued emergency-use authorizations for unproven treatments, in some cases hampering clinical trials and raising safety concerns.
Other therapies have met with more success. In June, a large trial of an immune-suppressing steroid called dexamethasone found that it reduced deaths by about one-third when given to people with COVID-19 who required supplemental oxygen. Another drug that targets the immune system, called tocilizumab, has yielded mixed results in clinical trials, but has shown promise in people severely ill with COVID-19.
Other interventions are being tested in those with milder COVID-19 symptoms, to see whether they reduce the chances of progressing to more serious illness. Studies in which people are given blood plasma harvested from those who are recovering from COVID-19 are ongoing. Some scientists hoped that mass-produced monoclonal antibodies to directly disable SARS-CoV-2 would help, but studies have yet to show whether these expensive treatments will live up to their promise.
Ultimately, COVID-19 treatment will probably require a combination of drugs, tailored to a person’s risk factors and severity of illness, says Derde, who is on the steering committee for REMAP-CAP, an international trial that tests COVID-19 treatments alone and in combination. “The most logical thing to assume is that there is not one wonder drug that will make a huge difference,” she says.
Research interrupted
Not since the Second World War has scientific research been disrupted so broadly. As the virus started spreading across countries, many universities closed their campuses in March. Laboratories paused all but the most essential experiments, fieldwork was cancelled and conferences went virtual.
In many fields not directly related to the pandemic, projects and progress slowed to a crawl. Suddenly forced to work from home, researchers found their lives upended, often struggling with family care and limited access to resources such as libraries. Many students also found themselves without data from fieldwork or the lab that they needed to complete their degrees. Travel shutdowns made job searches much more difficult.
Particularly hard-hit are women, parents, early-career researchers and scientists from historically under-represented groups — for whom the pandemic is magnifying factors that already made it harder for them to participate in science. A survey7 of 3,345 academics in Brazil in April and May found that Black women, as well as mothers of all ethnicities, reported the greatest reduction in productivity during the pandemic, as measured by their ability to submit research papers and meet deadlines. “The results can be translated to other countries, no doubt,” says study leader Fernanda Staniscuaski, a plant biologist at the Federal University of Rio Grande do Sul in Porto Alegre.
Governments around the globe responded in various ways, with some providing financial support for higher education and research-intensive industries. Australia, for instance, injected Aus$1 billion into university research for 2021. In the United States, by contrast, research mostly missed out in a US$2.3-trillion economic bailout plan.
By August, many university campuses in the United States and Europe were starting to reopen, despite surging infection rates in many communities — often driven by students returning to campus. Other countries with large outbreaks, such as India and Brazil, did not reopen to the same extent.
There have been a few bright spots. Even as borders closed, some international collaborations grew8; researchers began to share data more openly and many published their work on preprint servers; and most publishers made their COVID articles free to read. Research culture also shifted, at least temporarily, away from emphasizing productivity and towards discussing broader issues such as work–life balance. “I am hopeful that the positive changes induced by the pandemic could remain,” says Xin Xu, a research fellow at the University of Oxford, UK, who studies international research patterns.
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References
- Zhu, N. et al. N. Engl. J. Med. 382, 727–733 (2020).
- Hoffmann, M. et al. Cell 181, 271–280 (2020).
- Gupta, A. et al. Nature Med. 26, 1017–1032 (2020).
- Sun, K. et al. Science https://10.1126/science.abe2424 (2020).
- Horby, P. et al. N. Engl. J. Med. 383, 2030–2040 (2020).
- Horby, P. W. et al. Lancet 396, 1345–1352 (2020).
- Staniscuaski, F. et al. Preprint at bioRxiv https://doi.org/10.1101/2020.07.04.187583 (2020).
- Fry, C. V., Cai, X., Zhang, Y. & Wagner, C. S. PLoS ONE 15, e0236307 (2020).
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