In today's edition:

  • What's in a year?
  • Atlanta shooting spree comes amid rise in anti-Asian attacks
  • Catching up with a hospital in North Dakota
Hindsight on 2020: One Year of Expert Insights
Meet the EI Team: From left to right: Grace Fernandez, Lindsay Smith Rogers, Lymari Morales, Melissa Hartman, Brenda Hageter, Annalies Winny, Carly Kempler, Josh Aspril, Jonathan Herndon, Neiman Outlen, Nick Moran, Kaila Dodd. Not pictured: Hawk-eyed copy editor Jackie Powder who is taking a well-deserved vacation.
Exactly one year ago today,  we sent out the very first issue of the Expert Insights newsletter—formerly known as the COVID-19 Daily Roundup—thinking there would be a hunger for reliable information on a pandemic that was changing life as we knew it... and we didn’t even know how much yet.
That first email went to 630 recipients. Today’s will go to 83,728. And we’ve learned a lot in between. 
So today we’re reflecting on the past year, and our first-ever issue, with a round of How It Started vs. How It’s Going. 
First, the good news: 

Vaccine expectations were far exceeded.

HOW IT STARTED:A piece of good news is that phase one of the first COVID-19 vaccine trial launched on March 16 (2020). Under a best case scenario, a vaccine could be ready in 12–18 months, Andy Pekosz says.” 
HOW IT’S GOING: By late 2020—just nine months later—two vaccines had been granted emergency use authorization by the FDA. Today, there are three vaccines authorized for emergency use in the US. Around 38.3 million Americans—11.68% of the total population—are fully vaccinated.
It was a rollercoaster year.

A year ago we were still asking what “flattening the curve” means and getting used to the new normal of social distancing, closed schools, and self-isolation. Community transmission was new. 
On the March 17, 2020, podcast, Caitlin Rivers explained that “flattening the curve” is a public health response strategy that extends the period of time over which people get sick to avoid overwhelming health systems. “It’s only in the last couple weeks that we’ve begun to recognize community transmission in the U.S.,” she says. “I don’t think we’ve turned the corner yet, but there’s greater awareness about protecting the community. I think we can turn things around.”
The graph shows the trajectory of COVID-19 from January 2020 to the present. Source: CDC
HOW IT’S GOING: See the graph above. The US has now experienced three distinct “waves'' of COVID-19 cases, which peaked around mid-April, mid-July, and again in late January. Currently, daily case rates are averaging nearly as high as the second “peak” during the summer of 2020 and are starting to tick up again. There is troubling news from Europe, where a sluggish vaccine rollout and the rise of more transmissible variants of SARS-CoV-2 are leading to a “fourth wave” of infections and countries are reentering strict lockdowns. 
The US has trailed a few weeks behind Europe’s fluctuations throughout the pandemic and, now, may face a similar “fourth wave” if vaccines are not readily distributed and public health safety measures are not maintained until community transmission drops significantly.
One thing that hasn't changed.

Experts stressed and continue to stress that individual choices—wearing masks, social distancing, and avoiding large gatherings—will be key to ending the pandemic. 

Now we are lucky enough to add another item to the list: get vaccinated.
On This Day in March 2020
This time last year, we knew distancing was important, but wearing masks indoors even when you displayed no symptoms was not yet widely understood to be important.
Josh Sharfstein and Caitlin Rivers demonstrated the now ubiquitous 6-foot rule in a COVID-19 webcast. 
A Special Shout Out
Throughout the pandemic, the Center for Health Security has been one of EI’s go-to sources. Big thanks to people like Caitlin Rivers, Crystal Watson, Jennifer Nuzzo, Tom Inglesby, Gigi Gronvall, Monica Schoch-Spana, Tara Kirk SellMargaret Miller, and the many more scientists and scholars whose work has helped bring context and solutions to the biggest public health crisis of our lifetime.
The Center’s pandemic work is ongoing and covered in regular “situation updates.” Subscribe to stay in the know about the state of the pandemic in the US and around the world. 
A Horrific Display of Hate
The pandemic has coincided with an uptick in violent attacks on Asian Americans
Last night added to the horrors.
A 45-minute shooting spree across several Atlanta massage parlors left eight people dead. Six of them were Asian women, according to The Atlanta Journal Constitution.
“Absolutely horrific. These attacks against Asian Americans must stop,” tweeted Ashani T. Weeraratna.
A COVID-19 Update from a North Dakota Hospital

Last fall, the state of North Dakota had the highest COVID-19 rate per capita in the world, and Sanford Medical Center in Fargo was nearly overwhelmed with COVID patients from as far away as Montana. Doug Griffin, Sanford Health vice president and medical officer, talks with Stephanie Desmon about how the hospital got through that crisis, what things are like today, his fears of another surge, and the hope that a robust vaccination plan will keep COVID cases in check. 
TOMORROW: COVID-19 and POTS—Postural Orthostatic Tachycardia Syndrome

POTS is a chronic syndrome marked by high blood pressure and dizziness that can be debilitating. It’s often diagnosed after patients recover from infections like strep or mono, and now doctors are seeing patients develop POTS-like symptoms after recovering from COVID-19. Christina Kokorelis and patient Vanessa McMains talk with Stephanie Desmon about POTS and the long-term prognosis for patients suffering from symptoms long after recovering from COVID. 
Europe’s Vaccine Suspension May Be Driven as Much by Politics as Science (The New York Times)
Once it became clear that Germany was suspending use of AstraZeneca’s COVID-19 vaccine, the pressure mounted on other governments to hold off as well, out of fear of seeming incautious and for the sake of a united front. However, experts believe the most lives will be saved by continuing to administer thevaccine. Naor Bar-Zeev agrees: “We need to do the thing that reduces the burden of total risk in the community. At this stage, that means continuing to vaccinate, but making sure we have very rapid, very thorough, and as good as possible an analysis of the available safety data.”
COVID-19 Data Miss A Lot Of People — Raising Questions (NPR)
What does it take to make good data? Paul Spiegel says in lower-income countries and among certain at-risk populations, reliable data aren't always available. He recently authored an article in Nature Medicine discussing the gaps in pandemic data and how that lack of data impacts fragile populations such as refugees and people living in conflict areas. 

Is flying safe now? Answers to your burning COVID-19 travel questions (
Chris Beyrer says it’s certainly safer to travel once you’re immunized, “but on the other hand, we also do not know the answer to the question of ‘Are people who have been immunized still infectious for others?’” With widespread vaccinations on the horizon, Amesh Adalja believes “[travel is] going to become more and more of an acceptable risk for people.”

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