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冠状病毒已经伴随我们几个月了。发生了什么变化,我们要去哪里?

2020-07-17 21:32   美国新闻网   - 

今年4月,当东北地区处于冠状病毒大流行的阵痛之中时,人们谈论着要越过顶峰,推动经济重新开放,尤其是在基本上没有受到影响的地区,并在可能是一个世纪以来最大的公共卫生危机之后让该国重回正轨。

这一过程在5月份认真开始,早期结果看起来令人鼓舞——纽约的死亡率和病例数起初趋于平稳,然后开始下降,各州开始重新开放,有些州恢复得非常快,尽管在唐纳德·特朗普总统的压力下,这些州没有达到白宫的准入标准。

随着南部和西部出现创纪录的病例激增,死亡人数开始再次上升,医院人满为患,这一希望基本上已经破灭。

美国已经达到了另一个严峻的里程碑,根据约翰·霍普金斯大学的数据,已有350万人确诊为艾滋病病毒19型,每100名美国人中就有一人检测出病毒呈阳性,40个州以及华盛顿特区和波多黎各都报告了病例数的增加。COVID追踪项目在7月16日报告了美国71,229例新病例的记录

在世界卫生组织正式宣布COVID-19危机为全球大流行近五个月之后,许多专家担心该国部分地区的疫情爆发反映了联邦和地方政府应对措施的重大挫折和失败,这些措施受到了严厉批评。

设备短缺和测试不足等问题在新的热点地区再次出现。4月份之后,这些问题似乎已成为过去。尽管大多数科学家一致认为戴口罩可以减少传播,甚至降低个人严重感染的风险,但关于戴口罩这一高度政治化问题的争论仍很激烈。更不用说对即将到来的学年以及这将如何影响孩子、他们的父母和整个经济缺乏清晰的认识。

另一方面,我们已经了解了很多关于冠状病毒的知识,正朝着有助于对抗这种新型疾病的疗法和疫苗的方向发展。医学界在治疗病人方面似乎越来越好,许多美国人已经采取了控制感染的措施,如社交距离、戴口罩、洗手以及尽可能在家工作。

但是接受美国广播公司采访的专家警告说,目前,我们仍然处于危险的边缘,前面还有一条漫长而危险的道路。

2020年7月13日,佛罗里达州彭布罗克派恩斯,急救人员在纪念西医院外清洗救护车,那里治疗冠状病毒患者。

“回到灾难模式”

马修·海因茨博士是一名住院医生和内科医生,他在亚利桑那州图森市行医。图森市是美国最新的热点地区之一。

“最令人担忧的区域”是那些检测阳性率正在上升的区域——这些区域通常与你看到的医院使用更多能力的区域重叠冠状病毒他是约翰·霍普金斯健康安全中心的高级学者,专门研究新出现的传染病、大流行的防范和生物安全。

海因茨说,佛罗里达最近一天就创下了15000例的记录,“这抹杀了大多数国家的记录。”他说,在他位于亚利桑那州皮马县的医院里,他们几乎没有太平间的空间了,正在考虑用新的方法来冷藏和保存尸体。

他补充道:“我们又回到了灾难模式。”“我们所有的医疗机构都不得不扩大医院的服务范围,这样我们就可以在全州范围内看到COVID-19患者。”

在亚利桑那州,7天的平均检测阳性率达到了近25%,根据亨氏的说法,这表明“病毒的完全传播”,并表明没有足够的轻度到低风险的病例被检测。

这些新的热点地区中,许多都位于美国疫情早期未受病毒严重影响的州。

阿达利亚说:“他们在早些时候幸免于难,他们认为这是不可能发生在他们的国家,这影响了他们的行为。”当他们看到其他州,如纽约,经受住了COVID-19风暴时,这些地方政府官员“抵制要求任何公共健康监管措施就像全州范围内的面具订单或封锁或完全关闭酒吧、餐馆和海滩。”

在他的亚利桑那州,他说,“我们执行了几个星期的宽松的封锁,短暂延长,然后匆忙开放。没有分阶段重新开放。”

阿达利亚说,控制病毒依赖于对检测、追踪和隔离病例的大量投资。

测试资源和能力是国家的主要问题,尤其是在国家的最新热点。例如,像Quest这样的主要诊断公司报告了结果转变的延迟。海因茨在谈到亚利桑那州时说:“我们每天做的测试肯定不够。”根据COVID-19跟踪项目,亚利桑那州在7月15日做了大约14,000次测试,但海因茨说他们应该做大约75,000次。

“它继续挫败整个反应,”他补充说,“如果你把它看作是一场战争,我们怎么知道敌人在哪里瞄准我们的资源。”

该国最高传染病医生安东尼·福奇(Anthony Fauci)在最近接受《国家报》(The Hill)采访时表示,看到病例死灰复燃的各州应该考虑暂停重新开放的程序。他说各州可以做“非常基本的事情”,比如关闭酒吧,戴着面具保持社会距离有助于遏制病毒的传播。“我们从关闭走向开放,基本上跳过了所有的路标。那不是该走的路。我们必须重新思考这个问题,并采取不同的方式。”

最近在加州,州长加文·纽瑟姆宣布了重大的改变,停止在餐馆、酒厂和电影院等场所的室内操作。该州“观察名单”上的县也必须关闭健身中心、礼拜服务和购物中心等场所。

另一方面,纽约,这个病毒早期的中心和死亡人数远远超过其他州的州,似乎已经设法控制了感染,每天只诊断出几百个新病例,相比之下,高峰时期只有几千个,只有少数人死亡。

从三月底到六月初,纽约一直被要求呆在家里,现在正经历一个缓慢的、分阶段的重新开放,每个地区都必须满足感染门标准。公众场合需要戴面具,社交场合也是如此。7月初,康涅狄格州自3月以来首次报告了零冠状病毒死亡。

2020年7月14日,在佛罗里达州基西米的一个试驾点,数百人前来接受COVID-19测试,汽车在场地上排成一队。

科学家们更多地了解了这种病毒以及如何对抗它

即使在6月底至7月初病例激增的情况下,全国范围内由COVID-19引起的死亡人数也呈下降趋势。但是专家说,由于最近全国死亡人数开始再次上升,这种乐观情绪还为时过早。

哥伦比亚大学的病毒学家安吉拉·拉斯姆森博士说,没有确凿的证据表明病毒已经变异了或者已经变得或多或少的严重。她补充说:“查看全国数据可能会产生误导,但如果你看看热点地区,我们开始看到这些曲线回到上升轨道。”

美国广播公司新闻撰稿人、波士顿儿童医院首席创新官、哈佛医学院流行病学教授约翰·布朗斯坦(John Brownstein)博士说:“人们认为病毒可能已经发生了变化,但重要的是要记住,在报告的COVID-19死亡病例中存在滞后现象。”

阿达利亚说:“我们可能会看到在这个新的时代,年轻人代表了大部分的流行滞后。”

福奇博士在最近接受《大西洋月刊》采访时说被感染人群的年龄范围今天比几个月前被感染的人的年龄范围小15岁。

人们对此持乐观态度,因为年轻人,尤其是那些没有疾病的年轻人,往往会过得更好,但也担心粗心大意或不负责任的行为会导致快速传播和更脆弱的人群受到影响。

包括总统在内的一些官员也将病例的增加归因于检测的扩大,但住院人数的增加和病例阳性率的上升证明了这一论点的正确性。

布朗斯坦补充说,死亡率轨迹已经出现了令人担忧的变化。他说:“我们已经开始看到增长。”“如果你看看全国数据,我们看到的死亡人数是自6月初以来从未有过的。”

根据COVID追踪项目,7月16日,各州共报告了977例死亡,这是自5月29日以来的最高水平。因COVID-19住院的患者也上升到了自4月23日以来从未见过的水平。此外,该组织表示,“在经历了相对较少的春季死亡后,韩国进入了一个新阶段。”

然而,专家们对医学进步以及实验疗法和治疗的创纪录进展速度抱有希望,包括早期仅导致许多住院和死亡的并发症。阿达利亚说:“现在我们对疾病的病理生理学有了更多的了解,这意味着我们了解了凝血、肺栓塞、细胞因子风暴等并发症。”

美国急诊医师学会主席、佛罗里达州阿文图拉市的主治医师比尔·贾奎斯博士解释说:“我们目前还没有治愈这类疾病的方法,但我们确实有治疗方法,这正是我们目前正在研究的。”

在流感大流行的早期,人们大力推广机械通气,将其作为一种潜在的救生措施,用于那些低氧水平和严重疾病患者。但是数据表明,呼吸机的结果并不令人鼓舞。医生还必须掌握如何治疗细胞因子风暴,这种新型病毒在一些人身上引发的大规模免疫反应。

诺思韦尔健康中心勒诺克斯山医院的急诊内科医生罗伯特·格拉特博士说,在过去的五个月里,医生们已经建立了一些治疗方法,这些方法明显改善了治疗效果。这些措施包括“在选定的患者中更明智地使用无创通气和“俯卧”,以及“针对经历细胞因子风暴的患者的靶向治疗,如雷地西韦、恢复期血浆、[和]选定的白介素-6抑制剂。”"

类固醇地塞米松的使用对严重呼吸窘迫的患者来说也是有希望的,但是需要更多的数据来确定何时给予该药物以最大化其效果。科学家们还在致力于开发实验性的单克隆抗体疗法,据阿达利亚说,“这是一种合成抗体,在治疗埃博拉病毒方面非常有用。”

2020年7月6日,星期一,休斯顿,联合纪念医疗中心,约瑟夫·瓦龙博士(右)带领一个团队,试图挽救一名冠状病毒科病人的生命,但没有成功。

疫苗竞赛的快速进展

全国和世界各地的科学家正在争分夺秒地开发一种疫苗,这种疫苗将从一开始就防止人们被感染,并限制或停止在人群中的传播。根据世卫组织的最新更新,目前有23种疫苗已经进入人体临床试验,另有140种疫苗正在实验室进行研究。

最近,莫德纳分享了其第一阶段试验的有希望的结果,证明它对所有45名受试者都相对安全,并诱导了抗COVID-19抗体的产生。

据UAB阿拉巴马疫苗研究诊所主任保罗·戈伯特博士说,莫德纳和辉瑞公司的COVID-19疫苗“在人体内显示的中和抗体诱导率高于自然感染。”中和抗体被认为可以保护身体免受病毒侵害。Goebfert希望这些疫苗有效,但承认我们需要更多的数据。

根据戈伯特的说法,“如果我们做得很好,我们将有一种60%有效的疫苗”——因为没有疫苗是100%有效的。他希望当这种疫苗出现时,“即使是被感染的人,尽管接种了疫苗,也会有不太严重的疾病。”"

相比之下,根据美国疾病控制与预防中心的数据,流感疫苗通常有40-60%的效力,当大多数流行的流感病毒与流感疫苗很好地匹配时,它还能为那些被感染的人提供预防严重病例的保护。

在接受《大西洋月刊》采访时,福奇博士说,他希望“到今年年底和2021年初,我们将有一种疫苗,能够开始部署给有需要的人。”显然是全体人民,但优先考虑那些最脆弱的人。”

尽管戈伯特同意福西博士的估计,但他警告说,诸如意外副作用或疫苗耐受性等问题可能会“破坏”整个过程。

制造商与联邦政府的翘曲速度行动合作,也采取了前所未有的措施,在知道疫苗是否有效和安全之前就增加生产。

专门研究供应链管理的哥伦比亚大学商学院决策、风险和运营(DRO)部主任、管理学教授Awi Federgruen博士说:“人们低估了实际生产和分发所需数量疫苗的巨大挑战。”

已经出现的资源问题,如玻璃瓶供应有限,可能会造成重大瓶颈延迟生产和分销。他表示:“在供应有限的情况下,谁将获得优先权,地缘政治问题和国与国之间的地盘之争无疑也会出现。”

阿达利亚说:“我认为,直到我们有一个疫苗,我们将看到定期爆发在不同地区的国家,希望得到更好的管理,并会给医院一定程度的压力,但希望不要打破点。”

专家们一致认为,我们现在对这种病毒有了更多的了解,包括如何治疗以及不同的传播方式。但许多问题仍在继续出现,尤其是暴露水平如何导致感染、免疫持续时间和程度以及再次感染的可能性——所有这些都与阻止感染的可能性有关。

Glatter说:“早期研究表明,在最初感染后的几个月内,免疫力下降,因此实现免疫力的道路将是具有挑战性的。”

2020年7月11日,唐纳德·特朗普总统戴着面具参观位于马里兰州贝塞斯达的沃尔特·里德国家军事医疗中心。

展望未来

专家们没有水晶球,但他们一致认为,病毒将伴随我们一段时间,在可预见的未来,我们必须调整到正常状态的修正形式。“病毒将与我们同在。它不会像在台湾那样受到控制,这个机会已经失去了多次。”“它会不断被这种病毒灼伤。除非有疫苗,否则我们永远不会完全控制它。每天都有新的人出生,这将是敏感的。”

作为一个国家,我们面临着一个关键时刻,我们的行动不再仅仅影响我们自己,而是影响整个社会。尽管许多人已经越来越接受COVID-19的风险,但它是长时间和广泛疲劳的自然结果,需要保持警惕和坚持公开健康措施可以在国家层面上改变大流行的进程。

疾病控制和预防中心主任罗伯特·雷德菲尔德博士在最近接受美国医学会杂志采访时说,我们在与病毒的斗争中都要发挥作用:“掩盖不是一个政治问题。”这是一个公共健康问题。这确实是我们所有人的个人责任。”

尽管如此,许多州和联邦政府拒绝强制要求戴口罩,并撤回州重新开放计划,以帮助阻止病毒的蔓延。就在本月,一直不愿在公开场合戴口罩的特朗普总统表示,他认为COVID将“从某种程度上消失。”

“屠杀仍在继续,”海因茨说,并补充说,各州州长不愿意制定戴口罩的规定,以及其他公共卫生法规,“这不仅是令人沮丧的疏忽。”

他补充说:“我们必须认真对待这个问题,这是一场战争,我们正在输掉这场战争。”

Coronavirus has been with us for months now. What has changed and where are we going?

When the Northeast was in the throes of the coronavirus pandemic in April, there was talk of passing the peak, pushing to reopen the economy, especially in areas that had largely been spared, and getting the country back on track after arguably the biggest public health crisis in a century.

That process started in earnest in May and early results looked encouraging -- death and case rates at first plateaued and then started to decline in New York and states began to reopen, some very rapidly and even though they did not meet White House gating criteria under pressure from President Donald Trump.

That promise has largely evaporated with a record surge of cases being seen in the South and West, the death toll starting to rise once again and hospitals filled to capacity.

The United States has reached another grim milestone, with 3.5 million confirmed COVID-19 cases, according to Johns Hopkins University, one in 100 Americans testing positive for the virus and 40 states, as well as Washington D.C. and Puerto Rico, reporting an increase in case numbers. The COVID Tracking Project reported on July 16, a record number of 71,229 new cases in the U.S.

Almost five months since the World Health Organization officially declared the COVID-19 crisis a global pandemic, many experts are concerned that the flares in cases in parts of the country reflect major setbacks and failings on the federal and local governments' responses, which have been roundly criticized.

Problems such as equipment shortages and shortfalls on testing, which seemed to be in the rearview mirror after April, have reemerged in new hotspots. And debates rage about the highly political issue of mask-wearing, despite most scientists agreeing that it reduces transmission and even the risk of severe infection for individuals. This is not to mention the lack of clarity about the upcoming school year and how this will affect both children, their parents and the economy at large.

On the other hand, we have learned a lot about the coronavirus, are progressing towards therapeutics and vaccines to help combat the novel disease. The medical community appears to be getting better at treating those who are sick and many in the U.S. have adopted infection-control measures like social distancing, mask-wearing, hand washing and working from home when possible.

But experts interviewed by ABC News warn that for the time being, we remain at the brink, with a long and dangerous road ahead.

EMTs clean their ambulance outside Memorial West Hospital where coronavirus patients are treated, in Pembroke Pines, Fla., July 13, 2020.

'Back in disaster mode'

"There are hotter spots, but everywhere is on the upswing," said Dr. Mathew Heinz, a hospitalist and internist who practices in Tucson, Arizona, one of the nation's newest hotspots.

The most concerning regions "are those where the percent positivity of testing is rising -- and these are places which usually overlap with areas where you see hospitals using more of their capacity forcoronaviruspatients," added Dr. Amesh Adalja, a senior scholar at Johns Hopkins Center for Health Security, specializing in emerging infectious disease, pandemic preparedness and biosecurity.

Florida recently hit a record of 15,000 cases in one day, "which obliterates records in most countries," said Heinz. He said that at his hospital in Pima County, Arizona, they are almost out of morgue space and thinking about new alternatives to refrigerate and preserve deceased bodies.

"We are back in disaster mode," he added. "All of our facilities had to expand the places within the hospital where we can see COVID-19 patients and you can see that across the state."

In Arizona, the seven-day average test positivity rate hit almost 25%, which, according to Heinz, indicates an "unmitigated spread of the virus" and shows that not enough mild to low-risk cases are being tested.

Many of these new hotspots are in states that were not hit very hard by the virus early in the U.S. epidemic.

"They were spared earlier on and they thought it wasn't something that could happen in their state, and that influenced their behavior," said Adalja. As they watched other states, like New York, weather the COVID-19 storm, these local government officials were "resistant to the concept of requiring any publichealth regulatory measureslike statewide mask orders or lockdowns or fully closing bars restaurants and beaches," Heinz said.

In his state of Arizona, he said, "We did a loosely-enforced lockdown for several weeks, briefly extended and then rushed the opening. There was no phased reopening."

Controlling the virus relies on a heavy investment in testing, tracking and isolating cases, Adalja said.

Testing resources and capacity are major issues nationally, especially in the country's newest hot spots. For example, major diagnostic companies like Quest are reporting delays in result turnarounds. "We are definitely not doing enough tests on a daily basis," said Heinz on the state of Arizona. According to the COVID-19 Tracking Project, Arizona did approximately 14,000 tests on July 15, but Heinz said they should be doing about 75,000.

"It continues to frustrate the entire response," he added, "If you think about it as a war, how are we supposed to figure out where the enemy is to target our resources."

Dr. Anthony Fauci, the country's top infectious disease doctor, said in a recent interview with The Hill that states seeing a resurgence of cases should consider pausing their reopening process. He said states can do "very fundamental things," like closing bars,wearing masksand maintaining social distancing to help curb the spread of the virus. "We went from shutting down to opening up in a way that essentially skipped over all the guideposts. That's not the way to go. We've got to rethink that and do it differently," he said.

Most recently in California, Gov. Gavin Newsom announced major changes, ceasing indoor operations in settings like restaurants, wineries and movie theaters. Counties on the state's "watch list" must also close places like fitness centers, worship services and malls.

On the other hand, New York, the epicenter of the virus early on and the state with a death toll that far surpasses the others, appears to have managed to get a handle on the infection with just several hundred new cases diagnosed a day compared to thousands at the peak and just a handful of deaths.

New York was under a stay-at-home order from late March through early June and is going through a slow, phased reopening, with each region having to meet infection gating criteria. Masks are required in public as is social distancing. Earlier in July, Connecticut reported zero coronavirus deaths for the first time since March.

Cars form a queue in a field as hundreds of people arrive to be tested for COVID-19 at a drive through testing site in Kissimmee, Fla., July 14, 2020.

Scientists learn more about the virus and how to fight it

Even amidst a surge of cases from late June to early July, deaths due to COVID-19 trended downwards across the nation. But experts say the optimism that engendered was premature as the national death count most recently started trending upwards again.

Dr. Angela Rasmussen, a virologist at Columbia University, said there is no conclusive evidence thatthe virus has mutatedin any dramatic way or has changed to become less or more severe. "Looking at the national data can be misleading, but if you look at the hotspots, we started to see those curves turn back into an upwards trajectory," she added.

"People think that maybe the virus has changed, but it's important to remember there is a lag" when it comes to reported COVID-19 deaths, said John Brownstein, Ph.D., an ABC News contributor, chief innovation officer for the Boston Children's Hospital and professor of epidemiology at Harvard Medical School.

"We might see a longer lag in this new era where younger people are representing the bulk of the pandemic," Adalja said.

Dr. Fauci, in a recent interview with The Atlantic, saidthe age range of people that are getting infectedtoday is about 15 years younger than the age range of people who were getting infected a few months ago.

There was some optimism surrounding this because younger people, especially those without preexisting conditions, tended to fare better, but also fear that carelessness or irresponsible behavior would lead to rapid transmission and more vulnerable populations being affected.

Some officials, including the president, also attributed the rise in cases to an expansion in testing, but an increase in hospitalizations and growing case positivity rate belied that argument.

Brownstein added that there is already a worrying change in the mortality trajectory. "We are already starting to see increases," he said. "If you're looking at the national data, we are seeing numbers of deaths that we haven't seen since the beginning of June."

According to the COVID Tracking Project, on July 16, states reported a total of 977 deaths, which is the highest it's been since May 29. Patients hospitalized with COVID-19 also rose to levels that haven't been seen since April 23. Additionally, the organization said, "After experiencing relatively fewer deaths in the spring, the South has entered a new phase."

Experts are, however, hopeful about the medical progress and the record speed in which experimental therapies and treatments have progressed, including for complications that early only led to many hospitalizations and deaths. "Right now we know a lot more about the pathophysiology of disease, meaning we understand the complications like blood clotting pulmonary embolisms, cytokine storms," Adalja said.

"We don't have cures for this type of illness, but we do have treatments and that's what we are working with now," explained Dr. Bill Jaquis, the president of the American College of Emergency Physicians and an attending physician in Aventura, Florida.

In the early days of the pandemic, there was a massive push for mechanical ventilators as a potential life-saving measure for those with low oxygen levels and severe disease. But data indicated that outcomes from those on ventilators was not encouraging. Doctors also had to get a handle on how to treat cytokine storm, the massive immune response that the novel virus sparked in some.

According to Dr. Robert Glatter, an emergency medicine physician at Lenox Hill Hospital, Northwell Health, doctors have established forms of treatments in the past five months that have markedly improved outcomes. These include "more judicious use of noninvasive ventilation and "proning" in selected patients, along with "targeted therapeutics such as Remdesivir, convalescent plasma, [and] selected IL-6 inhibitors for patients experiencing cytokine storm."

The use of the steroid, dexamethasone, also appears promising for patients with severe respiratory distress, but more data is needed to determine when to give the drug to maximize its effects. Scientists are also working on developing experimental monoclonal antibody treatments, which, according to Adalja, “are synthetic antibodies that were very useful in the treatment of Ebola.”

Dr. Joseph Varon, right, leads a team as they try to save the life of a patient unsuccessfully inside the Coronavirus Unit at United Memorial Medical Center, Monday, July 6, 2020, in Houston.

Rapid progress in the race for a vaccine

Scientists across the country and world are now racing against the clock to develop a vaccine that would prevent people from becoming infected in the first place and limit or stop transmission in the population at large. According to the latest update from the WHO, there are now 23 vaccines that have advanced to clinical trials in people and an additional 140 vaccines being studied in the laboratory.

Most recently, Moderna shared promising results from its phase 1 trial, demonstrating that it was relatively safe for all 45 people it was tested on, and induced the production of antibodies against COVID-19.

According to Dr. Paul Goebfert, the director of the Alabama Vaccine Research Clinic at UAB, Moderna and Pfizer's COVID-19 vaccines "are showing neutralizing antibody induction in humans that are higher than what you get with natural infection." Neutralizing antibodies are thought to protect the body from the virus. Goebfert is hopeful that these vaccines will be effective, but admits we need more data.

According to Goebfert, "If we're doing really well,we will have a vaccine that is 60% effective" -- as no vaccine is 100% effective. He is hopeful that when this vaccine comes, "even people that are infected, despite vaccination, will have a less severe disease."

The flu vaccine, by contrast, is generally 40-60 percent effective, according to the CDC, when most of the circulating flu viruses that season are well matched to the flu vaccine and also provides protection against severe cases in those who become infected.

In an interview with The Atlantic, Dr. Fauci said he is hopeful that by the "end of this calendar year and the beginning of 2021, we will have a vaccine that we'll be able to begin to deploy to people who need it. Obviously, the entire population, but with priorities for those who are most vulnerable."

Although Goebfert agreed with Dr. Fauci's estimates, he cautioned that issues such as unexpected side effects or issues with tolerating the vaccine could "derail" the entire process.

Manufacturers in collaboration with the federal government's Operation Warp Speed are also taking unprecedented measures, ramping up production before knowing if the vaccine will, in fact, be effective and safe.

"People underestimate the tremendous challenge to actually manufacture and distribute the vaccine in the quantity that is going to be needed," said Dr. Awi Federgruen, a professor of management and the chair of the Decision, Risk, and Operations (DRO) Division of Columbia University's Graduate School of Business, specializing in supply chain management.

Resource issues that are already emerging -- like a limited supply of glass vials -- may create major bottlenecks thatdelay production and distribution. "Geopolitical issues and turf battles between countries [of] who gets priority when there is limited supply," he said, will undoubtedly also emerge.

"I think until we have a vaccine we will see periodic flare-ups in different parts of the country that hopefully are better managed and will put hospitals on some degree of stress, but hopefully not to the breaking point," Adalja said.

Experts agree that we now know a lot more about the virus, including how to treat it and different modes of transmission. But many questions continue to emerge, particularly around what level of exposure leads to infection, duration and extent of immunity and potential for reinfection -- all of which have bearing on the possibility of stopping the infection.

"With early studies showing waning immunity after a just a few months following initial infection, the road to achieving immunity will prove to be challenging," Glatter said.

President Donald Trump wears a mask as he visits Walter Reed National Military Medical Center in Bethesda, MD., on July 11, 2020.

Looking ahead to the future

Experts do not have a crystal ball, but they agree that the virus will be with us for some time and we must adjust to a modified form of normalcy for the foreseeable future. "The virus is going to be with us. It won't be controlled like in Taiwan, that opportunity has been lost multiple times," Adalja said. "It will be constant burn with this virus. [We will] never get it under full control until there is a vaccine. Everyday new people are born that will be susceptible to it."

As a nation, we face a pivotal point in time, where our actions no longer affect just ourselves but our community at large. While many have become more accepting of the risks of COVID-19, a natural outcome of prolonged time and widespread fatigue, maintaining vigilance and adhering to publichealthmeasures can change the course of the pandemic on a national level.

Dr. Robert Redfield, the director of the Centers for Disease Control and Prevention, said in a recent interview with JAMA that we all have a role to play in battling the virus: "masking is not a political issue. It's a public health issue. And it really is a personal responsibility for all of us."

Still, many states and the federal government refuse to mandate masks and roll back state reopening plans to help stem the tide of the virus. Just this month, President Trump, who has been reluctant to wear a mask publicly himself, said that he said he believed COVID would "sort of just disappear."

"The slaughter continues unabated," said Heinz, adding that state governors' reluctance to institute mask-wearing mandates, among other public health regulations, "is more than frustrating its negligence."

"We have to take this seriously, this is a war and we are losing it," he added.

Eden David, who studied neuroscience at Columbia University and is matriculating to Icahn School of Medicine at Mount Sinai later this year, is a member of the ABC News Medical Unit.

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