It was March 11, 2020, and the World Health Organization had just declared COVID-19 a worldwide pandemic. In the next two years, the virus would go on to infect half a billion people, killing more than 6 million, across the globe. But, when the WHO pronouncement came down initially, New Orleans was already in the thick of it, having seen its first case on March 9. The then-regional medical director for the Louisiana Department of Health, and currently the state health officer, Dr. Joe Kanter (M ’10, PHTM ’10), an emergency medicine physician, had already heard about the cluster of cases on the West Coast.

“We went from that very first case to 10 cases in the blink of an eye, and it progressed exponentially after that,” remembered Kanter. “It became apparent just how serious this was already when we realized that first patient had not been involved in international travel, or any travel, for that matter. This was beyond the canary in the coal mine.”

For Dr. Josh Denson (TC ’06, SSE ’08, M ’11), who spends his workdays in the intensive care unit, his first case in Louisiana is one he won’t ever forget. Denson is assistant professor of pulmonary diseases and associate director of the Pulmonary and Critical Care Fellowship Program at the Tulane School of Medicine.

“The first case of COVID-19 in Louisiana was diagnosed at the VA,” said Denson. “Later that day, at UMC, I intubated the first person in Louisiana to be put on a ventilator. Although this patient hadn’t traveled to or from New Orleans, he was in a very public sort of job where he came in contact with a lot of people on a daily basis. There was a sense of impending doom. We got three more COVID patients on that first day.”

A month later, the virus was no longer just the conundrum that doctors were trying to get a handle on. It was already taking its toll on those we knew. For Tulane cardiologist and Professor of Medicine Dr. Keith Ferdinand, it hit close to home.

“It was Feb. 25, and I was walking with the jazz bands and marching clubs as part of Mardi Gras,” said Ferdinand. “Just a few weeks after that first case appeared in New Orleans, my good friend [musician] Ellis Marsalis died of complications from this coronavirus, followed just a couple of weeks later by my dear friend Ronald Lewis, whose museum in the Ninth Ward told the colorful history of the Mardi Gras Indians. When you see a virus like this overtake large cities so quickly, coastal cities like Seattle and New York, it seems understandable, but why was New Orleans hit so intensely, so quickly? Of course, we had just celebrated Mardi Gras, and with 300,000 people in the city, packed tightly street by street, it was the opportunity of a lifetime for a very contagious virus.”

Just two weeks into the virus, New Orleans had the distinction of being the city with the fastest-growing outbreak in the world. Between Mardi Gras, the numerous large conventions that had been in the city in February, and the constant disembarking of cruise ship passengers into New Orleans, the predictions were dire. It was concluded that if the numbers continued to rise exponentially, by April 1, area hospitals would exceed capacity by 1,000 patients a day. To that end, the New Orleans Ernest N. Morial Convention Center was built out for the intake of new cases.

Immigrant Children

While the city propelled itself into emergency mode, one physician at Tulane had already been dealing with constant crises. Dr. Kim Mukerjee, assistant professor of clinical pediatrics and director of immigrant and community health, had been faced with an overwhelming influx of Central American immigrant children. But, when COVID hit, a critical situation became alarming, adding fuel to an already devastating fire of marginalized health care.

“It has been exhausting,” said Mukerjee. “With so many families already in need, having come from holding cells and detention centers while seeking asylum, being joined by their children amidst a pandemic was incredibly stressful. How can you ask people to socially distance when they live in extremely crowded households? Many of these people are essential workers, who went to work in the beginning of the pandemic, and were exposed to crowds, when no masks were available. Many were food insecure before the pandemic, and now we’re asking them to buy disinfectant, when they cannot afford food. And, with the lockdown and subsequent business closures, they couldn’t work, couldn’t get food stamps because they weren’t on Medicaid and weren’t eligible for unemployment because of their immigration status. These children have no health insurance, yet are suffering from a variety of maladies, not the least of which are mental health issues.”

The Long Haul

Throughout the next two years, and five separate surges, surviving the initial infection has only been half the battle for many people now suffering with what’s come to be known as Long COVID, its victims known as Long-Haulers. Described as a continuation of symptoms or an onslaught of new symptoms after testing negative for the initial COVID-19 infection, it affects one in four people, with varying lengths of duration. For Dr. Michele Longo (NC ’89, M ’93, PHTM ’93), assistant professor of neurology at Tulane medical school, who co-founded Tulane’s Long COVID Clinic along with Dr. Gregory Bix, professor of neurology, in fall 2020, the questions still outweigh the answers, after studying these patients for over a year and a half.

“Over 200 symptoms have been described, but the most common among them are brain fog, shortness of breath, fatigue, exercise intolerance, blood pressure inconsistencies, chest pain, lung problems, joint pain, and loss of taste and smell,” said Longo. “Why are some folks able to clear their symptoms when the infection is no longer there, while others cannot? Is there residual virus left in the body, or has the infection now produced an autoimmune scenario, in which the body turns on itself? Did some people get a higher viral load initially, making it harder to clear all of the symptoms? And, what if people who had preexisting conditions (where autoimmune antibodies are already present, as in rheumatoid arthritis), were inherently at an increased risk for Long COVID?

“This is why we are part of the RECOVER initiative from NIH [National Institutes of Health], which is designed to study a large nationwide patient base in order to truly understand the lingering effects of COVID.”

Lessons Learned

The darkest days of this coronavirus outbreak may be behind us, but with tragedies on a grand scale, come lessons.

The doctors we spoke with have universally blamed much of the COVID-19 confusion over the last two years on inconsistent messaging from governmental agencies, which were learning as they collected data, and to the ills of social media, often politically motivated by those with agendas who saw an opening to criticize governmental agencies and healthcare workers.

“There’s been a general lack of respect for those of us who essentially laid our lives on the line fighting a pandemic, when in the beginning we were reusing our masks and wiping down our gowns with vinegar day after day, because there was not an adequate supply of personal protective equipment,” said Denson. “And the misinformation is still everywhere. Last week, I had a patient tell me I didn’t know what I was talking about because he read something else on Google.”

In March 2022, U.S. Surgeon General Vivek Murthy called on Big Tech and the public to share research, data and personal experiences related to COVID-19 misinformation in order to stop the spread of confusion in the digital information environment. But, the genie may already be out of that bottle.

“Pronouncements by politicians who don’t know science have also eroded the trust in public health experts, because the messages are mixed,” said Ferdinand. “In fact, the World Health Organization has called it an infodemic, in which a flood of information overwhelms us, much of it unreliable. It’s kept people from wearing masks, getting vaccines and from social distancing, which could have saved many lives.”

Prepared for the Next Virus

So, what have we learned after two years? According to State Health Officer Kanter, we’ve seen that when the federal government works in conjunction with pharmaceutical companies by assuming all financial risks, we can manufacture a successful vaccine in record-breaking time.

“Although we need better systems in place to predict future outbreaks, and more genomic surveillance with genetic sequencing, our monitoring of wastewater gives us a five-day heads-up, while targeting the specific geography of the virus,” said Kanter. “And, although the CDC stopped collecting data, here in Louisiana we still track breakthrough infections. In combination with our unparalleled preparedness, dating back to Katrina, I think we’re better prepared for the next variant, or even the next virus.”

“No one dreamed when this virus erupted that we’d be dealing with 25% of the infected patient population becoming Long-Haulers, but we’re learning more and more with each patient who enters our clinic,” said Longo. “We now have a patient profile as to who generally becomes a Long-Hauler. The majority are not vaccinated, are women, and are between 30 and 50 years of age. We also know that 96% of patients will recover from Long COVID, and with our growing bio database, we are constantly gaining new insights.”

“It has certainly been a learning experience over the last two years,” said Denson. “We know that we need better leadership from the outset of a pandemic, and I feel we need to make decisions for our country at the federal level, as we’ve allowed too much individual freedom at the state level, which hasn’t been good for public health, generally. We’ve learned that this virus or another may always be with us, and the Omicron subvariant BA.2 is more transmissible than the original Omicron strain. So, it’s important that we keep our guard up with respect to protecting ourselves, down the road. Assess your own personal risks, and act in the best interest of yourself and those around you.”

“We have learned from this pandemic that we don’t have the appropriate safety nets for some of our people,” said Mukerjee. “Our Children’s Health Project has been on the front lines since well before the beginning of this pandemic. Now, we feel like we’re in crisis mode all the time, exacerbated by a recent hurricane and a pandemic. If we’ve learned anything, it’s that we need policy changes regarding public health.”

Ferdinand has known that the stress of the pandemic has only worsened the symptoms of his cardiology patients, who were already at a heightened risk for COVID-19 from the get-go. A tireless advocate combating vaccine hesitancy in the Black community, he’s hopeful that we’ve all learned something from a pandemic where the U.S. death toll is the highest in the world.

“You know, we’ve lost a million people in this country to COVID, but we hide dying,” lamented Ferdinand. “We wash away the terrible toll of this disease because it’s easier than assessing how we got here. We must do better at coming together as a community. There’s an African philosophy called Umbuntu, which translates, ‘I am, because we are.’ It’s the belief in a universal bond which connects all humanity. And, it’s particularly apropos in any public health crisis.”