Like so many aspects of medicine, pulmonary and critical care has been inexorably changed, for better or worse, by COVID-19. The learning curve has been steep and often challenging. Now, 3 years after the World Health Organization declared COVID-19 a global pandemic, we can afford to reflect on recent history and ask: what have we learned from this unprecedented experience? What will we need to do to confront the next respiratory viral epidemic/pandemic? What do we need to continue to learn?
In this issue of Clinics in Chest Medicine, we review the collective knowledge of COVID-19 lung disease, particularly as experienced in the first 2 years of the pandemic. We assembled a diverse group of authors from multiple disciplines, all of whom were on the frontline caring for patients with COVID-19 in the intensive care unit<AQ1> and in the clinic, in operating rooms, and in the community. Many of our authors were also leading the charge in composing clinical guidelines, conducting clinical trials, and innovating and advocating for the care of patients with COVID-19. Everyone synthesized a great deal of new data in a short period of time, and we thank our panel of authors for sharing their insights while managing ever busier schedules.
As detailed in our opening article, we learned how to mitigate the risk of SARS-CoV-2 transmission posed by the chest physician’s basic tools of the trade: pulmonary function tests, bronchoscopies, and other aerosol-generating procedures. The collective experience of COVID-19 has forced us to evaluate all aspects of our understanding of infectious pneumonia, including atypical clinical presentations, the role of infection versus inflammation in the pathophysiology of COVID-19 lung disease, the protean manifestations that set COVID-19 apart from other respiratory viral illnesses, and how different aspects of the disease should be managed. We continue to learn about the long-term effects of SARS-CoV-2 infection on health. So much of medical practice was tested, stretched, and now accepted because of COVID-19. This includes the use of corticosteroids, novel immunomodulatory and antiviral agents, noninvasive oxygen support strategies, extracorporeal membrane oxygenation, and even lung transplantation.
We have learned about the unexpected manifestations of COVID-19 in special populations, including children, pregnant women, those with chronic lung disease, and the immunocompromised host. Importantly, we have learned (and relearned) how our behaviors and social structures make us vulnerable to respiratory viral illnesses, and how we can mitigate the spread of the virus with simple precautions. These measures have also altered the usual epidemiology of other respiratory viruses and infections. We have learned hard lessons about the social determinants of health, laid painfully bare as health care systems struggled to handle surges of critically ill patients in the early phases of the pandemic. The outsized burden of COVID-19 on socially disadvantaged populations highlights racial and socioeconomic disparities that exist here in the United States as well as in countries around the world.
By nature, COVID-19 is a fluid and evolving topic. What we offer in this issue of in Chest Medicine is not the last word, but a point of departure for understanding the lessons learned from the pandemic so as to better prepare us for the future.
In addition to our authors, we would like to thank Jo Gascoine and Karen Dino of Elsevier as well as all of the production staff for shepherding this issue to fruition. Last but not least, we are grateful for the family, friends, and colleagues who have supported us through this project.
Publication stageIn Press Accepted Manuscript
AQ1: Please verify ICU and ECMO are spelled out correctly.
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GUANG-SHING CHENG, MD, Associate Member, Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
CHARLES DELA CRUZ, MD, PhD, Associate Professor, Yale University School of Medicine, New Haven, Connecticut
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