The COVID-19 Pandemic: 5 Years Later

COVID-19 has reached its fifth anniversary, and although everyone had hoped it would be long gone by now, scientists suspected it would settle into its current iteration. The COVID-19 pandemic led to approximately 37 million excess deaths from COVID-19 as well as all causes, including cancer, cardiovascular diseases, and diabetes in individuals whose care was limited.^1,2 The pandemic also caused an increased number of deaths from alcohol, drugs, and vehicular accidents.^3,4 Although the numbers are sobering, the anniversary provides an opportunity to look at what we’ve learned and what has changed.

Doctor holding a coronavirus COVID-19 test tube - Image credit: bizoo_n | stock.adobe.com

SYMPTOMS HAVE CHANGED

The symptoms of COVID-19 have been a conundrum since the pandemic’s start. Most infected individuals experience influenza-like symptoms, but some are asymptomatic. Those who are older, have a chronic illness, or are immunocompromised are at an elevated risk of hospitalization.

One symptom that garnered considerable attention in 2020 was loss of smell, suspected to be a manifestation of a dysfunctional immune response. Geneticists found that the virus attaches to the ACE2, FI44, and NDUFAF4 gene receptors in the nose, changing the genetic activity of certain nasal nerves.⁵ Consequently, it disrupts the sense of smell. Research findings also suggest that an aggressive immune response may cause inflammation and contribute to lingering neurological concerns such as brain fog, headaches, and tingling or numbness.⁶

THE CUMULATIVE IMPACT OF COVID-19

Although COVID-19 is no longer as prevalent or virulent, it still has a significant impact. CDC data showed a test positivity rate of 4.8% and roughly 1000 deaths (Figure⁷) for the week ending February 5, 2025.

Long COVID, defined as persistent symptoms after initial infection lasting weeks to years (also called post–COVID-19 condition), also remains in the spotlight. Some individuals develop multiorgan effects involving the heart, lungs, kidneys, skin, and brain.⁶ Researchers have been unable to identify the mechanism that underlies long COVID, and more studies are needed.⁸ Study findings from the CDC reported that in June 2023, 6% of American adults reported having long COVID and more than a quarter of them said their symptoms significantly limited their activity.⁹ More recent study data on children indicate that 1.3%, or approximately 1 million children, have experienced long COVID, with missing school a primary concern.¹⁰ The US Department of Veterans Affairs has developed the Long COVID Fact Sheet, which includes a checklist for concerned individuals to check their symptoms.¹¹

RAPID RESPONSE WORKS

Although health care policy makers have long known that the world experiences a pandemic every 30 to 35 years, globally, almost all countries were unprepared for COVID-19.^12,13 One of the countries with the best response was Taiwan, which halted flights from China and quarantined travelers early. New Zealand also mounted a rapid response, implementing its national pandemic influenza plan. Its leadership declared a countrywide lockdown, resulting in one of the lowest rates of COVID-19 deaths in the world. South Korea was remarkably aggressive with testing, which had significant success.^14,15 The Table^14,15 lists areas in which the most successful countries excelled.

The COVID-19 pandemic highlighted the critical need for robust public health infrastructure, rapid information sharing, and flexible health care systems. To respond to future pandemics, governments should invest in surveillance networks to detect outbreaks early and develop adaptable vaccine platforms for a quick response. International collaboration is key to coordinating research, sharing resources, and ensuring equitable vaccine distribution.

mRNA VACCINES: SAFE AND EFFECTIVE

The rapid development of the first effective mRNA vaccines against COVID-19 and its many variants remains a noteworthy success. The Commonwealth Fund estimated that by December 2024, the vaccines prevented more than 18 million hospitalizations and 3 million deaths. If the vaccines had not been available, nearly 120 million more people would have contracted COVID-19. The financial savings were enormous: $1.15 trillion in medical costs.¹⁶

MASKING

At the pandemic’s start, COVID-19’s mechanism of spread was unclear. People wiped down groceries and surfaces with disinfectants, fearful that the virus could spread from contaminated surfaces. Now we know that similar to influenza and norovirus, COVID-19 spreads by aerosols (droplets produced when a person coughs or sneezes) that may be as small as 5 μm.¹⁷

Findings from multiple studies confirmed that masking slows the spread of COVID-19 and other respiratory illnesses. Findings from one CDC-sponsored study found that among 534 participants, the consistent use of cloth masks lowered the chances of testing positive by 56%.¹⁷ Participants who wore surgical masks were 66% less likely to test positive than those who did not mask, and wearing an N95 or KN95 mask lowered the odds by 83%. Masks are most effective when worn correctly and used concurrently with other precautions.¹⁷

A LASTING LEGACY: THE ROLE OF PHARMACISTS

The COVID-19 pandemic significantly altered the role of pharmacists and the public’s perception of them. Pharmacists, often seen as just dispensers of medication, stepped into a much broader role in health care. They became frontline health care providers, offering essential services such as COVID-19 testing, vaccinations, and crucial health counseling when access to physicians was limited. This increased accessibility and expanded services highlighted the pharmacist’s expertise and their vital role in public health.

The pandemic also showcased the adaptability and resilience of pharmacists. They quickly adapted to new safety protocols, managed increased workloads, and addressed drug shortages, all while continuing to provide essential medications and care. This dedication and commitment to patient care earned them increased public trust and recognition as valuable members of the health care system. The pandemic underscored the importance of pharmacists not just as dispensers but as trusted health care advisers and vital community health resources.

Pharmacists delivered many clinical health services to communities across the nation and around the world. Notably, over half of all COVID-19 vaccinations in the US were administered at pharmacies, including up to 80% in some urban areas.¹⁸ It’s a record that we need to be proud of and remember.

REFERENCES

1. Pizzato M, Santucci C, Islam N, La Vecchia C, Alicandro G. Relationship between COVID-19 cases and monthly mortality from all causes, cancer, cardiovascular diseases and diabetes in 16 countries, 2020-21. Int J Epidemiol. 2024;54(1):dyaf006. doi:10.1093/ije/dyaf006

2. Mathieu E, Ritchie H, Rodés-Guirao L, et al. Excess mortality during the coronavirus pandemic (COVID-19). Our World in Data. Updated 2024. Accessed February 17, 2025. https://ourworldindata.org/excess-mortality-covid

3. Sumetsky N, Brooks MM, Buchanich J, Molina B, Mair C. Changes in six categories of alcohol-attributable mortality from before to during the early phases of the COVID-19 pandemic. J Stud Alcohol Drugs. 2024;85(5):658-666. doi:10.15288/jsad.23-00187

4. Vingilis E, Beirness D, Boase P, et al. Coronavirus disease 2019: what could be the effects on road safety? Accid Anal Prev. 2020;144:105687. doi:10.1016/j.aap.2020.105687

5. Spedicati B, Pecori A, Concas MP, et al. Scent of COVID-19: whole-genome sequencing analysis reveals the role of ACE2, IFI44, and NDUFAF4 in long-lasting olfactory dysfunction. Life (Basel). 2025;15(1):56. doi:10.3390/life15010056

6. Signs and symptoms of long COVID. CDC. July 11, 2024. Accessed February 17, 2025. https://www.cdc.gov/covid/long-term-effects/long-covid-signs-symptoms.html

7. Trends in United States COVID-19 deaths, emergency department (ED) visits, and test positivity by geographic area. CDC. Updated February 18, 2025. Accessed February 18, 2025. https://covid.cdc.gov/covid-data-tracker/#trends_weeklydeaths_select_00

8. Proal AD, Aleman S, Bomsel M, et al. Targeting the SARS-CoV-2 reservoir in long COVID. Lancet Infect Dis. Published online February 10, 2025. doi:10.1016/S1473-3099(24)00769-2

9. Ford ND, Slaughter D, Edwards D, et al. Long COVID and significant activity limitation among adults, by age – United States, June 1-13, 2022, to June 7-19, 2023. MMWR Morb Mortal Wkly Rep. 2023;72(32):866-870. doi:10.15585/mmwr.mm7232a3

6. Ford ND, Vahratian A, Pratt CQ, Yousaf AR, Gregory CO, Saydah S. Long COVID prevalence and associated activity limitation in US children. JAMA Pediatr. Published online February 3, 2025. doi:10.1001/jamapediatrics.2024.6206

7. Long COVID Fact Sheet. US Department of Veterans Affairs. Accessed February 17, 2025. https://www.publichealth.va.gov/n-coronavirus/docs/Fact-Sheet-Veteran-Facing-Long-COVID-0083022-FINAL.pdf

8. Sandman PM. A severe pandemic is not overdue – it’s not when but if. University of Minnesota Center for Infectious Disease Research and Policy. February 22, 2007. Accessed February 17, 2025. https://www.cidrap.umn.edu/business-preparedness/severe-pandemic-not-overdue-its-not-when-if

9. Piret J, Boivin G. Pandemics throughout history. Front Microbiol. 2021;11:631736. doi:10.3389/fmicb.2020.631736

10. Frieden T. Which countries have responded best to Covid-19? Wall Street Journal. January 1, 2021. Accessed February 17, 2025. https://www.wsj.com/articles/which-countries-have-responded-best-to-covid-19-11609516800

11. Covid: the countries that nailed it, and what we can learn from them. BBC. March 21, 2021. Accessed February 17, 2025. https://www.bbc.com/news/uk-56455030

12. Fitzpatrick MC, Moghadas SM, Pandey A, Galvani AP. Two years of US COVID-19 vaccines have prevented millions of hospitalizations and deaths. Commonwealth Fund. December 13, 2022. Accessed February 17, 2025. https://www.commonwealthfund.org/blog/2022/two-years-covid-vaccines-prevented-millions-deaths-hospitalizations

13. Andrejko KL, Pry JM, Myers JF, et al; California COVID-19 Case-Control Study Team. Effectiveness of face mask or respiratory use in indoor public settings for prevention of SARS-CoV-2 infection – California, February-December 2021. MMWR Morb Mortal Wkly Rep. 2022;71(6):212-216. doi:10.15585/mmwr.mm7106e1

14. El Kalach R, Jones-Jack N, Elam MA, et al. Federal Retail Pharmacy Program contributions to bivalent mRNA COVID-19 vaccinations across sociodemographic characteristics – United States, September 1, 2022-September 30, 2023. MMWR Morb Mortal Wkly Rep. 2024;73(13):286-290. doi:10.15585/mmwr.mm7313a2