COVID pandemic at 3 years: Recalling Chicago-area victims. Fewer cases. Preparing for the next health crisis.

Although much of the nation has largely dropped most COVID-19 pandemic protocols, Gretchen Musa continues to wear a mask whenever she’s around others, including during frequent outdoor walks with a friend in her west suburban Wheaton neighborhood.

The 50-year-old has had islet cell transplants to treat Type 1 diabetes and takes immunosuppressant medications, which put her at a higher risk of severe illness from COVID. She no longer attends church services in person, refrains from eating in restaurants, gave up teaching when remote positions weren’t an option and has stopped singing in a choir, because it’s considered a higher-transmission activity.

The threat of the virus is still a constant presence for Musa — and she doesn’t know if this feeling will ever dissipate.

“COVID changed my life completely,” she said. “It changed my career, mental health, church involvement, faith in humanity, travel plans etc.”

Three years ago, the world was gripped with fear as a new and mysterious virus spread across continents. On March 11, 2020, the World Health Organization declared the novel coronavirus an international pandemic, urging every nation to take immediate measures to curb the spread of illness and protect the most vulnerable.

“WHO has been assessing this outbreak around the clock and we are deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction,” World Health Organization Director-General Tedros Adhanom Ghebreyesus announced that day. “Find, isolate, test and treat every case and trace every contact; ready your hospitals; protect and train your health workers. And let’s all look out for each other, because we need each other.”

Two days later, President Donald Trump issued a proclamation declaring the COVID-19 outbreak a national emergency.

As the three-year anniversary of the pandemic declaration approaches, the threat of COVID-19 is strikingly lower. Safe and effective vaccines have immunized billions around the globe. COVID cases and hospitalizations are on the decline nationally as well as in Chicago; Cook County remains at a low community level of COVID. Treatments are now available for those at greater risk of serious disease or death.

Yet the imprint of the pandemic still lingers in so many ways, from the people killed by the virus who will never be forgotten to the long-term health and economic consequences that still plague humanity.

For those who lost family members and friends to COVID-19, the post-pandemic world will never be the same without those loved ones. The virus has so far killed more than 36,000 in Illinois, around 1.1 million in the United States and nearly 6.9 million worldwide.

For long-haul COVID patients who suffer from symptoms months or even years after the initial infection subsided, many fear their health and abilities could be forever compromised.

Businesses locally and around the globe closed during lockdown, some to never reopen again. Schools abruptly switched to long periods of remote learning, resulting in educational losses and social repercussions for youth that continue today.

And scientists and medical experts around the globe suddenly shifted their entire focus to understanding, containing, treating and preventing one illness caused by a little-understood, microscopic enemy.

“It does change you,” said Dr. Rachel Rubin, senior medical officer at the Cook County Department of Public Health, who served as co-lead of the agency during the height of the pandemic. “Everybody has been affected by it. … I think this will have a lasting impact.”

On May 11, the Biden administration plans to end the COVID-19 national and public health emergencies, yet another sign that the period of acute crisis has largely faded. But the emergency declaration’s end comes with financial fallout: Insurers will no longer be required to fund at-home COVID tests.

Although free COVID vaccines will still be available, the federal government has said it’s running out of money to buy up those doses; Congress hasn’t acquiesced to President Joe Biden’s requests for more money for vaccines and other COVID-related costs, and it’s uncertain whether vaccines will continue to be funded when flu season hits this fall.

While COVID-19 is far less a threat now compared with the height of the pandemic, scientists and physicians caution the nation against letting its guard down. Additional COVID variants of concern can still emerge. New public health threats on large and small scales can strike at any time.

The three-year fight against COVID exposed many American public health weaknesses, from a slow ramp-up of coronavirus testing to basic health care inequities to supply chain problems.

“We were sort of ill-prepared to deal with this because of — at least in the United States — the underfunding and the lack of support for public health that reaches back decades,” Rubin said

Now medical experts are wondering how well the nation and local governments are poised to battle the next pandemic.

“The whole scientific world pretty much stopped what they were doing and focused on this one disease,” said Dr. Allison Arwady, commissioner of the Chicago Department of Public Health. “So we saw huge advancements in virology, vaccinology and understanding of variants. That has paid off and will continue to pay off.”

She pointed to many gains in local public health capabilities since early 2020. The University of Illinois’ Discovery Partners Institute has been working with local public health agencies to monitor wastewater, an often more reliable method to measure community COVID levels. Rush University Medical Center launched an advanced molecular lab for genome sequencing, which allows researchers to identify emerging COVID variants and track and trace their spread across the city.

While these programs were built up in response to COVID, they can be used to monitor and better understand all sorts of public health problems, Arwady said.

The city’s health department had assembled teams of contact tracers that turned into vaccine ambassadors after the COVID-19 shots were authorized; now Arwady wants to keep these teams on the ground to help sign residents up for health insurance, work on violence prevention, and offer diabetes education and support.

But many of these new COVID-era public health initiatives aren’t funded long-term, she said.

“I’m facing a huge funding cliff,” she said. “I hope one of the big lessons we’ve learned is not to do exactly what we had done with every emerging disease in history — which is, ‘Oh, that disease is over, we don’t need to fund the activities that (were) successful.’ … Because I’m just tired of building temporary scaffolding around here.”

Testing, long-COVID

First came the cough. Then there was a flu-like illness that felt severe but never life-threatening.

Candy Malina of the Lakeview East neighborhood was never hospitalized for the COVID infection, but had one of the earliest local cases to be diagnosed in mid-March 2020. Yet so many of her symptoms continued long after she tested negative for the virus. Hoarseness. Gastric issues. Brain fog.

The worst symptom was fatigue.

“That’s what makes it hard to function,” said Malina, who had mild asthma pre-COVID but described herself as otherwise healthy and energetic.

She recounted driving to the hospital to get tested. It was at the start of lockdown. Gov. J.B. Pritzker had announced that all restaurants and bars would be closed to dine-in customers as of March 16, 2020, and then issued a March 21, 2020, “stay-at-home” order. The normally congested city streets were eerily empty. Office buildings were dark. Many restaurants and shops were closed.

At the time, Malina was among the rare recipients of the few — and highly coveted — COVID tests available.

In late January 2020, a Chicago woman had become the first confirmed coronavirus case in Illinois, contracting the virus after a trip to Wuhan, China. Then her husband caught the virus, marking the first person-to-person transmission case in the nation. The couple were hospitalized at Amita Health St. Alexius Medical Center Hoffman Estates and monitored round-the-clock, but their specimens had to be sent out of state for Centers for Disease Control testing, local health authorities recalled.

Then in February 2020, Illinois became the first state to test for the new coronavirus rather than sending specimens to the federal government, which was expected to speed up testing and results. Yet by March, the nation was facing a critical shortage of tests and other testing missteps. The first drive-thru coronavirus testing sites popped up in Chicago-area hospital parking lots only to shut down, in some cases days later, due to a dearth of tests.

Then when testing capacity increased, patients locally and around the country reported lengthy delays to get results due to overwhelmed laboratories. This was months before the COVID testing landscape would proliferate with everything from saliva tests that detected the virus in a spit sample to antibody tests that revealed prior infection to at-home tests, which can take a matter of minutes.

Malina recalled waiting 11 days for her positive result. This was about 18 days after her symptoms began.

So little was known about the virus that she, like many, thought victims either died or got better.

Then physicians started chronicling a third type of patient: survivors like Malina whose symptoms persisted long after the initial infection went away. The condition was dubbed “long-haul COVID” and sometimes referred to as “post-COVID syndrome.” Patients began reporting a litany of often strange symptoms following COVID infections, from hair loss to skin rashes to mental health conditions to persistent loss of taste or smell.

Anywhere from 5% to 30% of those who have had COVID might develop long-haul symptoms, and around a million Americans are out of the workforce at any moment due to long-COVID symptoms, according to a November U.S. Department of Health and Human Services report.

Malina recently enrolled in a University of Illinois at Chicago study of long-haul patients, which is expected to receive about $22 million in funding over four years from the National Institutes of Health. Researchers are trying to understand why some patients suffer from these lasting conditions and determine new ways to treat patients.

While Malina’s symptoms are less severe than they were in 2020, long-COVID has greatly diminished her quality of life. Three years later, the fatigue is still unrelenting; she’s starting to lose hope that she’ll ever recover.

“It’s totally changed my life, probably forever,” she said. “I don’t know that I have totally accepted that I will never get better.”

‘Take care of each other’

Feliks Ogorodnik, 88, and his wife, Luiza, 84, had emigrated from Ukraine decades ago and settled in north suburban Skokie.

He was an avid gardener. She had worked as a physician back in Ukraine.

After falling ill to COVID, Feliks died a few minutes before 5 p.m. on March 28, 2020. His wife, also infected with the virus, died about 4 ½ hours later, at the same hospital.

“They died in one day,” said their daughter, Irina Greenwald of Evanston. “It was just at the beginning of the pandemic when no one really knew what was happening and what was going on.”

Due to COVID-19 restrictions, there were only four mourners and two rabbis at the funeral, which was livestreamed so family and friends overseas could take part remotely, Greenwald recalled.

She wishes her sister, who lives in Germany, could have been there in person as well.

Around the world, last rites and funeral services had to quickly be revamped to prevent spread of the virus. Grieving began to take different forms, sometimes through modified religious rites or virtual services. Some families opted to postpone burials and services until the world was safer.

A year and a half after the deaths of Feliks and Luiza Ogorodnik, a larger group of family and friends gathered at their grave site for a memorial service. Greenwald’s sister was finally able to travel from Germany and attend.

“That felt right to have,” Greenwald said. “Only then, it felt like a complete closure for me.”

Rubin, of the Cook County Health Department, suffered a similar loss when both her parents died of COVID in a two-week span. Harvey Rubin, 93, passed away Dec. 23, 2020, and his wife, Aviva Rubin, 91, died less than two weeks later.

They lived in an independent living apartment in Lincolnwood, and their daughter couldn’t have many in-person visits with them due to COVID-19 restrictions and fear of spreading the virus. She and her sister were able to see them in summer 2020, spending the time together outdoors to lower the risk.

“That is precious time that I’ll never get back,” she said.

While scientists and medical experts say the pandemic isn’t over, the world is markedly different today, with new methods of testing for the virus, good treatments for the sick and readily available vaccines, despite some hesitancy and opposition to mandates. The physician conjectured that perhaps the virus might mutate to become less and less virulent, “because historically, that’s what viruses do.”

Until then, she urged the public to remain cautious and encouraged high-risk individuals to continue wearing high-quality masks.

“Don’t be embarrassed,” she said. “I put a mask on when I go to the grocery store. Take care of each other. That’s one thing that did come out of this, that there’s a sense of trying to care for each other. It’s not just for yourself. We’re a community. … And we need to be taking care of those of us who are more vulnerable.”

The Associated Press contributed.

eleventis@chicagotribune.com

In the last paragraph of an earlier version of this story, Dr. Rachel Rubin was misquoted. The story has been changed to indicate that she said care is needed for those who are more vulnerable.