My children were playing in the car the other day and pulled open the glove box. Inside, they found a brown paper bag with my last name “KUMAR” in black Sharpie and a red sticker that read, “Do not lose. No replacements available.” It wasn’t long before the kids tore that bag apart to find the treasure inside. They were a little disappointed that it was only a blue-green N95 mask, but in the year 2020, it may have well been worth its weight in gold and diamonds.
It’s hard to realize that it has been five years since COVID-19 came to our shores. It seems simultaneously like yesterday and also many decades ago. The panic, the lockdowns, the social bubbles, the store shortages—they seem almost quaint in retrospect. With today’s certainty of knowing that we have survived the past, that era almost seems nostalgic. After all, we were able to spend time away from our workplaces with the people that we cared about the most. However, as I tugged at the rubber strings of the N95 mask, that nostalgia faded away to a more sobering reality.
Our grief was sometimes even anticipatory: I recall one text message from a rheumatologist colleague who said, “Things are bad here. I don’t know when my turn will come.”
The omnipresence and intimacy of these thoughts change you and force you to look deep into the soul.
We experienced more than the anticipatory grief and collective mourning for those who died. The numbers creeping up and maps turning redder and redder told only part of the story. We also grieved for the loss of normalcy, routine and certainty.
Once our initial lockdowns eased up, every rheumatology clinic became quieter, not just because of fewer in-person visits, but because of the weight that each encounter carried. Patients arrived (online) more anxious, acutely aware that their medications could make them more vulnerable to a virus the world barely understood.
For too many of us, the grief was deeply personal. We lost loved ones, jobs and social connections. Grief is rarely static. Yet it morphed into persistence—a defiance of this invader into our lives. I saw it in the patients who attended virtual visits, holding their smartphones at awkward angles to show swollen joints. I saw it in colleagues who juggled childcare, research and clinical duties while wearing masks for hours on end. Surprisingly, grief didn’t paralyze us; it mysteriously propelled us forward, forcing us to adapt to a world in which uncertainty became the only certainty.
After the initial shock, that persistence became the quiet undercurrent of the pandemic. It fueled researchers, who worked around the clock to understand how COVID-19 intersected with autoimmune disease. It sustained clinicians, like me, who learned how to deliver compassionate care through a computer screen. In the face of unimaginable loss, persistence reminded us that life continued, albeit in a different form.
The Power of Community
If this grief informed our persistence, then it was community that gave us strength. The Global Rheumatology Alliance (GRA), born out of necessity in the early days of the pandemic, stands as one of the most remarkable examples of what can happen when our community comes together to combat a seemingly insurmountable threat.1 What began as a handful of concerned rheumatologists exchanging emails quickly evolved into an international collaborative effort, gathering real-world data to understand how COVID-19 affected patients with autoimmune diseases.
The GRA didn’t just collect data; it created solidarity. Rheumatologists from around the world shared observations, treatment strategies and, perhaps most importantly, reassurance.2 I remember reading the early reports that suggested that patients on biologics didn’t seem to fare much worse than the general population, but that methotrexate might complicate vaccine responses and that repeated infections might lead to worse disease. These insights didn’t just inform my completely upturned practice; they brought peace of mind in a time of chaos.
That community extended beyond professional circles. Patients formed their own networks, sharing experiences and advice in online forums and social media groups. They exchanged tips on navigating telehealth, managing medication refills and coping with isolation. The pandemic fractured our world, but it also revealed the vitality of our connections. In rheumatology, community became both a shield and a salve—a reminder that, although physically apart, when we keep our well-wishers in mind, we were never truly alone.
The Limits of Science
The pandemic was also a coming of age for our scientific community. For all the triumphs of science during the pandemic, such as rapid vaccine development, innovative treatment protocols and unprecedented data sharing, we also faced the humbling limits of science. Early on, our understanding of COVID-19 was incomplete, evolving by the hour. Recommendations shifted quickly: Wear a mask; don’t wear a mask, but a shield; wear two masks, just in case; and so forth. For patients with autoimmune diseases and other immune dysfunction, the stakes of this uncertainty were even higher. Would their medications increase susceptibility to illness and disease, or somehow protect them by dampening inflammation? We simply didn’t know.
This uncertainty underscored a fundamental truth: Science is not a product or a dogma, but instead a process that unravels. Science is a method of inquiry that thrives on iteration, questioning and authentically admitting ignorance. In that way, science is not to be gatekept by scientists; rather, we must invite the general population to adopt scientific mindsets and become citizen scientists.
Toward that end, the pandemic reinforced that understanding patient perspectives is as crucial as discovering pathophysiologic mechanisms. Even five years after COVID-19 entered the stage, we’re still trying to inculcate a culture of experience-informed medicine and negotiate the need for patience in biomedical science with the pressing need to answer urgent questions.
The Present Matters
Amid the complete disorder unleashed by the pandemic, many of us found ourselves reassessing our priorities and our values. The greatest realization that COVID-19 forced upon me was a renewed appreciation for the present. When the world slowed down, I began noticing the small moments that once slipped by unnoticed: morning sunlight filtering through the kitchen window, the sound of my children laughing in the next room, the quiet satisfaction of completing a telehealth visit without technical glitches (these were rare).
Mindfulness, once an abstract concept, became a survival strategy. Without human contact beyond people in my bubble, I found myself revisiting events in the distant past, often with great regret and reflecting the grief I felt in my day to day. At the same time, I couldn’t imagine what the future would look like, with my own mortality on the line. It is safe to say that in that March, I felt like I was losing control of my mind.
Slowly I realized that although I couldn’t control the pandemic’s trajectory, I could control how I engaged with each day. This shift wasn’t just personal; it influenced my practice as well. In clinic, I found myself asking different questions—not just about pain and function, but about how patients were experiencing life amid uncertainty. What brought them joy? What small victories had they celebrated that week?
We are fortunate because we are living in a future that we weren’t sure would even occur. For that reason, I’ve concluded that living in the present doesn’t mean ignoring the future. It means recognizing that each moment holds value, even when the world feels precarious. As rheumatologists, we often work toward long-term goals—disease remission, functional improvement, better quality of life. But the pandemic reinforced that the journey matters as much as the destination. Every appointment, every conversation, every moment of shared understanding is an opportunity to connect, to heal and to find meaning in the now.
The Mysteries of Immunity
Perhaps the most enduring scientific legacy of the pandemic is what it taught us about the immune system. COVID-19 exposed both the brilliance and the fragility of our immune systems. The same immune system that protects us from pathogens can, at a moment’s notice, turn against us. Cytokine storms, multisystem inflammatory syndromes and post-acute illness syndromes revealed the complexity of the body’s defenses, highlighting just how little we truly understood.
For rheumatologists, this wasn’t entirely new territory. We’ve long grappled with the duality of the immune system—its capacity to heal and to harm. But COVID-19 added new layers to this understanding. We saw how, in susceptible patients, viral infections could unmask underlying autoimmune conditions, how systemic inflammation affects cognition (the brain fog many of us felt), and how immune dysregulation could persist long after the acute phase of illness had passed.
The pandemic also accelerated research into immune modulation. Janus kinase inhibitors, already familiar to us in the treatment of rheumatoid arthritis and other systemic autoimmune rheumatic diseases, emerged as promising therapies for severe COVID-19 in the correct contexts.3 Monoclonal antibodies, designed to target specific inflammatory pathways, became household names. These advances didn’t just change how we approached the virus—they reshaped our understanding of inflammation itself, opening new doors for autoimmune and infectious disease management.
But perhaps the greatest lesson was one of absolute humility. For all our scientific progress, the immune system remains an enigma and will remain so for a very long time. Despite what it may look like in textbooks, its intricacies are far from fully mapped. COVID-19 reminds us that curiosity and caution must go hand in hand—that every answer leads to new questions, and that true understanding is always just beyond the horizon.
Conclusion
As I folded the N95 mask back into a new brown paper bag, I couldn’t help but reflect on how much had changed in five years. The world we inhabit today is different—not just in terms of public health protocols or hybrid work schedules, but in how we understand community, resilience, and the delicate balance between certainty and uncertainty.
The pandemic undoubtedly fractured our lives, but it also illuminated what matters the most. It taught us the complicated relationship between grief and persistence, that community can persist even in social isolation, that science has limits but also boundless potential, and that focus on the present moment can lead to a brighter future.
In short, COVID-19 didn’t just change how we practice medicine; it changed how we see the world. And as we move forward—still wary, still hopeful—we carry these lessons with us, stitched into the very fabric of our lives. Of course, we don’t know the future course of this pandemic, the long-term sequelae of disease that will only be revealed decades from now, or when a new pandemic will arise. That’s why I save that mask—not just as a potential tool in case there is another shortage, but also as a potent reminder of those strange and scary times that I will always carry with me.
Bharat Kumar, MD, MME, FACP, FAAAAI, RhMSUS, is the director of the rheumatology fellowship training program at the University of Iowa, Iowa City, and the physician editor of The Rheumatologist. Follow him on X (formerly Twitter) @BharatKumarMD.
References
- Liew JW, Bhana S, Costello W, et al.; COVID-19 Global Rheumatology Alliance. The COVID-19 Global Rheumatology Alliance: Evaluating the rapid design and implementation of an international registry against best practice. Rheumatology (Oxford). 2021 Jan 5;60(1):353–358.
- Gianfrancesco M, Hyrich KL, Al-Adely S, et al.; COVID-19 Global Rheumatology Alliance. Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: Data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis. 2020 Jul;79(7):859–866.
- Tanaka Y. A review of Janus kinase inhibitors for the treatment of COVID-19 pneumonia. Inflamm Regen. 2023 Jan 9;43(1):3.
