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.
