10 months into the SARS-CoV-2 pandemic, what we have learned
1.SARS-CoV-2 is not only emergent virus we have to concern about.
2.SARS-CoV-2 is going to be circulating and stay with us forever.
3.I think SARS-CoV-2 will become the 5th seasonal coronaviruses.

4.SARS-CoV-2 may be on its way to endemicity.
5.Based on every data we know about SARS-CoV-2, it could eventually behave like one of endemic coronaviruses.
6.SARS-CoV-2 will probably behave like 1918 Spanish flu (3 big waves).

8.After recovering from COVID-19, RT-PCR can become positive, but you are not infectious.
9.People can be re-infected.
10.Children of all ages can get infected and spread SARS-CoV-2.
11.Herd immunity a long way off in the near future.

12.This winter will be difficult to fight SARS-CoV-2 (twindemic). + overlapping symptoms with several other viral respiratory infections.
13.We don’t know how SARS-CoV-2 will behave when other respiratory viruses start circulating during this winter.

14.May countries will impose curfew, partial or even complete lockdown, movement and travel restriction.
15.Schools should be closed in countries with high COVID-19 cases.
16. No recorded COVID-19 death in Mongolia?? (First imported case was in 10 March 2020). WHY???

17.We do not know much about COVID-19 vaccine safety in phase III clinical trials.
18. No data about suboptimal concentration responses of COVID-19 antibodies in COVID-19 vaccine recipients, great attention has paid to COVID-19 vaccine immune response in vaccinated groups.

Antibody-dependent COVID-19 disease enhancement or vaccine‐induced disease enhancement upon natural SARS-CoV-2 infection may occurs.
19.Antibody-dependent disease enhancement in vaccinated groups following natural viral infection has been seen in many viral diseases for example:

A.Measles (withdrew in 1967)
B.Human respiratory virus (HRSV) (TH2 cell- skewed immune response+ eosinophil infiltration and inflammatory cytokines)

C.SARS-CoV-1 inactivated, protein-derived peptide and recombinant vectored vaccines have induced TH2 based immune responses with eosinophils infiltration after challenge with SARS-CoV-1 in animal model
D.MERS-CoV inactivated vaccine also developed antibody-mediated pathogenesis

20.Whether SARS‐CoV‐2 vaccines will cause vaccine‐induced disease enhancement and have undesirable outcomes among vaccinated group upon natural SARS-Cov-2 infection is presently hypothetical, based on previous experience gained from other viral vaccines.

21.COVID-19 vaccine should be effectively generating humoral and cellular immunity, low titers, non-neutralizing antibodies and lacking CD8+ T cells activation are the risk factors for vaccine‐induced disease enhancement.

22. Men are at higher risk to develop more severe COVID-19 disease (Robust proinflammatory response).
23.SARS-CoV-2 pathogenesis is affected by several factors (Innate immunity, Antibody, T cell, renin angiotensin system, other seasonal coronaviruses infection cross protection).

24.Eyes are also entry point for SARS-CoV-2.
25.Remdesivir is probably valueless (approved October, 2020).
26.I think there is a key host factor and/or viral factor that could lead to full understand the complexity of covid-19 immunity (not yet discovered). I name it X factor.

27.What causes some people to become long COVID-19 (long haulers)?
28.There’s still lots to learn about SRAS-CoV-2 biology, COVID-19 immunity, molecular host and viral factors interaction.
29.This is not the last pandemic, and new pandemics will happen many times in the future.

30.Preparedness is key in any outbreaks/pandemic.
31.There are more than 10 infectious disease that could be the next pandemic.
32.We need a new effective international system for virus surveillance to spot viruses early enough.

32.We need a new effective international system for virus surveillance to spot viruses early enough.
33. In this pandemic everyone has a role to play in the fight against SARS-CoV-2.
34.Are we ready for the next pandemic?