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What will 2021 be like? 7 infectious disease experts discuss

COVID-19 vaccines offer hope, but it will take some time before they can really change the course of the pandemic in the U.S.
/ Source: TODAY

The coronavirus pandemic has consumed much of 2020 — COVID-19 infected tens of millions around the world and led to widespread illness, deaths and lockdowns. It also made things like masking and social distancing part of our everyday lives. In the fall, the news took a positive turn as multiple vaccines were approved, and shots started being administered in the United States and around the world.

While those vaccinations are reason to hope, epidemiologists and public health experts say that the pandemic will continue to be a major factor in 2021. TODAY Health spoke to seven experts to get their thoughts on what the next year will look like.

What will this winter be like?

Infectious disease experts said that the next few weeks will likely be the darkest of the pandemic so far, citing increasing hospitalizations and positivity rates on top of holiday-related surges in case counts.

“We are in the middle of a doom and gloom period. We’re at the highest rate of hospitalizations that we’ve had this entire pandemic, the highest rate of positivity, cities are out of ICU beds," Dr. Michael Ison, an infectious disease specialist at Northwestern Medicine in Chicago, told TODAY. “You don’t need to look forward, we’re there and it’s pretty awful.”

Ison warned that if significant mitigation measures aren’t put in place nationally, the number of cases and deaths will continue to rise.

“The message is for people to keep focused on what is individually within their control and work on countering some of that sadness and loneliness,” said Abigail Turner, associate professor of epidemiology and internal medicine at Ohio State University Wexner Medical Center in Columbus. “Find safe ways to be with people. Pull out your blankets and your warmest coats and sit in the winter sunshine … Call and play games over the internet … The end is in sight, but it’s not here.”

What about the vaccines?

“They’re not going to help us over the short term,” Ison stressed. As of Jan. 5, the Centers for Disease Control and Prevention reported that more than 4 million initial doses of the two COVID-19 vaccines have been administered. Over 17 million doses have been distributed.

“The vaccine doesn’t have an immediate effect, at an individual level. It takes a booster shot, and then several weeks from the time of your first injection before your immune system is fully primed to protect you against COVID-19,” Turner said.

"It (the vaccine) is not a magic bullet," said Dr. Otto Yang, a professor of medicine in the division of infectious diseases at the David Geffen School of Medicine at UCLA. "It is not a cure-all. It is one tool in a toolset that we should be applying overall ... We still do have to be careful."

Will things be better in the spring?

While vaccines offer some optimism for the spring, experts say that they likely won't be reaching the majority of the population for several months. However, protecting those who are most at-risk can help bend the curve of mortality rates.

“It’s going to take time, we may have an increasing number of vaccines, but to get them produced and in sites — and in arms (will take time),” Ison said, outlining that health care workers, long-term care facility residents and workers, essential workers and people ages 75 and older will receive the bulk of vaccinations until at least March.

“Until we get to 70% of the population protected, we’re still going to need to be cautious and will not have normalcy back,” Ison stressed.

Dr. Yvonne Maldonado, a professor of pediatrics (infectious diseases) and health research and policy at Stanford Health Care in California, told TODAY that the lack of large holidays during the spring months would probably reduce gatherings and related transmission.

"We've seen Thanksgiving, Christmas, New Year's, Hanukkah — all rolled into one," she said. "You keep building on the spike from before, and as the transmission rate in the community goes up, the likelihood that even having dinner with one other person who is infected is going to go up ... By March, there's less gatherings. I don't know how far (transmission) will drop, but it will go down."

Maldonado said that warming spring weather should also help. Since indoor activities are riskier, she said, the ability to go outside and socialize safely would make a difference.

"March and April isn't perfect weather but hopefully most of the heavy winter storms will be slowing down, and people can start to get outside a little more," she said. "I think the combination of starting the vaccine rollout and weather and less holidays will probably start to put a damper on the transmission. ... Between April and June, we'll have more vaccine for the general population, so I do think it'll be a really big period of transition."

Robert Hecht, Ph.D., a professor of clinical epidemiology at Yale University in New Haven, Connecticut, told TODAY that a major factor in how fast things improve will be non-pharmaceutical interventions (NPIs) like masking and selective closures.

"If we do the right thing with NPIs, I think in the second quarter of the year, we could really see the hospitalization and COVID deaths fall even further and even faster," he said. "As we pick up momentum and we (vaccinate) more and more people who are likely to develop illness, I think we'll start to see the growing herd immunity effect."

Are there any predictions for the summer and fall?

While it was hard to make concrete predictions about what the later months of the year might look like given the unpredictable nature of the pandemic, some doctors said that they expect things to improve in the second half of the year even though the virus will likely still be prevalent.

"We're going to still be seeing ongoing transmission of this virus," Dr. David Dowdy, an epidemiologist and associate professor at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, told TODAY. "I don't think that it's realistic to think that the virus is going to be eradicated next year. ... But I do think by that time a substantial fraction of the population will be vaccinated and that will be the path to getting life back to normal."

Maldonado said that she hopes that by fall there will be "real changes," even though it's likely that people will still have to wear masks and distance.

"We'll know a lot more about the vaccine, if it prevents transmission rather than just disease," she said. "If it just prevents disease, that (just affects) that person. If it prevents transmission, even a little bit, then you're talking about public health impact."

When will other interventions be effective?

Contact tracing can be an important step in fighting any pandemic, but with the sheer amount of cases being diagnosed daily in the U.S., it's a difficult job to do effectively. Hecht said that if case counts fall in the spring, it will be easier to trace chains of infection and stop outbreaks before they start.

"If we can get the community transmission under control, all that testing and tracing starts to become useful again," Hecht said. "Right now, there's no way that the test-and-trace programs can keep ahead of the number of infections that are occurring. In an optimistic scenario, if we work well on not just the vaccines but the non-pharmaceutical interventions, and we get the new infections down, we can see a continued decline."

Maldonado said that another key will be making treatments, like monoclonal antibody therapy, more accessible to the public, and developing new treatments and therapies that can make the disease less severe.

When will remote learning come to an end?

While many were optimistic about returning students to the classroom in fall 2021, experts said that online learning will likely continue through at least spring 2021.

“A lot depends on disease within a specific community — and how quickly we can get teachers vaccinated,” Ison stressed. “They’ll feel more comfortable (going back to in-person classes) once they’re vaccinated and rates start going down in communities — (then) they may feel more safe.”

Ison pointed to mid-to-late spring as a likely timeline for when teachers could become vaccinated. Dr. Chris Beyrer, a professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, told TODAY that the vaccine is not yet authorized for use in children, so that may complicate the return to the classroom.

"Pfizer-BioNTech didn't have enough data on younger teenagers" to file for an emergency use authorization for that age group, Beyrer explained. "We have to do trials in younger children ... There are 100 million people under the age of 18 in this country. If we have approval for pediatric use, then we also have to immunize the kids, and that is, of course, going to have a very big impact on return to school and day care, and all those elements."

Turner emphasized that it’s likely most schools will follow a hybrid model of in-person and remote learning for most of 2021, though much is still unknown.

“We now have a lot of data showing that in-person school, when distancing and masking — when adults and kids adhere to those guidelines — school is really safe,” Turner said. “(Yet) thinking about in-person school for a lot of districts, they don’t have the space to keep that distance. So, in some areas, we’ll still be looking at hybrid (schedules),” she said.

When will weddings be OK again?

During an interview with Dr. John Whyte, the chief medical officer of WebMD, Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, offered an optimistic look into the future. When asked if people who planned to get married this spring will need to reschedule the events, he suggested the summer could be a more realistic timeline.

“… If we get priority people vaccinated (the ones that the Advisory Committee on Immunization Practices is recommending) between now and, let’s say, March, beginning of April, and we can start in April doing what I call ‘open season’ on vaccinations, meaning anybody in the general population who wants to get vaccinated will get vaccinated," said Fauci. "If that’s the case, when we go through April, May, June, July — by the time we get into the middle or end of the summer, if we do it correctly, we could have 70 to 85% of the population vaccinated. When that occurs, there will be an umbrella of protection over the entire country that the level of virus will be so low, that you will essentially be able to establish herd immunity.”

When will we be able to see friends and family more regularly?

The isolation of the pandemic has been hard on many, and while social bubbles and distancing have offered some opportunity to safely see loved ones, experts estimate it will probably be a while before regular interactions can resume safely.

“I will feel comfortable when I’m vaccinated, when my elderly relatives are vaccinated and when case rates and community prevalence in the places where I go has gone way done,” said Turner. “But even in those scenarios, I’m going to still be most comfortable wearing a mask if I’m indoors with people who are not in my household.”

What will the holidays look like next year?

The 2020 holiday season was a time of isolation and small, household-only gatherings for many, but experts are optimistic that the 2021 season will be different if the vaccine rollout is well-managed — and other interventions, like masking, remain consistent.

“I’m always hopeful, and I’m not really certain,” Turner said with regard to the 2021 holiday season. “We don’t know what the virus is doing, we don’t know what policy will do, we don’t know what individual people will do … It’s impossible to predict what holidays will look like. I really am hopeful and I’m kind of really not sure what it’s going to be.”

"It's really going to depend on us all working together, the public, working together to have society reach the point that the virus is at low enough levels, that those things (family gatherings indoors) become safe," said Yang. "And so if we can get the virus down through current effective (mitigation) measures that we know already exist, and throwing the vaccine on top of that. I hope that we can."

“I’m hopeful for next year,” Ison said, noting that he hasn’t been able to see his parents or his brother who has a new baby. “Everyone wants to know when everything is going to happen. It’s hard to tell … Logistics are complex. It’ll get there.”