A realistic look at the future in a COVID world -- 2020, 2021, and beyond

Oh, great. More to worry about.

Masking appeared to be effective vs the flu. People have masks. Governments have mask mandate policy experience. Expect public mask mandates every flu season.

I doubt it would be a blanket mandate like now. Unlike covid and its long incubation period, the flu is only contagious a day before symptoms according to the CDC so there’s little need for everyone to wear masks all of the time to combat the flu. Now, a targeted you must wear a mask if you’re ill ordinance I could see happening and it’d be a good idea.

I doubt that would be very enforceable. Something like mandatory masks for hospital or LTC visitors/workers during flu season, I could definitely see.

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The end of the coronavirus pandemic is on the horizon at last, but the timeline for actually getting there feels like it shifts daily, with updates about viral variants, vaccine logistics, and other important variables seeming to push back the finish line or scoot it forward. When will we be able to finally live our lives again?

Spring 2021

For the most part, daily life will continue to be far from normal for the next few months. Normal is of course a slippery word, given that many Americans have had to report to work or have chosen to dine out, travel, and do all sorts of things that others have avoided. But whatever people have not been doing for the past year, they can expect to keep not doing it this spring.

It’s unlikely that enough people will get vaccinated in the spring to restore normalcy. In fact, experts fear that the pandemic could get much worse in the near term, because variants of the virus that are more contagious or vaccine-resistant than the original version have begun circulating in the United States. The damage those variants will do is still unknown; “March to May is the mystery,” as my colleague Robinson Meyer wrote earlier this month.

The good news, though, is that even with these variants, existing vaccines appear to reduce the risk of severe illness, meaning more and more people will be protected as vaccinations continue.

Summer 2021

Whatever happens in the spring, the summer should be a sublime departure from what Americans have lived through so far. As my colleague James Hamblin wrote last week, “In most of the U.S., the summer could feel … ‘normal,’” even “revelatory.”

“Barring some variant that is just really crazy, I expect the summer to be a lot like the summer of 2019,” Andrew Noymer, a public-health professor at UC Irvine, told me. Based on the drop-off in cases and hospitalizations over the past few weeks, he thinks life could even be close to normal as soon as sometime in May.

Other experts I consulted were slightly less optimistic, but they generally agreed that at some point between June and September, the combination of widespread vaccinations and warmer weather would likely make many activities much safer

Fall/Winter 2021–22

Even if the summer feels like the end of the pandemic, it could turn out to be more of a temporary reprieve.

Most of the U.S. population should be vaccinated by the fall, but some resurgence of the virus seems likely in the colder months.

Another outcome seems less probable but more troubling: Whether because a variant ends up evading existing vaccines or because infections surge among unvaccinated people, cases might climb again. Even after a wonderful summer, a rise in cases could necessitate a reversion to many of the precautions from earlier in the pandemic, even if it doesn’t require full-on lockdowns.

Spring/Summer 2022

Beyond next winter, experts’ predictions are blessedly simple: Life in the warmer months of 2022 should be normal, or at least whatever qualifies as normal post-pandemic. The virus will still exist, but one possibility is that it will be less likely to make people severely ill and that it will, like the flu, circulate primarily in the colder months; some people would still die from COVID-19, but the virus wouldn’t rage out of control again. Meanwhile, Americans should be able to do most, if not all, of the things that they missed so much in 2020 and 2021, mask- and worry-free.

[Drastically edited]

Here’s another look at the near and distant future. I’ve only included the headers, but there is a lengthy analysis under each bullet point.

The Arguments for Optimism

  • COVID cases, hospitalizations, and deaths are all dropping dramatically.

  • The vaccines work really, really well.

  • The U.S. vaccination effort continues to improve.

  • Getting vaccinated is going to change people’s personal lives for the better.

  • Seasonality may now be working against the coronavirus instead of for it.

  • We may not have reached herd immunity, but there is now undoubtedly more immunity in many hard-hit locales.

  • Most Americans now have a whole lot of experience protecting themselves and others from COVID-19.

  • Donald Trump is no longer in charge of the U.S. pandemic response.

  • The economy (or at least parts of it) might come roaring back if COVID can be kept at bay.

The Arguments for Caution

  • We don’t actually know why COVID cases, hospitalizations, and deaths have suddenly dropped off.

  • The variants remain a real threat.

  • A lot of Americans don’t want the shot, and kids can’t get it yet.

  • COVID isn’t going to go away or be eradicated.

  • Regardless of what humans do, COVID will still have free rein in the animal kingdom.

  • The coronavirus is still novel.

We’re just over one year into this new COVID reality, and there remain a lot of questions that have, at best, incomplete answers. That is to be expected, as Jennifer Beam Dowd wrote about at Slate last week:

[D]espite our best scientific efforts, we must humbly admit that human understanding of SARS-CoV-2 infection dynamics in the real world is limited. The uniformity of the recent drops across U.S. states as well as globally points to something — a rhythm, a natural ebb and flow, a viral boom-and-bust cycle. This “natural” cyclicality is surely a complex interaction of the factors above, each contributing to push the reproductive rate below that critical threshold for which the exponential momentum starts to work in our favor. Things that are cyclical like the economy or epidemics are cyclical because we don’t fully understand how to control them. If we did understand them, we’d always have 7.2 percent GDP growth and low unemployment. Human behavior is beautifully adaptive but with such individual diversity that it is not easily modeled. … [W]hile we should avoid the temptation to cherry-pick our favored explanations for every twist and turn of the epidemic curve, neither should we be fatalistic.

And we probably shouldn’t start making post-pandemic plans for the Fourth of July just yet either.

I can’t tell you what a refreshing relief it is to hear this kind of humble analysis. What a different world we’d be in right now if this had been the attitude from the start.

Add I’d another bullet point to the ‘caution’ list: the wealthier nations had better take seriously the need to vaccinate the population of nations that aren’t as wealthy as the G7/8 countries, upon whom much of our supply chain depends and where many of our investment opportunities are.

I’m pretty sure that once a large enough segment of the non-elderly/pre-existing condition population has been vaccinated, and if case rates continue to decline, there’ll be a sort of “land grab” by the general populace to go back to normal operations despite whatever cautions and warnings medical authorities say, and politicians won’t want to look like assholes by mandating and enforcing restrictions at that point.

This will happen faster in states like Texas, where there are tripwires in the restrictions that automatically impose/lift restrictions based on factors like % of hospitalizations, case counts, etc…

As I see it, the issue may end up being whether a large enough % of people are vaccinated or have survived COVID to avoid a large uptick in cases when that land grab happens.

My amazing powers of prediction tell me that this will probably take place in the late summer/early fall, based on the forecasts for vaccinations.

I’m so used to not going anywhere, that I don’t really have the desire for it anymore. It depresses me, but I’m used to being depressed I guess. I could go out to eat whenever I want, right now, which I did frequently pre-covid, but I’ve gotten used to eating at home, and I don’t know if that’s going to change. I just don’t think about it anymore. That alone has saved me a ton of money, and has helped me finish projects that would have taken years. I don’t know that I ever will go back to “normal” in that regard, I don’t think I’m the only one, and I think restaurants are going to continue taking a huge hit for years to come.

Let’s get specific about the next few months: how will you handle small (10-25-ish people) events WHEN ALL ATTENDEES HAVE RECEIVED BOTH VACCINES?

GIVEN: Having had both vaccinations does NOT constitute license to return to the Before Times, i.e., dine indoors, go to bars, sing in the choir, shout at crowded sports events, hug and shake hands with everyone and their dog (actually, shaking hands with dogs is probably okay). In public we will still need to wear masks, keep distance, avoid physical contact, etc. Public behavior around lots of strangers will need to stay as it is.

What about these situations?

  1. Book Club- there are 10 women in my book club. All of them and their spouses (where applicable) have had both vaccines. Can we meet in person now? Does it need to be outside? I don’t see us sharing hugs around the room like we used to, or crowding together on the sofa or at the table, but if we keep our distance, can we be maskless? What about food? (Frankly, the idea of being in a room with unmasked people fills me with trepidation…)

  2. Ladies lunch group. This group has seven members, and we’ve been getting together monthly for almost 30 years-- except for the last year, of course. Everyone in that group (and spouses-- all parties are 70-ish and older) has had both vaccines. EXCEPT one anti-vaxxer who has told us she’s not going to get the vaccine. :rage: I can see us getting together outside, but we will have to exclude this one idiot (I don’t know what her reasons are and don’t care). Or can we invite her and keep our masks on, even outside?

Please suggest your own scenarios. Easter is coming. And Passover. Mother’s Day. Will you have in-person gatherings for those and other occasions when all attendees have been fully vaccinated? What restrictions will you still observe (no hugs, I guess :worried: – or maybe you’ll feel okay about vaccinated people hugging each other)? What about the one or two anti-vaxxers?

My scenario is flying home to visit my parents. Both they and I have had the Pfizer vaccine so can I stay in their house? Can I be maskless at home? Can I hug them? Because until this thing happened, I didn’t realize how much I want and need to see them occasionally.

If I were in a group where everyone has had a full vaccine (two doses where applicable) I would absolutely return completely to “normal.” If that situation doesn’t warrant dropping all precautions, what would? We all gave up a lot over the past year to get to this point. Let’s enjoy it. (I’m probably a long way from getting my shot, but the rest of you should start relaxing a bit)

When my kids had chicken pox, I took no effort to prevent them from giving it to me, since I had it as a child. Sure there is “some risk,” but a risk I’m willing to take.

You built up a reflex but in a room full of vaccinated people, it’s no longer a correct reflex. I think you should treat it like a before times book club. Get those hugs.

I’ll get there eventually, but not immediately. It will take a while to unlearn the response.

This article from the Atlantic is (according to them) not paywalled.

The vaccines were never expected to block infection by the virus altogether, explains Stephen Thomas, the chief of the infectious-disease division at SUNY Upstate and the coordinating principal investigator for the Phase 3 Pfizer-BioNTech vaccine clinical trial. “I don’t really think that’s feasible or plausible,” he told me. Most vaccines work by training the body to prevent a virus from replicating to such a degree that a person gets sick. They don’t typically prevent a person from getting infected; they simply make that infection less consequential, and enable the body to clear it more quickly.

But in a room full of vaccinated people … getting infected presumably doesn’t matter. It wouldn’t seem.

There are some preliminary findings that, succinctly, vaccinated people essentially don’t spread COVID to others. My thought is that the virus, even if it gets that initial foothold in a vaccinated person’s body, never achieves that critical mass of virions necessary to start being shed in meaningful numbers from that person.

It’s just really been conditioned hard into us that there’s no individual risk assessment with COVID. COVID precautions are public duty. At what point are my actions creating so little risk for the community that they are ethical?

Obviously, some risk is ok. It’s ok to drive, even though I am risking the lives of others when I do. But drunk driving is too risky, it’s not okay.

When is a vaccinated person hanging out unmasked with other vaccinated people like driving, not like drunk driving? How do we know?

Eta: if you follow the Israel study link, there’s actually a couple discussed.

Not necessarily. It depends how long ago they were vaccinated and whether it was the first or second dose. Even a vaccinated person can still spread the virus for a certain amount of time. Throwing caution to the wind would be unwise.

The scenarios were clearly meant as fully vaccinated participants.