Here’s How the Pandemic Finally Ends (Part 1, Politico)

 

A vaccine by early 2021, a steady decline in cases by next fall and back to normal in a few years—11 top experts look into the future.

Elizabeth Ralph is deputy editor at Politico Magazine.

Part 1

“The microscopic bundles of RNA, wrapped in spiky proteins, latch on to human cells, hijack them, use them as factories to replicate, and then leave them for dead. It’s a biological blitzkrieg—an invasion so swift and unexpected that the germs are free to jump from host to host with little interference.

“Fast forward to the future. Now, when the prickly enemies invade the lungs, they slip past the human cells, unable to take hold. They’re marked for destruction, soon to be surrounded and eliminated. Though some escape through the airways, they confront the same defenses in their next target—if, that is, they can get anywhere near the human cells. There are so few people left to infect that the germs have nowhere to replicate, nowhere to survive.

“This is the end of the coronavirus pandemic. And this is how it could happen in the United States: By November 2021, most Americans have received two doses of a vaccine that, while not gloriously effective, fights the disease in more cases than not. Meanwhile, Americans continue to wear masks and avoid large gatherings, and the Covid-19 numbers drop steadily after a series of surges earlier in the year. Eventually, as more and more Americans develop immunity through exposure and vaccination, and as treatments become more effective, Covid-19 recedes into the swarm of ordinary illnesses Americans get every winter.

“‘It will take two things to bring this virus under control: hygienic measures and a vaccine. And you can’t have one without the other,’ says Paul Offit, director of the Vaccine Education Center and an attending physician in the Division of Infectious Diseases at Children’s Hospital of Philadelphia.

“The future laid out above is the likeliest scenario for how the pandemic could end, based on interviews with 11 top-level experts who think about the future of those microscopic SARS-CoV-2 particles every day. They agree there’s a lot of fog left in the Covid-19 crystal ball, but most accept several likelihoods: At least one effective vaccine—hopefully several—will be approved in the U.S. by early next year. Producing and distributing a vaccine will take months, with the average American not receiving their dose (or doses) until at least mid- or late 2021. And while widespread inoculation will play a large role in bringing life back to normal, getting the shot will not be your cue to take off your mask and run free into a crowded bar. The end of the pandemic will be an evolution, not a revolution, the vaccine just another powerful tool in that process.

“That assessment dramatically contrasts with President Donald Trump’s Panglossian certainty that the U.S. has ‘rounded the corner’ in the pandemic, that a vaccine will be ready by Election Day and that every American can get the shot by April. Most importantly, it contradicts the underlying assumption of Trump’s many proclamations: that life will immediately return to normal after a vaccine is administered. ‘I don’t see this pandemic ending as in like, you know, ‘This is the day, the pandemic ended,’ says virologist Angela Rasmussen. ‘I see this as being a process that will go for a long time, potentially even years.’

“Experts’ estimates of the timeline vary, but there seems to be some agreement that the virus could be in decline and under control by the second half of 2021, and that society could see pre-Covid ‘normal’ within two years. ‘I’ve said November 2021,’ predicts Zeke Emanuel, former Obama adviser and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania. ‘I think you’ll have enough herd immunity [in the U.S.] that we’ll have an unremitting decline.’ Herd immunity is the point at which so many people are immune that the virus can no longer spread widely.

“Florian Krammer, professor of vaccinology at the Icahn School of Medicine at Mount Sinai, put it this way: ‘What I think is going to happen at some point in [20]21 is the virus is basically morphing from a real spread into something that’s in the way and causes some low numbers of cases and probably very low numbers of deaths.’

“The precise timing, of course, is uncertain—an elusive future that rests on a series of known unknowns, things like how many people continue to wear masks and social distance and whether rapid Covid-19 tests become widely available and properly deployed. Much will depend on how effective the vaccines are, how many people refuse to get inoculated and how many people forget to get their second dose if the vaccine requires two (yes, that is a significant concern). And then there’s what epidemiologist Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, calls ‘the trillion-dollar word of the day with this disease’: immunity. How long, on average, will immunity from natural infection and from the vaccine last?

“‘We can get [to herd immunity] with vaccination and clinical disease,’ he says. ‘The question is how long can we stay there. Meaning, if we get to, say, 75 or 80 percent immune projection, would it stay that way if we didn’t do anything else?’ Perhaps that’s the most important thing to understand about the pandemic right now: Though experts can make their best guesses, there is no certainty about Covid-19’s future. ‘If this were an influenza pandemic, I would feel confident telling you how it would end,’ says Osterholm. ‘But this coronavirus keeps throwing us curve balls day after day.’

“This kind of unpredictability is why Sarah Cobey, an epidemiologist at the University of Chicago, chose her field in the first place: ‘One of the reasons I wanted to study infectious disease dynamics is that they can be really unintuitive. They can be mathematically very predictable, but they can always be unintuitive.’

“Before the vaccine: ‘Masks and distance’

“The pandemic is far from over. It’s not even in decline. Cases of Covid-19 are on the rise in more than 19 states, and in just one day this week, the U.S. saw more than 40,000 new cases and more than 1,000 deaths.

“Experts don’t expect those numbers to improve much as people move indoors for the fall and winter. Harvard epidemiologist Michael Mina sees norms shifting as social distancing fatigue settles in: ‘Little by little there’s going to be fewer people wanting to sit outside, more people sitting inside,’ he says. ‘And then people are going to say, ‘Well, you know, I was at dinner two nights ago and I was fine. I can go to this gathering of 30 people.’ Then ‘I can go to the gathering of 100 people.’ And it will probably be just kind of a slow … change of opinion about what the risks are. Unfortunately, this is all occurring … at times that coronaviruses are very likely to potentially tick up due to seasonal effects,’ he adds.

“The expected surge underscores the idea that Americans are not going to achieve ‘normal’ before a vaccine, not with this country’s outmatched testing system and total failure to contact trace. The key, then, to making sure that society finds some degree of normalcy in the meantime—meaning places like schools can stay open—continues to be ‘masks and distance,’ says Emily Landon, chief infectious disease epidemiologist at University of Chicago Medicine. That means avoiding places like restaurants where you can’t wear your mask inside. Masks and distance really work,’ she says.

“Continued social distancing is far better than the alternative. Disease experts all warned against White House adviser Scott Atlas’ proposal to reopen the economy and reach herd immunity by letting natural infection tear through the population. Not only is the idea ‘a Russian roulette plan’ that could lead to millions—millions—of deaths, says Landon, but the strategy might also be impossible, given that a sizeable chunk of the U.S. population is more likely to stay home than decide it’s OK to venture out to inevitably get infected. In that case, the United States would hover below the herd immunity threshold while the economy stays stagnant, achieving neither of Atlas’ goals.

“There is another possibility, says Mina. There’s been recent buzz surrounding rapid Covid-19 antigen tests—cheap tools recently approved by the Food and Drug Administration that can deliver results within minutes. Some experts have questioned their utility, because they aren’t yet as accurate as more common lab-based tests. But Mina thinks that, if they’re produced on a massive scale and authorized for at-home use, rapid tests can help quell the pandemic in surge areas. The idea is that people would use them not as passports to enter crowded spaces and do things they wouldn’t ordinarily do, but as daily checks before they go about their normal business.

“‘They don’t have to catch everyone, because the messaging would have to be you do exactly what you’re going to do anyway. If the test is negative, you continue everything the same. But if the test is positive, then you definitely don’t go out,’ he says. ‘We actually [can] use it as a tool to create herd effects so that you have enough people who are high transmitters not transmitting.’…” (Politico).