As we enter a new year with a new president, facing the most severe stage of COVID-19 thus far and with highly effective vaccines being rolled out far too slowly, what can we expect from the pandemic in 2021?
We consulted six global experts in infectious disease. They have led successful fights against other pandemics, including Ebola, AIDS, and Zika, and are currently battling COVID-19 in the United States and abroad.
The consensus is that the next three months will be grim. After that, things will probably get better. Yet the rate of improvement will depend on whether vaccinations outpace the march of the virus, especially the increasing dominance of the more infectious mutant strains from Britain and South Africa. What happens to us between now and April also depends on whether Americans simultaneously maintain mask use, social distancing, and selective business restrictions — or relax these measures.
Dr. Julio Frenk, former health minister of Mexico and current president of the University of Miami, told us, “We can see the light at the end of the tunnel, but we are still inside the tunnel.”
Assuming vaccination rates improve and the public follows protective measures, life should be better in the United States by the summer. At that point, health and government leaders will need to turn their attention to helping stamp out COVID-19 in other parts of the world.
The next three months will be dark, according to Dr. Albert Ko, professor of epidemiology at the Yale School of Public Health and COVID-19 advisor to Connecticut Governor Ned Lamont. “I’m worried about the more infectious UK strain, which could make it hard to avoid more lockdowns.”
Marc Lipsitch, an epidemiologist at Harvard’s T.H. Chan School of Public Health, said, “The new strains are still rare in the United States, so we don’t need extreme closures to deal with them yet, but the mutants will double as a share of cases every two weeks. That gives us just a couple of months to get ahead of them with widespread vaccination.”
All of those we spoke with said that COVID-19 deaths and infections would remain high through the first quarter of the year. Some argued that daily new cases could more than double from the current level of 250,000 to more than half a million. Nearly all said they expected the situation would improve by mid-year but that the United States would be far from out of the COVID-19 woods.
Dr. Peter Piot, former head of the UN agency fighting AIDS and co-discoverer of Ebola, and current dean of the London School of Hygiene & Tropical Medicine, told us, “By June 30, mortality and severe disease will be on the way down and the ICUs will be clearing out in North America and Europe. We can have a brighter summer.”
We expect to see a new pattern by mid-year, in which COVID-19 deaths in the United States fall to under 500 a day compared with a daily average of 4,000 now, and ill patients emptying out of emergency rooms and ICUs — but new cases will remain stubbornly high. This is because vaccinations will have reached the elderly and those with comorbidities, who are most likely to die of COVID-19, while younger unvaccinated people will continue to catch and transmit the virus.
“I wouldn’t like to see [continued transmission], but at least we will have stopped the COVID-19 deaths,” said Piot.
This is why rolling out vaccination quickly and overcoming the initial glitches is critical.
“I’m not surprised that the US and Europe are faring badly in the early days,” said Dr. Seth Berkley, head of the Global Alliance of Vaccines and Immunization in Geneva. “They have no experience with mass vaccination of the kind that African and Asian countries do very well.”
Said Ko of the potential for new vaccines to become available soon: “The new Johnson & Johnson vaccine could be a game changer. It requires a single dose and can be stored in simple fridges. We will have a strong signal from clinical trials of the J&J vaccine by the end of January.”
Our consensus is that by the end of the year, there will be fewer COVID-19 deaths and infections, with businesses and schools open. “By then things will be much better, but I hope we never go back to ‘normal,’ ” said Dr. Mark Shrime, chair of Global Surgery at the Royal College of Surgeons in Ireland. “We need to keep doing the things we have learned from COVID-19, like wearing masks in the winter when cold and flu viruses spread, and installing better filters in our air conditioning systems.”
Several of those interviewed argued that the United States urgently needs to help stop COVID-19 in other countries.
“This is a global pandemic, so the response has to be global,” said Berkley. “To avoid the reintroduction of COVID-19 from other countries, it is in US interest to back a worldwide vaccination campaign.”
US leadership and funding for a global effort, which have been missing under President Trump, must come to the forefront under the Biden administration.
Americans cannot let down their guard. Those we spoke with were worried that as vaccination expands, Americans could allow the virus to spread by neglecting masks, social distancing, and limits on gatherings. They have to understand vaccination is one part of “combination prevention” against COVID-19 and not a magic bullet.
Said Shrime, “We need to continue to do the proven things until COVID-19 is driven down to minimal levels. You don’t want to be the last soldier shot in this war.”
Robert Hecht is president of the Boston-based nonprofit Pharos Global Health Advisors and a clinical professor of epidemiology at the Yale School of Public Health. Shan Soe-Lin is managing director of Pharos Global Health Advisors and a lecturer in global health at the Jackson Institute for Global Affairs at Yale University.