COVID-19: What to Expect in 2021

COVID-19 cases, which have spiked since Thanksgiving and continue to remain high, are being called a “surge on top of a surge.” Hospitalizations and deaths in California hit record highs during the holiday season, with intensive care units reaching capacity in many regions. 

At the same time, vaccine shipments have arrived and thousands of health care workers have begun receiving the first of two doses.
SDSU NewsCenter spoke with two of San Diego State University’s leading public health experts about the outlook for 2021: 

• Eyal Oren, an infectious diseases researcher, is an associate professor and interim director of the School of Public Health. He is involved in several COVID-19 research projects and is co-lead of a $5 million National Institutes of Health-funded project focused on testing. 
• Corinne McDaniels-Davidson is director of the Institute of Public Health and co-lead for Communities Fighting Covid!, a $3 million contact tracing contract with the County of San Diego Health and Human Services Agency. She will be a panelist on a webinar on Jan 14 where experts discuss lessons learned and tips for the year ahead. 

Why are we seeing such an alarming surge nationwide?

McDaniels-Davidson: The surge really began after gatherings at Halloween and Thanksgiving and picked up steam from there. With a respiratory disease that has exponential spread like COVID-19, once you start on an upward trajectory it can be difficult to reverse course. Unfortunately, the holiday gatherings one after another in the fall and winter — Halloween, Thanksgiving, Hanukkah, Christmas, New Year’s Eve — coincided with pandemic fatigue. Many people were growing weary of social isolation and let down their guard.  Although state officials have repeatedly requested  individuals not to gather outside their household, more than 1 million passengers flew nationally over the four-day Thanksgiving holiday, with potential new exposures at their destinations and with family or friend interactions.

The surge may also be related to a new variant of the virus first reported in the United Kingdom, which is significantly more infectious than other circulating variants. It’s possible that it has been in the U.S. undetected for some time.

What can we expect as the year progresses?

Oren: We can expect continuing vaccine rollouts with a lot of variation across states, depending on the specific approaches, vaccine allocations, and healthcare systems available in different areas. If enough individuals are vaccinated, and given the high vaccine efficacy that has been observed, we may reach a point where there is herd immunity in late summer or early fall. This would be particularly true if we are able to pair vaccination with more effective implementation of public health measures such as distancing and masking, which would allow us to more quickly transition towards “normal life.” This would also depend on long-term safety, acceptance and prolonged immunity of the vaccine.

When should members of the general public expect to get vaccinated? 

McDaniels-Davidson: We have a tiered distribution system in San Diego County and California, with first priority to healthcare staff. After that, next in line are those who live or work in high-risk settings and older adults, followed by those with certain underlying health conditions or work in industries with elevated transmission risk. After that, the general population will be eligible. If we do a thorough job of moving through the tiers, it will likely be late summer or early fall before a healthy young adult in the general population is eligible. It’s no secret the U.S is far behind where we’d hoped to be at this point in terms of the proportion of the population that has received the vaccine. We have a lot of work to do to iron out our logistical challenges and catch up. 

Oren: Ultimately, when one gets vaccinated depends on the risk and exposure level as well as age. For example, it is not yet clear when use in children will be approved.

What will change once a majority of the public receives the vaccine? And what will remain the same? 

Oren: It is clear that even during post-vaccine life, there will be a period  when it will be important to stay masked and remain cautious. While effective, vaccines do not offer perfect protection and we do not yet know whether those who are vaccinated can still transmit the virus to others. As long as coronavirus continues to spread, not much is likely to change.  Once most people are vaccinated, in theory it will be safer to socialize within a known vaccinated group and we will expect indoor environments such as restaurants and gyms to fully reopen as well as workplaces and schools.  It is likely that in our new normal, there will be more mask-wearing and potentially more awareness of good hygiene practices in the face of other disease risks.

Will a COVID-19 vaccine be needed every year, like the flu vaccine?

McDaniels-Davidson: This remains to be seen. COVID is likely here to stay for some time. And it’s important to remember that as we make new discoveries and receive new information, it’s expected that we change our conclusions. This can sometimes be seen by the lay public as “flip-flopping” when in reality it is a sign of good science and of policy being responsive to the science. 

What concerns you the most? And what offers you signs of hope?

McDaniels-Davidson: That we get over this hump and collectively forget the hard-learned lessons. Forget the inequities and injustices that were laid bare. Forget the importance of a robust and well-funded public health infrastructure. Forget the sacrifices and losses that we experienced.  

Oren: It is concerning how much mistrust and misunderstanding of the science that exists at this time, particularly in a politically polarized country. There is, however, hope: we have established better systems for tracking emerging infectious diseases, screening procedures and risk management protocols. There is hope and optimism around the impressive development of the vaccines, as well as their rapid approval in this country.