The Crystal Ball

Throughout the pandemic, many people have asked questions about the future. Among the most popular was, “When will COVID end?” I would jokingly ask for a moment to find my crystal ball. In all seriousness though, these were important questions, and I tried to provide well-researched and appropriately uncertain responses that would be both reassuring and realistic. Now, as Vermont’s vaccination rate nears 80 percent, I have a few thoughts about what we can expect over the next 12 months.

Summer. Cases are falling throughout the U.S., primarily due to vaccination. I anticipate they will continue to fall as more people become fully vaccinated.

Nearly all of the remaining cases occur in unvaccinated individuals. In addition to vaccination, we do know that cases fall in the summer, just as we saw last June, July, and August. We can relate this decline to people spending more time outside. Warm weather may also have a direct impact at decreasing virulence or transmission of the virus, although this is not the experience in other countries with warm climates year round.

Fall. The Pfizer vaccine should receive a biologics license, also known as “full approval”, by early fall. Moderna applied for full approval earlier this week, which will likely be granted later in the year, and Johnson & Johnson should follow shortly thereafter. 

All three vaccines are undergoing trials in children under 12. Pfizer plans to seek emergency authorization (EUA) for its COVID-19 vaccine in September for children ages 2 and above. The studies of these vaccines are focused on safety, efficacy, and optimal dosing. The scientists work to provide the lowest dose needed to achieve the desired result, immunity against acquiring COVID-19. Assuming there are no unexpected setbacks, we can expect those ages 2 and older to be eligible to receive the Pfizer vaccine in September or October.

Winter. The virus has not disappeared. There will be a resurgence this winter among those who are unvaccinated. It is unavoidable, because unvaccinated people have no protection unless previously infected. Note that the vaccination is expected to provide better and longer protection than natural infection does. Limited use of masks, less distancing, and more travel will contribute to increased infection rates in those who have not been vaccinated.

In Vermont, where most people will be vaccinated, the rise in cases and subsequent hospitalizations will be manageable. I anticipate that the medical staff here at SVMC will be doing quite a bit of dual testing for influenza and COVID-19, not necessarily to decide on treatment strategies, but rather, to determine quarantine duration.

In other parts of the country, however, there may be as little as 50 percent of the population vaccinated. These areas will see outbreaks. Hospitals will be dealing with high numbers of COVID-19 and influenza patients.

An extremely important concept for us to understand and accept is that schools and businesses that require vaccination will have a significant competitive advantage over those that do not. They will experience operations that are more efficient and less absenteeism due to illness.

2022. Results from Moderna’s clinical trial in children as young as 6 months are expected by the end of the year. If all goes according to plan, those aged 6 months and older could be eligible to receive the Moderna vaccine by February 2022.

We know from history that all pandemics end. COVID will become endemic, meaning that it will be continue to be prevalent in unvaccinated and previously uninfected individuals, through at least mid-2022 in the U.S. and much longer in other parts of the world. Whether this endemic continues to cause severe disease remains to be seen. Vaccination remains our best tool in mitigating the spread of COVID-19.

Trey Dobson, MD, is chief medical officer at Southwestern Vermont Medical Center in Bennington, VT.