The coronavirus pandemic has changed our day-to-day lives, changed the way the medical community created vaccines and treatments, and will likely have an ongoing effect on many areas of life worldwide for some time to come. Knowing which of these changes require our full attention, and which might be OK to allow to fade into the background, can be difficult.

Professor and virologist Dr. Larry Corey, past president director at Seattle’s Fred Hutchinson Cancer Research Center, and Dr. Donna Hansel, professor and chair of pathology and laboratory medicine at Oregon Health & Sciences University, in Portland, share their insights on what we’ve learned about COVID-19 so far and get their predictions for the near future.

Vaccines and boosters

At present, about 57% of the U.S. population is vaccinated. With boosters in the mix, “I think we have a chance to shut down acquiring the disease and interrupting the transmission from person to person,” Corey says. Waiting to pick up COVID-19 and gain natural immunity — or skipping the vaccine in favor of catching COVID-19 in the wild — is risky for patients, their families and health care workers, he adds.

Some still feel that catching COVID-19 in the wild — from an infection — provides better protection than the vaccine. But the vaccine’s antibody protection is 20 times that provided by the natural disease. The delta variant is eight times more infectious than the original virus over a shorter transmission period. An unvaccinated person is transmitting COVID-19 at the same rate as ultra-infectious chickenpox.

For those already vaccinated, boosters help reduce the risk and severity of COVID-19 infection as they’re spaced over time, much like hepatitis B, MMR and other vaccines. Three-dose vaccine regimens seem to be most helpful for RNA vaccines like Pfizer and Moderna, Corey says. In general, you can boost with the same vaccine you first received, but you can also change vaccines, Corey says. Those who got a Johnson & Johnson vaccine the first time can get an RNA vaccine to super-charge immunity or another J&J vaccine.

“We need to get people vaccinated, but we need to think about why we haven’t been successful,” Hansel says. Even when the evidence profoundly supports vaccines, the communication was hampered by changing information and disconnect between government and CDC sources. “We need to think about what we need to do in the future, not to get ourselves into the same sort of situation,” Hansel says.

Dr. Larry Corey

Misinformation and mandates

The vaccine-hesitant group includes a diverse mix of populations and rationales. Black communities have a history of medical abuse and exploitation. Internet misinformation consists of a wide range of concerns, such as that the vaccine can give you COVID, serious side effects or make you sterile.

Other individuals are understandably nervous about new vaccine technology, Hansel points out. While medical professionals may get excited about the technology developed, the typical person may feel more anxious about the side effects of any new technology. Relationships between providers and communities can help address concerns.

“You have to work to meet people at their level and ask them, ‘What is it that you need from me?’ I’m not here to tell you what you need to do. I need to understand what you need and what information I can provide,” Hansel says. “There are a lot of benefits of having these conversations, but the truth is that you have to build the relationship.”

In hindsight, when vaccinations didn’t rise to the levels necessary, policymakers might’ve considered beyond incentives and paying people to get vaccines, she says. The “mandate” term is enough to inspire resistance by many, she says and creates a difficult situation. However, mandates may make sense in some fields — for example, a medical provider exposing sick people for whom COVID-19 could be a death sentence.

But there may be other situations where mandates should be discussed to achieve common ground, such as keeping children in school. Framing vaccination as a family and community responsibility may help more get vaccinated, Corey points out.

Children

As the mother of two 11-year-old children, “I want to recognize how much hard work schools and teachers and administrators have put into getting kids back to school, and a health routine on top of their regular education curriculum,” Hansel says. 

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Hansel and Corey both say they’re impressed by schools showing how nonpharmaceutical interventions powerfully reduce disease spread. These measures include hand sanitizing and handwashing, masking and improving ventilation to introduce fresh air circulation into the classrooms.

Soon, children ages 5-11 will become eligible for a COVID vaccine. (Emergency use has already been granted.) Vaccine results data are strong, and Corey guesses that the Pfizer vaccine’s approval and rollout are likely imminent for the group. Why the delay in approval?

One concern surrounded a disease called inflammation of the heart, known as myocarditis, which can occur naturally, more often in boys. The disease is one reason why the FDA slowed down to closely examine the data related to teens and young children. But myocarditis was shown to be 20 to 50 times more frequently after catching COVID than the vaccine.

Despite the good news, vaccine uptake may depend on the family dynamics. Some families endorse vaccinations and will take their children in for a jab. Hansel plans to schedule her children for immunization as soon as it’s available.

“The risk of not being vaccinated and either getting COVID or one of the associated effects of covid is so much worse than anything you could think of as minor side effects of the vaccine,” Hansel says.

Dr. Donna Hansel

Back to normal

In six to 12 months, we might expect more widespread vaccination along with monoclonal therapy for remedying COVID-19. More people will head back into clinics to get preventive care, and schools will stay open.

Hansel says that the virus will be monitored for new variants with the potential to break through vaccine-provided immune protection. After all, the common cold is just another coronavirus. While the COVID of the future could be transmissible, it’s also something we can learn to live with, Hansel notes, thanks to vaccines — much like the seasonal flu. “When we think about viral pathogens, we always need to think that there could be another round,” requiring preparation, she says, as the virus mutates and spreads.

“This is a formidable pathogen and the virus is not going away,” Corey says. But assuming success after a bad spell has dogged the public and government officials in the past.

In the future, Hansel anticipates sick individuals will be able to test at home. Now that people are entering a rhythm of in-person attendance at schools and the workplace, a quicker diagnosis of symptoms is essential. At the pandemic’s beginning, many of us relied on PCR testing for COVID, which sometimes took up to a week for results. By the time results were finalized, you might be over your symptoms.

Rapid antigen testing kits promise results within minutes, and can be sold in grocery stores. Or they will be, after supply chain manufacturing issues improve, hopefully in a few weeks, Hansel says. Rapid tests aren’t as sensitive as PCR tests — but if you have a positive result, you likely have COVID. However, if you’re negative, there’s still a chance you could be harboring the virus, which requires a follow-up PCR test, especially if you’re having symptoms.

“If you have questions to make sure you reach out to a physician or other healthcare provider to get your questions answered and try not to go It alone,” Hansel says.  

Corey says that getting back into restaurants, theaters, and other enclosed, crowded spaces may take more adaptation. But behavioral changes and defensive measures may keep us feeling “safe.” The vaccine will also soon improve the ability for children to resume the usual life activities necessary for development, Corey points out. Children attending more activities may also reintroduce a sense of normalcy for some families. 

Some changes may stay with us — for example, masking when sick. “I’ve enjoyed not being sick for an entire year,” Hansel says. “I think we’ve gotten used to always having colds and it’s been terrific not to.”

Corey says he feels “cautious optimism” thanks to a robust medical infrastructure and efficient deployment of countermeasures such as masking and vaccination in the past year. Common sense, testing, and human behavior will determine the future’s course and a return to normal-like life. Agreeing with that optimism, Hansel says people will increasingly understand the science, become more comfortable in general, and with the vaccine.

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