Expert Opinion: The Pandemic and What Can We Expect as We Head into 2021?

Hospital epidemiologist and chief of the Division of Infectious Diseases at Penn (and Scranton alumnus) weighs in on how to mitigate the risk of COVID-19 through the holidays and what we can expect in the new year.

Expert Opinion: The Pandemic and What Can We Expect as We Head into 2021? banner image

By: Judith O’Donnell, M.D. ’85

The messages on preventing the spread of the virus that causes COVID-19 have been the same for months now, and everyone can recite them if asked. They now come in easy-to-remember phrases like “The 3 W’s”: Wear a mask; Wash your hands; Watch your distance. Although the messages easily can be distilled down to a quick reminder like “The 3 W’s,” the actual implementation of the messages has sadly proved challenging for many Americans. For some, there is just plain COVID fatigue — it has been a long, hard year for many people, and there is a wistful longing for things to just get back to normal. For others, mask-wearing has become politicized, with opposing sides using mask-wearing (or not) as a symbol of where they sit on the political spectrum. And for some people there has been the mistaken belief that for their family, a one-time get-together will be safe, because everyone is “low risk.”

Together, all of these scenarios have contributed to widespread community transmission rates across the country. The inability to uniformly and consistently practice the safety measures that prevent COVID-19 spread has now led us to the anticipated second wave of the pandemic, also known as the fall surge of infections. As of early December, every state in the U.S. except Hawaii had widespread increasing transmission of the virus, with hospitalizations at an all-time high, and the numbers of new cases increasing exponentially.

The time course of vaccine development from March to December is awe-inspiring and a testimony to human ingenuity, perseverance and creativity.

In the spring, when the Northeast was experiencing the brunt of the first wave of COVID-19, many other parts of the country were not. As with any infectious disease that is spread from person to person, the first outbreaks are always seen in the more populated areas like big cities. The national stay-at-home orders were successful in flattening the curve in the Northeast and preventing the unchecked spread across the entire nation. However, this prevention of the spread to other parts of the country has not been highlighted explicitly enough. Many in areas with little or no COVID-19 came to resent the shutdown, and because there were few or no COVID-19 cases in their communities, when re-openings began, the need for masks and social distancing were not considered important or necessary. What followed was that after re-opening in late spring, the south and Midwest had their “first wave” after Memorial Day and through the summer. The western states saw their first wave in late summer and September.

Beginning in late October, and through the Thanksgiving holiday, cases were on the rise — everywhere. As the colder weather forced many people indoors for the winter months, the virus continued to spread even more efficiently. Despite CDC warnings not to travel for Thanksgiving, many Americans flew to holiday gatherings with their friends and families. These indoor gatherings where meals are eaten together, and masks are not worn, are the most efficient way for COVID-19 to spread. Hospitals in many parts of the country, especially in rural areas, are at or near capacity, and there was an expectation that more cases would develop after Thanksgiving spread, leading to more admissions about three to four weeks later. December and January were then expected to become the most dangerous time of the COVID-19 pandemic in the U.S. We should all expect that cases will continue to rise along with hospitalizations and deaths. The curve of this second wave is still climbing, and no one knows yet when it will plateau and begin to decline. Again, the next two to three months will be bleak in many parts of this country, and in many families across the U.S. there will be illness, and suffering and loss. What can be done? 

  • First, it is never too late to begin following the best practices. Masks work — really well.
  • Second, commit to:
    • staying home as much as possible
    • getting take-out
    • avoiding indoor gatherings
    • and especially avoiding indoor drinking and dining with those outside your household.
  • Third, limit travel. If you must travel by plane or mass transit, wear your mask at all times, consider wearing eye protection or a face shield too, and pack the hand sanitizer so you can cleanse your hands frequently.
  • Fourth, cancel the traditional holiday parties, gatherings, and get-togethers. Make a new tradition this year, and plan to bring back the old traditions for 2021. Virtual gatherings are not the same as being together in-person, but they are better than not connecting at all.
  • Fifth, commit to checking in on neighbors, older family members, and others who are vulnerable, lonely, or both. Checking in with a phone call or text can make a real difference during these next few months.

We may ring in 2022 with COVID-19 firmly in the rearview mirror.

I am hopeful that 2021 will bring this pandemic under control with the arrival of effective COVID-19 vaccines. The development of several promising vaccine candidates has resulted in excellent preliminary data. It is impressive how quickly scientists and researchers were able to isolate the virus, map its genome, identify the parts of the virus to target for vaccine development, and then develop vaccine candidates. The time course of vaccine development from March to December is awe-inspiring and a testimony to human ingenuity, perseverance and creativity. The FDA approved the Pfizer-BioNtech and is expected to approve the Moderna vaccine soon for emergency use. The initial supplies will go to hospitals and health systems to begin widespread vaccination of health care workers. Residents of nursing homes and the staff that care from them will also receive vaccination with this first supply. By late spring/early summer vaccine will be available for the general population.

There is still a lot we do not know about the vaccines. How long will the protective immunity last? Will the vaccine need to be given annually like flu vaccines? Will they work in children, pregnant women, or those with compromised immune systems? What will happen if many people are hesitant to get vaccinated or refuse it altogether? There are many unknowns, but I, for one, am willing to accept them and feel hopeful that the vaccine will put us all on the road back to “normal.”

When will we be able to declare an end to the pandemic and throw away our masks? If history serves as a guide, then like the 1918-19 influenza pandemic, which slowly ebbed, eventually being forgotten by 1920, we may ring in 2022 with COVID-19 firmly in the rearview mirror. That is my timeline, and I am sticking to it! 


odonnell252.jpegJudith O’Donnell, M.D. ’85

Judith O’Donnell, M.D. ’85 is a professor of medicine and chief of the Division of Infectious Diseases at the University of Pennsylvania Perelman School of Medicine and hospital epidemiologist and director of the Department of Infection Prevention and Control at Penn Presbyterian Medical Center.

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