When Will My Family’s Life Return to Normal? An Epidemiologist Provides the Possible Timelines

As back-to-school season continues, schools across the nation have splintered off into equally uncertain paths – some kindergartners are masking up to go to school five days a week while middle-schoolers are sitting on their living room floor, a teacher's blurry face plastered across their laptop screens. Still other students are embarking on a complicated compromise – a hybrid schedule or a "microschool" pod – while a fraction are being homeschooled for the very first time. Although most parents are acutely focussed on the coming days for their child, a painfully pessimistic question looms just ahead. When will life return to normal for all families? When will every classroom in every community be able to welcome its entire student population back inside, without fear of a COVID-19 outbreak?

The answer, as with nearly every coronavirus-related question, is some variation of, "well, it depends."

For starters, there's no silver bullet. There's no one metric. And there's no single timeline. In fact, POPSUGAR worked with Jessica Malaty Rivera, an infectious disease epidemiologist now serving as the science communication lead at the COVID Tracking Project and a member of the COVID-19 Dispersed Volunteer Research Network, to develop several possible predictions for what the future might hold for families amid the pandemic. Even these scenarios, she warns, are only as reliable as the people living within them.

"Everything about tomorrow and next month and next year is dependent on today and this week and the following week," Malaty said. "If anything can be taken away from this, it's the fact that everybody's behaviour – their personal behaviour in a public health crisis — has an impact on the overall way that this pans out."

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The one certainty, however, is what needs to happen before we'll see a nationwide return to normalcy, and that is attaining a "population-level immunity" – when enough of the population is resistant to COVID-19 to stifle the disease's spread from person to person.

The ways in which we reach this goal vary, and although there are potentially countless alternate realities, these are the four main timelines parents may need to consider.

Timeline 1: Best-Case Scenario - Normalcy Returns By Fall 2021

Even the ideal scenario may feel like more bad news for those holding out hope that their children's academic lives will right themselves before the school year is out. According to Rivera, at best, "we're a year away from normal" or, more accurately, "a year from being close to normal." This timeframe is dependent on two key factors. First, a safe and effective vaccine released in the first quarter of 2021.

According to the Food and Drug Administration, a vaccine will only be released if it's at least 50-percent effective. "Let's assume that we're going to land somewhere in the 50- to 70-percent range," Rivera said. "It's going to require more than just a lot of people getting it. Measles is the most effective vaccine to date. It's about 98-percent effective and, even still, if there's any kind of variance in how many people take it, it becomes a problem."

Because it's incredibly unlikely we'll get a fool-proof vaccine in January, in order for the moderately effective one we do get to do its job, it will require a high majority of Americans to take it. If even just 70-percent of the population were to take a 70-percent effective vaccine, that would get society nowhere near the herd immunity needed to protect the population.

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That's where the second key factor – behaviour modification in the form of social-distancing protocols like mask-wearing – comes in. "If everybody wore masks consistently for the next few months, through flu season, through the winter, it would change this pandemic's trajectory dramatically because, for the vaccine to work, it has to be on top of all other efforts that we're still doing." Only in tandem, she said, "can we get the transmission rates to go down and the reproduction value to go down until we've actually stamped out the disease."

So, if most of the population consistently wore masks for the rest of the year and were able to receive a moderately, or even mildly, effective vaccine by Q1, Rivera said that "things could look closer to normal than what we've seen these past six months by next fall 2021 or even by next summer." Considering how difficult it has been to foster universal mask adherence across the US, she is not optimistic: "I would not put money on this guess."

Timeline 2: We Get a Vaccine That's Not Very Effective

The likelihood that a vaccine is released in early 2021 is thankfully high. Several candidates are in various stages of clinical trials with a handful currently in Phase 3, which means they are testing diverse groups of healthy adults at varying age ranges. "So far, the data is encourageing," Rivera said.

It's just as likely, however, that the first batch of approved vaccines won't be the most effective.

"There could be studies that go much longer into 2021 that prove to be better than the first batch that get approved in the early part of 2021," she said. It could take longer, for instance, to do testing of diverse populations that include trials specifically for children, pregnant women, or people with pre-existing conditions.

The awareness that this ongoing process exists, on top of rampant vaccine hesitancy in general, might result in families opting out of the first-available COVID vaccine released by the FDA. "Maybe the later ones will be better, maybe they'll be just more of the same," Rivera said. "I don't think the message should be to take this one or wait. They'll probably say, 'Take this now because we're in a pandemic.'"

With roughly 30 percent of Americans still unsure if they would get a COVID-19 vaccination, this timeline is perhaps the most realistic, and Rivera said that "it's safe to assume normalcy will return a lot later than we think" – as far off as the start of the 2022-2023 academic year.

Timeline 3: We Get a Vaccine Later Than Expected

With so much chatter about a vaccine coming as early as January 2021, is there a world in which we don't get one by that deadline?

"Yes, absolutely," Rivera said, noting the longest we could expect to wait is a staggering 15 years.

"Clinical trials typically take 10 to 15 years for approval, which is a talking point for anti-vaxxers who say, 'if they take 10 to 15 years, how are you going to do it in 11 months?!' Well, the short answer to that is there's a lot of bureaucracy and a lot of people working and a lot of money that needs to be moving around to make sure that the processes keep going without interruption. Right now, though, they're limiting all of that because this is an all-hands-on-deck emergency. So it's not to say that a vaccine couldn't be approved in this time, but it could also prove to be not safe enough or not effective enough."

If this were the case, and it took years of trials, Rivera said the need to socially distance and wear masks would unfortunately not wane. "Here's the thing – this virus is here to stay," she said. "It's going to be with us for awhile. We'll probably be seeing outbreaks happening for years. It's not going to just fade away without a vaccine."

Thankfully, Rivera and most other epidemiologists on record don't think such a long wait is realistic, but, as Rivera said, "we just don't know for certain."

Timeline 4: Worst-Case Scenario - Nothing Changes

The worst possible outcome is one in which we have no viable vaccine and a population increasingly unwilling to continue modifying their behaviour to decrease the spread of the virus.

"I have nightmares about this because I already feel like my life is Groundhog Day," Rivera said. "We'll be just living in Groundhog Day. Nothing will change. The disease has shown that it doesn't have seasonality. It doesn't care if it's summer, if it's warm or cold. Unless we're doing things to actually slow down transmission, the disease will continue to have clusters of outbreaks as people become less inclined to follow public health recommendations, as things reopen out of necessity or out of desperation or out of quarantine fatigue. We will just be in a yo-yo effect of ongoing closures, re-openings, closures, re-openings. We'll be yo-yoing for awhile. For years, potentially. Just as things could be better in a year, they could be worse in a year. So, yes, we could be doing the same damn thing, this day next year. Especially if we don't have a good vaccine."

For some parents, the idea that they must wait an entire year in even the best-case scenario, this yo-yo effect might not seem so bad – everyone hunkers down for several weeks when numbers begin to spike, and then when cases level off, they can go about a slightly more normal lifestyle. For example, kids return to school for a few weeks and then transition back to remote learning as needed. This outlook isn't practical, Rivera said.

"We need a slow, steady, calibrated approach forward, otherwise we'll be stuck having to correct mistakes over and over again," she said. "It's like chores –letting go for a few weeks so you then have to lose a whole weekend to deep cleaning your house instead of being diligent about maintaining things each day. With COVID, it will be less chaotic data, less burden on healthcare systems, and less back and forth for businesses and schools."

It's also in this no-vaccine scenario that people consider the prospect of reaching population-level immunity by letting the disease work its way through the population.

"This is a horrendous idea," Rivera said. "It 100-percent will include unnecessary, preventable deaths. Even if we're talking about 10 to 11 percent of people who get COVID-19 who require hospitalization and might have really bad outcomes, that's too many people for a population off our size. That could be 500,000 deaths in the country. Some models are already saying we could reach 300,000 by the end of the year. And people don't realise the fact that the statistics might be in their favour in general, but do they want to play Russian Roulette with something that has killed healthy people, too? Children, young adults, long haulers with no existing issues whose lives have been completely altered by this disease. Why would you ever want to play with that risk?"

What's more, even if this type of herd immunity were attempted, it wouldn't necessarily work.

"We haven't known about the disease long enough to even know what kind of long-term protection natural infection gives you," she said. "People who got it might still need to get the vaccine. There's no guarantee."

The Timeline For Schools to Return to Normal

No matter the timeline, when the day comes that schools across the nation are all able to safely open their doors to students, parents may need to prepare for another phased approach to normalcy.

"Assuming things are going well, and transmission and test positivity are both low, schools should reopen," Rivera said, noting that some communities may still lag behind others and need to take a more cautious approach, particularly in the best-case scenario of a fall 2021 benchmark. "Even if things are going great, it's not disease elimination. The disease will still be around. Schools that are already burdened by things like staffing and space constraints will suffer more still."

For instance, colleges and universities will need to remain primarily virtual due to dorm living and the fact that adult transmission is more effective than in children. Even elementary and high schools won't be able to open back up with a business-as-usual mentality. "We'd still be seeing an impact on schools depending on how good they're able to do things like mitigation efforts with distancing and sanitization and proper ventilation. Those will still be issues they must continually address."

In fact, she can't stress enough the importance of maintaining proper hygiene and continuing with whatever disinfecting procedures were put in place in the midst of the pandemic. "Sanitize classrooms always – never stop doing this," she said. "That should be par for the course when dealing with little people because it's going to benefit everyone involved in education."

Although the prospect of "immunity checks" seems unrealistic to her, particularly in a world in which schools are safely reopening, she does wonder if there will eventually be long-term COVID-specific vaccine requirements within the school setting. "It's definitely controversial," she said. "I would hope that if we really nail down a highly effective vaccine that it might be folded into the pediatric vaccine schedule."

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Some things, however, will feel like a flipped switch once the pandemic is under control. For starters? Masks will no longer be necessary. "I imagine that when people are sick or when people feel like something's going around and they don't want to get it, parents might put them back on their kids," she said, adding that seasonal or situational mask wearing could be a good precautionary tool in general. "I don't think it'll become mandated in flu seasons in the future, but I definitely think some families might adopt it as a public health behaviour."

And as for extracurricular activities like choir or team sports or all-school assemblies and pep rallies, Rivera believes these opportunities can actually pick right back up, too: "Things like theatre and football games – if things are good, they'll resume. If things are only sort of good, they might be delayed. My hope is that all things are good."

Once more, Rivera reiterated that an "all things are good" scenario will arrive much faster if our society takes a more holistic approach to disease mitigation, which includes, in addition to a viable vaccine, a shift in behaviour. That's a goal post she's unsure we'll cross anytime soon.

"I think people who have been mindful and understand the science and are willing to accept the sacrifice required are going to continue doing that, and I think the people who are continuing to deny it and resist it will continue doing that, too."