President Donald Trump recently put forward recommendations for reopening the economy, indicating that parts of the United States may soon return to normal. The administration's optimistic outlook contrasts with the views of medical experts and scientists. The future remains uncertain, with many questioning when we will be able to leave our homes. How long will it take before we have a treatment or vaccine for the virus? How can we prevent the virus from spreading? Some believe that American innovation could lead to advancements in easing the situation. The key to moving forward depends on various factors such as a gradual reopening plan, widespread testing and monitoring, an effective treatment, sufficient resources for healthcare workers, and ultimately a successful vaccine. Despite these efforts, there are still pessimistic predictions for the upcoming year. Most experts believe that the optimistic scenario presented by Trump in his daily press briefings, such as the imminent end of lockdowns and the availability of a protective pill, is unrealistic. Dr. Harvey V Fineberg, a former president of the National Academy of Medicine, predicted a bleak future with a unhappy population stuck indoors for months, and the possibility of the most vulnerable being quarantined for even longer. They expressed concerns about the potential difficulty in finding a vaccine, citizens growing tired of restrictions, and the virus becoming a permanent presence. Dr. William Schaffner, a preventive medicine specialist at Vanderbilt University medical school, remains hopeful that the virus will diminish in the summer and a vaccine will be developed soon. "I am becoming more cautious despite my natural optimism," experts thought that after the crisis ends, the nation and its economy will recover quickly but there will still be a difficult period ahead. The outcome of the pandemic will rely on future medical advancements and the actions of individual Americans. If we take measures to protect ourselves and our families, more people will survive. If we fail to recognize the seriousness of the virus, it will affect us. The number of deaths due to COVID-19 in the US may be higher than what is being reported by the White House. The virus has been causing more than 1,800 deaths in Americans daily since April 7, and the official count may not be accurate. In comparison, heart disease and cancer typically result in fewer daily deaths than COVID-19 currently does. The coronavirus curves have reached a plateau, with a decrease in hospital admissions in New York, the epicenter of the outbreak, and fewer COVID-19 patients in intensive care units. While the daily death toll remains high, it is no longer increasing. The epidemiological model used by the White House, created by the University of Washington's Institute for Health Metrics and Evaluation, initially projected 100,000 to 240,000 deaths by midsummer. That estimate has now been revised to 60,000. The view of New York from Weehawken, NJ on April 16, 2020 is a positive sight, but it also brings to light some important issues. The projection by the institute only covers the first wave of the epidemic until August 4, and without a vaccine, the virus is expected to continue circulating for years, leading to an increase in the death toll over time. The progress made so far in combating the pandemic has been due to a nationwide shutdown, but this cannot be sustained indefinitely. The White House's plan for reopening in phases is expected to increase the death toll, even if implemented carefully. The goal is to minimize fatalities, but projections from experts show a grim outlook, with estimates of up to 1.7 million deaths if the virus is not contained. A study conducted by researchers at Imperial College London, mentioned by the president on March 30, projected 2.2 million deaths in the US by September under similar conditions. This number is significantly higher than the approximately 420,000 Americans who died in World War II. The data from China is also concerning, as their epidemic has currently been contained, with almost all individuals infected in the initial wave either recovering or passing away. China has reported around 83,000 cases and 4,632 deaths, resulting in a fatality rate of over 5%. The accuracy of fatality rates during the COVID-19 pandemic has been questioned by the Trump administration, as they have not provided more precise figures. Fatality rates are influenced by the degree to which hospitals are overwhelmed and the percentage of cases that are tested. In early January, China had an estimated death rate of 17% during the chaos in Wuhan, but by late February, it had dropped to 0.7%. Hospitals in cities like New York have been pushed to the brink of chaos. Both Wuhan and New York officials had to increase their death counts after realizing that many individuals had died at home from COVID-19, strokes, heart attacks, or other causes, or because ambulances did not arrive in time. In rapidly spreading epidemics, the number of victims who are hospitalized or pass away exceeds the capacity for testing by doctors. Simultaneously, those with mild symptoms or who are asymptomatic often do not get tested, leading to an inaccurate representation of the true fatality rate. Without knowing the extent of infection, it is impossible to determine the true lethality of a virus. The CDC has indicated that as many as 25% of those who test positive for COVID-19 may be silent carriers, but only widespread antibody testing will provide a clear picture. Icelandic researchers suggested the number could be twice as high. A health worker in Central Park, New York, is seen checking her personal protective gear in a mirror on April 16, 2020. The New York Times reported that China is also reevaluating its estimates. A previous study in February found that only 1% of cases in Wuhan were asymptomatic, but new research suggests that the actual number could be closer to 60%. Our lack of knowledge in epidemiology is significant enough to cause frustration for experts. Dr. Anthony S Fauci, science adviser to the White House coronavirus task force, acknowledges that models are constantly changing as new data is obtained. Despite this inconsistency, there is a possibility that the virus is evolving to cause milder symptoms. While movies often depict viruses becoming more deadly, in reality, they typically become less harmful as asymptomatic strains spread to more individuals. Even though the 1918 Spanish flu virus eventually transitioned into the seasonal H1N1 flu, the current situation of the virus is still uncertain in terms of its transmission and lethality. The presence of refrigerated trucks outside hospitals indicates that the virus is more severe than a typical flu season. The lockdowns will eventually come to an end, but it will be a gradual process. The exact percentage of Americans who have been infected remains unknown, with estimates ranging from 3% to 10%, suggesting that a significant portion of the population, possibly around 300 million people, are still susceptible to the virus. Epidemiologists agree that it is not safe for a large number of people to suddenly stop social distancing until a vaccine or other protective measure is available. Dr. Peter J Hotez warns against magical thinking that a vaccine will quickly become available. Tomas Pueyo correctly predicted the national lockdown and suggested a gradual reopening of essential parts of the economy. All epidemiological models anticipate a pattern similar to a dance, with the virus spreading rapidly when there are too many hosts, leading to lockdowns. This cycle of surges and declines in deaths is illustrated by curves that resemble shark teeth in the models. The models suggest that surges will occur even with strict measures in place, such as closing public venues and quarantining travelers, to prevent the spread of the virus from high-intensity areas to low-intensity areas. According to experts, stricter restrictions lead to fewer deaths and longer intervals between lockdowns. Many models predict that states will eventually implement widespread temperature checks, rapid testing, and contact tracing, practices common in Asia. Even Trump's "Opening Up America Again" guidelines include three levels of social distancing and advise vulnerable Americans to remain isolated. The plan supports testing, isolation, and contact tracing, but does not specify how these measures will be funded or how long it will take to implement them. However, on Friday, the president contradicted his own message by urging protesters in Michigan, Minnesota, and Virginia to oppose their states' shutdowns. China waited until there were no new cases for 14 consecutive days in cities like Wuhan and Nanjing before allowing them to reopen. In contrast, the US is still relatively unrestricted, with Americans able to travel domestically, drive freely, and gather in public spaces. Despite some restrictions in place, many individuals are still arranging gatherings and social events, leading to a high number of new daily infections in the country, reaching up to 30,000 cases. Schaffner emphasized the importance of people understanding that it is not safe to play poker while wearing bandannas. Despite implementing strict measures, Asian countries have faced challenges in controlling the virus. China, for example, reported around 100 new infections daily and subsequently closed all movie theatres. Singapore has shut down schools and nonessential workplaces, while South Korea and Japan are also facing difficulties with the outbreak, with Japan declaring a state of emergency. Dr. Thomas R Frieden's public health advocacy group Resolve to Save Lives has released strict criteria for reopening the economy, including 14 days of declining cases, tracing 90% of contacts, and more. Frieden emphasizes the need to gradually reopen to prevent a surge in cases and highlights the importance of working towards these goals. He also discusses the potential societal divide between those who have recovered from COVID-19 and have immunity and those who are still vulnerable. Dr David Nabarro, a special envoy on COVID-19 for the World Health Organisation, predicted that there will be a frightening divide in society. Those who have antibodies will have the ability to travel and work, while others will face discrimination. People with presumed immunity are currently in high demand, being asked to donate blood for antibodies and take on risky medical jobs without fear. The government will soon need to find a way to identify who is truly immune, possibly through a test for IgG antibodies, which are produced once immunity is established, according to Dr Daniel R Lucey, an expert on pandemics at Georgetown Law School. Numerous companies are currently working on developing these tests. Fauci mentioned that the White House was considering the implementation of certificates similar to those in Germany. In China, QR codes linked to personal details are used to prevent others from borrowing cellphones. The adult film industry in California introduced a similar concept ten years ago, where actors use a cellphone app to prove they have tested negative for HIV in the past 14 days, and producers can verify the information on a secure website. Experts predict that as Americans in lockdown see their immune neighbors returning to normal life, there may be a strong temptation to self-infect in order to join them and potentially regain lost jobs. Younger individuals, especially, may rationalize that the potential of contracting a severe illness is preferable to facing financial hardship and social isolation. Dr. Michele Barry, who heads the Centre for Innovation in Global Health at Stanford University, shared that her daughter, a Harvard economist, believes that COVID-19 parties are necessary for her age group to build immunity and sustain the economy. This approach has been seen before, as in the 1980s when Cuba effectively controlled its small AIDS outbreak by mandating isolation for those who tested positive, providing them with comfortable living conditions, medical care, and various activities. Dr. Jorge Pérez Ávila, a specialist in AIDS and often referred to as Cuba's version of Fauci, stated that many of Cuba's homeless youths became infected through risky behaviors such as sex or blood injections in order to gain access to resources. Before the introduction of antiretroviral therapy, many of these individuals died. This serves as a cautionary tale for American youth, as even those who are slim and healthy have succumbed to COVID-19. It is important to allocate sufficient resources to control the virus effectively. According to experts, the coming two years will involve periods of progress and setbacks. The economy will continue to improve as more people with immunity return to work, but the threat of new lockdowns looms if cases spike. To prevent this, widespread testing is crucial. Dr. Fauci believes that the virus will indicate when it is safe to resume normal activities. He is implying that by implementing a national baseline of daily tests, any potential viral spread can be detected when the percentage of positive results increases. Monitoring rising fevers with Kinsa's smart thermometers may provide an early warning, according to Schaffner. However, there have been ongoing issues with diagnostic testing, despite promises from the White House. To effectively control the virus, experts believe that all sick individuals, even those with mild symptoms, should be isolated. In this country, patients who test positive are instructed to stay in their homes but avoid contact with their families. Television reports have shown recovering individuals like CNN's Chris Cuomo isolating in their basements while loved ones leave supplies at a distance. However, Cuomo's case highlighted the WHO's stance against home isolation when he announced that his wife had also contracted the virus. Dr. Bruce Aylward, who headed the WHO team in China, emphasized the importance of quickly isolating all cases as the top intervention. In China, individuals who tested positive for COVID-19, regardless of the severity of their symptoms, were mandated to go to a hospital set up in a gymnasium or community center with oxygen tanks and CT scanners. Nurses supervised their recovery, reducing the risk of transmission to their families and alleviating some patients' fears by providing a sense of community. Nurses also organized dance and exercise classes to uplift spirits and help patients maintain lung function and muscle tone. Despite these efforts, experts had differing opinions on the effectiveness of these wards. Fineberg and Marc Lipsitch have differing opinions on the idea of mandatory quarantine processes, with Lipsitch expressing concern about the government forcibly separating families. Testing all contacts of known cases is essential for controlling the spread of a virus, but the US is currently lacking in this regard. In China's Sichuan province, for instance, each known case had an average of 45 contacts. The CDC and state/local health departments have limited resources for contact tracing. China recruited and provided training for 9,000 individuals in Wuhan alone. Frieden has projected that the United States will require a minimum of 300,000 people. A vaccine is not expected to be available in the near future. Despite the initiation of limited human trials for three potential vaccines, with two in the US and one in China, Fauci has emphasized that developing a vaccine will take a minimum of 12 to 18 months. Experts in vaccine production have all concurred that even this timeframe is optimistic. Dr. Paul Offit, a vaccine expert at the Children's Hospital of Philadelphia, mentioned that the mumps vaccine holds the record for development time at four years. There is a sharp difference of opinion among researchers on how to expedite the process. The use of modern biotechnology techniques utilizing RNA or DNA platforms allows for quicker development of potential vaccines. However, clinical trials are time-consuming as the production of antibodies in the human body cannot be rushed. Additionally, some previous vaccine candidates for coronaviruses like SARS have caused "antibody-dependent enhancement," increasing susceptibility to infection rather than decreasing it, for reasons that are not clear. In the past, vaccines for HIV and dengue have shown similar unexpected results. Typically, a new vaccine is first tested on a small group of less than 100 healthy young individuals. If the vaccine proves to be safe and generates antibodies, it will then move on to a Phase 3 trial where thousands of volunteers, likely frontline workers at highest risk, will receive either the vaccine or a placebo. To expedite this process, challenge trials can be implemented. In these trials, a small number of volunteers are vaccinated, monitored for antibody development, and then intentionally exposed to the disease to determine if the vaccine is effective. Challenge trials are only used for diseases that are easily treatable, such as malaria or typhoid fever. Under normal circumstances, it is considered unethical to expose individuals to a disease without a cure, like COVID-19. However, some experts believe that in these unprecedented times, conducting challenge trials on a small number of individuals at high risk could be more ethical than putting millions at risk for an extended period. Lipsitch, who has advocated for challenge trials, argued that fewer people would be harmed in a challenge trial compared to a Phase 3 trial involving thousands of participants. Following the publication of his paper in the Journal of Infectious Diseases, Lipsitch received immediate interest from volunteers, while others expressed discomfort with the idea. Lucey expressed concerns about the ethics of challenge trials, but acknowledged their potential usefulness. Vaccinologists warned that challenge trials may not recruit enough volunteers to detect rare but dangerous issues like vaccine enhancement. Michael T Osterholm of the University of Minnesota cautioned that challenge trials may not provide information on safety and could pose significant risks. Virologist Dr. W Ian Lipkin proposed an alternative approach of testing multiple vaccine candidates in humans before conducting challenge trials in monkeys. Experts recommend starting to produce the winning vaccine immediately, while also expanding human testing to uncover any potential issues. Although testing a vaccine is challenging, experts say that producing hundreds of millions of doses is even more difficult. American vaccine plants typically produce only 5 to 10 million doses per year, mainly for the 4 million babies born and 4 million individuals who turn 65 annually. However, if a vaccine is developed, the US could require up to 300 million doses - or even 600 million if two doses are needed. Additionally, the same amount of syringes would be necessary. Douglas emphasized the importance of thinking on a large scale when it comes to producing vaccines. He noted that traditional flu vaccine plants that use chicken eggs are not ideal for modern vaccines that grow in cell broths. While European countries have their own vaccine plants, they may need to prioritize their own citizens. China has a significant vaccine industry and could potentially expand it in the near future, possibly even producing vaccines for the US, according to experts. However, customers who are captive must pay the seller's price, even though some Chinese companies may not have perfect safety and efficacy standards. India and Brazil also have large vaccine industries. If the virus spreads quickly through their densely populated areas, they may reach widespread herd immunity before the US. In this scenario, they could potentially have extra vaccine plant capacity. Another option, proposed by Arthur M Silverstein, a retired medical historian at the Johns Hopkins School of Medicine, is for the government to take control and repurpose existing liquor or beer plants, which have large fermentation vats. He stated that any distillery could potentially be transformed for this purpose. Experts believe that treatments will likely be developed before vaccines, with many expressing optimism about the effectiveness of convalescent serum. This method, which has been utilized for more than a hundred years, involves drawing blood from recovered individuals and filtering it to isolate the antibodies. The immunoglobulin containing antibodies is administered to patients. A challenge is the limited number of survivors available to donate blood. Previously, antibodies were obtained from horses and sheep, but this method was difficult to maintain sterility and could cause allergic reactions due to animal proteins. The current solution is the use of monoclonal antibodies. The treatment regimens that were close to ending the Ebola epidemic in eastern Congo are considered by experts to be the most likely short-term game changer. The most effective antibodies are selected and their genes are inserted into a harmless virus that will grow in a cell culture. However, like vaccines, the process of growing and purifying monoclonal antibodies is time-consuming. In theory, if enough antibodies are produced, they could not only save lives but also protect front-line workers. Antibodies can remain effective for weeks before deteriorating, although the duration of their effectiveness depends on various factors, and they are unable to eliminate viruses that are already hidden inside cells. A daily preventive pill would be a more efficient solution than vaccines or antibodies, as pills can be manufactured quickly in factories. However, even if such a pill was developed, production would need to be significantly increased to ensure widespread availability. Trump has frequently mentioned hydroxychloroquine and azithromycin in his news conferences, but experts, including Fauci, emphasized the importance of waiting for clinical trial results before making any decisions. Some experts pointed to the tragic consequences of inadequate testing in the past, such as the thalidomide scandal in the 1950s which resulted in birth defects in thousands of children. Multiple studies on hydroxychloroquine have been stopped due to patients experiencing abnormal heart rhythms from high doses. Barry expressed skepticism about high doses being tolerable and potential vision issues from accumulation, but suggested exploring its potential as a preventative drug similar to PrEP for HIV. Other experts, like Dr. Luciana Borio, were more critical of President Trump's proposal to combine chloroquine with azithromycin, dismissing it as "total nonsense." "I informed my family that if I were to contract COVID-19, they should not administer this particular medication combination to me." Some doctors believe that chloroquine may be beneficial in protecting hospitalized pneumonia patients from potentially deadly cytokine storms by suppressing immune responses. However, this does not mean it is effective in preventing infections, as suggested by Trump, as it lacks antiviral properties. Several antiviral drugs, such as remdesivir, favipiravir, and baloxavir, are currently being tested against the coronavirus, with trials in China expected to yield results next month. However, these results may be limited due to a lack of patients available for testing. Trial end dates in the US have yet to be determined. The concept of 'America First' is being bid farewell as unprecedented societal changes have occurred, with widespread closures of schools and businesses, millions filing for unemployment, and delays in taxes and mortgage payments. Refrigerated trucks are even being used as mobile morgues in New York. Stimulus checks have started being distributed to help alleviate the crisis, turning much of America into a temporary welfare state. Food banks are being established in various locations throughout the country, resulting in long lines. In New York, refrigerated trucks are being utilized as mobile morgues on Randall's Island. The New York Times reported on April 15, 2020. The current public health crisis necessitates unprecedented international cooperation. Despite this, President Trump is working to defund the WHO, the only organization capable of effectively coordinating a response. Additionally, his actions have strained relations with China, which now boasts the world's strongest economy and may emerge as a key provider of medications and vaccines. China has taken advantage of the pandemic to increase its global influence by providing medical supplies to nearly 120 countries, including the US through Project Airbridge overseen by Jared Kushner. Experts suggest that in a world where "America First" is not a sustainable strategy, collaboration with China is necessary for effective public health efforts. Nicholas Mulder of Cornell University has compared Kushner's project to "Lend-Lease in reverse," referencing American military aid during World War II. Osterholm was more straightforward in his response, stating that if we upset the Chinese with our language, it could have negative consequences in the future. He raised the point that if China develops the first vaccine, they may have control over who they sell it to, and questioned if the US would be at the top of that list. After the pandemic is over, it is possible that the country's recovery will happen quickly. The economy recovered after previous world wars, but it may be more difficult to measure the psychological effects of the pandemic. Prolonged isolation and poverty resulting from the shutdown could lead to increased rates of domestic abuse, depression, and suicide, as well as potential changes in political viewpoints. At first, the virus primarily affected Democratic cities such as Seattle, New York, and Detroit. However, as it continues to spread across the country, no one will be spared from its impact. Even voters in Republican-leaning states who may not currently hold President Trump responsible for the country's lack of preparedness or limited access to health insurance could change their perspective if they witness loved ones succumbing to the virus. In a thought-provoking analysis in his subsequent article titled "Coronavirus: Out of Many, One," Pueyo examined Medicare and census data on age and obesity in states and counties that resisted shutdowns and supported Republicans in the 2016 election. According to his calculations, these voters may be 30% more likely to die from the virus. In the aftermath of both wars, Mulder observed that there was greater equality in society and incomes. Programs were established for veterans' and widows' pensions, leading to the creation of social safety nets. Measures such as the GI Bill and VA home loans were implemented, unions gained strength, and tax advantages for the wealthy declined. Experts believe that if a vaccine is developed to save lives, many Americans may become more trusting of traditional medicine and more open to scientific advancements, including accepting the reality of climate change. The clear skies seen above American cities during the lockdown period might even become a permanent feature.