President Donald Trump recently put forth recommendations for reopening the economy and indicated that a portion of the United States would soon return to a semblance of normalcy. However, the administration's optimistic outlook on the crisis and our future has differed from that of medical experts and scientists. The ultimate trajectory of this crisis remains uncertain, with over 20 experts in various fields offering their insights on when we can safely come out of our homes. How far away are we from finding a treatment or vaccine? How can we prevent the spread of the virus? Some believe that with American innovation, progress can be made to alleviate the challenges. The key to moving forward lies in implementing a strategic reopening plan, increasing testing and monitoring, finding an effective treatment, providing sufficient resources for healthcare workers, and ultimately developing a successful vaccine. Despite these efforts, pessimistic predictions for the upcoming year are unavoidable. Experts have stated that the optimistic scenario presented by Trump in his daily press briefings, which includes the end of lockdowns, the availability of a protective pill, and a return to full football stadiums and restaurants, is unrealistic. Dr. Harvey V Fineberg and others believe that we are facing a grim future, with the possibility of people being stuck indoors for months and the most vulnerable individuals being quarantined for an extended period. They are concerned that a vaccine may not be readily available, that people may stop following restrictions, and that the virus will be a long-term issue. Dr. William Schaffner, on the other hand, remains hopeful that the virus will lessen in the summer and a vaccine will be developed. "I am learning to be cautious despite my natural optimism." Many experts predicted a quick recovery for the nation and economy after the crisis, but acknowledged a period of hardship. The outcome of the pandemic will be influenced by future medical advancements and individual behaviors. If we prioritize safety and protection, more lives will be saved. If we fail to take the virus seriously, it will impact us. The number of American deaths from COVID-19 may be higher than what the White House is reporting. The virus has been responsible for a significant number of daily deaths in the US since April 7, possibly more than the official count suggests. In comparison, heart disease and cancer typically cause fewer daily deaths than COVID-19 currently. Yes, the spread of the coronavirus is stabilizing. Hospital admissions in New York, the epicenter of the outbreak, are decreasing, as are the number of COVID-19 patients in intensive care units. While the daily death toll remains high, it is no longer increasing. The epidemiological model referenced 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. View of New York City from Weehawken, New Jersey on April 16, 2020, as reported by The New York Times. Despite some positive developments, there are still major worries as the current projections only account for the initial wave of the pandemic until August 4. Without a vaccine, experts anticipate that the virus will continue to spread for years, leading to a gradual increase in the number of deaths. The gains achieved so far required shutting down the country, a measure that cannot be sustained indefinitely. The White House's plan for reopening in phases is expected to increase the death toll, regardless of the precautions taken. The goal is to keep fatalities to a minimum. Long-term projections on the number of American deaths vary but are all concerning. Experts consulted by the CDC in March predicted that the virus could eventually infect 48% to 65% of Americans, with a fatality rate just under 1%, potentially resulting in up to 1.7 million deaths if no action is taken to prevent the spread. According to a model developed by researchers at Imperial College London, it was predicted by the president on March 30 that there would be 2.2 million deaths in the US by September under the same conditions. In comparison, around 420,000 Americans died during World War II. The data from China is also concerning, as their epidemic has been temporarily halted and nearly all those infected in the first wave have either died or recovered. China has reported approximately 83,000 cases and 4,632 deaths, resulting in a fatality rate of over 5%. The Trump administration has questioned the accuracy of the figures regarding fatality rates during the COVID-19 pandemic, but has not provided more precise numbers. The death rates can vary depending on the level of strain on hospitals and the percentage of cases that are tested. For example, in China, the estimated death rate was 17% in early January when Wuhan was facing chaos, but decreased to 0.7% by late February. Hospitals in cities like New York have been on the verge of chaos. Both Wuhan and New York officials had to revise their death counts recently after realizing that many people had died at home from COVID-19, strokes, heart attacks, or other reasons, or because ambulances did not arrive. During rapidly spreading epidemics, a large number of individuals who are either hospitalized or pass away without being tested, while those with mild symptoms or who are asymptomatic are not tested at all. This creates distortion in the actual fatality rate in both directions. Without accurate data on the number of infected individuals, it is impossible to determine the true lethality of a virus. It is only after conducting a significant number of antibody tests that the extent of silent carriers in the US will be known, with the CDC estimating it could be as high as 25% of those who test positive. Scientists in Iceland suggested that the number of asymptomatic cases may be twice as high as previously estimated. A healthcare worker in New York City is seen checking her personal protective gear in Central Park on April 16, 2020. According to The New York Times, China is also reevaluating its own estimates. A study conducted in February indicated that only 1% of cases in Wuhan were asymptomatic, but new research suggests that the actual percentage may be closer to 60%. Our lack of understanding in certain areas of knowledge is significant enough to cause epidemiologists to become emotional. Dr. Anthony S. Fauci, a science advisor to the White House coronavirus task force, has emphasized that all models are subject to change as new data is received. This inconsistency may lead to a positive outcome, as the virus could potentially be mutating to produce milder symptoms. Contrary to what is often portrayed in movies, viruses tend to become less deadly over time as asymptomatic strains spread to more hosts. The 1918 Spanish flu virus eventually evolved into the seasonal H1N1 flu, but currently, we are unsure of the transmissibility or lethality of the virus. The presence of refrigerated trucks outside hospitals indicates that it is more severe than a typical flu season. The lockdowns will eventually come to an end, but it will be a gradual process. Estimates of the percentage of Americans infected so far range from 3% to 10%, suggesting that at least 300 million people are still susceptible to the virus. Epidemiologists agree that until a vaccine or another protective measure is developed, it is not safe for a large number of people to suddenly stop social distancing. Dr. Peter J Hotez warns against the belief that things will go back to normal once a vaccine is available, and Tomas Pueyo predicted in his article "Coronavirus: The Hammer and the Dance" that the national lockdown would lead to a new phase where parts of the economy could reopen with precautions. Each epidemiological model anticipates a pattern similar to a dance, where the virus flourishes when there are too many hosts, leading to another lockdown. This cycle of surges and declines in deaths is represented by curves that resemble shark teeth on the models. Despite strict measures such as closed stadiums, churches, theatres, bars, and restaurants, quarantines for international travelers, and restrictions on domestic travel, the models still predict inevitable surges as high-intensity areas may reinfect low-intensity ones. Experts suggest that stricter restrictions result in fewer deaths and longer intervals between lockdowns. Many models predict that states will eventually implement widespread temperature checks, rapid testing, and contact tracing, similar to practices in Asia. Even President Trump's "Opening Up America Again" guidelines include three levels of social distancing and advise vulnerable individuals to remain isolated. While the plan supports testing, isolation, and contact tracing, it does not clarify how these measures will be funded or how long they will take to implement. Despite this, the president sent out tweets on Friday encouraging protests against state shutdowns, contradicting his own message. China only allowed cities like Wuhan and Nanjing to reopen once intensive surveillance showed no new cases for 14 days, which is the virus' incubation period. In comparison, the US is still relatively unrestricted, with Americans able to take domestic flights, drive freely, and move around in public spaces. Despite some restrictions, many people are still engaging in social activities like arranging play dates for children, having backyard barbecues, and meeting up with others through dating apps. As a result, the country has been seeing up to 30,000 new cases of infection each day. Schaffner emphasized the importance of people understanding that playing poker while wearing bandannas is not safe. Despite strict measures, Asian countries have faced challenges in controlling the virus. China, with around 100 new daily infections, has closed all movie theatres. Singapore has shut down schools and nonessential workplaces, while South Korea and Japan are also experiencing difficulties, with Japan declaring a state of emergency. Resolve to Save Lives, a public health advocacy group led by Dr. Thomas R Frieden, former CDC director, has released detailed and stringent guidelines for reopening and closing the economy. Reopening criteria include a 14-day decline in cases, tracing 90% of contacts, no infections among healthcare workers, availability of recovery facilities for mild cases, and other challenging benchmarks. Frieden emphasizes the need to gradually reopen the economy, rather than all at once, in order to prevent a surge in cases. He also highlights the importance of working together to achieve these goals sooner. In the future, immunity may become a social advantage, with society potentially divided into those who have recovered from the coronavirus and have some level of immunity, and those who are still susceptible. Dr David Nabarro, a special envoy on COVID-19 for the World Health Organisation, has warned that there will be a troubling divide in society. Those who have antibodies will have advantages in traveling and working, while those without will face discrimination. People who are believed to have immunity are already in high demand, being asked to donate blood for antibodies and take on risky medical roles without fear. In the near future, the government will need to devise a system to confirm who is genuinely immune. Dr Daniel R Lucey, a pandemic expert at Georgetown Law School, suggests that testing for IgG antibodies, which indicate established immunity, would be a logical approach. Numerous companies are currently developing such tests. Fauci mentioned that the White House was considering implementing certificates similar to those seen in Germany, where China utilizes QR codes linked to personal details on cellphones to prevent sharing. The adult film industry in California introduced a similar concept ten years ago, with actors using a smartphone app to show recent negative HIV tests and producers verifying the information on a secure website. Experts predict that as Americans in lockdown observe others resuming normal activities, there may be a strong temptation to purposefully infect themselves in order to join them. Younger individuals may believe that risking a severe illness is preferable to facing poverty and social isolation. Dr Michele Barry, who leads the Centre for Innovation in Global Health at Stanford University, shared that her daughter, a Harvard economist, suggests that her age group should have COVID-19 parties to build immunity and support the economy. This approach has been seen in the past, such as in Cuba in the 1980s when individuals who tested positive for AIDS were isolated in camps where they received various amenities and services. Dr. Jorge Pérez Ávila, an AIDS specialist often compared to Fauci, stated that many homeless youths in Cuba purposely infected themselves through risky behaviors in order to gain access to medical care. Before antiretroviral therapy was available, many of these individuals died. Similarly, even young and healthy Americans have died from COVID-19, showing that the virus poses a risk to all individuals. In order to effectively control the virus, more resources are needed. Experts have stated that the next couple of years will progress with intermittent periods of advancement and setbacks. As more individuals with immunity return to work, the economy will improve. However, if a large number of people are infected simultaneously, new lockdowns may be necessary. To prevent this, widespread testing will be crucial. Dr. Fauci has mentioned that "the virus will indicate" when it is safe to proceed. He is suggesting that by implementing a national baseline of hundreds of thousands of daily tests, any viral spread can be detected when the percentage of positive results increases. Detecting rising fevers through smart thermometers may provide an early warning sign, according to Schaffner. However, there have been issues with diagnostic testing from the start. Despite promises from the White House, delays and shortages continue to be reported by doctors and patients. To effectively control the virus, experts believe that all sick individuals, including those with mild cases, must be isolated. In this nation, individuals who receive a positive test result are instructed to remain in their homes but avoid contact with their families. Media coverage has shown prominent figures such as CNN's Chris Cuomo recovering in isolation in his basement, with his wife delivering food while maintaining a distance. However, Cuomo's situation highlighted the World Health Organization's strong opposition to home isolation. Dr. Bruce Aylward, who led the WHO team in China, emphasized the importance of quickly isolating all cases as the most crucial intervention. In China, individuals who tested positive for the virus, 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 spreading the virus to their families. Some patients found comfort in being with others in similar situations. The nurses organized dance and exercise classes to boost morale, clear lungs, and maintain muscle tone. However, experts had differing opinions on the effectiveness of these specialized wards. Fineberg collaborated on a New York Times op-ed piece advocating for mandatory yet compassionate quarantine measures. In contrast, Harvard epidemiologist Marc Lipsitch disagreed, expressing concern about the government forcibly separating individuals from their families. To effectively control a virus, it is necessary to test all contacts of confirmed cases, a goal the US is currently falling short of achieving. In China's Sichuan province, for instance, each confirmed case had an average of 45 contacts. The CDC has approximately 600 contact tracers, and state and local health departments, until recently, had around 1,600, primarily focused on tracing syphilis and tuberculosis cases. China has recruited and educated 9,000 individuals in Wuhan. Frieden has suggested that the US will require a minimum of 300,000. A vaccine will not be available in the near future. Although initial human trials for three potential vaccines have commenced, Fauci has emphasized that developing a vaccine will take between one to 18 months. Experts in vaccine production believe that even this timeline is overly optimistic. Dr Paul Offit, a vaccinologist at the Children’s Hospital of Philadelphia, highlighted that the current record for developing a vaccine is four years, specifically for the mumps vaccine. There is a significant debate among researchers regarding how to accelerate the vaccine development process. Advancements in biotechnology, such as using RNA or DNA platforms, have enabled the creation of candidate vaccines at a faster pace than ever before. However, clinical trials still require time, as the production of antibodies in the human body cannot be expedited. Additionally, past vaccine candidates for coronaviruses like SARS have caused "antibody-dependent enhancement," which paradoxically increases susceptibility to infection rather than reducing it, for reasons that remain unclear. In the past, both HIV and dengue vaccines have unexpectedly shown similar results. Typically, a new vaccine is first tested on a small group of less than 100 healthy young volunteers. If the vaccine is deemed safe and effective in producing antibodies, thousands more volunteers, likely front-line workers at high risk, will participate in a Phase 3 trial. One way to expedite this process is through "challenge trials," where scientists vaccinate a small group of volunteers, monitor antibody development, and then intentionally expose them to the disease to test vaccine efficacy. Challenge trials are only used for diseases that are completely curable, 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 unusual times, conducting challenge trials on a small number of Americans at high risk could be more ethical than leaving millions at risk for an extended period. Lipsitch, who proposed challenge trials in the Journal of Infectious Diseases, pointed out that fewer people would be harmed in a challenge trial compared to a Phase 3 trial involving thousands of participants. Despite some volunteers showing interest, others expressed strong discomfort with the idea. "I find it morally questionable, but I understand the reasoning behind it," Lucey commented. Vaccinologists warn that challenge trials may not recruit enough volunteers to determine if a vaccine causes enhancement, a potentially rare but serious issue. According to Michael T Osterholm, challenge trials may not provide conclusive evidence on safety and could potentially present a significant problem. Virologist Dr. W Ian Lipkin from Columbia University's Mailman School of Public Health proposed an alternative approach of testing at least two vaccine candidates briefly in humans before conducting challenge trials in monkeys. Experts recommend starting production of the winning vaccine immediately, while also expanding human testing to detect 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 only produce 5 to 10 million doses annually, primarily for the 4 million babies born and 4 million people who turn 65 each year. However, if a vaccine is developed, the US could require 300 million doses - or 600 million if two shots are needed - along with a corresponding number of syringes. Douglas emphasized the importance of thinking on a larger scale, especially when it comes to producing flu vaccines. He noted that traditional methods of growing vaccines in chicken eggs are not suitable for modern vaccines that grow in cell broths. While European countries have vaccine plants, they may need them for their own citizens. China, on the other hand, has a large vaccine industry and could potentially expand it in the future. Experts suggest that China may be able to produce vaccines for the US as well. However, customers who are captive must pay the price set by the seller, and the safety and efficacy standards of certain Chinese companies may be lacking. India and Brazil also have significant vaccine industries. If the virus spreads quickly through their dense populations, they could potentially reach widespread herd immunity before the US, even if they suffer significant loss of life. If this occurs, they may have excess vaccine production capacity. Another suggestion by Arthur M Silverstein, a retired medical historian at Johns Hopkins School of Medicine, is for the government to potentially convert existing liquor or beer plants with large fermentation vats for vaccine production. He mentioned that any distillery could potentially be transformed for this purpose. It is expected that treatments will be developed before vaccines. In the near future, experts expressed more positivity towards treatments rather than vaccines. Many believed that convalescent serum could be effective. This traditional method, which involves drawing blood from recovered individuals and filtering it to extract antibodies, has been utilized for more than one hundred years. The immunoglobulin containing antibodies is administered to patients. The challenge is that there are only a small number of survivors available to donate blood. In the past, antibodies were extracted from horses and sheep before vaccines were available. However, this method was difficult to maintain sterility and could cause allergic reactions due to animal proteins. A more current option is the use of monoclonal antibodies. According to experts, these treatment regimens, which were nearly successful in stopping the Ebola outbreak in eastern Congo, are considered the most promising short-term solution. The most effective antibodies are selected and their genes are inserted into a harmless virus that will multiply in a cellular solution. However, like vaccines, the process of cultivating and purifying monoclonal antibodies is time-consuming. In theory, with sufficient production, these antibodies could be utilized not only to save lives but also to safeguard frontline workers. The longevity of antibodies varies depending on multiple factors, but they can remain effective for weeks before deteriorating, and they are unable to eliminate viruses that are hidden within cells. Having a daily preventive pill would be a more efficient solution compared to vaccines or antibodies, as pills can be produced quickly in factories. However, even if such a pill was created, production would need to increase to ensure widespread availability. Trump has frequently mentioned hydroxychloroquine and azithromycin, resembling infomercials in his news conferences, but experts like Fauci agree that no decisions should be made until clinical trials are finished. Some experts referenced the 1950s thalidomide tragedy as a cautionary tale of the dangers of inadequate testing. Multiple studies on hydroxychloroquine have been stopped due to patients experiencing abnormal heart rhythms from high doses. Barry expressed skepticism about high doses being tolerated and potential vision issues from accumulation, but suggested further investigation into its potential use as a preventative drug, similar to PrEP for HIV. Other experts, including Dr. Luciana Borio, criticized Trump's suggestion of combining chloroquine with azithromycin as "total nonsense." "I informed my family that if I were to contract COVID-19, I do not want to be treated with a combination including chloroquine. Some doctors believe that chloroquine may help protect patients in the hospital with pneumonia from dangerous cytokine storms by reducing immune reactions. However, it is not effective for preventing infections as President Trump has suggested, as it does not have any known antiviral properties. Other antiviral drugs such as remdesivir, favipiravir, and baloxavir are currently being tested against the coronavirus, with results expected from trials in China next month. The outcomes of these trials may be limited due to a shortage of patients to test. End dates for trials in the US have not been determined yet." The concept of "America First" is being left behind as unprecedented societal changes have occurred. Schools and businesses across the country have shut down, millions have lost their jobs, and relief measures such as delayed taxes and mortgage payments have been put in place. Refrigerated trucks are 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 all over the country, resulting in long lines of people waiting for assistance. In New York, refrigerated trucks are being used as mobile morgues on Randall's Island. The current public health crisis necessitates global collaboration on a level not seen in years. However, President Trump is taking steps to defund the WHO, the only organization capable of organizing such a response. Additionally, he has been actively provoking China, which currently has the world's strongest economy and has the potential to become the main provider of medications and vaccines. China has taken advantage of the pandemic to expand its influence globally by providing medical supplies to nearly 120 countries, including the US through Project Airbridge overseen by Jared Kushner. Experts suggest that an "America First" approach is not effective in the current situation and recommend collaboration with China instead. Nicholas Mulder from Cornell University has compared Kushner's project to "Lend-Lease in reverse," referencing American military aid during World War II. Osterholm was more direct in his statement. He expressed concern that if we offend the Chinese with our language, there could be negative consequences. He raised the possibility of China developing the first vaccine and having control over who receives it. He questioned whether the United States would be a priority for them. Once the pandemic is over, the country's recovery may happen quickly, as history has shown with the economy rebounding after previous world wars. However, it will be more difficult to measure the psychological effects of the crisis, such as increased rates of domestic abuse, depression, and suicide due to isolation and poverty caused by prolonged shutdowns. Additionally, there may be shifts in political perspectives. Initially, Democratic cities such as Seattle, New York, and Detroit were hit hard by the virus. However, as it continues to spread throughout the country, no one will be spared. Even voters in Republican-leaning states who may not currently blame Trump for the country's lack of preparedness or limited access to health insurance could change their opinions if they witness their loved ones succumb to the virus. Pueyo conducted a detailed analysis in his subsequent article, "Coronavirus: Out of Many, One," using Medicare and census data to examine age and obesity rates in states and counties that resisted shutdowns and voted Republican in 2016. According to his calculations, these voters could face a 30% higher risk of dying from the virus. In the time following both wars, Mulder observed that society and incomes became more balanced. Social safety nets were established through funds for veterans' and widows' pensions, measures such as the GI Bill and VA home loans were implemented, unions gained strength, and tax benefits for the wealthy decreased. Experts believe that if a vaccine is successful in saving lives, it could lead to a decrease in skepticism towards traditional medicine and a greater acceptance of science overall, including climate change. The clear skies seen over American cities during the lockdown period may potentially become a long-term occurrence.