President Donald Trump recently put forward recommendations for reopening the economy, indicating that parts of the United States may soon return to a state of normalcy. Despite this optimistic outlook from the administration, many medical advisers and scientists have a more cautious view of the current crisis and what lies ahead. The future remains uncertain, with experts in various fields unsure of when we will be able to safely leave our homes. How much time will it realistically take to develop a treatment or vaccine for the virus? How can we prevent the spread of the virus? Some believed that American innovation, when fully utilized, could potentially lead to breakthroughs that would alleviate the challenges. The future course of action will rely on challenging yet achievable factors such as a gradual reopening, extensive testing and monitoring, an effective treatment, sufficient resources for healthcare workers, and ultimately a successful vaccine. However, pessimistic predictions for the upcoming year could not be avoided. Most experts believe that the optimistic scenario presented by Trump during his daily press briefings, where the lockdowns will end soon and life will return to normal, is a fantasy. They predict a future where the population will be unhappy, trapped indoors for months, and the most vulnerable may be quarantined for even longer. There are concerns that a vaccine may not be found quickly, that people will abandon restrictions despite the risks, and that the virus will be a long-term issue. Dr. William Schaffner, a specialist at Vanderbilt University, remains hopeful that the virus will ease off in the summer and a vaccine will be developed. I am now being cautious about my inherently positive outlook. While many experts predicted a quick recovery for the nation and its economy post-crisis, they also acknowledged that a period of significant hardship was inevitable. The outcome of the pandemic will be influenced by future medical advancements and the behavior of individual Americans. If we prioritize protecting ourselves and our families, more lives will be saved. If we fail to recognize the severity of the virus, it will affect us. The number of Americans who may die from COVID-19 could be higher than what the White House is reporting. The virus has been causing more deaths in the US daily since April 7, with over 1,800 fatalities. This official count may not reflect the true extent of the deaths. In comparison, heart disease and cancer typically cause fewer daily deaths in the US. Yes, the number of new coronavirus cases has stabilized. Hospital admissions in New York, the epicenter of the outbreak, have decreased, as have the number of COVID-19 patients in intensive care units. Although the daily death toll remains high, it is no longer increasing. The epidemiological model frequently 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 since 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. However, despite this positive outlook, there are still major worries. The forecast by the institute only covers the initial wave of the epidemic until August 4, and it is predicted that the virus will continue to spread for years without a vaccine, leading to an increase in the number of deaths. The progress made so far in combating the pandemic was only possible by implementing strict shutdown measures, which cannot be sustained indefinitely. The White House's plan for reopening in phases is expected to result in increased death toll, regardless of how cautiously it is implemented. The goal is to minimize the number of fatalities, although long-term projections paint a grim picture. Experts have warned that without intervention, the virus could potentially infect a large percentage of the population and result in up to 1.7 million deaths in the United States. The president cited a model by researchers at Imperial College London on March 30, which predicted 2.2 million deaths in the US by September under similar circumstances. In comparison, approximately 420,000 Americans died in World War II. Limited data from China is concerning, as their epidemic has temporarily been halted and nearly all those infected in the first wave have either died or recovered. China has reported about 83,000 cases and 4,632 deaths, resulting in a fatality rate of over 5%. The Trump administration has raised doubts about the numbers, but has not provided more accurate data. Fatality rates are influenced by the strain on hospitals 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 faced overwhelming situations. Officials in Wuhan and New York had to increase their death tolls after realizing that many people had died at home from various causes or because they did not receive medical attention. During fast-moving epidemics, hospitals are overwhelmed with victims who may not be tested, while those who are asymptomatic never get tested, leading to an inaccurate fatality rate. Without knowing the true number of infections, it is impossible to determine the true lethality of a virus. The CDC has proposed conducting tens of thousands of antibody tests to identify potential silent carriers, which may make up 25% of positive cases in the US. Researchers in Iceland have suggested that the number could be twice as high. A health worker in Central Park, New York, checks her personal protective equipment in a mirror on April 16, 2020. The New York Times reported that China is also reevaluating its estimates. A recent study had previously indicated that only 1% of cases in Wuhan were asymptomatic, but new research suggests that the actual number might be closer to 60%. Our lack of knowledge in epidemiology is significant enough to cause epidemiologists distress. Dr. Anthony S Fauci, science adviser to the White House coronavirus task force, has emphasized that all models are subject to change when new data is received. This inconsistency may actually bring some positive news: the virus could be mutating to result in milder symptoms. While movies often portray viruses becoming more deadly, in reality they typically become less severe as asymptomatic strains are able to reach more hosts. Even though the 1918 Spanish flu virus eventually transitioned into the seasonal H1N1 flu, the current situation with the virus is still uncertain in terms of its transmissibility and lethality. 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 may not be a smooth process. While the exact percentage of Americans who have been infected remains unknown, it is likely that a large portion of the population, possibly around 300 million people, are still susceptible to the virus. According to epidemiologists, it is not safe for a large number of people to suddenly stop social distancing until a vaccine or other protective measures become available. Dr. Peter J Hotez of Baylor College of Medicine warned against the belief that a vaccine will quickly solve the problem. Tomas Pueyo predicted a national lockdown followed by a gradual reopening of essential parts of the economy in his article "Coronavirus: The Hammer and the Dance." Each epidemiological model anticipates a scenario similar to a dance, where the virus flourishes when too many hosts are present, leading to the need for another lockdown. This cycle of surges and declines in deaths is depicted as a row of shark teeth on the models. Despite efforts such as keeping public venues closed, quarantining travelers, and restricting domestic travel, the models still predict inevitable surges in infections. 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, as is common practice in Asia. Even President Trump's "Opening Up America Again" guidelines include three levels of social distancing and recommend that vulnerable individuals stay isolated. The plan supports testing, isolation, and contact tracing, but does not specify how these measures will be funded or how long it will will take to implement them. Despite this, on Friday, President Trump contradicted his own message by encouraging protesters in Michigan, Minnesota, and Virginia to fight against their states' shutdowns. China did not permit cities like Wuhan and Nanjing to reopen until strict monitoring showed no new cases for 14 consecutive days, which is the virus' incubation period. In contrast to China and Italy, the US is still operating freely. Americans can travel domestically, drive wherever they please, and freely move about streets and parks. Despite restrictions, many individuals are secretly organizing play dates for their children, hosting backyard gatherings, or meeting others through dating apps. Consequently, the country has been experiencing up to 30,000 new cases of infection each day. Schaffner emphasized the importance of people understanding that it is risky to play poker while wearing bandannas. Despite strict precautions, Asian nations have faced challenges in controlling the virus. China has closed all movie theaters due to about 100 new infections daily. Singapore has shut down schools and nonessential businesses, while South Korea and Japan are also facing difficulties with the virus. Resolve to Save Lives, a public health advocacy organization led by Dr. Thomas R Frieden, a former director of the CDC, has released specific and stringent criteria for when the economy should reopen and when it should remain closed. The guidelines include requirements such as a 14-day decline in cases, contact tracing for 90% of individuals, no infections among healthcare workers, availability of recovery spaces for mild cases, and other challenging objectives. Frieden emphasized the need to gradually reopen the economy rather than rushing to do so, stating that now is the time to work towards achieving these goals sooner. He also highlighted the potential societal division between those who have recovered from the coronavirus and have some level of immunity, and those who are still susceptible to the virus. Dr David Nabarro, a special envoy on COVID-19 for the World Health Organisation, is predicting a terrifying divide in society. He believes that those who have antibodies will have the privilege of traveling and working, while others will face discrimination. People with presumed immunity are already in high demand, being asked to donate blood for antibodies and take on risky medical jobs without fear. Soon, the government will need to create a system to confirm who is truly immune. Dr Daniel R Lucey, a pandemics expert at Georgetown Law School, suggests that a test for IgG antibodies, which indicate established immunity, would be a logical solution. Many companies are currently working on developing these tests. Fauci mentioned that the White House is considering implementing certificates similar to those in Germany. China utilizes cellphone QR codes connected to personal information to prevent others from using them. The adult-film industry in California introduced a similar concept ten years ago, where actors use a cellphone app to show recent negative HIV tests and producers can confirm this on a secure website. With Americans in lockdown watching their immune neighbors return to normal life, there is a strong urge to follow suit through self-infection, according to experts. Younger individuals, especially, may consider that facing a severe illness is preferable to dealing with poverty and loneliness. Dr. Michele Barry, who leads the Centre for Innovation in Global Health at Stanford University, mentioned that her daughter, a Harvard economist, suggests that her age group should hold COVID-19 parties to build immunity and support the economy. This strategy has been used in the past - in the 1980s, Cuba successfully controlled its small AIDS outbreak by forcibly isolating individuals who tested positive. Despite the harsh measures, those in isolation camps had access to their own accommodations, food, healthcare, salaries, entertainment, and art classes. Many homeless youths in Cuba contracted HIV through risky behaviors before antiretroviral therapy was available, according to Dr. Jorge Pérez Ávila, a well-known AIDS specialist in Cuba. Similarly, young Americans may also be at risk of contracting COVID-19, even if they are healthy and slim. The virus can be controlled, but only with increased resources. Experts predict that the next two years will be characterized by periods of progress and setbacks. As more people with immunity return to work, the economy will gradually improve. However, if there is a sudden surge in infections, new lockdowns may be necessary. To prevent this scenario, widespread testing will be crucial. Dr. Fauci has stated that the virus will indicate when it is safe to resume normal activities. He is saying that by having a large number of daily tests conducted nationwide, any increase in viral spread can be detected when the percentage of positive results goes up. Detecting rising fevers through Kinsa's smart thermometers may provide an early warning, according to Schaffner. However, there have been issues with diagnostic testing from the start, with doctors and patients still experiencing delays and shortages 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 nation, individuals who receive a positive test result are instructed to remain in their residences but maintain a distance from their families. Television reports have shown well-known figures such as CNN's Chris Cuomo, who recovered while in isolation in his basement while his wife left food at the top of the stairs, his children waved from a distance, and the dogs stayed back. However, Cuomo's situation highlighted the reasons why the WHO strongly opposes home isolation. He later disclosed that his wife also had the virus. Dr. Bruce Aylward, who headed the WHO observer 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 be admitted to a hospital resembling an infirmary, typically located in a gymnasium or community center equipped with oxygen tanks and CT scanners. In these facilities, patients received care from nurses while recovering, which helped minimize the risk to their families and provided comfort in being surrounded by others in similar situations. Nurses also organized activities like dance and exercise classes to boost morale, aid in clearing lungs, and maintain muscle tone. However, opinions among experts were split on the concept of these specialized wards. Fineberg collaborated on an op-ed piece for the New York Times advocating for mandatory yet compassionate quarantine procedures. On the other hand, Marc Lipsitch, an epidemiologist at the Harvard TH Chan School of Public Health, disagreed with the concept, expressing concerns about the government forcibly separating individuals from their families. To effectively combat a virus, it is essential to test all the contacts of every confirmed case. However, the United States is falling short of this objective. For instance, individuals working in restaurants or factories may have numerous contacts. In China's Sichuan province, each confirmed case had an average of 45 contacts. The CDC has approximately 600 contact tracers, and, previously, state and local health departments had around 1,600, primarily for tracing cases of syphilis and tuberculosis. China recruited and provided training for 9,000 individuals in Wuhan alone. Frieden has recently predicted that the United States will require a minimum of 300,000 trained individuals. A vaccine is not expected to be available in the near future. Although human trials for three potential vaccines have commenced, with two in the United States and one in China, Fauci has emphasized that the process of developing a vaccine will take at least 12 to 18 months. Experts in vaccine production have collectively agreed that even this timeline may be overly optimistic. Dr. Paul Offit, a vaccinologist at the Children's Hospital of Philadelphia, pointed out that the current record for vaccine development is four years for the mumps vaccine. There is a debate among researchers about how to expedite the process. Advances in biotechnology, such as using RNA or DNA platforms, allow for faster development of potential vaccines. However, clinical trials still require time as the production of antibodies in the human body cannot be rushed. Additionally, some past vaccine candidates for coronaviruses like SARS have caused "antibody-dependent enhancement," which increases susceptibility to infection rather than providing protection, for reasons that are not entirely clear. In previous cases, vaccines for HIV and dengue have unexpectedly shown similar results. Typically, a new vaccine is initially tested on a small group of less than 100 healthy individuals. If the vaccine proves to be safe and generates antibodies, thousands more volunteers, particularly those at high risk like front-line workers, will participate in a Phase 3 trial where they will receive either the vaccine or a placebo. To expedite the process, scientists can use "challenge trials," where a small group of volunteers are vaccinated, develop antibodies, and then intentionally exposed to the infection to determine if the vaccine provides protection. 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 the current unusual circumstances, conducting challenge trials on a small number of high-risk individuals may be more ethical than leaving millions at risk for an extended period. Lipsitch, who recently wrote a paper supporting challenge trials in the Journal of Infectious Diseases, argued that fewer people would be harmed in a challenge trial than in a Phase 3 trial involving thousands of participants. Following the publication of his paper, Lipsitch received volunteers willing to participate, while others expressed discomfort with the idea. "I believe it is highly unethical, but there may be a possibility of conducting challenge trials," stated Lucey. Vaccinologists warn that challenge trials may not recruit enough volunteers to detect potential safety issues like enhancement, which could be rare but dangerous. Michael T Osterholm, director of the University of Minnesota's Centre for Infectious Disease Research and Policy, emphasized that challenge trials may not provide definitive answers on safety and could potentially pose a significant risk. 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. Begin the production of the winning vaccine immediately, while also expanding human testing to identify any potential issues. Despite the challenges of testing a vaccine, experts have noted that producing hundreds of millions of doses is an even more daunting task. Most American vaccine plants typically only manufacture 5 to 10 million doses annually, primarily for the 4 million babies born and 4 million individuals who turn 65 each year, according to Dr. R Gordon Douglas Jr, a former president of Merck's vaccine division. However, if a vaccine is developed, the US may require 300 million doses - or potentially 600 million if two doses are necessary - along with a corresponding number of syringes. Douglas emphasized the importance of thinking on a large scale in terms of producing flu vaccines. He noted that while current flu vaccine plants are big, those that rely on chicken eggs are not ideal for modern vaccines grown in cell broths. European countries have their own vaccine plants, but they may need them for their own populations. China has a thriving vaccine industry and has the potential to expand it in the near future, possibly even producing vaccines for the US, according to experts. Captive customers have to pay whatever price the seller asks and some Chinese companies have imperfect safety and efficacy standards. India and Brazil also have large vaccine industries. If the virus spreads quickly through their crowded populations, they may achieve widespread herd immunity before the US does, potentially having spare vaccine plant capacity. Alternatively, retired medical historian Arthur M Silverstein suggested that the government could take over and sterilize existing liquor or beer plants, which have large fermentation vats. He stated that any distillery could potentially be transformed for this purpose. Treatments are expected to be developed and implemented before vaccines. In the near future, experts were more hopeful about treatments rather than vaccines. Some experts believed that convalescent serum could be effective. The traditional method of using antibodies from recovered individuals has been in practice for more than 100 years. The immunoglobulin containing antibodies is administered to patients through injections. The challenge is that there are currently only a small number of survivors available for blood donation. In the time before vaccines, antibodies were obtained from horses and sheep, but this method was difficult to maintain sterility and could sometimes lead to allergic reactions due to animal proteins. The contemporary solution is the use of monoclonal antibodies. Experts believe that these treatment regimens, which were on the verge of defeating the Ebola outbreak in eastern Congo, are the most promising short-term solution. The most effective antibodies are selected and their genes are inserted into a harmless virus that can multiply in a cellular solution. However, like vaccines, the process of growing and purifying monoclonal antibodies is time-consuming. In theory, with sufficient production, these antibodies could be used not only to save lives but also to protect frontline workers. The antibodies can remain effective for weeks before deteriorating, although the duration depends on various factors, and they are unable to eliminate viruses that are already concealed within cells. Having a daily preventive pill would be a more effective solution because pills can be manufactured in factories much quicker than vaccines or antibodies can be produced. However, even if such a pill was created, production would need to increase until it was widely available for all 300 million Americans to take daily. Trump has frequently mentioned hydroxychloroquine and azithromycin, making his news conferences sound like commercials. Despite this, experts, including Fauci, agreed that no decisions should be made until clinical trials are completed, citing the thalidomide tragedy in the 1950s as an example of the dangers of inadequate testing. Multiple hydroxychloroquine studies have been stopped due to patients experiencing abnormal heart rhythms from high doses. Barry expressed skepticism about the tolerability of high doses and potential vision issues from accumulation, but suggested exploring its potential as a PrEP-like drug. Dr. Luciana Borio criticized Trump's suggestion of combining chloroquine with azithromycin as "total nonsense." I informed my family that if I were to get COVID-19, they should not give me chloroquine. Some doctors believe that chloroquine may help protect hospitalized patients with pneumonia from severe cytokine storms by reducing immune reactions. However, it is not effective for preventing infections as President Trump has suggested, as it lacks antiviral properties. Various antivirals, such as remdesivir, favipiravir, and baloxavir, are currently being tested against the coronavirus, with trials in China expected to release results soon. Trials in the US do not have set end dates yet. Farewell to the 'America First' mindset as unprecedented societal changes have occurred. Schools and businesses nationwide have shut down, millions are jobless, taxes and mortgage payments are on hold, and foreclosures are prohibited. Refrigerated trucks serving as makeshift morgues in New York highlight the severity of the situation. Stimulus checks have started arriving in bank accounts, turning much of America into a temporary welfare state. Food banks are being established in various locations in the country, resulting in long lines of people. Refrigerated trucks are being used as mobile morgues on Randall's Island in New York as of April 15, 2020, according to The New York Times. The current public health crisis calls for unprecedented international collaboration, but President Trump is taking steps to defund the World Health Organization, the only organization capable of coordinating such a response. Additionally, he has been engaging in conflicts with China, which currently has the most powerful economy in the world and may become the leading provider of drugs and vaccines. China has used the pandemic to increase its global influence by providing medical equipment to nearly 120 countries, including the US through Project Airbridge, overseen by Jared Kushner. Experts suggest that in the current world climate, an "America First" strategy may not be effective, and recommend collaboration with China for public health efforts. Nicholas Mulder, an economic historian at Cornell University, has likened Kushner's project to a reverse version of America's Lend-Lease program during World War II. Osterholm was more straightforward in his statement. He mentioned that if we offend the Chinese with our language, it may have negative consequences. He raised the question of what would happen if they develop the first vaccine and get to choose who to sell it to. Would we be their first choice? Why should we be worried about what happens after the pandemic? The nation's recovery may happen quickly, as it did after previous world wars. However, the long-term psychological effects are more uncertain. Prolonged isolation and economic hardship could lead to increased levels of domestic violence, depression, and suicide. There may also be changes in political beliefs as a result. At first, the virus disproportionately affected Democratic cities such as Seattle, New York, and Detroit. However, as it continues to spread across the country, no one will be unaffected. Even residents in Republican-leaning states who do not hold Trump responsible for the country's lack of preparedness or limited access to healthcare may reconsider if they witness loved ones succumb to the virus. In a bold analysis outlined in his subsequent article titled "Coronavirus: Out of Many, One," Pueyo examined Medicare and census data regarding age and obesity in states that resisted shutdowns and counties that supported the Republican party in 2016. He concluded that these voters could face a 30% higher risk of dying from the virus. In the aftermath of both wars, Mulder observed that there was an increase in societal equality and incomes. Various measures were implemented such as funds for veterans' and widows' pensions, the implementation of the GI Bill and VA home loans, the strengthening of unions, and a decrease in tax benefits for the wealthy. Experts predict that if a vaccine is successful in saving lives, many Americans may become more trusting of conventional medicine and more open to accepting science in general, including climate change. It is even possible that the clear blue skies that have been seen over American cities during the lockdown could become a permanent feature.