President Donald Trump recently put forward suggestions for reopening the economy and indicated that parts of the United States would soon return to normal. The administration's optimistic outlook on the crisis contrasts with the views of medical advisors and scientists. The future remains uncertain, and experts in public health, medicine, epidemiology, and history have differing opinions on when we can safely leave our homes. How long will it take before we have a treatment or vaccine for the virus? How will we prevent the spread of the virus? Some believed that American innovation could lead to advancements in easing the situation. The key to moving forward relies on challenging but achievable factors: a gradual approach to reopening, extensive testing and monitoring, effective treatment, sufficient resources for healthcare workers, and ultimately a successful vaccine. Despite these efforts, pessimistic predictions for the upcoming year could not be avoided. Experts have stated that the optimistic scenario presented by Trump during his daily press briefings, in which lockdowns end soon and life returns to normal, is unrealistic. Dr. Harvey V Fineberg warned of a grim future with people stuck indoors for months, the vulnerable possibly quarantined longer, and a vaccine proving elusive. Dr. William Schaffner, while hopeful for a summer slowdown of the virus and a vaccine, acknowledged the uncertainty of the situation. "I am becoming more cautious due to my inherently positive outlook. Many specialists predict that after the crisis, the country and its economy will recover swiftly, but there will still be a difficult period ahead. The ultimate outcome of the pandemic will rely on future medical advancements and the behavior of individual Americans in the meantime. If we take strict precautions to safeguard ourselves and our families, more of us will survive." If we fail to recognize the seriousness of the virus, it will affect us. The number of deaths from COVID-19 in the US may be higher than what the White House is reporting. The virus has been responsible for more than 1,800 deaths daily since April 7, surpassing the daily death toll from heart disease and cancer. The coronavirus curves in New York, the epicenter of the epidemic, are leveling off with fewer hospital admissions and COVID-19 patients in intensive care units. Although the daily death toll remains high, it is no longer increasing. The epidemiological model from the University of Washington's Institute for Health Metrics and Evaluation, often mentioned by the White House, initially forecasted 100,000 to 240,000 deaths by midsummer but now predicts 60,000. New York was observed from Weehawken, NJ on April 16, 2020, according to The New York Times. This development is positive, but it conceals certain important issues. The institute's forecast extends until August 4, focusing solely on the initial wave of the epidemic. It is anticipated that without a vaccine, the virus will continue to spread for years, leading to an increase in the number of deaths over time. The progress made so far in battling the coronavirus was only possible by implementing strict shutdown measures, which cannot continue indefinitely. The White House's plan for reopening in phases will likely result in an increase in the death toll, no matter how cautiously it is implemented. The best-case scenario is minimizing the number of fatalities. Long-term projections from reputable sources suggest a grim outlook, with estimates varying on how many Americans may ultimately die from the virus. Experts consulted by the CDC in March predicted that the virus could potentially infect 48% to 65% of the population with a fatality rate just under 1%, resulting in up to 1.7 million deaths if no action is taken to stop its spread. Researchers at Imperial College London created a model that was referenced by the president on March 30, predicting 2.2 million deaths in the US by September under similar circumstances. This is significantly higher than the number of Americans who died in World War II. The data from China is also concerning, with the epidemic being temporarily halted and a fatality rate of over 5% among reported cases. The Trump administration has raised doubts about the statistics but has not provided more accurate information. The fatality rates are influenced by how overwhelmed hospitals become and the percentage of cases that are tested. A report from the Centre for Evidence-Based Medicine showed that China's death rate was 17% in early January during the chaos in Wuhan, but decreased to 0.7% by late February. Hospitals in cities like New York faced near chaos. Authorities in Wuhan and New York had to adjust their death tolls upwards last week after realizing that many individuals had died at home from COVID-19, strokes, heart attacks, or other causes due to a lack of ambulance services. During fast-moving epidemics, hospitals are overwhelmed with victims who may not be tested, while those with mild symptoms or who are asymptomatic are often not tested at all. This leads to a distorted fatality rate for the virus. Knowing the true number of infected individuals is crucial in determining the true lethality of a virus. In order to understand the extent of silent carriers in the US, tens of thousands of antibody tests need to be conducted. The CDC has estimated that it could be as high as 25% of those who test positive. Researchers in Iceland suggested that the number of asymptomatic cases may be twice as high as previously estimated. A health worker in New York is seen checking her personal protective equipment in Central Park on April 16, 2020. The New York Times reported that China is also reevaluating its own estimates, as a recent study found that only 1% of cases in Wuhan were asymptomatic, while new research suggests that the actual number may be closer to 60%. Our lack of understanding in certain areas of knowledge is significant enough to cause experts in epidemiology to feel overwhelmed. Dr. Anthony S Fauci, the science adviser to the White House coronavirus task force, has emphasized that all models are simply representations and can be altered based on new information. Interestingly, there is a possibility that the virus is evolving to produce milder symptoms. While in movies viruses tend to become more dangerous, in actuality they typically become less harmful as asymptomatic strains spread more easily. Even though the 1918 Spanish flu virus eventually transitioned into the seasonal H1N1 flu, the current virus's level of transmissibility and lethality remains unknown. However, 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 the process will be gradual. The exact percentage of Americans who have been infected is uncertain, with estimates ranging from 3% to 10%. It is probable that at least 300 million Americans are still susceptible to the virus. Epidemiologists agree that until a vaccine or other protective measure is developed, it is not safe for a large number of people to suddenly come out of hiding. If Americans do so, there may be a temporary calm for about three weeks before emergency rooms become overwhelmed again. Dr. Peter J Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, warns against assuming that a vaccine will quickly become available. Tomas Pueyo, in his popular article "Coronavirus: The Hammer and the Dance," accurately predicted the national lockdown and suggested a phased reopening of essential parts of the economy. Every epidemiological model anticipates a pattern similar to a dance, where the virus will continue to spread as more hosts become infected, leading to the need for lockdowns. This cycle of surges and declines in deaths is represented by curves that resemble shark teeth in the models. The models predict that surges will occur even with strict measures such as closed stadiums, churches, theatres, bars, and restaurants, quarantining travelers from abroad, and tightly restricting domestic travel to prevent reinfection of low-intensity areas by high-intensity ones. Experts suggest that 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, similar to practices in Asia. Even the guidelines outlined in Trump's "Opening Up America Again" plan include three levels of social distancing and advise vulnerable individuals to remain secluded. The plan supports testing, isolation, and contact tracing, but does not address the funding or timeline for implementing these measures. Despite this, the president contradicted his own message by tweeting support for protesters in Michigan, Minnesota, and Virginia who were opposing 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 comparison, the US has been more lenient, with Americans still able to travel domestically, drive freely, and gather in public spaces. Despite some restrictions in place, many people are still organizing gatherings for children, hosting backyard barbecues, and meeting others through dating apps. This has contributed to the US seeing as many as 30,000 new cases of infection each day. Schaffner emphasized the importance of people understanding that playing poker with bandannas is not safe. Despite taking strict measures, Asian countries have faced challenges in controlling the virus. China has closed all movie theatres due to approximately 100 new infections daily. Singapore has shut down schools and nonessential workplaces, while South Korea and Japan are also facing difficulties, with Japan declaring a state of emergency recently. Dr Thomas R Frieden's public health advocacy group, Resolve to Save Lives, has outlined strict criteria for reopening and closing the economy. Reopening requires a 14-day decline in cases, tracing 90% of contacts, no health care worker infections, and other challenging goals. Frieden emphasizes the need to gradually reopen the economy and work towards achieving these goals to ensure a safer future. Immunity to the virus may create a societal divide between those who have recovered and are presumed immune, and those who are still vulnerable. Dr David Nabarro, a special envoy on COVID-19 for the World Health Organisation, anticipates a frightening divide in society. Those who have antibodies will have the privilege of traveling and working, while others will face discrimination. Individuals with presumed immunity are already in high demand, being asked to donate blood for antibodies and undertake risky medical tasks without fear. The government will soon need to develop a method to verify true immunity, with a test for IgG antibodies being a logical choice according to Dr Daniel R Lucey, a pandemics expert at Georgetown Law School. Numerous companies are currently working on developing such tests. Fauci mentioned that the White House was considering implementing certificates similar to those in Germany. China utilizes QR codes on cellphones that are linked 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 they tested negative for HIV within the last 14 days, and producers can verify this on a secure website. Experts believe that as Americans in lockdown watch their immune neighbors return to normal life and potentially reclaim lost jobs, there may be a strong temptation to purposely infect themselves. Younger individuals, especially, may weigh the risk of a serious illness against the possibility of 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 support the economy. This approach has been seen before, as Cuba controlled its small AIDS outbreak in the 1980s by forcibly isolating those who tested positive in camps that provided various amenities and services. Dr. Jorge Pérez Ávila, an AIDS specialist often compared to Fauci in Cuba, revealed that many homeless youths in Cuba intentionally infected themselves through risky behaviors before antiretroviral therapy was available, resulting in numerous deaths. This risky behavior could also pose a threat to American youth, as even healthy individuals have succumbed to COVID-19. Adequate resources are crucial in controlling the virus. According to experts, the next two years will be characterized by periods of progress followed by setbacks. As more individuals with immunity return to work, the economy will gradually improve. However, if a large number of people become infected simultaneously, new lockdowns may be necessary. To prevent this scenario, widespread testing will be crucial. Dr. Fauci has emphasized the importance of letting the virus guide decisions on when it is safe to resume normal activities. He is suggesting that once a sufficient number of daily tests are conducted nationwide, any increase in the percentage of positive results can indicate the spread of the virus. Monitoring rising fevers using 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 cases, must be isolated. Patients in this country who receive a positive test result are instructed to remain at home but avoid contact with their families. The media has been showing examples of well-known individuals, such as CNN's Chris Cuomo, recovering alone in their homes. However, Cuomo's situation highlighted the reasons why the WHO is against home isolation. Dr. Bruce Aylward, who headed the WHO observer team in China, emphasized the importance of quickly isolating all cases if he had to choose only one intervention. In China, individuals who tested positive for the virus, regardless of how mild their symptoms were, were mandated to go to a hospital set up in a gymnasium or community center with oxygen tanks and CT scanners. Nurses monitored their recovery, reducing the risk to their families and providing comfort by being with others in similar situations. Nurses also organized activities like dance and exercise classes to boost morale and aid in clearing the lungs and maintaining muscle tone. Despite these efforts, experts had differing opinions on the effectiveness of these specialized wards. Fineberg and Lipsitch had differing views on the idea of mandatory quarantine processes, with Fineberg advocating for them and Lipsitch expressing distrust in the government's ability to enforce such measures. In order to effectively suppress a virus, it is crucial to test all contacts of known cases, but the US is currently lacking in this area. In China's Sichuan province, for instance, each known case had an average of 45 contacts. The CDC has around 600 contact tracers, while state and local health departments have employed about 1,600, primarily for tracing syphilis and tuberculosis cases. China recruited and educated 9,000 individuals solely in Wuhan. Frieden has predicted that the United States will require a minimum of 300,000. A vaccine is not expected to be available in the near future. Despite the fact that initial human trials for three potential vaccines have commenced, with two in the US and one in China, Fauci has consistently stated that developing a vaccine will take at least a year to 18 months. Experts in vaccine production all concur that even this timeline is overly optimistic. Dr. Paul Offit, a vaccinologist at the Children's Hospital of Philadelphia, mentioned that the current record for vaccine development is four years, specifically for the mumps vaccine. There is a disagreement among researchers on how to accelerate the process. With the use of modern biotechnology techniques such as RNA or DNA platforms, it is now possible to create candidate vaccines more quickly than ever. 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 actually makes recipients more vulnerable to infection rather than offering protection. In the past, vaccines for HIV and dengue have both unexpectedly behaved similarly. Typically, a new vaccine is initially tested on fewer than 100 young, healthy individuals. If it proves to be safe and generates antibodies, thousands more volunteers, usually front-line workers at high risk, will participate in a Phase 3 trial where they will receive either the vaccine or a placebo. In order to accelerate this process, "challenge trials" can be conducted. In these trials, a small group of volunteers are vaccinated, monitored until they 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 with no cure, like COVID-19. However, some experts believe that in the current situation, it may be more ethical to conduct challenge trials on a small number of people at high risk in order to obtain results quickly, rather than leaving millions of people at risk for an extended period of time. Marc Lipsitch, who has advocated for challenge trials in the Journal of Infectious Diseases, pointed out that fewer people would be harmed in a challenge trial involving a few individuals compared to a Phase 3 trial involving thousands. While some volunteers have expressed interest in participating, others find the idea unsettling. Lucey expressed that while he finds it unethical, he can see the potential for challenge trials. Vaccinologists warned that challenge trials may not recruit enough volunteers to accurately assess if a vaccine causes enhancement, a rare but dangerous issue. Osterholm emphasized that challenge trials may not provide definitive answers on safety, potentially posing a significant risk. Lipkin proposed an alternative approach of testing at least two vaccine candidates in humans before conducting challenge trials in monkeys. Experts recommend starting production of the winning vaccine immediately, while also expanding human testing to identify any potential issues. Developing a vaccine is challenging, but producing hundreds of millions of doses is even more difficult. American vaccine plants typically only produce 5 to 10 million doses per year, primarily for newborns and elderly individuals. However, if a vaccine is successfully developed, the US may need 300 million doses, or 600 million if two doses are required, along with a corresponding number of syringes. Douglas emphasized the need for people to think on a larger scale and increase production volume. He noted that current flu vaccine plants that use chicken eggs are not ideal for modern vaccines, which are grown in cell broths. While European countries have vaccine plants, they may prioritize their own citizens. China has a thriving vaccine industry and is poised to potentially ramp up production in the near future. Experts suggest that China could even produce vaccines for the US. However, customers who are unable to choose where to purchase their products must accept the seller's asking price, even though the safety and effectiveness standards of certain Chinese companies may be flawed. India and Brazil also possess significant vaccine industries. If the virus spreads rapidly through their densely populated areas, they may suffer the loss of millions of citizens but achieve widespread herd immunity before the United States. In such a scenario, they could potentially have excess vaccine production capacity. Another option, as proposed by Arthur M Silverstein, a retired medical historian at the Johns Hopkins School of Medicine, is for the government to take control of and repurpose existing liquor or beer plants, which have large fermentation vats. He mentioned that any distillery could potentially be changed. It is expected that treatments will be developed before vaccines. In the near future, specialists were more hopeful about treatments than vaccines. Some believed that convalescent serum could be effective. This traditional method has been utilized for more than a hundred years: Blood is taken from individuals who have recuperated from a disease, then filtered to eliminate everything except the antibodies. The immunoglobulin, which is rich in antibodies, is administered to patients through injections. A challenge now is that there are fewer survivors from whom blood can be collected. Before vaccines were available, antibodies were obtained from horses and sheep, but this method was difficult to maintain sterility and could sometimes cause allergic reactions due to animal proteins. The current solution is the use of monoclonal antibodies. According to experts, these treatment plans, which recently showed promise in controlling the Ebola outbreak in eastern Congo, are considered to be the most likely immediate solution. The process involves selecting the most effective antibodies and inserting the genes responsible for producing them into a harmless virus that can replicate in a cell culture. However, like vaccines, the production and purification of monoclonal antibodies is time-consuming. With sufficient production, these antibodies could potentially be used not only to save lives but also to protect healthcare workers. The longevity of antibodies varies depending on multiple factors, but they typically remain effective for weeks before degrading. It is important to note that antibodies cannot eliminate viruses that are already hidden inside cells. A daily preventive pill would be a more efficient solution than vaccines or antibodies because pills can be manufactured more quickly in factories. However, even if a pill was created, production would need to increase until it was widely available for 300 million Americans. Trump has repeatedly mentioned hydroxychloroquine and azithromycin, making his news conferences seem like infomercials. 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 studies on hydroxychloroquine 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 preventative HIV drug. Dr. Luciana Borio strongly criticized Trump's suggestion of combining chloroquine with azithromycin as "total nonsense." I informed my family that if I were to contract COVID-19, they should not give me a certain combination of medications. Some doctors believe that Chloroquine could potentially protect hospitalized patients with pneumonia from dangerous cytokine storms by suppressing immune reactions. However, this does not mean it is effective for preventing infections, as President Trump has suggested, since it does not have antiviral properties. Various antiviral drugs, such as remdesivir, favipiravir, and baloxavir, are currently being tested against the coronavirus, with trials in China expected to release results next month. The outcomes of these trials may be inconclusive due to a shortage of patients available for testing. End dates for most trials in the US have not been determined yet. Farewell to the 'America First' ideology as unprecedented societal changes have occurred. Schools and businesses have shut down nationwide, millions have filed for unemployment, taxes and mortgage payments are postponed, and foreclosures are prohibited. Refrigerated trucks are being used as morgues in New York. Stimulus checks have started being distributed to help with the crisis, turning much of America into a temporary welfare state. Food banks are being established nationwide, leading to long lines of people in need. In New York, refrigerated trucks are being used as mobile morgues. The current public health crisis necessitates global cooperation on a level not seen in years. However, President Trump is working to cut funding for the WHO, the only organization equipped to coordinate such a response. Additionally, his ongoing conflicts with China, now the world's leading economy, could potentially impact the supply of essential drugs and vaccines. China has taken advantage of the pandemic to increase its influence globally by providing medical supplies to nearly 120 countries, including the US through Project Airbridge overseen by Jared Kushner. Experts suggest that in the current world, an "America First" strategy may not be effective, and instead recommend collaboration with China to improve public health efforts. Nicholas Mulder, an economic historian at Cornell University, has compared Kushner's project to the reverse of the Lend-Lease program during World War II. Osterholm was more straightforward in his statement, expressing concern that if we upset the Chinese with our words, it could have negative consequences. He pointed out the possibility that China may develop the first vaccine and have the power to choose who to sell it to. This raises the question of whether or not we would be a priority as a potential buyer. After the pandemic is over, the country's recovery may happen quickly, as it did after the world wars. However, it will be more challenging to measure the psychological impact of the crisis. Prolonged isolation and economic hardship could lead to an increase in domestic violence, mental health issues, and suicide rates. Additionally, there may be changes in political opinions. At first, the virus primarily affected Democratic cities such as Seattle, New York, and Detroit. However, as it continues to spread across the country, it will impact everyone. Even voters in Republican-leaning states who do not currently 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 presented in his subsequent article, "Coronavirus: Out of Many, One," Pueyo examined Medicare and census data regarding age and obesity in states that have been resistant to shutdowns and counties that supported Republicans in the 2016 election. He determined that these voters could have a 30% higher risk of dying from the virus. In the aftermath of both wars, Mulder observed that society and incomes became more equal. Programs established for veterans' and widows' pensions created social safety nets, initiatives such as the GI Bill and VA home loans were implemented, unions gained strength, and tax advantages for the wealthy declined. Experts suggest that if a vaccine proves effective in saving lives, many Americans may become more trusting of traditional medicine and more open to scientific advancements, including in the realm of climate change. The clear skies seen over American cities during the lockdown period could potentially become a lasting feature.