How 700 epidemiologists are living now, and what they think is next

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Even with coronavirus vaccines on the way, many epidemiologists do not expect their lives to return to pre-pandemic normal until most Americans are vaccinated. In the meantime, most have eased up on some precautions — now going to the grocery store or seeing friends outdoors, for example — but are as cautious as ever about many activities of daily life.

In a new informal survey of 700 epidemiologists by The New York Times, half said they would not change their personal behavior until at least 70% of the population was vaccinated. Thirty percent said they would make some changes once they were vaccinated themselves.

A minority of the epidemiologists said that if highly effective vaccines were widely distributed, it would be safe for Americans to begin living more freely this summer.

"I am optimistic that the encouraging vaccine results mean we'll be back on track by or during summer 2021," said Kelly Strutz, an assistant professor at Michigan State University.

But most said that even with vaccines, it would probably take a year or more for many activities to safely restart and that some parts of their lives may never return to the way they were.

Karin Michels, professor of epidemiology at UCLA, said it would probably be many years until it was safe enough to "return to approximately the lifestyle we had." She said, "We have to settle to live with the virus."

Epidemiologists are worried about many unknowns, including how long immunity lasts; how the virus may mutate; the challenges of vaccine distribution; and the possible reluctance to accept the vaccine among some groups.

On the eve of the Covid winter, the epidemiologists are living with stringent precautions and new workarounds in place, far stricter than those of many ordinary Americans. Yet those precautions have evolved since the spring, as scientists have learned more about how the coronavirus spreads and what prevents it.

Of 23 activities of daily life that the survey asked about, there were only three that the majority of respondents had done in the past month: gathering outdoors with friends; bringing in mail without precautions; and running errands, like going to the grocery store or pharmacy.

The epidemiologists have almost entirely avoided other parts of pre-pandemic life — including activities that many Americans are doing now. Almost none said they had attended a sporting event, play or concert; met up with someone they didn't know well; or attended a wedding or funeral.

"Being in close proximity to people I don't know will always feel less safe than it used to," said Ellicott Matthay, a postdoctoral scholar at the University of California, San Francisco.

Three-quarters of respondents said they planned to spend Christmas, Hanukkah or other winter holidays only with members of their household, or not celebrate at all, similar to how they spent Thanksgiving.

When asked about the safest and riskiest activities on the list, most epidemiologists agreed on these general principles: They are less worried about outdoor activities and about touching surfaces, and more worried about indoor activities and those with large groups. But even the epidemiologists didn't all agree on their assessment of risk.

"Indoor venues with lots of people is the riskiest situation," said Leland Ackerson of the University of Massachusetts. "Outdoors with few people, social distancing and precautions is the least risky." He said that during the past month, he had hiked with friends, opened mail without precautions and run errands.

Six months ago, we asked a similar group of epidemiologists about when life might go back to normal. Most then guessed that people would need to wait a year or more for many aspects of daily life to normalise. This time, as the spread of the virus has worsened but the treatments have improved, we focused our questions on how they have been living in the thick of the pandemic.

"It's funny: When you asked this before, I was so optimistic about the U.S. being able to lead and address this in a timely fashion," said Rachel Widome, associate professor at the University of Minnesota. "I told you I thought things would be better by now. I was very wrong. They are dramatically worse."

Most scientists say around 70% of the population will need to be immune for the United States to reach herd immunity, when the virus slows down significantly or stops. Herd immunity is crucial, they say, for people to safely resume many parts of life, and the fastest and safest way to achieve it is through vaccination. Moncef Slaoui, who is leading the government's Operation Warp Speed vaccine development program, said this week that vaccines may roll out quickly enough for the United States to reach herd immunity by early summer. But scientists do not yet know if vaccinated people could still spread the virus.

Nearly a third of respondents said they would be comfortable returning to more activities of daily life once they were vaccinated. Some said they would feel comfortable doing only certain things, like socialising with people who had also been vaccinated. A few said they would wait until the country had reached the herd immunity threshold and they had received a vaccine themselves.

"I would change some behaviours but not others," said Gabriela Vazquez Benitez, a senior research investigator at HealthPartners Institute, a nonprofit group. "I would do some minimal travel, small indoor gatherings with other close relatives when I am vaccinated, but maintain safety precautions such as wearing a mask and social distance."

Since the spring, 79% of the epidemiologists said that their assessment of various risks had changed and that they had adjusted their behaviours accordingly. Science is a process, they said, and the virus is new, so even those studying it most closely have learned things along the way.

Some said they were less worried than in the spring about socialising outdoors, touching surfaces or sending young children to school. They were more worried about indoor air transmission and the dangers of not wearing masks.

About 8,000 epidemiologists were invited to participate in our survey, which was circulated by email to the membership of the Society for Epidemiologic Research and to individual scientists, and which was conducted from Nov. 18 to Dec. 2. Of the 700 who participated, around three-quarters work in academia; a similar share is doing work that is at least partly related to the coronavirus.

Many epidemiologists expressed disappointment and frustration that public health messaging had not been more effective, and that a growing share of Americans seemed to distrust science. They feared that the politicisation of measures like wearing masks and staying home would have long-term consequences.

"This virus has humbled me as a professional and a person," said Michelle Odden, associate professor of epidemiology at Stanford. "I did not think this level of failure in a federal response was possible in the United States. We have a lot of work to do."

As for the future, some said that parts of life could begin to return to normal sometime in the summer, thanks to vaccines. Others said some things would stay different, assuming a highly effective therapeutic drug isn't developed. The most mentioned change: the persistence of mask-wearing, particularly in crowded places or when they felt sick.

"I think it will be a few years before gathering with large groups of people in crowded public places and being on airplanes and other public transportation will feel safe to me," said Beth Molnar, an associate professor at Northeastern University.

Others cautioned that even when the physical dangers of the pandemic recede, other consequences are likely to be long-lasting. They mentioned the effects of isolation on children's developing brains; the exposure of deep inequities in health care and in safety nets; and the fear and sadness of so much illness and death.

"Mental health care will continue to be essential," said Daniel Vader, a postdoctoral researcher at the University of Pennsylvania. "This is a traumatic time, and many of us will be affected by the worry and grief it has induced for the rest of our lives."

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What epidemiologists said about life after the vaccine:

What share of the population would need to be vaccinated before you changed your behavior?

"If more than half the population is vaccinated, I would feel a little less stressed and anxious when heading out to do errands I normally do. I might actually feel comfortable to eat in a restaurant or see friends again one day if this is possible." — Vijaya L. Seegulam, research project manager, Boston University

"Vaccinations have become a political issue in this country. I can only control my own actions. So once I was vaccinated, I would feel more comfortable changing my risk profile in small ways." — Michaela George, assistant professor, Dominican University of California

"Once I and my family are vaccinated, I would change behaviours, except I can't imagine being in a crowd or attending any crowded events until 80% or more are vaccinated." — Julie Bettinger, associate professor, University of British Columbia

How and when will life go back to normal?

"For some, it has gone back to normal, and because of this, it will be two to three years before things are back to normal for the cautious, at least in the U.S." — Cathryn Bock, associate professor, Wayne State University

"The new normal will be continued masking for the next 12 to 18 months and possibly the next few years. This is a paradigm shift." — Roberta Bruhn, co-director, Vitalant Research Institute

"I think widespread availability of vaccines will result in the further relaxation of most precautions by mid-to-late summer 2021." — Michael Webster-Clark, postdoctoral researcher, University of North Carolina at Chapel Hill

"It's hard for me to imagine that it will ever go back to our previous 'normal,' but I do think that new preventive measures that we've had to adopt, like masks, will feel normal in time. In that sense, I'm optimistic that life will settle into a new kind of normal." — Marilyn Tseng, assistant professor, Cal Poly

"It is normal now; similar to 2019, never again." — Vasily Vlassov, professor, HSE University, Moscow

What will never return to normal?

"My relationships with people who have taken this pandemic lightly and ignored public health messages and recommendations." — Victoria Holt, professor emeritus, University of Washington

"Every part of my daily life that involves interaction with anyone other than my spouse." — Charles Poole, associate professor, University of North Carolina

"Staying home with my children has taught me that life with fewer errands to run and activities to partake in is kind of nice. I think in the future we will cut down on our family obligations." — Jennifer Nuzzo, associate professor, Johns Hopkins

"I won't take traveling to my extended family for granted." — Alicia Allen, assistant professor, University of Arizona

"I will never again have to explain what an epidemiologist is." — Janet Rich-Edwards, associate professor, Harvard

Written by: Margot Sanger-Katz, Claire Cain Miller and Quoctrung Bui
© 2020 THE NEW YORK TIMES