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A year into COVID-19, experts share what 'normal' could look like amid vaccines and variants?

In Austin, Gov. Greg Abbott issues a disaster declaration for Texas on March 13, 2020, in response to the growing threat of the coronavirus.

One year ago on March 13, Austin had its first three cases of COVID-19. Texas had 39 cases. The University of Texas and Austin Independent School District canceled classes. Gov. Greg Abbott issued a disaster declaration for all 254 counties. President Donald Trump declared the pandemic a national emergency. 

It's been a long year of wearing masks, washing hands and being physically distanced from friends and family.

"I know everyone is exhausted," says Dr. Robin Watson, the chief medical officer for Baylor Scott & White in the Austin and Hill Country region. "We've got to stay vigilant." 

When will this pandemic end? When will we be able to go back to "normal" and what will "normal" look like? 

Toby Hatton, a nurse who leads Ascension Texas' Infectious Disease Response Unit, knew when he started tracking a mysterious coronavirus in China, around December 2019 and January 2020, that it would be a minimum of 18 months of fighting this disease. "That puts us into June, July, August," he says.

Katie Connaghan looks out the window of her home near Airport Boulevard on March 23, 2020. She had been social distancing in her home with her boyfriend and parents since city officials ordered all residents to stay at home in order to mitigate the spread of the coronavirus. "I'm finding that life on lockdown is different because I'm surrounded by people now more than ever," Connaghan said. She tries to find alone time. "When I can't find that recovery time, I find myself digging deeper than I ever have before to be patient, and to be kind and to be empathetic while we all adjust to the new normal."

Bring on the herd immunity

This disease has been so hard to fight because it was new and no one had immunity to it, says Dr. Matthew Robinson, an infectious disease specialist at St. David's South Austin Medical Center.

In order to go back to a life that more closely resembles time before March 2020, we have to reach herd immunity. That happens when enough people have immunity so that the virus is no longer spreading heavily throughout the community and the virus has no fuel to create new variants. 

Herd immunity happens either through vaccinations or through infection, and through infection is the dangerous way, Watson says.

Really bad viruses don't usually get brought under control through treatments. "You handle most viruses through vaccinations," says Dr. Jordan Weingarten, who works in the intensive care unit at Seton Medical Center. "Polio went away, not because we learned how to treat it, but because we have vaccines." The same is true for measles, smallpox and chickenpox. 

"We need to get vaccinated to get back to pre-pandemic life," Watson says. "It allows us the freedoms that we all want."

Knowing that 15 percent of the population will never get a vaccine, based on surveys he's seen, Watson is looking at getting 60 percent to 70 percent of the population vaccinated before we can ease up on restrictions, he says. With about 8.5 percent of Texans fully vaccinated, we're not close to herd immunity yet. Robinson says we've already seen case numbers trending down here, most importantly in hospitalizations and even deaths, because of vaccinations as well as the number of people who have some immunity because of having had the virus.

He says if the trends continue, herd immunity will be reached sometime later this year. At that point, Robinson says, he will be more confident about our ability to gather without everyone masking, but with some people still choosing to mask because of they are more vulnerable or more comfortable wearing a mask. 

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Out vaccinating the variants

Variants, though, could prevent herd immunity.

As long as the virus is circulating, there is a pressure for it to infect more people and to mutate, says Darlene Bhavnani, an infectious disease epidemiologist at Dell Medical School at the University of Texas.

We need to get more people fully vaccinated or at least to have one dose to prevent more mutations or the vaccine becoming less effective. "We need to do this quickly," she says. March, April and May will be key months. 

Current vaccines still provide immunity to the variants, though it is decreased. "We haven't seen that strain yet that will break through" the vaccine, says Dr. Brian Metzger, an infectious disease specialist at St. David's Medical Center. 

The vaccine formulas might need to be tweaked or changed to control for variants. We also might learn from vaccine study participants, who are only three-to-six months ahead of the rest of the population, that the amount of immunity we have from vaccines wanes.

Then we'll need a booster. "It's quite possible that every year, we get a coronavirus shot and a flu shot," Hatton says. 

Tweaks or a booster shot won't take as much time to develop, test or get into arms. Metzger estimates six weeks instead of months. 

It's also possible that as people develop immunity either through infection or vaccination, this coronavirus becomes "like the common cold, where were know it exists and it doesn't cause devastation," Watson says.

Dr. Jordan Weingarten, who works in the intensive care unit at Seton Medical Center, says he believes that in a few years COVID-19 will be like a bad flu, with the occasional patient, "rather than a whole ICU full of it," he says. "I'd like to turn COVID into another respiratory illness. I think we'll get there, but that's not going to happen if we don't mask."

And if we don't vaccinate, he says. "Get vaccinated at the earliest opportunity," he says.

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Vaccines are coming

Hatton says he knows that people want restrictions to end now, and they want to get vaccinated now. They are frustrated that they can't get an appointment right now. "I know these people personally," he says. "They are my family members, my friends." He tells them, "Hang in there."

He helps organize the mass vaccine clinic at the Circuit of the Americas and he has seen a change even in the last month. "The amount of vaccines coming to us has exponentially grown," he says. It started as 600 vaccines, then 2,000, then 4,000. Last weekend, they had 10,000 vaccines. This weekend they'll have 14,000, he says. 

"We've got to keep up hope," Hatton says.

Every time he runs a vaccination clinic, "it's a party, it's a celebration," he says. "We have people coming through that haven't left the house in a year. It was the first time they got in the car for a year. There are tears the whole time." 

The Johnson & Johnson vaccine is changing things on the ground because more vaccines are available and it's easier at the mass clinics to pull each dose, lessening the time it takes per person to vaccinate. Plus, it's one dose, which means there's no time spent trying to get people scheduled for their next dose. 

Hatton wants people to stop worrying about the difference in the efficacy rates between the three vaccines. Moderna and Pfizer both showed a 95 percent efficacy rate in preventing disease. Johnson & Johnson showed a 66 percent efficacy rate in preventing disease, but there is a big  caveat with that. Moderna and Pfizer were tested from August through October, when the disease in the population was low and variants were not yet circulating here. Johnson & Johnson was tested in the late fall and winter when there was more disease and variants, Metzger says.

With all three, "The likelihood that you'll survive, that you'll get over it, it's 100 percent," Hatton says. "Not dying is what really should matter."

The fastest way to get back to "normal" is to get vaccinated with any shot offered, when it is offered to you. In Texas, beginning next week anyone 50 and older can get vaccinated as well as health care workers, teachers, pregnant women and anyone 16 and older with pre-existing conditions or who are obese.

As more and more people get the vaccine, more and more groups of people will be added to this list. The FDA has approved the Pfizer vaccine for ages 16 and older; Moderna and Johnson & Johnson are approved for 18 and older. 

Metzger expects that by May the FDA will have approved at least one vaccine for ages 12 to 15, followed by children 5 to 11, possibly by late summer or fall. The studies for that group have not yet begun but are expected soon. 

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Don't put away the masks, yet

The one factor that no one can predict is "individual behaviors," Bhavnani says. That means following guidelines.

This week, the Centers for Disease Control and Prevention released new guidelines about who can socialize without wearing masks. Two houses of fully vaccinated people or one household fully vaccinated with another household who is not vaccinated but is in a low-risk category do not have to wear masks when together, according to the new guidelines. Everyone else needs to continue to wear masks, stay 6 feet apart, be in well-ventilated areas and wash their hands. 

"We can start doing something, although it's not everything," Bhavnani says. 

Right now, doctors' biggest worry is spring break. Austin has seen big surges of cases come two weeks after Memorial Day, Fourth of July, Halloween, Thanksgiving, Christmas and New Year's. 

Hemline Austin employee Farrah Graham, standing right, helps customer Katherine Kemin, left, of Kansas City on March 10, 2021. The statewide mask mandate was lifted by Texas Gov. Greg Abbott this month. Austin and Travis County still have mandates in place.

Those holidays taught us that even small group gatherings create spread. 

"It's like a roller coaster," Bhavnani says. "Every time we start pumping the brakes, I breathe a sigh of relief. Every time we let up, we start accelerating, I get a little scared. The variants are scary." 

Watson worries that people are going to stop doing the things we know work. "We've already lost over 500,000 people," he says. "It could go as high as 1 million if we start relaxing." 

Masks will be the normal throughout this year and even into next year. "This summer, as long as the variants behave themselves, we will be able to get together and have larger groups," says Metzger, but that will be with wearing masks. 

Austin residents have done a good job this year wearing masks and staying socially distanced compared with other cities, Metzger says, which is why our surges have not been as bad. We have to continue to do that. 

Bhavnani is making her own plans for fall, but she says, even then, "I don't think we're going to get back to pre-COVID normal life." 

The "new normal is going to look a little different," she says. She believes we'll start to have more in-person activities while still wearing masks.  

"We're going to need to be smart and take baby steps and watch the rates of infection and what's going on around us," Bhavnani says. "As long as we're smart about this, grandparents might see a grandchild." 

Once we have a vaccinated population, we could get to a point where we can have concerts and outdoor sporting events again, Watson says, but "masking might be part of the future for a certain part of the population." 

"There will be a lot of hugging, a lot of vacation, a lot of travel once everything calms down," Hatton says. 

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A future after coronavirus

Coronavirus will change how we deal with illnesses, Bhavnani says.

"It will be a while before it's off our radar," she says. 

Many communities around the world have made it the practice to wear masks during cold and flu season or for people who are sick. "I think it will no longer be acceptable for someone to have sniffles and be in the same room," she says.

Employers will be happier to have people working from home when they are not feeling well. She says she believes we'll have at-home testing available so people can make sure they're not infectious before going out. 

Coronavirus also taught important lessons about disparities in health care equityand the importance of putting money into public health, she says.

Juan Tenorio and his daughters, Abagail, 20, and Isabel, 18, walk past a sign encouraging mask wearing on March 9, 2021, at the Austin Motel, the day before the statewide mask mandate was to end and Texas was to open at 100 percent.

It also taught us what happens when we put off preventative care.

Watson says he believes that even when his hospitals' COVID-19 numbers decrease, they will still be full. This time it will be with patients who delayed care because of fear of the virus. Hospitals across Central Texas are starting to see patients coming in with heart disease, strokes, cancer and diabetes who are far more sick than before the pandemic. 

He wants people to get vaccinated, yes, but to also stay connected with their doctors and get preventative care. "We don't want to lose the ground we gained over the past decade," Watson says. 

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Pandemic anniversary updates

American-Statesman reporter Katie Hall will interview Austin Public Health officials at 9:30 a.m. Saturday to talk more about the anniversary of the coronavirus pandemic in Travis County. Check Statesman.com throughout the day Saturday for updates on coronavirus case trends and the status of vaccination efforts.