2020 is over (Hallelujah!). COVID-19 is not (Ugh!). What to expect in the coming months

Jan. 1—The joy of watching 2020 mercifully come to an end is tempered by the knowledge that our battle with COVID-19 isn't over yet — not by a long shot.

The vast majority of us haven't been vaccinated, and won't be for several months at least. Kids still aren't in school full time statewide. Social activities are being canceled or altered beyond recognition. Boise State athletes are still playing in empty venues. Gatherings are limited to 10 people, with little chance to progress in the Idaho Rebounds plan anytime soon.

Life is decidedly not back to normal — and we can't blame it all on 2020 anymore. The recommendations to wear a mask (mandated in Ada County), practice social distancing of at least 6 feet, maintain good hand hygiene and stay home when sick will be with us for at least the first half of 2021.

So what will Idaho look like as 2021 begins? A lot like the end of 2020, but with at least one reason for optimism — there's a vaccine on the way and a rough timeline for when you can get one.

"As much as we want to turn the page on COVID and on 2020 — certainly we can be excited about entering into a new year — things aren't going to miraculously change," said Dr. Rob Cavagnol, a general surgeon and the executive medical director for the St. Luke's Clinic, which includes all of the providers in the St. Luke's Health System. "So we have to continue to remain vigilant with the efforts that are in place as far as masking, social distancing, hand washing, avoiding large crowds — all those things."

Here's what to expect over the next five months:

January: Back to school (sort of)

Idaho enters the new year riding a wave of positive trends after a scary surge from Halloween through Thanksgiving. Daily new case reports have dropped roughly 50% in the past three weeks, test positivity has decreased by a significant margin over the same period (19% to 13.2%) and hospitalizations and ICU cases tied to COVID-19 are declining.

Still, numbers that pass for good news now would have been dreaded on Oct. 1. And January brings a major uptick in community activity when school resumes.

Most notably, the Boise School District plans to return to a hybrid learning model Jan. 19 with students in class twice a week. The district resumes school Jan. 11 with one more remote-only week. Boise hasn't had in-person classes since Nov. 20 — the last day before Thanksgiving break.

The West Ada School District — the state's largest — resumes school Jan. 4. Kindergarten through fifth graders are scheduled to be in class daily with sixth through 12th graders attending on alternate days, a continuation from December.

The connection between schools and community spread has been challenging to decipher, particularly with health districts falling way behind on contact tracing. However, the Idaho Department of Health and Welfare reported 8,352 cases in children 5 to 17 years old from Oct. 16 through Dec. 31.

It had reported just 4,398 before that.

"We'll be monitoring that closely," said Russ Duke, the director of Boise-based Central District Health. "The one thing I have to share is that all my interactions and all my team's interactions with our schools and university, they're doing a great job. They really are working hard at this. ... But they're gatherings, for sure. And that's how the disease is transmitted."

Boise State will be back in session beginning Jan. 11. The university reported at least 40 new COVID-19 cases in its campus community every week from Sept. 10 to Dec. 10, with a high of 121 the week of Nov. 19. Most cases involved off-campus students.

The revived school activity comes in the same month when we'll learn whether there was an uptick in cases created by Christmas and New Year's celebrations.

"So thankful that the message was received about Thanksgiving," Cavagnol said. "... We didn't really see the surge that we had all really been worried about."

February: Hope for the vulnerable, possible virus collision

The second stage in Idaho's vaccine distribution plan tentatively arrives in February. The group eligible for vaccinations in that wave includes about 330,000 people, according to The Associated Press, including firefighters, police officers, schoolteachers, corrections workers, members of the Idaho National Guard, food processing workers and workers at grocery stores and convenience stores — plus people 75 and older.

That last group could be critical in limiting deaths. Of the 1,438 Idahoans who have died in connection with COVID-19, 52.3% have been 80 or older. Another 27.7% have been in their 70s.

Residents of long-term care facilities were included in the first phase of the vaccine rollout that began in December, along with many health care workers. Long-term care facilities have accounted for 39.3% of Idaho's COVID-19-related deaths, so Idaho could see a downturn in deaths early in 2021.

Through Thursday, the case fatality rate was 1%.

"It's going to be huge," Cavagnol said of vaccinating older residents. "That's the most vulnerable population — the long-term care facilities and the older population, especially folks with comorbidities."

For CDH, about one of six people 80 or older who contract COVID-19 die from it, Duke said. That drops to about one in 20 among those in their 70s.

"That's going to be the game-changer," Duke said. "... I'm very much looking forward to that time, and hopefully the vaccine will come in at a good pace and will meet these timeframes."

The vaccine won't, however, single-handedly prevent the state from enduring another COVID-19 surge. Since the pandemic reached Idaho in March, we've seen a string of peaks (April, July, October-November) and dips (May-June, August-September, late December) in Idaho's caseload. Each time the caseload slipped, it came back at a higher level than before.

On top of Christmas and New Year's, there's a three-day weekend in January (Martin Luther King Jr. Day), the Super Bowl on Feb. 7 and another three-day weekend in February (Presidents Day) that could fuel another surge.

"The other part of that is, we're still indoors," Duke said. "It's not until mid-, late March where we start being able to spend a lot more time outside, so it's kind of that combination of getting together and larger groups and being indoors for extended periods of time that inevitably will cause problems for us if we don't take all the precautions that everyone knows by now they need to be doing."

February is right at the heart of flu season, too. Influenza activity has been minimal in Idaho so far, according to the Centers for Disease Control and Prevention. "Flu activity peaks between December and February," the CDC says, and can last into May.

There is hopeful data out of the southern hemisphere indicating that COVID-19 precautions may lead to a milder flu season, Duke said.

"The interesting thing is that all of the measures that we're taking from a public health standpoint are also effective against flu," Cavagnol said. "Washing hands, wearing a mask, social distancing — all those things are going to probably have a significant reduction in our incidence of flu cases. That's going to be a good thing for us.

"Hopefully people are not at the level where they're so fatigued that they can't continue to be smart and do things around the Super Bowl and other events that we've done for the last several months, which is just be smart about those indoor gatherings."

March: The spring break test, and an unwelcome anniversary

Idaho will mark the one-year anniversary of COVID-19 in the state on March 13 — right about the time schools let out for spring break.

Will people travel? Will they gather with friends and family?

At least two Idaho universities saw a potential problem with spring break and rearranged their schedules. Boise State students will get their break April 12-16 — instead of in March — and all classes will be delivered remotely after that. Idaho State's break is even later, April 26-30, with one week of remote instruction afterward. The University of Idaho has kept its traditional March break.

The Boise and West Ada school districts have spring break planned for March 22-26.

Last year, the state was beginning to shut down at spring break. The Boise and West Ada school districts didn't return to school after the break, and Gov. Brad Little issued his stay-home order March 25.

This year, more restrictions seem unlikely. At the height of the November-December surge, Central District Health was unable to pass a new health order that would have mandated masks in Boise and Elmore counties and taken some actions around higher-risk environments like bars and restaurants.

Now, Duke says, he doesn't expect to recommend any more restrictions to the Board of Health unless there is a region-wide impact on hospitals. Even when local health leaders said the Treasure Valley was on a path toward health care rationing within weeks, the Board of Health wouldn't implement more mandates.

April: A major vaccine expansion

The third priority group for the vaccine is scheduled for April — people 65 to 74 years old, anyone 16 to 64 who has a medical condition that puts them at increased risk of severe illness, and essential workers not covered by earlier stages. This covers more than one-quarter of Idaho's population (500,000 people, according to AP), the largest group yet.

Could in-person schooling increase? Could we ditch the 10-person gathering limit? Could Boise State football fans attend the annual spring scrimmage?

"Especially people in the high-risk groups, once we get them vaccinated," Duke said, "there's not going to be really a need to continue with the restrictions we have in place."

Idaho has a string of criteria it must meet to advance from the current modified Stage 2 of the Idaho Rebounds plan and back to Stage 3 (we reached Stage 4 last summer before stalling). Stage 3 allows for indoor gatherings up to 50 people and outdoor gatherings at 25% capacity. Stage 4 doesn't have a limit.

Perhaps the largest stumbling block is the number of COVID-19 patients in ICUs. Idaho needs to get below an average of 25 per day to advance. The average hasn't been that low since the first week of July — and it was over 100 during much of the recent surge.

The Idaho Department of Health and Welfare reported 85 ICU cases on Monday, the most recent data available.

May: Vaccines and graduations

Nearly half the state — 800,000 people, AP reported — becomes eligible for the vaccine in the final group, tentatively set for May. It's unclear how long it might take to vaccinate that many people, and the two vaccines given emergency authorization so far require two injections three (Pfizer) or four (Moderna) weeks apart.

That means mass vaccinations might be too late to save one of the rites of passage that was all but wiped out last spring: graduations. Schools did develop alternative graduations that could be used again, but a packed arena might not be possible this year, either.

"If we've been really effective in distributing the vaccine and we're seeing a lot of people willing to take the vaccine and its effectiveness, then it's in the realm of possibility that this thing starts to get under control by then," Cavagnol said. "It would be overly optimistic probably to say, 'Oh yeah, for sure we'll be able to have graduations like we're used to.' It might be the same drive-by graduations that we saw this past May."

Said Duke: "I could envision a scaled-back version of normal graduations. I would envision still wearing face coverings because that's what the current recommendation is even if you do get vaccinated, and probably limiting the number of people who attend. But I would envision it looking a lot more normal than not at all or drive-through graduations that we saw."

Vaccines also won't rid us of the pandemic's three keys: masks, physical distancing and hand washing. The current thinking is that vaccinated people still can contract or carry the virus and spread it, Cavagnol said. The vaccine is expected to prevent recipients from developing significant illness.

"I hope that that message really penetrates with people," Cavagnol said, "because I could see where someone might assume that, 'Hey, I've been vaccinated, I'm good, I don't need to mask anymore.' And that's just not the case."

And it's still a long road to herd immunity. Only about 8% of Idahoans have had a confirmed or probable case of COVID-19 (more certainly have contracted the virus without confirmation, health experts say).

It could take more than 80% of people to build resistance to the virus through vaccines or infection to achieve herd immunity and stop the spread, Dr. Anthony Fauci said recently, according to The New York Times. Fauci is the director of the National Institute of Allergy and Infectious Diseases.

That makes it almost certain that COVID-19 will affect our daily lives into the summer of 2021 — and perhaps beyond.

Cavagnol said he's "pretty confident" we'll be back to something close to normalcy by fall — with schools full of children and football stadiums welcoming fans. But he also expects some COVID-19-related changes to stick, such as more people working from home and advances in telehealth. He even floated the idea of the public wearing masks every winter to reduce flu deaths.

"We'll probably be in a position (next fall) where we're able to ease the restrictions and start seeing things that are similar to what we've done historically," he said. "But make no mistake, this has changed things permanently in a lot of different areas."

For Duke, what life looks like in the second half of 2021 will depend on how well the vaccine and other measures limit COVID-19's prevalence. He doesn't have a metric in mind, but more a feeling.

"I would call it tolerable — people aren't dying every day from it, people aren't being put on ventilators every day," he said, "that's the point where I think we'll be able to really move back to that more normal state."

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