The world in 2021: what year two of the coronavirus pandemic may look like

There is hope for the year ahead, but vaccine shortages, anti-vaccination sentiment and sluggish economies could make for another difficult year

A security guard stands outside the Huanan Seafood Wholesale Market on January 24, where the coronavirus was detected in Wuhan. AFP

Personnel in biological hazard suits await passengers evacuated from Wuhan on January 29. AFP

A visitor wearing a protective face mask at the Arab Health conference held at Dubai World Trade Centre in Dubai on January 29, 2020. Pawan Singh / The National

A woman wears a plastic water bottle with a cutout to cover her face, as she walks on a footbridge in Hong Kong on January 31, 2020, as a preventative measure following a virus outbreak which began in the Chinese city of Wuhan. AFP

A shopper wearing a protective facemask sorts items in her trolley as she stands next to bare supermarket shelves, usually stocked with toilet paper and kitchen rolls, in Hong Kong on February 6, 2020. AFP

A drawing of the late ophthalmologist Li Wenliang with flower bouquets at the Houhu Branch of Wuhan Central Hospital in Wuhan in China's central Hubei province, February 7, 2020. Li, a doctor who was punished after raising the alarm about the new coronavirus, died on February 7 after being infected by the pathogen. AFP

Liu Yujia, the first person in the UAE to recover from coronavirus is congratulated by Consul General Li Xuhang of China and Dr Hussein Al Rand, assistant undersecretary of the Ministry of Health and Prevention, on February 9, 2020. Wam

Iranian Deputy Health Minister Iraj Harirchi wipes the sweat off his face, during a press conference with the Islamic republic's government spokesman Ali Rabiei in the capital Tehran on February 24, 2020. Iran's deputy health minister confirmed on February 25, that he has tested positive for the coronavirus. AFP

A nurse wearing protective mask and gear comforts another as they change shifts on March 13, 2020 at the Cremona hospital, southeast of Milan, Lombardy, during the country's lockdown. AFP

People clap from balconies in a show of appreciation for health care workers in Mumbai, India, on March 22, 2020. AP Photo

Gonzaga Yiga, a 49-year-old community chairperson, appeals to residents through a speaker from the tallest building of the area in morning and evening, on how to curb the coronavirus, in Kampala, Uganda, on March 24, 2020. AFP

Sanitation workers from Tadweer in formation on the first day of the UAE cleaning campaign on March 27, 2020. Victor Besa / The National

Britain's Prime Minister Boris Johnson on a screen as he remotely chairs the morning coronavirus meeting by video link, in Downing Street in central London, on March 28, 2020. The two men leading Britain's fight against the coronavirus, Prime Minister Boris Johnson and his Health Secretary Matt Hancock, both announced they had tested positive. AFP

A South African policeman points his pump rifle to disperse a crowd of shoppers in Yeoville, Johannesburg, on March 28, 2020 while trying to enforce a safety distance outside a supermarket. AFP

Police inspector Rajesh Babu wearing a coronavirus-themed helmet speaks to a family on a motorbike at a checkpoint during a government-imposed nationwide lockdown in Chennai, India on March 28, 2020. AFP

The new screening drive through at Zayed Sports City, Abu Dhabi, on March 29, 2020. Chris Whiteoak / The National

An inhabitant of the residence Maison Blanche, composed of 226 mostly unsanitary dwellings, collects food offered by neighbours from his balcony, using a rope made with blankets, on March 31, 2020, in Marseille, southern France. AFP

Bodies are moved to a refrigeration truck serving as a temporary morgue at Wyckoff Hospital in the Borough of Brooklyn on April 6, 2020 in New York. AFP

Health workers cry during a memorial for their co-worker Esteban, a nurse who died, at the Severo Ochoa Hospital in Leganes in Leganes, Spain, on April 10, 2020. AP Photo

A Palestinian mother entertains her children with makeshift masks made of cabbage as she cooks in Beit Lahia in the northern Gaza Strip on April 16, 2020. AFP

Health care workers stand in the street in counter-protest to hundreds of people who gathered at the State Capitol to demand the stay-at-home order be lifted in Denver, Colorado, US. April 19, 2020. Reuters

Members of the NYPD Honor Guard, wearing masks, prepare for the funeral of Traffic Section Commander Mohammed Chowdhury in New York, on April 22, 2020. AP Photo

A sign indicates that Bondi Beach is closed as a surfer arrives for the 7am opening in Sydney on April 28, 2020. AP Photo

The iconic Christ the Redeemer statue is lit up as if wearing a protective mask and with a slogan that reads in Portuguese: "Mask saves," in Rio de Janeiro, Brazil, on May 3, 2020. AP Photo

A medical worker takes a swab from a resident during home visits in Wuhan, the epicentre of China's coronavirus outbreak, in the central Hubei province, on May 14, 2020. AP

Guests watch the "Trolls World Tour" movie in the rain at the Four Brothers Drive In Theatre on May 15, 2020, in Amenia, NY. AP Photo

People are seen practising social distancing in white circles in Domino Park, on May 17, 2020 the in Brooklyn borough of New York City. AFP

View of the Intensive Care Unit treating coronavirus patients in the Gilberto Novaes Hospital in Manaus, Brazil, on May 20, 2020. AFP

Rectangles designed to help prevent the spread of the coronavirus by encouraging social distancing are drawn in a city-sanctioned homeless encampment at San Francisco's Civic Centre on May 21, 2020. AP Photo

Government health workers visit riverside communities of the municipality of Melgaco to test them for coronavirus infections in the Marajoara region, located in the southwest of the island of Marajo, at the mouth of the Amazon River in the state of Para, Brazil, on May 23, 2020. AFP

People attend a rave in boats of all sizes to give support to Berlin's world renowned dance clubs which were struggling due to the pandemic on the Landwehr canal on May 31, 2020 in Berlin's Kreuzberg district. AFP

Children run down a street past an informational mural warning people about the dangers of coronavirus in the Kibera slum of Nairobi, Kenya on Wednesday, June 3, 2020. AP Photo

A man on a balcony watches the second-division game between Rayo Vallecano and Albacete in Madrid, Spain, on June 10, 2020. AP Photo

Irish Paralympic hopeful Leo Hynes, who is legally blind, trains in his home-made training pool in his front garden at home in Tuam, Co Galway, west Ireland, on June 18, 2020. AFP

The Uceli Quartet perform for an audience made of plants during a concert created by Spanish artist Eugenio Ampudia and that would be later streamed to mark the reopening of the Liceu Grand Theatre in Barcelona on June 22, 2020. AFP

Agustina Canamero, 81, and Pascual Perez, 84, hug and kiss through a plastic film screen to avoid contracting the coronavirus at a nursing home in Barcelona, Spain, on June 22, 2020. AP Photo

Romelia Navarro, 64, weeps while hugging her husband, Antonio, in his final moments in a Covid-19 unit at St Jude Medical Centre in Fullerton, California, on July 31, 2020. AP Photo

Muslim pilgrims circumambulating around the Kaaba at the centre of the Grand Mosque in the holy city of Makkah, on August 2, 2020. AFP

Brazil's President Jair Bolsonaro puts on a mask during the inauguration of the new General Abreu civic-military school in Rio de Janeiro, Brazil, on August 14, 2020. AP Photo

The first day back at school at Gems Wellington Academy in Al Khail, Duba on August 30, 2020. Antonie Robertson / The National

An Iraqi family mourns around the coffin of a relative, who died of the coronavirus, during a reburial ceremony at the vast Wadi al-Salam cemetery in the Shiite holy city of Najaf on September 11, 2020. AFP

Sheikh Abdullah bin Zayed,, Minister for Foreign Affairs and International Cooperation of the UAE, as he virtually addresses the general debate of the 75th session of the United Nations General Assembly, on September 29, 2020, in New York. AFP

Medical workers celebrate as the last three patients are released from a field hospital at the National Stadium Mane Garrincha, after recuperating from Covid-19, in Brasilia, Brazil, on October 15, 2020. AP Photo

A woman speaks affectionately to a horse named "Tony" at the Maria Vieira Bazani nursing home in Rio de Janeiro, Brazil, on October 22, 2020. AP Photo

People wear face masks while watching the marine life at Ripley's Aquarium of Canada in Toronto, on October 28, 2020. AP

A technician sprays disinfectant as mourners pray over the body of a person who died, at the Behesht-e-Zahra cemetery on the outskirts of the Iranian capital, Tehran on November 1, 2020. AP Photo

Sheikh Mohammed bin Rashid, Ruler of Dubai, receives the Sinopharm vaccine on November 3, 2020. Courtesy: Dubai Media Office

People dance at a nightclub, almost a year after the global outbreak of the coronavirus disease in Wuhan, Hubei province, China, on December 12, 2020. Reuters

Medical workers of the Covid-19 intensive care unit at the Santo Stefano hospital in Prato, near Florence, Tuscany, pose wearing their PPE with photos of themselves printed on it, on December 17, 2020 at the hospital in Prato. AFP

D-Day veteran and Chelsea Pensioner Bob James Sullivan, 98, a resident at the Royal Hospital Chelsea, is applauded by staff after receiving an injection of the Pfizer/BioNTech Covid-19 vaccine from Pippa Nightingale, Chief Nurse at the nearby Chelsea and Westminster Hospital on December 23, 2020. Chelsea Pensioners are all former soldiers of the British Army over the age of 65, who reside at the Royal Hospital Chelsea, founded by King Charles II in 1682, and wear a uniform which includes a scarlet coat. Getty Images

One sure-fire prediction for 2021 is that Covid-19 will be the biggest health story of the year.

What is worryingly far from clear is how much closer we will be to ending the pandemic a year from now.

But as vaccines start to come on line, the signs are that the answer will lie in decisions made not by scientists or politicians, but each one of us.

Here we look at what the year ahead could hold for us.

An epidemic of errors

Last December, when doctors in Wuhan, central China, first reported cases of a mysterious respiratory illness caused a new virus, the official response was denial – followed by reprimands for spreading false rumours.

Beyond China, the outbreak initially sparked little concern. Inoculated through years of reports of viruses flaring up and fading away again, Covid-19 was put into the same box as Sars, Mers and swine-flu: nasty pieces of work if you get them - which you almost certainly won’t.

Of all the insights about Covid-19 gleaned in 2020, the most critical has been that this virus metes out severe punishment to the complacent and careless

That complacency vanished last January, as outbreaks emerged around the world and China put 60 million of its citizens under lockdown.

But as governments turned to the global research community for answers, complacency mutated into the belief that by “following the science” the virus would quickly be brought under control. As they put their countries under lockdown politicians – notably British Prime Minister Boris Johnson – talked of turning the tide against the virus within a few months.

But of all the insights about Covid-19 gleaned in 2020, the most critical has been that this virus metes out severe punishment to the complacent and careless.

This is what lies behind the stark reality that 2021 will begin with a pandemic that has already claimed over 1.7 million lives – and is still accelerating. How next year ends will depend on how well we avoid the complacency and carelessness of the past 12 months.

The need for speed

The emergence of a new, apparently far more infectious, variant of the original Covid-19 virus provides the first test of whether lessons have been learned. One of the most disastrous blunders was made in the very early days of the pandemic: a failure to recognise the need for speed.

Epidemics spread with exponential speed, with case-numbers increasing not like 1, 2, 3, 4 etc, but as 1, 2, 4, 8 – or even faster. Scientists capture this rate of spread by estimating how long it takes for the case numbers to double. Getting this figure wrong by even a few days leads can lead to disastrous delays in tackling the virus.

This does more than just give the virus more time to infect people, however. The mathematics of exponential growth shows the impact of the delay is permanently locked into the statistics. Experts have estimated that by getting the doubling time wrong by just two days, the resulting delay in the UK lockdown in March led to tens of thousands of unnecessary deaths.

Ever since, the UK government’s scientific advisors have been desperate to avoid making the same mistake. As soon as data on the spread of the new form of the Covid-19 virus became available, they began lobbying Mr Johnson to impose strict controls on most of South-East England over Christmas, regardless of the political or economic cost.

Testing times

While the swift reaction of the UK and other countries to the new variant is encouraging, the form of the response is less so. Within days of declaring the Covid-19 pandemic, the WHO said the key to extinguishing the virus was to "test, test, test".

Implementing that simple mantra remains anything but simple, however. Many countries still lack sufficient testing kits, even in the final days of 2020. But even when they are available, a trickier problem has emerged: how to interpret the outcome.

Experts stressed that all the tests have false-negative and false-positive rates – that is, a probability of wrongly giving the all-clear to those carrying the virus, or vice versa.

The so-called gold standard PCR test is regarded as having the lowest error rate, but it is expensive and slow. This led to greater use of faster, cheaper but less reliable tests.

Medical staff speak to drivers before they take a prick of blood from their finger that can rapidly be scanned for signs of the virus. All photos by Leslie Pableo for The National

Police direct a long line of vehicles waiting for the rapid test at the Dubai-Abu Dhabi border

Many commuters are expected to use the quick Dh50 to enter Abu Dhabi instead of undergoing a PCR nasal swab test, which costs about Dh150 in a private clinic

A medic takes a drop of blood from a commuter

A medic takes a drop of blood from a commuter

Medical staff use a laser scanning technique called DPI to look for signs that the body has generated antibodies to fight off a virus

Medical staff use a laser scanning technique called DPI to look for signs that the body has generated antibodies to fight off a virus

A medic takes a drop of blood from a commuter

Eighteen stations can handle 36 vehicles at any one time. The process takes several minutes to show a result

Although the DPI test does not specifically look for Covid-19, it quickly identifies whether someone may be ill

Drivers line up to be tested on Al Faya Road just off the E11 highway between Dubai and Abu Dhabi

The company that runs the service for the government said it should save drivers time and money

Drivers line up to be tested on Al Faya Road just off the E11 highway between Dubai and Abu Dhabi

One way to cut the risk of mis-diagnosis is to restrict testing to people who already have symptoms consistent with Covid-19: a persistence cough, fever and loss of a sense of smell – as these alone are quite strong evidence of infection.

But many people carrying the virus do not have symptoms. Understandable concern about identifying these “asymptomatic” carriers led some countries to use the fast, cheap tests across the board. Even now, the impact of this on the reliability of key data about the prevalence of the virus remains unclear.

The issue of testing flared again with the emergence of the new, more infectious form of Covid-19 virus. Some governments want to test for it using the "gold standard" PCR test. Yet this too is now under suspicion, its high sensitivity raising the risk of giving positive results with people who have long since recovered from Covid-19 and no longer pose a threat.

Many experts have stressed that the way forward lies in frequent testing plus effective contact tracing. The ability of governments to set up and maintain such testing systems will play a key role in their success against the virus over the coming year.

Lockdowns: too high a price to pay?

In the absence of wonder-cure or vaccines, lockdowns were the obvious – if drastic - first line of defence against Covid-19. And in some countries, notably China and South Korea, they appear to have worked.

Yet many other countries have found that lockdowns can prove worse than useless. While case numbers plunged once imposed, the end of lockdowns led to second waves with death rates dwarfing those of the initial outbreaks.

Scientists are already warning of impending third waves of infection. The surges reflect another vicious aspect of the pandemic: how it forces governments to make invidious choices.

A deserted Regent Street on a gloomy Boxing Day as Londoners continue to live under Tier 4 lockdown restrictions. Niklas Hallen / AFP

Even before the second waves emerged researchers cautioned that the rapid decline in cases following lockdowns could sucker governments into lifting them too early as concern switches to saving the economy. The still-rampant virus then comes roaring back as it regains access to new victims.

Trapped between the rock of Covid-19 and the hard place of economic collapse, governments have tried avoiding nationwide lockdowns with strategies such as regional “tiers” with varying levels of restrictions. But their complexity, varying socio-demographic impact and variable success will likely see them eclipsed by the Great White Hope for defeating the virus: vaccines.

Here come the vaccines

Around the world, thousands of scientists have dropped long-standing projects to join huge research programmes to fight the virus. It quickly emerged that even such basic issues as how respiratory viruses are spread and the effectiveness of masks had never been properly studied. Bitter disputes broke out between experts wielding small, badly-executed and misinterpreted studies.

While simple but potentially valuable measures such as antiseptic gargling were dismissed out of hand, huge sums were spent investigating "cutting-edge" therapies which then failed to live up to their billing.

The WHO Solidarity trial, involving Covid-19 patients in 30 countries, found that none of the sophisticated anti-viral drugs tried against the virus had any clear impact. Ironically, the only drug found to bring major benefit is dexamethasone, an old, cheap drug for calming the immune system.

While headlines trumpet the 90-plus per cent "effectiveness" of some vaccines, how effective they are in stopping vaccinated people acting as carriers remains unknown

Fortunately for the scientific community, these embarrassments have been eclipsed by their triumph in developing a whole suite of vaccines that have proved effective in clinical trials against Covid-19.

The first few – including two based on entirely novel ideas – have already been approved, and are now being rolled out. Unlike the restricted access offered by most countries, the UAE is making proven vaccines from Sinopharm and Pfizer-BioNTech available to most adults in the Emirates, free of charge.

But there are concerns that vaccination cannot live up to the hopes pinned on it. While headlines trumpet the 90-plus per cent “effectiveness” of some vaccines in preventing Covid-19, how effective they are in stopping vaccinated people acting as inadvertent carriers remains unknown.

And even the perfect vaccine won’t stop the pandemic unless enough people are vaccinated fast enough.

Over the coming months, billions of doses will have to be made and shipped around the world. But the biggest challenge may be overcoming the reluctance of people to be vaccinated. Surveys suggest that in some countries barely 50 per cent of people may accept vaccination – far too low to halt the pandemic.

We enter the new year with many critical questions still unanswered. But it is clear that 2021 will be the year when responsibility for ending the pandemic shifts decisively into the hands of each one of us.

Robert Matthews is visiting professor of science at Aston University, Birmingham, UK