Please Note

The Washington Post is providing this important information about the coronavirus for free. For more free coverage of the coronavirus pandemic, sign up for our Coronavirus Updates newsletter where all stories are free to read.

This column has been updated.

Here’s my best-case scenario for the coronavirus pandemic: With existing vaccines, we turn covid-19 into an illness akin to the seasonal flu. The virus might still be around and infect people. Some who get it might still end up sick. But covid-19 no longer leads to overwhelmed hospitals and terrifying death tolls, and by the end of 2021, we can resume much of our pre-pandemic lives.

I’m optimistic that this can happen because of a specific result in the vaccine trials that, so far, has received little attention. Much has been made of the Pfizer and Moderna vaccines being 95 percent efficacious in preventing symptomatic illness. That’s a terrific result, but it’s not the most important one. I’m not so impressed if a vaccine can prevent someone from developing a sore throat or runny nose. I care about whether vaccination means that people won’t become severely ill — to the point that they require hospitalization.

On this front, outcomes from the Pfizer and Moderna trials are extraordinary. In the Pfizer study, 170 participants had symptoms and were found to have covid-19. Five people ended up hospitalized; all five were in the placebo group. In the Moderna study, 196 participants had symptomatic covid-19. Ten people were hospitalized; only one was in the group that received the vaccine.

I cannot overemphasize this result: Out of more than 30,000 people who received either the Pfizer or Moderna vaccines, only one person became ill enough to be hospitalized.

This is the end point we should be scrutinizing with other vaccine candidates. Consider the Johnson & Johnson vaccine, which the company filed on Thursday for emergency-use authorization. (Full disclosure: I am a volunteer participant in this trial.) Some have already raised questions about Johnson & Johnson’s preliminary results, asking why people would take a vaccine that’s only 72 percent efficacious in the United States when the Pfizer and Moderna vaccines are 95 percent efficacious.

But let’s look at the crucial measure of hospitalization. The results released thus far show that the single dose of the Johnson & Johnson vaccine was 85 percent successful in protecting against severe disease. Crucially, not a single person who received the vaccine was hospitalized or died.

This is particularly striking because this vaccine trial had a site in South Africa, where nearly all the cases of covid-19 were due to infection with the dominant variant there, known as B.1.351. When it came to protecting against symptomatic disease, the vaccine appeared to be less effective in South Africa (57 percent) compared with the United States (72 percent), but it prevented all cases of hospitalizations with the B.1.351 variant, too.

This one measure stands to change everything. Plenty of grandparents would be thrilled to see their loved ones again if there were a very low chance of becoming severely ill. Families could safely spend holidays together again if the worst-case scenario shifted from being put on a ventilator or dying to possible fever and body aches. Certain settings might remain very high-risk — a packed indoor concert with tens of thousands could still become a superspreader event — but schools could safely reopen and much of the economy could return to normal if covid-19, though still circulating, were as lethal as influenza.

Of course, many unknowns could still complicate matters. Variants are emerging that could be more contagious and more lethal than existing strains. They could evade existing vaccines, and we might have to keep playing catch-up to develop boosters that target the mutations. Also, enough people might refuse vaccination that outbreaks still occur, and continual surveillance testing will probably be needed along with contact tracing and quarantining. Even if the United States and other developed countries succeed in vaccinating our populations, more virulent variants could arise in other parts of the world that end up affecting us.

We also don’t know yet whether vaccination protects against virus transmission. I wouldn’t want newly vaccinated people to think that they have an unconditional pass to return to their pre-pandemic lives, as they could potentially still be carriers who could infect others. Until a much higher level of community vaccination is reached, some degree of masking and physical distancing will still be needed.

The bad news is that it’s looking more and more like we might not be able to eradicate covid-19. But let’s not overlook the potentially excellent news that our current coronavirus nightmare could soon end. By late 2021, a large majority of the country could be vaccinated and thus protected against the virus’s most severe effects. Covid-19 could be rendered no more dangerous than the common cold at best and influenza at worst. We still wouldn’t want to get it, and we’d have to work to avoid infection through, say, annual vaccinations and regular testing. But the fear and isolation could be over — if we all get vaccinated and stay safe until that happens.

Read more: