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story.lead_photo.caption Liv Paggiarino/News Tribune The inside of the Samaritan Center’s warehouse is reflected in Shane Boessen’s glasses as he waits to see how many orders a visitor needs during Thursday’s drive-through pantry. Samaritan Center workers swiftly and efficiently loaded food into vehicles, keeping the long line moving throughout the afternoon. Last week, the center served around 150 families in the drive-through pantry, and anticipated about that many this week again.

As vaccinations against COVID-19 progress, expand and hopefully accelerate in the coming weeks and months, pushing Missourians toward a point of collective protection against the disease, it's possible to start looking ahead to a post-pandemic future that's likely to be seen at some point in 2021.

There are obviously some things that can never be fixed or replaced — lives lost, livelihoods destroyed. So far, as of Saturday, at least 5,944 Missourians have lost their lives to COVID-19.

When the pandemic ends, however, it will allow its survivors to return to a greater degree of normalcy from the lives Missourians knew before March 2020.

Details about what that new world will look like will continue to take shape in the months ahead, but state health Director Dr. Randall Williams said, based on what's currently understood, it's unlikely that at the middle or end of the summer, Missourians will be able to immediately go about their lives as if the pandemic never happened.

What protection means

The state is distributing available vaccines against COVID-19, first focusing on health care workers and long-term care facilities' residents and staff.

As of Friday, Capital Region Medical Center in Jefferson City reported having given approximately 900 vaccinations, including 650 or so to employees, according to spokeswoman Lindsay Huhman.

Huhman added 800 doses had been redistributed to other health care facilities to be administered.

Capital Region started administering second doses to employees starting Thursday, and Huhman said that would end Monday. She added: "We anticipate starting a new round of vaccinations on January 20 for employees who did not receive (it) in the first round."

Also as of Friday, SSM Health St. Mary's Hospital in Jefferson City reported having provided "just over 900 vaccinations," according to spokeswoman Jessica Royston.

Royston said the vaccine is not mandatory because it has only been approved under emergency use authorization, and it's been offered to all at-risk employees.

"We are currently holding daily vaccination clinics so at this point, I cannot say if we have any unused doses on hand. In the event that we have doses that may not be used at the hospital, we would work with our other health care partners in the community to make sure the vaccine is redistributed where it is needed," she added.

Other groups of people prioritized for their health vulnerabilities due to COVID-19 or their status as an essential part of basic services and the economy will come next in vaccinations, followed by the general public.

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Williams said last week the hope is to have finished phase 1B of vaccinations — people over age 65, people ages 18-64 who have underlying health conditions, first responders and essential workers — by mid-April.

He and Gov. Mike Parson have committed to providing more details this week about phase 1B.

Having more vaccines approved — and having them be available in large quantities — beyond the two currently available would speed the vaccination process up.

After phase 1B, and after phase 2 of administering vaccines to vulnerable people such as prisoners and the homeless, vaccinations would move to phase 3 — administering vaccines to the general public — and Williams hopes "everybody who wants a vaccine in Missouri will have gotten it by July."

That would mean the point of herd immunity would be reached in the state by July — the point when, on average, any infected person would no longer be able to infect another person or more, stopping widespread community transmission of the coronavirus that causes COVID-19.

Williams estimated reaching that point — 75 percent of the state's population having developed immunity to COVID-19 — would mean vaccinating between 3.6 million-4 million Missourians, assuming 10 percent of the state's population has already been exposed.

"We think that's very doable, based on what we know now," he said.

In the meantime, Williams said, it's not currently known whether someone who's vaccinated could spread the coronavirus to other people.

"The vaccine doesn't prevent you from catching it. It prevents you from getting sick from it," he said — though even with a 95 percent effectiveness rate, one of every 20 people vaccinated will not have immunity if they become infected.

Even with a vaccine, Williams said, "you still need to hand wash. You still need to social distance. You still need to wear a mask, and you still need to be careful about congregating."

Williams said someone who has been vaccinated should not get into a car with people not wearing masks who are coughing and have fevers, for example.

Reaching herd immunity would mean "we think we would be able to get to a place where things like schools, universities, events, conventions, big meetings will be possible," he said.

Williams said, however, that may not mean things would be as if the pandemic never happened, with everyone all of a sudden no longer wearing masks, using hand sanitizer or social distancing — with "some part" of those precautions probably still needed.

Determining what precautions would be needed and for how long would be based on watching community transmission rates.

Herd immunity would help protect even people who had not been vaccinated or otherwise exposed, and reaching that point would basically be the historical endpoint of the pandemic. But, COVID-19 would still be a risk, and the disease would still have a higher mortality rate than influenza.

"With COVID, there's enough unknowns about it that I'm not prepared to say that once we reach herd immunity, that (it's) literally like it never happened," Williams said.

It might be possible to reach a more carefree point, but he said it's just too early to know for sure.

"I don't know that we'll ever go back to not having an emphasis on cleanliness," he added.

"A big question will be 'Will we ever go back to shaking hands?' I don't know."

He said the emphasis on wearing masks and getting vaccinated for influenza — encouraged to help reduce the strain on hospitals during the pandemic — has already helped drive down rates of flu and childhood respiratory diseases.

"People are just more sensitive to the whole idea of respiratory infectious diseases."

Meanings for public health, health care

The pandemic will likely have long-term effects for public health and health care, Williams said.

The unprecedented alignment, cooperation and communication spurred by the pandemic between government authorities and health care professionals is going to continue — "the force-multiplier effect of working together," he said.

"One thing that's really, really impressed me is how the governor and the mayors have worked together and crossed every line you might think — Republican, Democrat, urban, rural," Williams said.

Other disasters can produce such partnerships, but they've been inherently limited in time and geographic scope, like when a tornado goes through a town.

"When it comes to health care, if not other things, you're going to see going forward the strength of that kind of integration between state government, our federal partners, our local partners and our private partners — whether academic or business," Williams said.

The aftermath of the pandemic will be more complicated than some silver linings, however.

There's undoubtedly some number of public health and health care workers who will be burned out by the stress of the pandemic, who will choose to go on to other careers. Williams said the state has lost 16 health directors since March.

"In health care, the big trend will be to telemedicine, telehealth, distance learning," he said. "You'll see a transformation in health care, in which people will work more remotely, and see patients more remotely, and you'll see the standards practiced where before you had to see the physician or provider, now that will be done by distance."

There's also a debate about what the authority of public health officials should be. Related legislation has already been filed by some state lawmakers.

"There's just no doubt, for the first time ever, the role of public health in quarantining, isolating and issuing orders — that they've always had the ability to do (but with diseases such as tuberculosis) — you're going to see a debate nationally about that responsibility, and that's going to happen here in Missouri," Williams said.

Beyond all those things, Williams said he and Gov. Mike Parson, "appreciate so many Missourians coming to the aid of other Missourians."

"Some people say that adversity builds character. Others say adversity reveals character. And I just think the character of Missouri has been — and I believe this fervently — that in tough times, the people of Missouri help each other. And I think that's probably been going on for 200 years. It's in our DNA."

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