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without overwhelming hospital capacity would require an unlikely balancing of multiple poorly defined forces (Brett 2020). Vaccines: In sight, finally! But be patient! Very few experts expected safe and effective vaccines to become available Christmas 2020. Modern technologies, massive funding, and both international cooperation and competition are making it a reality. However, even if vaccines are confirmed effective and safe soon, mass vaccination for COVID19 will be a huge logistic challenge and nobody should expect vaccines to have a noticeable impact on the SARS-CoV-2 pandemic before at least the summer of next year. In the meantime, people will need to be patient and continue to practice and observe the established alternative ways of protection. ‘Variolation’ – Finding of the year? Reducing the viral SARS-CoV-2 inoculum might not only reduce the probability of infection but also favor an asymptomatic infection while still generating immunity. A few papers (Bielecki 2020, Ghandi 2020; see also the comments to the paper by Rasmussen 2020, Brosseau 2020) suggested that if facial masking may help in reducing the size of the viral inoculum, universal facial masking might ensure that a greater proportion of new infections are asymptomatic. If universal masking could be proved to be a form of ‘variolation’ (inoculation), it would be an additional argument in favor of mandatory mask wearing.
Outlook At the beginning of autumn, many feared a second COVID-19 wave comparable to the devastating influenza pandemic during the autumn and winter 1918/1919 (Soper 1919). Fortunately, physical distancing (Bedford 2020) and – when needed – partial selective lockdowns have not allowed SARS-CoV-2 to play out its full potential. Now, with the first vaccine (BioNTech/Pfizer) approved in the UK and more vaccines and more approvals in other countries within reach, we can be confident: SARS-CoV-2 will not be like H1N1 and we have the tools and capacities to get through the winter (Bedford 2020). A month ago, we asked ourselves, ‘How long will SARS-CoV-2 stay with us? How long will it be before we return to pre-COVID-19 normalcy? For how long a combination of physical distancing, enhanced testing, quarantine, and contact tracing will be needed?’ We were skeptical, saying that ‘even vaccines might not have a substantial impact on the pandemic before 2024, if ever.’ We felt – and still feel today – that before mass vaccination, classical infection Kamps – Hoffmann
