American consumers are crowding back into stores, restaurants and other places of business as states ease pandemic-related restrictions that strangled the economy for months. But a full return to normal isn’t likely to happen until November 2021, according to Ezekiel (Zeke) Emanuel, vice provost for global initiatives and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania and Wharton professor of health care management.

“That’s your date,” Emanuel said. “I’m generally a very optimistic guy, and I’m being realistic here.”

Emanuel believes that’s how long it will take for an effective vaccine to be distributed widely enough to stop the spread of COVID-19, the disease caused by the novel coronavirus that in the U.S. has infected more than 3.2 million people and caused over 134,000 deaths.

Until then, he said, corporate employees should continue to work from home as much as possible, because enclosed spaces and prolonged exposure to other people increase the likelihood of transmission. In the case of frontline workers and others who cannot work remotely, including employees at retail stores, a detailed protocol should be implemented to protect both workers and customers – such as mandatory masks, plexiglass dividers, and regular sanitizing of hands and surfaces.

Emanuel shared his advice with retail executives and founders who joined an exclusive video conference in late June hosted by Wharton’s Jay H. Baker Retailing Center. During the hour-long call, he answered questions on a wide range of topics related to the pandemic, from how often cash registers and other store surfaces should be cleaned to the safety of air travel to whether schools should reopen. Emanuel, an oncologist and bioethicist, served as a special advisor for health policy to the director of the Office of Management and Budget in the Obama White House and is a key architect of the Affordable Care Act. He’s also a prolific author and a regular columnist for The New York Times.

“I’m generally a very optimistic guy, and I’m being realistic here.” –Zeke Emanuel

Emanuel said that while the deaths caused by COVID-19 already have been devastating, he expects the toll in the U.S. to reach 250,000 by the end of 2020. He also believes that non-pharmacological interventions – the measures that help prevent transmission of the virus – are working. They include social distancing; wearing masks; avoiding crowds and enclosed spaces; and staying away from people who are coughing, sneezing, singing or yelling. Those “deep exhalations” can propel droplets containing the virus into the air – in fact, Emanuel noted, sneezes travel at 200 MPH and can spread throughout a room.

Emanuel, who has advocated for a safe reopening of the economy, said strict adherence to non-pharmacological interventions work better than haphazard compliance with them, and it has been challenging to get everyone to comply. In fact, states like Arizona, Florida and Texas have seen infections skyrocket since they relaxed lockdown measures.

“I think it’s almost inevitable we’re going to have a second wave that pops up in October or November [of this year], when we’re all going inside. That worries me a lot,” he said. “Adhering to strict measures doesn’t seem possible in the U.S.”

What Should Stores Do?

Emanuel has been advising a number of national companies and organizations on how to reopen safely, and he said stores have much to consider. Can they put some of their merchandise outside to limit the number of shoppers inside? Can they open windows or doors to help air circulation?

Use of face masks will be important, he said, but he questioned the effectiveness of conducting temperature checks at the door. People have different baseline temperatures, while some who have COVID-19 do not exhibit high temperatures and are often asymptomatic in the early days of infection, he noted. Instead, employees should be asked symptom screening questions each day, such as whether they are experiencing shortness of breath. Testing for COVID-19 more than once a week for asymptomatic employees is wasteful and can create a false sense of security, he said. Instead, an emphasis on good, routine personal hygiene – especially washing hands — and store cleaning is reassuring for both employees and customers. More research is needed to determine whether clothing, shipping boxes, or store surfaces could transmit the virus, but he said these are likely not the main modes of transmission.

When should a store close its doors? The answer depends on a lot of factors, including the concentration of local cases, evidence of transmission from worker to worker, the design of the work site, etc. “It’s a little too abstract to say,” Emanuel said.

Racing for a Vaccine

While Emanuel acknowledged the “super-fast, super-human effort” underway to develop a vaccine, he cautioned that the process is complicated and takes time. “That’s biology; you can’t speed it up with an algorithm.” He also pointed to research that shows the immune system reaction to the virus is short-lived, with antibodies lasting only two to three months versus three to 12 months for other viruses, indicating that it might be difficult to develop a long-lasting vaccine.

“I think it’s almost inevitable we’re going to have a second wave that pops up in October or November [of this year], when we’re all going inside. That worries me a lot.” –Zeke Emanuel

Still, there is some hope that the fatality rate is notching down because doctors are learning more about effective treatments as they work through the pandemic — not because the virus is losing its potency.

“There’s so much uncertainty here,” he said. “My suspicion is the death rate is going down not because it’s getting weaker, but we’re getting better and managing it.”

Emanuel answered several other COVID-19 questions, and a short list of his responses are below:

Schools: They should reopen but with an emphasis on social distancing and a detailed plan of action. Schools may need to go to six days a week to reduce class density, for example.

Gyms: Exercise at home or outside – at least until there is a widely distributed vaccine or herd immunity is reached. Gyms are enclosed spaces where people are exhaling deeply.

Public Transportation: Avoid it. Emanuel is an avid bike rider and said he even rides his bike in the snow.

Air travel: Avoid it. While airplanes have good air filtration systems, they cannot protect against sneezes or other exhalations from fellow passengers two rows away from you or in the aisle. Emanuel said this is a tough one for him because he loves to travel for work and pleasure. He has canceled four international trips and a domestic trip planned for this year, including one to work with the World Health Organization.

Visiting the elderly at home: That’s an individual choice. Family members should evaluate their circumstances and risk factors before making that decision.

Football: Emanuel favors a shortened season without fans in the stadiums and where players “live in a bubble” to contain any spread. He wrote a recent opinion piece in the Washington Post on the topic.

Best website: Emanuel relies on Trust for America’s Health — a nonpartisan policy, research and advocacy organization — for comprehensive information on the pandemic.