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Looking Ahead: COVID-19

Leslie Acebo, AFRICOM; Filipe Neves, Muskan Muskan, CENTCOM; Iris Raith, EUCOM; Indirah Canzater, Tiffany Dove, Nicholas Fergreus, NORTHCOM; Tiberius Hernandez, PACOM; Stacey Casas, Jasmine Woolley, SOUTHCOM Cassandra Townsend, Clea Guastavino, Senior Editors

Week of Monday, November 22, 2021

People wearing face masks[1]


Through the end of 2021 and beginning of 2022, it is likely an increase in COVID-19 cases will be seen. Due to vaccination efforts, a smaller portion of those cases are likely to be serious compared to the end of 2020 and beginning of 2021. However, actual impacts will almost certainly vary regionally due to changing human behavior in response to changing seasons.

Since the first cases of COVID-19 were reported in December 2019 in Wuhan, China,[2] there have been over 261 million cases and over five million deaths worldwide.[3] The virus responsible, SARS-CoV-2, is in the Coronavirus family; generally, these viruses are known for causing the “common cold,” with the exception of SARS-CoV, MERS-CoV, and COVID-19, which cause more severe respiratory diseases.[4] Of those three more severe disease-causing viruses, COVID-19 has the highest transmission rate, resulting in exponentially higher levels of cases than was seen with SARS-CoV and MERS-CoV.[5] As with most viruses, cases of COVID-19 have occurred in waves correlating with the weather, which directly impacts human behavior. While this has not been confirmed outside the lab for COVID-19, lab studies have shown the virus transmits better in winter-like temperatures and humidity levels,[6] and an increase in cases and deaths across the globe during winter months was seen in late 2020 to early 2021.[7] This correlates to the transmission of the other coronaviruses, which transmit well in similar weather conditions.[8]

However, the increase in cases is more likely due to human behavior in response to changing weather, rather than due to the weather itself; in colder months, people tend to congregate inside more, resulting in them being closer to each other and to any aerosols they create. At the same time, many restrictions are lessening and vaccinations are increasing as the end of 2021 approaches, which will likely result in less mask-wearing and social distancing. Human behavior is likely why an increase in cases during the Northern Hemisphere winter months in both the Northern Hemisphere and Southern Hemisphere is seen: people are congregating in close quarters more, either to avoid the cold or the heat outside.

Currently, there are several vaccines available around the globe; despite this, an increase in cases will likely be seen, as the vaccines protect against severe disease as opposed to infection. Additionally, there are several variants circulating; they can be more transmissible, decrease effectiveness of vaccines, or be more deadly.[9] As variants continue to spread, increases in cases are likely as they reach new populations.


COVID-19 cases are likely to rise in the following months while several African regions, including West Africa, Central Africa, and East Africa, transition to the dry season. Poor air quality, low relative humidity, and cooler temperatures are expected throughout the dry season, which could be potential environmental drivers of COVID-19 cases.[10] During the dry season, poor air quality produced by large-scale desert dust and biomass burning will worsen, likely accelerating the spread of COVID-19. Colder temperatures in January and February are projected to intensify indoor activity, likely resulting in higher transmission rates. Despite a global effort to improve immunization rates in Africa, development is progressing at a slow rate. Unless efforts are made to expedite the speed of vaccinations, only five African countries, or less than 10% of Africa's 54 nations, are expected to meet the year-end target of fully vaccinating 40% of their people.[11] Limited access to critical supplies such as syringes, which would delay vaccination administration, is likely to constitute a severe setback. Aside from the scarcity of vaccines, a significant vaccine disparity primarily affects Africa's low-income countries (LICs). In Africa's LICs, only about 2% of individuals are fully vaccinated, and vaccination rates are still below 1% in several countries; in lower-middle-income countries (LMICs), the ratio is under 10%, but in advanced economies, more than 60% of the population is vaccinated.[12]

Given Africa's weak health system, the COVID-19 pandemic added pressure to health facilities and services already dealing with other lethal diseases, including HIV, tuberculosis (TB), and malaria, which continue to be the region's most significant causes of death.[13] The shortage of resources and a weak healthcare system will likely be Africa's most prominent challenge in combating the pandemic. Additionally, Africa has seen an increase in violent attacks by extremist groups, putting access to healthcare at risk; in some countries such as Niger, authorities have limited civilian mobility and impeded aid access at times due to the attacks.[14] This will likely further delay immunization and help facilitate the spread of COVID-19.

The Delta variant's advance will likely adversely impact Africa. Africa has had poor vaccination access, with most countries vaccinating only about 5% of their people.[15] Since the appearance of the Delta Variant in Africa, COVID-19 cases have risen significantly in countries such as South Africa. The Delta variant’s spread across Africa has launched a third wave, severely affecting countries like South Africa, which leads in number of COVID-19 cases in the region: only 22% of the population in South Africa is fully vaccinated.[16] Other countries heading into the dry season, such as Nigeria, Niger, Mali, and Democratic Republic of Congo, have less than 2% of their population vaccinated.[17] This indicates that vaccination coverage is still extremely low on the African continent, increasing the likelihood for further COVID-19 spread. Furthermore, only around 15% of COVID-19 cases in African countries are reported, making it difficult to determine how severely afflicted regions are.[18] Due to a lack of resources and staffing, cases will likely continue to go undetected, especially in Africa's rural areas.


In the coming months, the Middle East is likely to face an increase in COVID-19 cases. The region is primarily arid or semi-arid, with slightly lower temperatures in the winter and low humidity, which are environmental factors associated with a higher transmission of the virus.[19] Although a global vaccine rollout is ongoing, the situation in the Middle East isn’t likely to improve. Despite the continuous efforts of vaccinating the population, there is a wide gap in the vaccine rollout programs due to vaccine inequity among Middle Eastern countries.[20] This vaccine inequity reflects income disparities in the region; high-income countries like the Gulf nations and Israel have most of their citizens vaccinated, whereas low-income countries like Yemen and Syria have barely started their vaccination programs.[21] Yemen currently has the lowest vaccination rate with only 0.7% of the population fully vaccinated, while the UAE has the highest rate with around 89% of its population fully vaccinated and 29% with booster doses.[22]

With the rise of the highly contagious Delta variant and winter coming, COVID-19 will very likely pose a major challenge for countries with low vaccination rates and a poor healthcare system, such as Afghanistan and Lebanon. These countries will likely witness another wave of COVID-19 cases and an increase in hospitalizations and intensive care admissions. The lack of public health infrastructure, medical workers, funding, and lab facilities will almost certainly overwhelm existing hospitals and prevent them from admitting new cases, which will likely increase the death rate.[23] In addition, food insecurity and the socio-economic crisis will very likely hinder these countries in curbing the spread of COVID-19, eventually causing them to deal with multiple issues at one time.

The Delta variant is causing severe fatal diseases in unvaccinated people while rare breakthrough cases with mild symptoms are reported in vaccinated individuals.[24] Restrictions aimed at reducing daily infections will almost certainly be difficult to enforce in countries immersed in conflict, like Yemen and Syria, since the central governments do not control their entire territories. Testing and vaccination rates in these countries are likely to remain low due to the war and poor healthcare systems. Since millions of people are at risk of starvation in some countries, including Yemen and Afghanistan, it is almost certain that there will be a spike in deaths in these countries as people with malnutrition are more likely to die from COVID-19.[25]Yemen did not see a significant increase in COVID-19 infections last winter, but testing was limited, so there were likely many unreported cases. By November 1, 2021, Yemen had reported 9791 cases and 1889 deaths, with a mortality rate of approximately 19.3%.[26] This winter will likely be similar to last year's, with many COVID-19 infections and deaths going unreported.


The EUCOM region is very likely to be impacted by rising COVID-19 infections in the upcoming months given the cold temperatures that promote indoor daily life in most of the region. EUCOM countries have witnessed a steady rise in daily infections over the last three weeks with States like Romania having reached the highest rate in COVID-19 deaths within the EU, at 600 per day.[27] All EU member States face an increase in daily infections, prompting governments to promote booster shots and discuss expiration dates for the vaccination certificates.[28] States like Belgium and the Netherlands have reintroduced measures such as social distancing and masks in indoor spaces due to the rise in infections.[29] These measures are very likely to lead to renewed anti-vaccination protests throughout the EU given that strengthened restrictions will likely be put in place for non-vaccinated people.

The vaccination rate is likely to affect the rate of infections in the upcoming months. Statistics show that countries like Portugal, with a vaccination rate of 87.5%, currently have five times less cases than in November 2020.[30] This suggests that a high percentage of vaccinated people likely affects the transmissibility of the virus by decreasing infection rates, despite the vaccines being marketed as decreasing serious infections. In countries with a high vaccination rate, it is likely that despite rising cases, the extent of last year's cases won’t be repeated and there will likely be fewer deaths. In States with lower vaccination rates, more restrictive regulations are likely to persist. Most European countries are enforcing the use of COVID-19 passes and green passes for tourists for interior activities.[31] This measure is likely to promote a contained spread of the virus if rigorously implemented along with securing business activity and tourism throughout the winter months.

Turkey also likely faces implications of dropping temperatures during the upcoming months. In November 2020, Turkey saw a sharp increase in cases, reaching a weekly average of 20,000 infections at the end of the month.[32] Currently, the country shows to be on a similar path with a weekly average of 28,000 cases and a vaccination rate of 70%,[33] though booster shots are scheduled to be administered in the upcoming weeks.[34] In light of these numbers, Turkey likely needs to implement stricter measures to attempt containment of the virus in the next months, such as masking. Given the milder winter temperatures in the southern regions of the country, regulations should very likely be enforced in Central and Eastern Turkey due to their colder weather conditions.


Currently, the US shows a fully-vaccinated COVID-19 rate of 59.5%, and 70.0% of the population with at least one vaccine.[35] In Canada, 75.5% of the population is fully vaccinated against COVID-19 and 2.94% of the population is partially vaccinated.[36] The US Centers for Disease Control (CDC) approved the Pfizer vaccine for children under the age of 12 on November 2, 2021, allowing the opportunity for more people to get vaccinated.[37] Canada exhibits a higher COVID-19 vaccination rate although Health Canada has not approved any vaccines for children under 12.[38] The decline in COVID-19 cases in both the US and Canada since mid-September is likely to reverse in the coming months when cold weather and numerous other illnesses emerge.[39] The colder weather will likely increase individuals’ proximity as many activities will be moved indoors during the colder months from November to March; COVID-19 has a greater transmission rate in enclosed spaces, and the closer proximity of individuals will very likely raise the COVID-19 infection rate for both countries.[40] As the northern region of NORTHCOM generally experiences colder winters, it is likely that they will have another spike in the region’s COVID-19 cases as was seen during the winter months of 2020.[41] However, this winter will likely be an improvement from the winter of 2020 due to the increased number of individuals that are vaccinated in both countries.

Currently, northern US hospitals are experiencing surges that are straining healthcare systems beyond capacity.[42] Although the expanding vaccine availability will likely keep critical exacerbations at bay, the upcoming winter season will likely increase COVID-19 cases.[43] This will almost certainly lead to decreased quality of patient care, increased medical errors, and increased hospital stays.[44] Misinformation and protests against vaccine mandates are likely to increase vaccine hesitancy and resistance in the coming months.

The southern part of the NORTHCOM region, namely Mexico, has seen significant reductions in overall COVID-19 case counts over the past 11 weeks.[45] The reduction in daily cases in this region is likely a result of both the restrictions implemented by the Mexican government during its recent third-wave, as well as the increased vaccination rates throughout the country. This wave was driven largely by the Delta variant which remains the most prevalent strain throughout the region.[46] Case reductions are likely to continue in the coming months as the country continues to administer vaccines, with nearly three-quarters of the population of Mexico having received at least one dose.[47] This contrasts with the spike in cases earlier this year which was almost certainly a result of relatively lax public health restrictions combined with inadequate testing resources.[48] The southern NORTHCOM region will likely not experience the same increase in cases that typically occurs during the winter months in the northern regions of the continent due to its warmer climate. Sustaining vaccination rates will remain a significant concern in the coming months as the Mexican government has resisted administering vaccinations to children aged 12-17.[49] This, along with the approaching travel ban reversal with the US for vaccinated travelers, significantly increases the likelihood of future increases in COVID-19 cases.

Mexico’s mounting fiscal and security crises combined with unpopular policy changes and public dissatisfaction with the government response to COVID-19 increase the likelihood for government deterioration.[50] Mexican President Andrés Manuel López Obrador has resisted all calls, including a court order, to vaccinate youths, very likely countering recent progress Mexico has made in reducing COVID-19 cases.[51]The government’s initial lack of COVID-19 response has also allowed for an increase in public desperation, leading vulnerable populations to accept cartel aid packages, almost certainly allowing for expansion in drug cartel territory.[52] This will very likely lead to increasing crime and violence in Mexico’s major cities, while security forces are mainly focused on COVID-19.


The region of Asia is currently in the beginning of its cool, dry season, but is still reeling from the monsoon seasons that brought historic levels of flooding and damage.[53] While this period of time is generally considered the peak tourist season, restrictions on travel mean that there will be a relatively small and highly regulated tourist season this year. However, the region faces a unique challenge with disparate vaccination rates due to decentralized COVID-19 policies as well as a large imbalance of access to monetary and technological resources.[54] Despite this challenge, vaccination rates in countries previously struggling to immunize their citizens are likely to increase as more doses are made available either by purchase or international aid.[55]

Being one of the largest countries in Asia as well as the world, the progress of India’s COVID-19 policies is a critical factor to consider when evaluating the status of the pandemic in Asia. Although India has successfully vaccinated slightly more than 50% of its population with a single dose of a COVID vaccine, only around 21% of the nation’s adults are fully vaccinated, indicating a potential weakness in India’s health strategy.[56] While some antibody surveys seem to indicate a high level of resistance to COVID-19 in some sections of the Indian population, the transmission of new variants in some regions nullifies this advantage against infection.[57]

Another country of concern is Vietnam, a nation that is struggling to vaccinate both its urban and rural populations. While some cities such as Hanoi have exceeded 75% of citizens being fully vaccinated, Ho Chi Minh City is struggling to vaccinate even a fifth of its population due to a lack of resources.[58] With the acquisition of Chinese vaccines and aid, the nation likely hopes to make its urban centers more safe and subsequently ensure that major cities are immunized at roughly equal amounts in time for the holiday season.


Many countries in Latin America are entering their summer season with countries like Argentina and Brazil averaging around 29°C (84°F) by the month of January.[59] Colombia, which only has two seasons, is also entering its summer and dry season (December to January).[60] In contrast, the Amazon and Brazil will be moving into their rainy season. For the most part, however, Latin America is known for its summer-like weather during this time of the year. Although this type of weather is not likely to increase the spread of COVID-19, other factors, such as human behavior, likely will.

Latin America was hit particularly hard by the pandemic, surpassing 1.5 million COVID-19 deaths in October 2021.[61] However, many countries in the region are now seeing the positive impact of immunization, as cases are decreasing.[62] By November 2021, a total of 32 countries in the region had reached the World Health Organization’s (WHO) target of 40% vaccination coverage.[63] Latin America will likely still see increases in cases moving forward in the next few months due to low numbers of fully vaccinated people in countries such as Paraguay, with 32.7%, Venezuela with 21.6%, and Guatemala with 18.1%.[64] With many tourists traveling to Latin America during their winter seasons, many coastal areas will very likely see an increase in people at the beaches, hiking trails, and other outdoor activities. Given the climate alone may not increase the spread of COVID-19, indoor restaurants and bars will likely contribute to increased cases as masks are not usually worn inside these locations.

In the upcoming months, it is very likely that Latin America will see a rise in COVID-19 cases given that warm weather may promote travel and social gatherings. Additionally, the prevalence of political turmoil and public protests will likely be another contributing factor increasing cases in the region. For instance, countries such as Nicaragua, which is seeing mass protests over the recent election results, will almost certainly see a rise in cases, as only 5.4% of its population is fully vaccinated.[65] Similarly, general elections such as those in Chile, Brazil, and Colombia will highly exacerbate COVID-19 cases due to the increase of public political rallies. Countries such as Haiti that are experiencing significant political turmoil and natural disasters will very likely see a rise in COVID-19 cases as access to vaccines, necessary personal protection equipment (PPE), and healthcare is poor. A lack of government action from countries like Brazil will almost certainly result in health crises as rural communities struggle to gain access to vaccines.[66] Vaccine inequalities between wealthy and low-income Latin American countries will likely adversely impact vulnerable communities in the coming months as social gatherings become more frequent.[67] Vaccine inequalities and the impact on human behavior will likely result in increases of COVID-19 infections, though the rate of increase will likely vary across countries.

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[1]Face Masks” by Chris Yarzab licensed under Creative Commons

[2] CDC Museum COVID-19 Timeline, Centers for Disease Control and Prevention, August 2021,

[3] COVID-19 Dashboard, Center for Systems Science and Engineering at John Hopkins University, November 2021,

[4] Coronaviruses, National Institute of Allergy and Infectious Diseases, August 2021,

[5] COVID-19, MERS & SARS, National Institute of Allergy and Infectious Diseases, October 2021,

[6] “Weather Variability and COVID-19 Transmission: A Review of Recent Research,” International Journal of Environmental Research and Public Health, 2021,

[7] COVID-19 Dashboard, Center for Systems Science and Engineering at John Hopkins University, November 2021,

[8] Twindemic warning: COVID-19 and flu season will collide this winter, UC Davis Health, October 2021,

[9] Tracking SARS-CoV variants, World Health Organization, November 2021,

[10] The Intersections of Environment, Health, and COVID-19 in Africa, Eos, July 2021,

[11] Less than 10% of African countries to hit key COVID-19 vaccination goal, World Health Organization, October 2021,

[12] How can we tackle vaccine inequity in Africa?, World Economic Forum, October 2021,

[13] Ibid

[15] Delta coronavirus variant: scientists brace for impact, Nature, June 2021,

[16] Coronavirus (COVID-19) Vaccinations, Our World in Data, November 2021,

[17] Ibid

[18] Why you’re not hearing about Covid-19 outbreaks in Africa, Quartz Africa, October 2021,

[19] Do Humidity and Temperature Impact the Spread of the Novel Coronavirus?, Front Public Health, May 2020,

[20] Vaccine rollouts lay bare the Middle East's deep inequalities, CNN, January 2021,

[21] Coronavirus (COVID-19) Vaccinations, Our World in Data, November 2021,

[22] Ibid

[23] COVID-19 & Conflict in the Middle East, Middle East Institute, January 2021,

[24] Delta Variant: What We Know About the Science, Centers for Disease Control and Prevention, August 2021,

[25] UN food agency: 45 million people on the edge of famine, Al Jazeera, November 2021,

[26] Corona virus and healthcare in Yemen, WorldData, n.d.,

[27] Romania reaches historic high in Covid deaths, EU Observer, November 2021,

[28] Europe, at ‘epicenter’ of coronavirus pandemic, looks to booster shots, Politico, November 2021,

[29] Netherlands to reimpose Covid restrictions amid rising infections, Financial Times, November 2021,

[31] Green pass: Which countries in Europe are asking tourists for them right now?, Euronews, October 2021,

[32] WHO Covid-19 Tracker: Turkey, World Health Organization, November 2021,

[34] Turkey to start booster shots for Pfizer COVID vaccine recipients -minister, Reuters, November 2021,

[35] U.S. COVID-19 Vaccine Tracker: See Your State’s Progress, Mayo Clinic, n.d.,

[36] COVID-19 vaccination in Canada, Government of Canada, November 2021,

[38] Vaccines for children: COVID-19, Government of Canada, November 2021,

[40] Why Indoor Spaces are Still Prime COVID Hotspots, Nature, March 2021,

[41] Is Covid’s winter surge already here? Experts warn the pandemic isn’t over, NBC News, November 2021,

[43] Is Covid’s winter surge already here? Experts warn the pandemic isn’t over, NBC News, November 2021,

[44] 'We're in big trouble,' says ICU doctor amidst COVID surge in northern B.C., CBC News, September 2021,

[45] New COVID cases have been declining for 11 weeks, Mexico News Daily, October 2021,

[46] Ibid

[47] Ibid

[48] In Mexico, study of ‘excess deaths’ shows at least 60% more COVID-19 victims than reported, LA Times, March 2021,

[49] As other nations push to vaccinate children, Mexico is an outlier, The New York Times, October 2021,

[51] Covid Updates: Mexico Resists Vaccinating Children Despite Court Order, The New York Times, October 2021,

[52] Neighbor at Risk: Mexico’s Deepening Crisis, CSIS, September 2020,

[53] Asia-Pacific needs to tackle overlapping crises, World Meteorological Organization, August 2021,

[54] ASEAN’s divided response to COVID-19, East Asia Forum, November 2021,

[55] Ibid

[56] India administers 1 billionth COVID vaccine, but its inoculation drive has a major flaw, Fortune, October 2021,

[57] Why are COVID cases in India decreasing, despite the low double vaccination rate?, The Conversation, November 2021,

[58] Vietnam takes Sinopharm vaccines to ease Ho Chi Minh City’s woes, Financial Times, October 2021,

[60] The seasons in South America. When to travel?, Howlanders, November 2021,

[61] Latin America and the Caribbean, Reuters COVID-19 Tracker, November 2021,

[62] Timeline: Tracking Latin America's Road to Vaccination, AS/COA, November 2021, ​​

[63] Ibid

[64] Ibid

[65] Ibid

[66] Failed COVID-19 response drives Brazil to humanitarian catastrophe, Médecins Sans Frontières, April 2021,

[67] Targeting vaccine inequality, WHO announces plans to announce COVID-19 vaccines in Latin America, Global Americans, September 2021,



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