Editor’s note: This article was first published in May 2020, early in the COVID-19 pandemic. Its forecasts, including a vaccine by early 2021 at best and a second wave in autumn 2020, were projections at the time; vaccines were authorised from December 2020.
Epidemiologists are trying to predict what COVID-19 may have in store for us this summer and beyond. Even in the most optimistic scenario, we will have to learn to live with the coronavirus for months, possibly years.
Experts agree that the future of this pandemic is hard to predict, because we do not have a real figure for the number of people infected worldwide: we do not know how many asymptomatic people are out there without knowing it, able to infect others. Nor do they know for certain how summer will affect transmission of the virus, or how many people have acquired immunity to it.
Whatever the scenario, the so-called new normal will look nothing like the normal we had a few months ago.
How the coronavirus is changing the Western world
Wearing a mask will be the new normal in the West. Social gatherings will be under threat for a long time. A friend’s occasional cough will feel like a danger. Any stranger coming close will be seen as a potential threat. Taking public transport would be the best option for cutting polluting emissions, but using your own car will be seen as far safer for your own health.
October 2020 will not look like October 2019, but neither will October 2021, according to an analysis published on Thursday by the epidemiologist Michael Osterholm.
The three possible scenarios for COVID-19
The first wave of COVID-19, which hit the world in early 2020, has caused millions of infections and hundreds of thousands of deaths across the planet. In the first possible scenario, it is followed by a series of much smaller waves of outbreaks every few months.
In the second scenario, we would have a second wave that is much more aggressive and longer-lasting than the first, mainly because people let their guard down after a summer in which the coronavirus seems to have been contained.
This second wave could once again put health systems all over the world to the test, and they would find that, even though they were better prepared than in early 2020, they were not ready for a second wave of that size and ferocity.
In the third scenario, the current wave of coronavirus creates a new normal in which COVID-19 outbreaks are kept under control.
In the best case, these experts say, we could have a vaccine by early 2021. If that does not happen, it is quite possible that 50% of the population will be infected, whether or not they fall ill.
Osterholm estimates that no more than 5% of the world’s population is immune to the new coronavirus after surviving infection, so herd immunity may not deliver the hoped-for results in containing COVID-19.
COVID-19 scenario 1
In this future, the current peak of COVID-19 cases is followed over the next two years by peak and trough, peak and trough, with the peaks less than half the size of the current outbreak. In this case, governments would need to be ready to contain an outbreak in time, or we could quickly switch scenarios.
Although this scenario treats COVID-19 as something seasonal, the experts start from the assumption that heat and humidity may slow the spread of the virus but will not eliminate it. Heat and humidity can kill the virus on surfaces, but it could still be passed from person to person through contact, coughing or talking.
It is worth remembering that, in a way, even the common seasonal flu practically disappears in summer, not only because of the heat but because schools are closed and children (potential carriers of the virus) stop passing it on.
Governments may reopen beaches, bars and restaurants, with or without capacity limits and with or without social distancing, because many people will keep up voluntary social distancing out of fear. People know that as soon as they let their guard down, they will be in danger again.
Concerts, sports stadiums and large crowds will all be under threat in the new normal. This will also be the final blow for many shopping centres. Some were already dying.
The impact on small shops and on jobs is still unknown, because we do not have all the variables in the equation: the size of the crisis we are heading into, how long this new normal will last, or the arrival of an effective drug or a vaccine. Still, we should be clear that many small shops will never reopen, others will close as the new normal takes its toll, and as the situation unfolds, large companies will be forced into a wave of layoffs.
Remote working will gain ground in the new normal. People will not only avoid public transport, they will probably also avoid taxis and ride-hailing apps. Even the way we go to see a doctor or a dentist may change.
Once all this has happened, the outbreak would begin to fade. Social distancing would become less strict, people would gradually let their guard down, and another wave would hit. That would be the pattern until a vaccine arrived.
Scenario 2: the worst and, historically, the most likely
In March 1918 the first, moderate wave of the so-called Spanish flu appeared. Cases fell that same summer, but a few months later, with the arrival of autumn, the pandemic exploded. That was followed by smaller peaks in early 1919. Then the epidemic ended. The 1957–58 flu pandemic and the 2009 swine flu followed a similar pattern. If there is one thing we know about pandemics, it is that there is a huge danger of the second wave being fiercer than the first.
In this second scenario, instead of reappearing throughout the year like the peaks of the first scenario, COVID-19 would come back harder in late summer and autumn and then fade. This is what Osterholm calls a cliff case.
The steep drop would have a cause. So many people would be infected in the first wave and in the second, gigantic one (probably arriving in late October) that the population would approach herd immunity. On the other hand, Osterholm predicts that this second wave would bring down the health system.
We should also bear in mind that all of this assumes herd immunity, and to this day we know nothing about herd immunity to COVID-19. In other words, we do not know whether a high percentage of people could become immune, or for how long someone stays immune after being infected.
In any case, epidemiologists are advising governments to make the most of the respite COVID-19 would give us over the summer to get health systems ready and prepare for a significant rise in cases, because, however well they prepare, in this second scenario all their resources would probably fall short.
Under this scenario, the population would have to be locked down again, with measures even stricter than the ones we lived through in March and April 2020.
If there is one thing we know about this new coronavirus, it is that it is far more infectious and spreads far more easily than the other members of the coronavirus family known so far.
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Scenario 3: the so-called slow burn
If everything goes wrong and governments still fail to test quickly enough to isolate infected people and those who have been in contact with them, we would keep having outbreaks and would keep having to put them out as we go, in a constant tug of war.
Epidemiologists say that no influenza pandemic has followed the pattern this scenario describes, but they give several reasons why COVID-19 might.
One is biological: coronaviruses, as the four endemic ones show, can keep circulating and never go away; the SARS coronavirus of the early 2000s was an exception.
The other is sociological: there are real doubts about society’s ability to withstand another economic shutdown, let alone make it an endless cycle. In the future, these policies may be less strict in order to avoid another blow to the country’s economy, and would therefore be less effective at controlling outbreaks. That is why this scenario could happen.
Business closures, stay-at-home orders and other mitigation measures have helped to control this pandemic, so they have proved useful for survival, even though they are damaging for the economy. And that is the dilemma no politician or government would want to face again.
Still, the epidemiologists remind us that flattening the curve does not mean zero infections and deaths, but we do need to be ready to take measures that keep health systems from going through chaos again.
In any case, we may well find ourselves fighting the same battle again, caught between doing what is right for public health and doing what is right for the economy and for people’s social and emotional well-being.
Which scenario is most likely, according to Osterholm?
It is hard to say. All three are plausible, because this virus plays by its own rules, in a game our scientists still do not fully understand, and one whose rules may yet change.
Welcome to the new normal.
Featured image: Saint Paul Area Synod, CC BY 3.0, via Wikimedia Commons.
