More than two years into the COVID-19 pandemic, experts have learned just how hard it is to predict what this virus will do next.
"I would never have expected, you know, in the middle of summer in a heatwave, we would have a surge in cases two and a half years into this pandemic," Dr. Scott Roberts, associate professor and associate medical director for infection prevention at Yale School of Medicine, told TODAY.
Roberts said he's "disappointed" and "discouraged" about where we are compared to last summer. But patterns in the virus' behavior are emerging and, armed with treatment options and a variety of vaccines, we're in a very different place than we were in 2020.
The questions experts are figuring out now are about how long this transition period will last — and how much the virus will change during this phase.
What will happen this fall and winter?
"We seem to be on these two-month wave cycles," Roberts said. He predicts the BA.5 variant, now responsible for more than 85% of U.S. cases, will fall within the next few weeks.
From there, COVID-19 cases will likely remain low for a month or two "and then probably spike as things get cold again around October," he said. The past two winters have seen major surges, so it's a good bet we'll have one this year, too.
The virus may “take the track of other coronaviruses” and continue to become less severe but more transmissible over time, Dr. Taison Bell, assistant professor of medicine in the divisions of infectious diseases and international health and pulmonary and critical care medicine at the University of Virginia, told TODAY.
But "the big question," Roberts said, is what will come after BA.5 — and to what extent the virus will mutate before the end of the year. His suspicion is that the pattern we've seen with variants will continue, meaning that we will continue to have new variants emerge that evade our immune protection "to some degree but not fully."
So he expects that we'll still have adequate protection against severe disease and death from the vaccines even against new variants.
When — and how — will COVID-19 actually end?
“I don’t think we’ll have a point where we can plant the flag in the ground and say COVID is over,” Bell said. “This (virus) has shown the ability to survive and thrive in every season of each year since we’ve gotten to know it.”
Rather than a specific calendar date, what we'll likely continue to see is the gradual shift to "more of this endemic response,” Neysa Ernst, nurse manager for the Johns Hopkins Biocontainment Unit, told TODAY. An endemic virus is certainly still a problem, but it isn't overwhelming health care systems or disrupting travel, TODAY reported previously.
For instance, Ernst’s hospital has adopted automatic testing protocols for new patients, which help staff get “ahead of the game” in identifying and isolating people with COVID-19, she said. And there's now infrastructure in place to stand up emergency COVID-19 wards when necessary, she said, but staff members don't have to be anxious about suddenly needing to set them up overnight.
"This disease will continue to be in endemic circulation that, at some point, will follow a more seasonal pattern," Roberts said, meaning we'll still have larger surges in the fall and winter similar to other respiratory viruses.
Bell agreed: Over the next few years, COVID-19 "will become much more of a nuisance rather than something that's a potential death sentence in a small percentage of people," he said.
So, how long will it take to get to that phase? It's tough to predict, of course, but Bell predicts it will take another two to four years “to get to the long-term steady state.” A recent modeling study suggested we may reach true endemicity in 2024, Roberts noted.
Updated vaccines that protect against specific coronavirus strains will be key in getting to that point. The upcoming BA.4/BA.5 boosters may be the first updated shots, but they likely won’t be the last: Roberts said that annual boosters designed to target the variants circulating that year could become the norm.
The emergence of mRNA technology allows for a shorter lead time when making new vaccines, Bell said. That means companies should be better able to match their shots to the strains circulating at the time — and to pivot quickly if a surprise variant pops up.
For now, we're still in a gradual transition phase
Death rates are dramatically lower than they were at the beginning of the pandemic, hospital systems are no longer stretched to their limits, and we have many tools to keep people alive that we didn't have in 2020.
“Even if cases are going up, we’re not seeing hospitalizations and deaths rise to that degree,” Bell said. So, in that regard, we’ve reached a kind of turning point, he said. “Very few patients are on ventilators these days and very few of them die,” Roberts added.
In the long term, there's not going to be much "appetite" for keeping up COVID-19 precautions, like masking and avoiding big events, Bell said. “But COVID is still going to be here, in my opinion,” he said. Even now, the virus is still circulating at levels that are too high and unpredictable for COVID-19 to be considered over, the experts agreed.
So the goal now is to "mitigate the damage and determine how we are going to live with COVID going forward,” Roberts said.
The truth is that this transition phase from pandemic to endemic has been "longer than any of us would have predicted," Roberts said. And while we continue to adjust to living with the virus, the same precautionary advice still applies.
First, get vaccinated — for COVID-19 and the flu, Ernst urged. And don't let go of the tools we've used successfully for so long, like wearing a high-quality mask while traveling or in other risky situations. Expanded access to fast, at-home testing can also help slow the virus's spread.
"We're slowly seeing this virus evolve into becoming a more endemic seasonal virus," Roberts said. "Although we're not there yet."