HOW COVID-19 COULD PAN OUT FROM HERE / BARRON´S MAGAZINE

How Covid-19 Could Pan Out From Here

By Josh Nathan-Kazis

Employees at deserted check-in counters at Hongqiao International Airport in Shanghai, as the city battles Covid./Qilai Shen/Bloomberg; Bernd Settnik/picture alliance via Getty Images

After two years, predicting the course of the pandemic has proved to be impossible. 

Even the most sophisticated models seem to be of limited use when faced with the random evolution of the virus.

Experts trying to look into the future of the pandemic are clear about the limits of their foresight. 

They can, however, offer broad predictions to help shape ideas of what the next two years of living with Covid-19 might look like. 

Their best guess: The pandemic isn’t ending, but antivirals will make it much easier to live with.

“It seems super unlikely, unless there is an absolute killer variant that somehow evolves to evade the antivirals, that we’re going to see major lockdown ever again,” says Chris Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington, and the most prominent U.S.-based modeler who has worked to predict the course of the pandemic.

The most likely scenario seems to be a pandemic that doesn’t go away but is largely manageable through the use of antivirals like Pfizer ’s (ticker: PFE) Paxlovid.

Karl Friston, the neuroscientist at University College London behind UCL’s Covid-19 forecast, expects a “high-prevalence endemic equilibrium.” 

The question, he says, “is how high is high, and what are we going to do about it.”

One crucial factor in answering those questions is when the next Omicron-like leap in the virus’ evolution arrives and sets off another rapid, global rise in cases. 

It might come every year, or every decade. It might come so frequently that vaccines can’t be updated fast enough, or so infrequently that vaccines never need to be updated. 

It might render the antivirals ineffective, or it might not.

“It comes down to the properties of the virus and the properties of the collective world immune system, and that’s not simple,” says John P. Moore, a professor of microbiology and immunology at Weill Cornell Medicine, of how the pandemic will evolve.

To think about what might happen over the next two years, it’s useful to split the way the virus changes into two categories: the big leap, and the gradual drift.

What’s remarkable about the virus that causes Covid-19 is not only that it can take huge leaps in evolution, like the one that created the Omicron variant, but also that its more-mundane mutations also happen extraordinarily quickly.

In a presentation to a Food and Drug Administration advisory panel in April, Trevor Bedford, a professor at the Fred Hutchinson Cancer Center, said that it took just a year from when the Delta variant appeared to when it became dominant globally, a process that would take three to five years for a quickly spreading, quickly mutating version of influenza known as H3N2. 

The virus itself, meanwhile, has changed as much in two years as H3N2 does in five years.

Bedford said that, based on the experience of the virus so far, an Omicron-like leap could be expected every year, or every decade. 

“We really don’t know whether these wildly divergent viruses will be a common feature or a rare feature of SARS-CoV-2 evolution,” Bedford said in his presentation. 

He estimated a nearly 70% chance of no Omicron-like event this year, but a more than 30% chance of at least one happening this year.

Forecasters can’t predict these jumps. 

“We don’t model the evolution of new variants in our...forecast,” Murray says. 

“Nothing has been proposed by anybody that’s any good on that front.”

Some models do, however, assume that the virus will change. 

Friston says that his model assumes an increase in transmission risk every two months caused by the mutation of the virus.

Another Omicron-like jump isn’t the only bad-case near-term outcome. 

Moore says it is possible to imagine Omicron mutating slightly and achieving lethality on the level of the Delta variant. 

“That, to me, is one of the worst-case scenarios that’s reasonably foreseeable,” he says.

This all sounds dire. 

But to the modelers, the picture is not at all bad. 

Murray, whose current model has the number of daily deaths in the U.S. continuing to drop over the next three months, expects that access to antivirals will substantially dampen the pandemic’s impact. 

He does not expect future lockdowns.

“It is really about risk assumption, because with access to antivirals, even Delta really would not be worse than flu,” Murray says. 

“Nobody stopped going to restaurants because of flu. 

People’s sense of risk is massively heightened.”

In the United Kingdom, Friston expects just a “gentle shift in attitudes.” 

Still, his model, which projects future “mobility,” based on car use and workplace and retail activity, doesn’t project a full return to normal. 

His model has “mobility” in the U.K. topping out at 90% of prepandemic levels.

“It doesn’t look like that’s ever getting back to 100%,” he says.