More than three years into the COVID-19 pandemic, experts have learned just how hard it is to predict what this virus will do next. But with vaccines, treatment options and a better understanding of how the virus spreads, we’re in a very different place than we were in 2020. For now, experts are cautiously optimistic.
"COVID came in like a lion, and I think it's going to exit kind of like a lamb," Dr. Emily Volk, president of College of American Pathologists, tells TODAY.com.
"Obviously, we've seen a lot of lives lost and a lot of long-term (consequences) from COVID," she says. But at this point, the virus isn't flooding ICUs and emergency departments, she says, and it's becoming something we treat more like the seasonal flu.
But that doesn't mean COVID-19 will go away completely, Dr. Timothy Brewer, professor of medicine and epidemiology at the UCLA David Geffen School of Medicine, tells TODAY.com.
"This virus is very well adapted for human-to-human transmission," he says. And even as it begins to adhere more closely to seasonal patterns, "we likely will continue to see year-round transmission at least for the near future."
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,” 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, tells TODAY.com.
Rather than a specific calendar date, we'll likely continue to see the gradual shift to "more of this endemic response,” Neysa Ernst, nurse manager for the Johns Hopkins Biocontainment Unit, tells TODAY.com. An endemic virus is certainly still a problem, but it isn't overwhelming health care systems or disrupting travel, TODAY.com 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 says. And there's now infrastructure in place to stand up emergency COVID-19 wards when necessary, she says, 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 says, meaning we'll still have larger surges in the fall and winter similar to other respiratory viruses.
Looking at data from the past three years, Brewer notes there have been increases in cases throughout the year, with the biggest peaks in the fall and winter months. "What will probably happen over time is that those (smaller peaks) will smooth out a little bit," he says, "and it will tend to be more of a fall-winter peak and less in the spring and the summer."
Updated vaccines that protect against specific coronavirus strains will be key in getting to that point. The BA.4/BA.5 boosters may have been the first updated shots, but they likely won’t be the last, Dr. Scott Roberts, associate professor and associate medical director for infection prevention at Yale School of Medicine, tells TODAY.com
Annual boosters designed to target the variants circulating that year could become the norm, Roberts says, although the CDC and Food and Drug Administration haven't made a decision on that yet.
The emergence of mRNA technology allows for a shorter lead time when making new vaccines, Bell says. 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.
Are we entering the endemic phase now?
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.
“This is really the best I’ve seen the numbers without a lockdown,” Dr. Bernard Camins, medical director for infection prevention at the Mount Sinai Health System, tells TODAY.com.
At the height of the first January 2021 wave, the CDC counted 1.7 million cases and 23,464 deaths in one week. During the original omicron peak in January 2022, there were around 5.6 million cases in the U.S. and 17,350 deaths in a week.
But now, during the week ending in March 22, 2023, the Centers for Disease Control and Prevention counted 133,500 COVID-19 cases and 2,060 deaths. Clearly, the virus is still with us, but those numbers are significantly down from previous records and even reduced from this winter’s peak of about 495,000 cases and 4,360 deaths in early January.
With that in mind, depending on your definition, we may already be in the endemic phase, Camins says, because the virus is no longer causing mass disruptions in life for the general public. And in the sense that an endemic virus is one that’s with us forever, the virus was already endemic as of late 2020, Brewer adds.
Right now, more than 69% of the country has gotten at least the primary series of COVID-19 vaccines, Brewer says, and 58% has gotten infected with the virus, according to a CDC analysis of antibody levels. That "level of background immunity" is likely a major reason why "we weren't paying as much attention to COVID-19 this winter," he says. "But that doesn't mean it wasn't around and it wasn't infecting people."
Another aspect of endemicity is predictability — and this year may be a test of whether the virus is ready to follow a predictable seasonal pattern.
"Maybe this is the first year where we truly will say that COVID, being a respiratory virus, will recede during the spring and summer and come back in the fall," Camins says. In the fall, we'll likely see an uptick, he says, but the question is: How high will the increase go?
"No one can really predict that," he says, adding that we haven’t seen another subvariant emerge yet to replace omicron subvariant XBB.1.5, which picked up steam this past winter.
"The big unknown is whether we’ll see a new variant arise," Brewer says. And the degree to which COVID-19 will disrupt life this winter may depend on the particular characteristics — transmissibility, the severity of disease, the ability to evade previous immunity — of the strain that becomes dominant at that time, he explains.
Don't forget about these precautions
The truth is that this transition phase from pandemic to endemic has been “longer than any of us would have predicted,” Roberts says. And while we continue to adjust to living with the virus, the same advice on precautions still applies.
Does that mean widespread recommendations, like mask mandates or testing requirements, will come back, too? That’s not likely, the experts say. But that doesn’t mean you can’t use those tools on an individual basis, especially in higher-risk situations (like on public transportation) or if you have risk factors that make you more likely to develop severe COVID-19 symptoms.
People may individually decide to wear a mask on a plane, for instance, Brewer says. “But the urgency and need for government intervention that was present at the beginning of the pandemic aren’t there anymore,” he says.
President Biden declared that the "pandemic is over" back in September 2022. And with the federal public health emergency set to expire this May, the public will be less able to rely on the government for access to free and low-cost testing, treatment and vaccines.
In the long term, there likely won’t be much “appetite” for keeping up COVID-19 precautions, like masking and avoiding big events, on a large scale, Bell says. “But COVID is still going to be here, in my opinion,” he says.
So the goal now is to “mitigate the damage and determine how we are going to live with COVID going forward,” Roberts says.
First, get vaccinated for COVID-19 and, when the time comes, the flu, the experts urged. If seasonal boosters become available, "hopefully even the folks who consider themselves relatively healthy will consider getting them to not only keep themselves healthy but also to reduce the risk for those around them that are more vulnerable," Volk says.
And don't forget about the tools we've used successfully for so long, like high-quality masks. At-home testing can also help make gatherings and events safer, especially if you're feeling under the weather.
"This is going to transition from something that we didn't think we could live with to something that, overall, becomes part of what we live with," Volk says.