This document outlines 3 possible scenarios for the future course of the COVID-19 pandemic over the next 18-24 months according to medical experts: 1) alternating smaller peaks and valleys gradually diminishing over time, 2) a large second wave in fall/winter followed by smaller waves in 2021 similar to the 1918 flu, or 3) a "slow burn" of ongoing low-level transmission. The worst case scenario is a massive second wave exceeding the initial outbreak, overwhelming healthcare systems. Ongoing social distancing measures may be needed intermittently into 2022. Lifting lockdowns does not mean the end of COVID-19, which could remain for months or years until a vaccine is developed.

1. 1

2. COVID-19 : A look at possible
future Scenarios?

3. By

4. ◼ I believe that the COVID-19 pandemic is the most serious global public
health threat humanity faced since the 1918/19 influenza pandemic.
◼ People around the world are now asking what will be the future for
the COVID-19 pandemic.

6. ◼ How our lives will look in the short- to medium-term future is uncertain,
but what does seem clear is we won’t return to a pre-COVID-19 life any
time soon.
◼ What seems clear is that the end of 2020 won’t be the end of COVID-
19, and that we are likely to be dealing with it for at least the next
18-24 months.

7. ▪ How will the COVID-19 pandemic end?
Experts predict 3 possible scenarios based on key lessons from past influenza
pandemics.
▪ Epidemiologists for the University of Minnesota Center for Infectious Disease
Research and Policy (CIDRAP) have laid out three possible scenarios for what
the next 18 to 24 months might look like. (May 08, 2020)

8. ◼ The medical experts warn that “we must be prepared for at least another
18 to 24 months of significant COVID-19 activity.”
◼ The current pandemic is likely to last 18 to 24 months, or until about
60% to 70% of the population reaches immunity.

9. Up to two-thirds of a population needs immunity,
via infection or vaccines, to stop COVID-19

13. Possible COVID-19 wave Scenarios ?

15. The first scenario shows an initial wave of cases — the
current one — followed by “peaks and valleys” that
shrink over time.

16. Scenario 1: Peaks and valleys
◼ The current initial wave of cases is followed by alternating mini-waves of
much smaller outbreaks every few months with only a few (but never
zero) cases in between.
◼ The location of the outbreaks may depend on regional variations in the
sort of mitigation measures that are in place .

17. ◼ In this scenario, the current wave of COVID-19 cases is followed by a
series of smaller waves, or "peaks and valleys," that occur consistently
over a one- to two-year period, but gradually diminish in 2021.

18. In scenario 2, a larger “fall peak,” or possibly a winter
peak, and subsequent smaller waves come after the
current one. This is similar to what happened during
the 1918 Spanish influenza pandemic

19. Scenario 2: Fall Peak
◼ The worst-case scenario, and the most likely outcome we need to prepare
for it., is one in which the first wave is followed by a larger wave in the fall
or winter of 2020, and one or more smaller subsequent waves in 2021.
◼ This mirrors what happened during the 1918 Spanish influenza pandemic
and the 2009 H1N1 flu.

20. ◼ The current outbreak will be followed by a massive second wave in the
fall or winter, that is twice as large and long-lasting. Subsequently, one
or more smaller waves could occur in 2021.
◼ This is exactly what happened with the 1918 Spanish flu pandemic; a
moderate wave in March 1918 was followed by an explosion in cases
that September, followed by smaller peaks until early 1919.

23. The third possibility shows an strong spring peak that
turns into a “slow burn,” with smaller ups and downs.

24. Scenario 3: A 'slow burn' of ongoing transmission
◼ The final scenario suggests that the current wave of coronavirus infections
is the biggest we'd see.
◼ Then in the coming months, the COVID-19 pandemic would shift into a
"slow burn" of ongoing transmission and new cases .

25. ◼ A “slow burn” of the pandemic would look like a sustained continuation
of cases over a long period of time with “no clear wave pattern.”
◼ "While this third pattern was not seen with past influenza pandemics, it
remains a possibility for COVID-19,"

26. ◼ “This third scenario likely would not require the reinstitution of mitigation
measures, although cases and deaths will continue to occur .
◼ Scenario 3 is a “slow burn” of ongoing transmission until we reach herd
immunity (60-70% of people infected).

28. ◼ The only thing that will prevent all of these potential scenarios is the
development of a vaccine.
◼ If one doesn’t become available, then we are likely to have continued
outbreaks until at least half of the world has been infected – only 10%
of the world is estimated to have been infected so far.

44. ◼ Scenario 2 is the worst-case scenario, and the most likely outcome
we need to prepare for it.
◼ A second wave of infections with an even higher peak would require
countries to reinstitute mitigation measures like lockdowns.

45. ◼ The second scenario is possibly the most frightening because in many
countries health systems are only just about coping right now.
◼ If later this year we have a second outbreak of COVID-19 that dwarfs this
one, most health systems – especially fragile ones in low- and middle-
income countries – could buckle under the strain and collapse, causing
extremely high death rates.

46. ◼ The second wave, “would absolutely take the health care system down.”
Avoiding that was the whole point of efforts to “flatten the curve” to
prevent an imminent or actual crash of the health care system, similar
to what northern Italy experienced in March,Health authorities should
plan for the worst-case scenario.

48. ◼ Flattening the curve: slowing the spread of Covid-19 enough to keep
the number of patients needing hospitalization, intensive care, or a
ventilator no greater than the health system’s capacity. Flattening
the curve did not mean zero cases and deaths .
◼ “If we also had a bad flu season, it would be really difficult for hospitals
to cope.

50. Is 'flattening the curve' enough?

55. The best defence is preparation
◼ The researchers strongly recommend that governments and local
authorities prepare as best they can for future outbreaks –and for
a potential worst-case scenario, where no vaccine is found to be
effective, and where herd immunity cannot be achieved.

56. ◼ Regardless of which scenario unfolds, "we must be prepared for at least
another 18 to 24 months of significant COVID-19 activity, with hot spots
popping up periodically in diverse geographic areas.
◼ During new "waves" of cases, areas may need to periodically reinstate and
relax mitigation measures, such as social distancing, to prevent the health
care system from being overwhelmed with cases.

61. ◼ While one-time social distancing may suppress critical cases to within
hospital capacity, infections will resurge once these measures are lifted
◼ This will overwhelm hospitals to the extent that social distancing may need
to be maintained intermittently into 2022

63. ◼ A single round of social distancing will probably not be sufficient in the long
term.
◼ Instead, researchers say, we should be prepared for occasional restrictions
and lockdowns over the next few years, until there’s widespread immunity or
an effective vaccine.

64. ◼ Until there is a vaccine, there is no way other than social Distancing to
stop the spread of the virus.
◼ Social Distancing Might Stop. And Start. And Stop. And Start. Until We
Have A Vaccine. (on and off social distancing).

66. ◼ “We want to re-emphasize that easing restrictions is not the end of the
epidemic in any country,” Lifting lockdowns does not signal the end of
COVID-19.
◼ It’s becoming clear that the coronavirus is not going to simply vanish
after restrictions are lifted,Instead, it’s going to be with us for a while —
certainly for months, and possibly years.