Best- and worst-case scenarios for COVID in future as case numbers are ‘dive-bombing’

February 16, 2022
Hands surround a crystal ball that contains the coronavirus.
There's no crystal ball that can tell us exactly what's next for COVID, but scientists are making some predictions. iStock

The seven-day average number of new COVID cases for the Charleston Tri-county area is dropping with stunning speed. “It’s dive-bombing low,” said Michael Sweat, Ph.D. He leads the Medical University of South Carolina’s COVID-19 Epidemiology Intelligence Project.

His team found that as of Feb. 15, that seven-day average was 44 cases per day per 100,000 people in Berkeley, Charleston and Dorchester counties combined. Just a month ago, the area’s Omicron-driven surge peaked at 416 cases per day per 100,000 people.

Dr. Michael Sweat 
Dr. Michael Sweat

And the percentage of positive test results reported to the South Carolina Department of Health and Environmental Control has plunged, too. “At DHEC today, the state positivity rate was 11%. It was around 30% for a while.”

COVID hospitalizations are falling as well. In late January, there were about 180 COVID patients in MUSC Health’s Charleston hospitals. That number was down to 140 on Feb. 14.

But we’ve seen dramatic declines before. A graph of the pandemic’s progress shows the virus falling to low levels three other times — only to roar back. “I don't think this is going away.”

However, Sweat, a professor in the College of Medicine at MUSC, an adjunct professor in the Johns Hopkins Bloomberg School of Public Health and a former research scientist with the Centers for Disease Control and Prevention, does see a way forward. It involves mapping out best- and worst-case scenarios so we can have an idea of what might lie ahead. 

Best-case scenarios

Sweat laid out five best-case possibilities for COVID. The first looks to the past, to the most famous pandemic of the 20th century. “Like 1918 flu pandemic, we could see the coronavirus mutate to a seasonal variant that, most years, isn’t too deadly.”

And that ties into his second best-case possibility. “We'll be able to adapt the vaccines as we go forward, just like we do with the flu."

Third: “We’ll have nasal and pan-coronavirus vaccines. Scientists are very optimistic, particularly when it comes to the pan-coronavirus one.” There are multiple nasal vaccines in the pipeline. Sweat said they could prevent COVID infections by producing antibodies in the nasal passages, as opposed to the current vaccines that attack the virus once it’s in the body. Pan-coronavirus vaccines, also in clinical trials, would work against multiple variants  and other coronaviruses.

Fourth: More people could decide to get vaccines and booster shots. That’s no simple matter, though. Just over half of all eligible South Carolinians are fully vaccinated. Sweat said a study in the medical journal The Lancet found that people’s trust in government, and each other, was an important factor in determining how well a society fared in the pandemic. “The U.S. actually has a very low level of trust right now. We're a very divided country. I think it's a public health intervention that we need to pursue to try to increase people’s trust in science.”

Finally, he said medications could play a key role in tamping down the virus’ impact. “Oral antivirals could suppress things.”

Worst-case scenarios

Sweat also laid out four worst-case possibilities. First, more variants emerge. “They could show up quickly and be highly transmissible. They could be highly transmissible but not very virulent, but they could be highly transmissible and virulent. That's a risk.”

Second, the coronavirus could follow in HIV’S footsteps and figure out how to evade antiviral treatments. But if it does, there’s another option. “It was discovered in the HIV world that if you combine the antivirals, different classes of them, it overcame that problem. So I think that may be the future. Right now, we have very potent antivirals, and that could really save the day.” 

Third, time may not be on our side. “There's this issue of should we adapt our vaccines to the variants? And the problem is it takes a while to do that because you have to do clinical trials and produce them. And by the time you do that, you get another variant.”

Fourth, a problematic new coronavirus could crop up. “Not many people are talking about it, but we've had three coronavirus pathogens, SARS, MERS and SARS-CoV-2, within a fairly short time. SARS was around 2002, 2003. MERS was 2014. Then in 2019, we got this. So another one could come along too.” He said coronaviruses’s ability to spread, not only in humans but also in animals, increases the odds of that.

All of those things could happen, Sweat said. But he’s taking an optimistic overview. “I lean toward the best-case scenario. I don't think the worst case is as likely. Only time will tell.”

For now, he’s happy to see the numbers going down. “Maybe this will just be the end of the disruption of our lives. I hope so. I think we'll only know when it happens.”

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