COVID in 2023 and beyond why viral trends are harder to predict three years later

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In 2020, we knew very little about the new virus that would become known as COVID-19. Now, as we enter 2023, a search on Google Scholar produces around five million results containing the term.

So how will the pandemic be felt in 2023? It is in some respects impossible to answer this question, given a number of unknowns. In early 2020, the scientific community focused on determining key metrics that could be used to make projections about the severity and extent of the virus’ spread. Now, the complex interplay of COVID variants, vaccination and natural immunity makes this process much more difficult and less predictable.

But that doesn’t mean there’s room for complacency. The proportion of people estimated to be infected has varied over time, but this figure has not fallen below 1.25% (or one in 80 people) in England for the whole of 2022. COVID is still very present and people are infected over and over again.

Meanwhile, the number of people self-reporting long COVID symptoms in the UK is around 3.4%, or one in 30 people. And the cumulative risk of getting long COVID increases as people become re-infected by COVID.

The UK healthcare system is under enormous pressure, with very high pre-COVID waiting times having been exacerbated during the pandemic.

Why COVID screenings have become more difficult

During the early days of the pandemic, simple models could be used to project the number of COVID cases and the likely effect on the population, including health care demands.

Relatively few variables were needed to produce the first projections. This is because there was one main variant of COVID, the original strain, that everyone in the world was susceptible to.

But now those simple assumptions no longer hold. It is estimated that a large portion of the world’s population has had COVID and there are significant differences between individual levels of protection in terms of vaccines and the number of doses people have received around the world. A total of 13 billion doses of vaccines have been administered, but inequitably.

The modeling also works well when people act in predictable ways, whether it’s normal, pre-pandemic behavior or in times of severe social restrictions. As people adapt to the virus and make their own risk-benefit assessment of behavior, the modeling becomes more complex.

Read more: Six unknown factors in coronavirus models and how they could affect predictions

Reduced monitoring also makes modeling more difficult. At the height of the COVID emergency response, this was a priority, including monitoring people with the virus and monitoring for variants. This allowed new variants such as the omicron to be quickly identified and responses to be prepared.

The UK in particular has produced two million COVID sequences through February 2022, representing a quarter of global genome sequencing output. But sequencing activity subsequently declined, which may increase the time needed to identify new variants of concern.

The pandemic is not over

There remain large differences in pharmaceutical and non-pharmaceutical interventions in place around the world, for example the use of masks, COVID testing and building ventilation. As governments loosen and sometimes tighten their responses to react to dynamic medical and social pressures, there is a risk that variants will emerge that evade some of the defenses that populations have built.

The next steps of the pandemic will also be influenced by people’s behavior. For example, how much we work from home and whether we reduce our social contacts when contagious.

There is no certainty that new variants will emerge that will have an effect on the order of the delta or the omicron, but it is possible. If this happens, it is important that plans are in place to respond in the context of waning interest in COVID and the resurgence of misinformation and disinformation.

The evolution of the virus can make modeling more difficult. Kateryna Kon/Shytterstock Beyond 2023, the next pandemic

It is relevant to ask how much learning has taken place during the COVID pandemic to improve the response to the next pandemic.

During this pandemic, we have often seen short-term national interests prioritized, emphasizing national responses to vaccine equity while neglecting the long-term global availability of vaccines. While laudable initiatives such as Covax have been put in place, designed to provide equitable access to COVID vaccines and treatments, the challenge is to design incentives for nations to cooperate to reduce long-term global risks.

Read more: Coronavirus: We’ve had ‘Imperial’, ‘Oxford’ and many more models, but none can have all the answers

As with any policy response, emergency phase priorities can all too easily be overlooked, such as the ability of governments to manufacture vaccines. An example of this is the UK government’s sale of the Vaccine Manufacturing and Innovation Centre. The ability to quickly develop and produce vaccines would serve us well for the next pandemic, but these priorities must now compete with others that are more immediate or politically expedient.

The UK’s COVID inquiry is bound to be presented with thousands of pages of evidence, with many submissions giving clear and consistent accounts of lessons learned. Whether these lessons are put into practice is quite another matter.

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