Pathogens are rarely fully eradicated from the planet. In fact, this feat has only been achieved with smallpox and rinderpest (a viral disease that afflicts cows). SARS-CoV-2 will not break the trend: The virus is here to stay.
If that’s the case, it’s worth asking: What will COVID-19 look like in 10 years?
In 10 years, COVID-19 will be circulating seasonally alongside the four other major coronaviruses that cause mild to moderate illnesses, such as the common cold. Long before that time, however, the virus will have ceased being a public health emergency everywhere in the world.
The lack of a systemic risk posed by COVID-19 will be the result of several factors, chief of which will be the vaccination of high-risk people around the world coupled with prior immunity arising from natural infections. And unfortunately, a proportion of the most vulnerable will have succumbed to the disease.
It’s hard to forecast the exact niche SARS-CoV-2 will occupy in the future, but the seasonal coronaviruses are one benchmark and influenza is another. That means over the span of a year in the U.S., perhaps a maximum of tens of thousands may die and a hundred thousand may be hospitalized. These deaths and hospitalizations are likely to be clustered in the winter months in temperate climates, reflecting the favorability of colder, less sunny, less humid, and less socially distanced environments.
While there will be a baseline level of illnesses, hospitalizations, and deaths, what will be absent is a concern for hospital capacity. Cases will no longer mean that large surges of people will end up in the hospital or with severe disease.
Breakthrough infections and reinfections will be more common, as the virus will continue to circulate and, over time, immunity will wane. However, like reinfections with seasonal coronaviruses that we have now, the severity of these infections will be mostly mild.
Antiviral treatments for mild disease will also be widely available. These new medications will likely decrease symptoms, contagiousness, and complications. They will be used in combination with monoclonal antibodies in high-risk individuals. Hospital care will likely also be refined and some of the most dreaded complications, like cytokine storms, will routinely be recognized and amenable to targeted therapy.
In 10 years, vaccines will likely have undergone a refinement, with second generation vaccines being more potent, less likely to cause adverse reactions, and more easily incorporated into routine childhood immunization schedules and potentially offered seasonally as part of an adult immunization program.
In all likelihood, the U.S. government will adopt a new approach toward pandemic preparedness—abandoning its previously reactive, flat-footed approach. The government will be proactive in anticipating pandemic threats by using analytical and forecasting tools. And it should develop vaccines and antivirals to counter certain high-consequence viral families.
These countermeasures will complement a more robust range of at-home diagnostic tests, building on the momentum of effective COVID-19 and HIV testing. Most households could have the ability to test not only for COVID, but also the flu, strep throat, and other common infections.
A decade from now, COVID will be a tamer disease. But that doesn’t mean the threat of new, deadly viruses will disappear. With foresight and planning, the world will be more prepared for the next infectious disease challenge that emerges.
Amesh Adalja is a senior scholar at the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health. He is a board-certified physician in internal medicine, emergency medicine, infectious diseases, and critical care medicine.
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