After the pandemic: perspectives on the future trajectory of COVID-19

Amalio Telenti (), Ann Arvin (), Lawrence Corey (), Davide Corti (), Michael S. Diamond (), Adolfo García-Sastre (), Robert F. Garry (), Edward C. Holmes (), Phillip S. Pang () and Herbert W. Virgin ()
Additional contact information
Amalio Telenti: Vir Biotechnology
Ann Arvin: Vir Biotechnology
Lawrence Corey: Fred Hutchinson Cancer Research Center
Davide Corti: a subsidiary of Vir Biotechnology
Michael S. Diamond: Washington University School of Medicine
Adolfo García-Sastre: Icahn School of Medicine at Mount Sinai
Robert F. Garry: Tulane University
Edward C. Holmes: School of Life and Environmental Sciences and School of Medical Sciences, The University of Sydney
Phillip S. Pang: Vir Biotechnology
Herbert W. Virgin: Vir Biotechnology

Nature, 2021, vol. 596, issue 7873, 495-504

Abstract: Abstract There is a realistic expectation that the global effort in vaccination will bring the pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) under control. Nonetheless, uncertainties remain about the type of long-term association that the virus will establish with the human population and, in particular, whether coronavirus disease 2019 (COVID-19) will become an endemic disease. Although the trajectory is difficult to predict, the conditions, concepts and variables that influence this transition can be anticipated. Persistence of SARS-CoV-2 as an endemic virus, perhaps with seasonal epidemic peaks, may be fuelled by pockets of susceptible individuals and waning immunity after infection or vaccination, changes in the virus through antigenic drift that diminish protection and re-entries from zoonotic reservoirs. Here we review relevant observations from previous epidemics and discuss the potential evolution of SARS-CoV-2 as it adapts during persistent transmission in the presence of a level of population immunity. Lack of effective surveillance or adequate response could enable the emergence of new epidemic or pandemic patterns from an endemic infection of SARS-CoV-2. There are key pieces of data that are urgently needed in order to make good decisions; we outline these and propose a way forward.

Date: 2021
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DOI: 10.1038/s41586-021-03792-w

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