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What does the future of COVID-19 look like in Minnesota?

A number of possibilities exist: a second, bigger wave; a slow-burning decline; a series of peaks and drops.

coronavirus patient
The number of people who are hospitalized, growing quickly just a few weeks ago, has stabilized, and the number of deaths in Minnesota do not appear to be growing at an increasing rate.
REUTERS/Lucy Nicholson

As of mid-June, Minnesotans are rounding out a third month of living with COVID-19. It’s been about that long since the World Health Organization declared a pandemic; that long since Gov. Tim Walz declared a state of peacetime emergency and put restrictions on gatherings, and that long since Minnesota’s first confirmed case.

While in some ways, it feels like it’s been three years, experts say this is still just the beginning: we will be living with COVID-19 until the population reaches herd immunity, either through exposure or vaccine.

In other words, it could be a while. Here’s what experts say our lives with this pandemic might look like in the coming months.

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Where things are now

In order to talk about where the disease may be going, it helps to first talk about where things stand today.

In recent days, Minnesota Department of Health officials have said the novel coronavirus seems to be hitting a plateau — at least for now — in Minnesota.

The number of new confirmed cases has slowed in growth. The number of people who are hospitalized, growing steadily just a few weeks ago, has stabilized, and the number of deaths in Minnesota do not appear to be growing at an increasing rate. At least for now.

Cumulative confirmed COVID-19 cases in Minnesota by day
Source: Minnesota Department of Health

“I would say more likely than not, that we will stay in a situation where we’re going to continue to have a fair degree of COVID in the community for quite some time to come,” Health Commissioner Jan Malcolm said in a press briefing last week.

Meanwhile, there’s still a lot that isn’t known about this virus. Importantly, we still don’t know how long someone who has been infected with COVID-19 is immune to becoming reinfected — if at all.

“If you had an infection and then you’re exposed to it again, does that mean you’ll have no infection and no symptoms? Does that mean you might have virus on board and shed virus and you could potentially spread virus but you have no symptoms? Or does it mean you do get sick again or potentially even sicker?” said Dr. Ruth Lynfield, Minnesota’s state epidemiologist.

Going off the SARS and MERS playbook — different coronaviruses that have popped up in recent decades — a sort-of educated guess would say that protective antibodies might last about two to three years. But COVID-19 could be different.

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The coming waves

Experts say the only way this pandemic is likely to end is through herd immunity, meaning so many people have developed antibodies to the virus in the population that it has a hard time finding hosts, so it can’t effectively spread.

When COVID-19 first emerged, no one had antibodies to the virus — it was completely new. Currently, MDH officials estimate 5 percent of Minnesotans have had COVID-19.

“We have every reason to believe it’s going to continue to transmit until at least 60 to 70 percent of the population is immune,” said Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

wave scenarios
Center for Infectious Disease Research and Policy, University of Minnesota
Herd immunity could be reached either by exposure — living with the virus until enough people have been infected — or through a vaccine administered to a large portion of the population. Currently, there is no vaccine for COVID-19, and while many vaccines are in development and some are in clinical trials, many experts believe it will be 2021 before a vaccine is widely available.

So then, back to exposure. Osterholm and his colleagues have laid out three potential scenarios for the pandemic’s path forward.

In one, there are a series of waves of COVID-19 over the next year or two, which may be geographically concentrated due to mitigation measures being put into place and eased on and off over time. Those waves may also require mitigation techniques — things like closing restaurant dining rooms — to be re-instituted and relaxed over time to ward off bigger waves.

A second scenario would be similar to the 1918 flu pandemic, which saw a second, even bigger peak in the fall, followed by smaller waves in subsequent seasons.

In the flu pandemic, the lull between the first and second waves was driven in part by the flu virus’ tendency to die down in warmer, more humid weather, at least in the northern hemisphere. Experts don’t know why the flu does this, and it’s not clear the new coronavirus does. There are currently major outbreaks in many hot, humid countries, including Brazil, India and South Africa.

The prospect of a major fall COVID-19 peak is concerning because it would presumably come right as flu season begins, putting people’s immune systems — and the country’s hospital systems, which tend to be near-capacity in a normal flu season — under assault from two respiratory pathogens.

Dr. Lee Riley, a professor and chair of the Division of Infectious Disease and Vaccinology at UC Berkeley’s School of Public Health said he thinks a major fall peak is unlikely based on what’s happening in Asia. Where countries have opened up, they’ve seen some increase in cases, but nothing like the first big wave of COVID-19.

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Of course, mask-wearing — which Riley said can itself help prevent a huge recurrence —  is a more standard practice in many Asian countries. While many Americans are wearing masks and are likely to continue to do so into the fall, it’s less of a standard practice here.

A third possibility is that the current wave of cases is the big peak, and the number of cases in the future will continue at low levels, going up and down in smaller waves for the next year or two. Under this scenario, reinstating strict mitigation measures might not be necessary.

Michael Osterholm
University of Minnesota
Michael Osterholm
Osterholm said if COVID-19 cases decrease substantially by mid-to-late July, he thinks there’s a good chance of a second peak. If the number of cases is steady, it could indicate more of a slow burn, like in the third scenario.

Right now, things are volatile. Compared to last week, more states are seeing increases in cases and more are seeing decreases in cases — less are holding steady, Osterholm said.

In the coming months, ebbs and flows in cases will be dictated by things like the degree to which social distancing and hygiene practices are observed, the density of populations, as well as events, Lynfield said: For example, the lifting of some restrictions and the demonstrations in the wake of George Floyd’s death.

“We’ll have transmission and then people will be a little bit more careful, and it will go down. And then people will be a little less careful,” she said.

Weakening virus?

Another possibility, though an uncertain one, is that the virus weakens.

Historically speaking, other coronaviruses have become attenuated — less likely to cause severe illness or death — over time, Riley said. For example, the common cold is believed to have appeared in humans about 200 years ago. At that point, it may have been virulent enough to cause severe disease, but now, it’s mostly associated with sniffles and a cough.

How does this process happen?

Most people who become infected with COVID-19 recover because their bodies are able to fight it off, a process that puts the virus under a lot of stress.

“They want to replicate but the body is trying to kill them, so that forces the virus to undergo mutations. It forces the virus to try to be undetectable,” Riley said.

Some doctors in Italy, the country hardest-hit by COVID-19, say recent samples of COVID-19 show less potency than previous samples. While it’s not clear how fast the virus is changing and whether that could make a difference, it’s possible, maybe even by fall.

“We’re actually seeing a lot of mutations. Whether the mutations are associated with attenuation, we don’t know that yet,” Riley said.