I know, I know, I know – a writer’s rule is: Never change Shakespeare. The quote, as you all know, is “What’s past is prologue” and that sentiment has been a guiding principle of the way I see the world for over 4 decades. Come to think of it, the quote would be an excellent guideline for the American electorate as we face the 2024 election. But let’s not go down that road today.

Quite a few people in my current life seem to know that I am an epidemiologist and that I used to head a Division at CDC. Therefore, I get more than my fair share of questions about the Covid pandemic, about reasonable precautions, and about their personal safety. The public’s concerns surrounding Covid make perfect sense when you consider the overwhelming amount of information being published almost daily on variants, reinfections, seasonal variability, long term consequences, and increasing infectiousness, among many other Covid-related topics. Also, of course, the information comes from a wide variety of sources, not all of which have the best welfare of the public uppermost in mind. Confusion reigns (as confusion is wont to do).

Maybe we can simplify all of this information. Hence, the title of this essay. In my opinion, what the US has experienced with Covid in 2022 will be what we see over the next few years, with some variability.

Let’s get that variability out of the way first. Viruses are mutable things. We’ve certainly seen that with the long line of Covid variants over the last 18 months. The US response to the virus has not been consistent and Congress has already cut back significantly on public health funding even though we’re not yet 3 years out from the start of this pandemic. The public’s patience with this virus and willingness to take precautions is waning precipitously. Just look at the proportion of the population willing to be vaccinated against this virus. For each new booster, the numbers drop significantly. Also, politics.

Even considering those factors, I think the next few years will see a series of increasingly infectious variants; increasing then decreasing rates in geographical areas and individual states; some seasonal variation in cases, hospitalizations, and deaths with winter seeing the highest numbers of all; Covid-related deaths hovering at about 120,00 to 140,000 per year; less emphasis on masks and distancing; and much less interest on Covid from the public, for an illness that will kill approximately 10,000 Americans per month.

I am not claiming that that what I describe above is good or bad, right or wrong. I just think that this is how the next 2-3 years will play out. I am also aware that the whole scenario could go south if one of these highly infectious variants is also more virulent and infects a wide swath of the population with a more severe illness. But let’s hold those good thoughts for now.

The one other fly-in-the-ointment that I see as a distinct possibility is a dangerous flu season during this fall and winter. Based on recent national experiences in the southern hemisphere, a flu season with worrisome severity of symptoms and a high number of deaths is quite likely. I am just not sure how many deaths a harsh flu season would result in this year, since so much of the population vulnerable to dying from flu have already been taken by Covid over the last 3 years. That phenomenon is called “displaced mortality” and is a subject public health people are loathe to discuss because it invariably spotlights an earlier public health failure. In this case, old people dying from Covid in 2020 and 2021.

So, if I am right, 2023-2024 will look a lot like 2022 and, quite frankly, you are likely to be infected a few times in those years. What can you do? Well, for me, I’m going to be erring on the side of safety while continuing to live my life. I will also get any and every updated vaccine as they become available and try to stay health and optimistic.

So far, I have not been infected. I think that’s more luck than knowledge in play.

Be safe. Stay informed. Get all the shots. Get the flu shot. Yeah, I know you never get the flu, except that one year when you got a flu shot and you got sick. You’re an idiot – get the flu shot.