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There have been several studies, interviews, and seminars breaking down what the long-term future of COVID-19 might look like. laid out his own thoughts on Twitter this week, detailing a potential “COVID endgame” where we may very well see yearly spikes in cases and deaths.

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revolves around “what COVID will look like in its endemic state,” where regions and countries have developed a high enough level of immunity to the virus to slow transmission down to a more manageable rate.

“I expect endemicity to be achieved at different times throughout the world due to inequities in vaccine distribution and I expect this to be a soft transition rather than a sudden flip of a switch,” he tweeted.

That said, he also pointed how that “there may still be significant circulation of the virus due to waning immunity and viral evolution.”

Bedford compares it to the seasonality of the flu, which infects around 10% of adults every year, and kills an estimated 30,000 people in the United States annually. The flu is also far less infectious than COVID-19, with an R0 number “around 2.”

R0 — pronounced “R-naught” — represents the number of people a single person with the virus is likely to infect. Comparatively, the R0 number for the early strains of COVID-19 was roughly three, while the delta variant sits around five or six.

Based on his estimations of waning immunity and how the virus may evolve and adapt in the future, Bedford estimates that between 20-30% of the population could be infected annually by COVID-19.

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“At endemicity, circulation does not necessarily translate to disease burden,” he clarifies, thanks in large part to “robust vaccine effectiveness against severe outcomes.”

If vaccination rates remain high, he believes the fatality rate could drop to “a flu-like 0.06%,” totaling between 40,000 and 100,000 yearly deaths in the United States.

“Most infections would be relatively mild (just like flu), but there’s enough of them that even a small fraction of severe outcomes add up,” Bedford describes. “This is not cancer or heart disease, but it’s still a substantial public health burden. That said, yearly boosters just like flu vaccine, therapeutics like molnupiravir, improved ventilation and rapid testing can all contribute to reducing this ongoing burden.”

You can read Bedford’s full Twitter thread , and see an archive of his past Twitter threads on COVID-19 .