This article does not present specific predictions. Instead, it explores the range of possible developments over the next few weeks regarding the coronavirus and the factors that will influence which scenarios actually unfold.
To help make sense of this complex situation, we’ve developed an internal framework at The Prepared to discuss the pandemic. This model helps us understand the current state of the virus in different regions and how things might evolve.
The Six Levels of the COVID-19 Pandemic
Although the number of cases can vary widely from one place to another, the overall state of the epidemic—socially and in terms of public health—can be usefully categorized into a few distinct levels. These levels represent the degree of SARS-CoV-2 transmission in a given area and may not always reflect the actual case count.
- Level 0: No active cases of COVID-19 in the area. This is the baseline or default state.
- Level 1: There are some active cases, but they are contained. If containment holds, the situation should return to Level 0 soon.
- Level 2: Local transmission is occurring, but it's limited. With good tracking, these cases could be grouped into identifiable clusters.
- Level 3: Widespread local transmission has occurred, making cluster tracking difficult even with strong efforts. However, hospitals are not overwhelmed yet.
- Level 4: The local healthcare system is under significant strain due to high numbers of cases, but the impact is still relatively small compared to the population as a whole.
- Level 5: The disease burden is so high that it affects a large portion of the population.
While the lines between these levels aren't always clear-cut, they remain useful for understanding the progression of the outbreak.
So far, many regions have reached Level 3, including major cities in China, parts of Europe, and places like Seattle and New York in the U.S. Only a few areas—such as Hubei, Lombardy, Daegu, and Qom—have hit Level 4. Level 5 has only been seen on the Diamond Princess cruise ship, which was a closed environment.
Three Ways to Stop the Virus: Natural Immunity, Public Health, and Therapies
The difference between a region at Level 2 and one at Level 3 often comes down to how the local population responds to the outbreak. Keeping the virus under control and preserving the medical system depends on reducing its spread, or lowering the reproduction number (R). R represents how many people each infected person goes on to infect. If R drops below 1, the virus begins to die out.
In the long run, the only way the pandemic will end is if R stays below 1 globally for an extended period. There are three main ways to achieve this:
- Natural immunity: When a large portion of the population becomes immune through prior infection, it reduces the spread of the virus.
- Public health measures: Actions like isolation, contact tracing, lockdowns, social distancing, and mask-wearing all help slow transmission.
- Therapies: Vaccines and treatments play a key role, but their availability and scale are critical.
Each of these strategies has its own strengths and limitations. Natural immunity requires a large portion of the population to become infected, which can be dangerous. Public health measures are most effective when the outbreak is small and manageable, but they become harder to implement as the virus spreads. Therapies offer hope, but they’re unlikely to be available at scale in 2020.
Think of public health as the car’s brakes and steering wheel, while therapies and natural immunity act like guardrails and cliffs. If you handle the car well, you avoid disaster—but as the situation worsens, the challenge increases.
Three Possible Outcomes
Based on these three tools, there are three major possibilities for the future of the pandemic:
- The virus is eradicated using public health measures before therapies are widely available.
Levels Can Change
The pandemic isn’t irreversible. The Chinese experience shows that even a Level 4 area can be brought back down to Level 2 with strict public health measures. Similarly, a Level 3 area can move to Level 2 without a full lockdown if testing and isolation are effective.
While moving from Level 2 to Level 0 hasn’t happened on a large scale yet, it’s possible, as seen with other diseases. On the flip side, any area can move up a level quickly if transmission isn’t controlled.
These transitions can happen within a couple of months. That means the situation in any location can change dramatically in just a short time. A city that’s currently at Level 3 could be at Level 5 in a few months, or vice versa.
Overall, the pandemic is likely to last several years. As such, we must think in terms of patterns rather than specific events. The best or worst outcomes can occur anywhere, depending on how prepared and responsive communities and governments are.
Conclusion
As the pandemic continues to evolve across different regions, we’ll use this framework to track where things stand and what might come next. In our next post, we’ll explore three potential future scenarios and analyze them using the levels we’ve outlined.
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