This article does not offer specific predictions. Instead, it explores the range of possible outcomes over the next few weeks related to the ongoing pandemic and the factors that could influence which scenario becomes reality.
To make this complex situation easier to discuss, we’ve developed an internal framework at The Prepared to help us understand the current state of the coronavirus outbreak. This model divides the pandemic into six distinct levels, based on the transmission rate and the impact on public health systems rather than just case numbers.
The Six Levels of the COVID-19 Pandemic
Regardless of the actual number of cases in a given area, the overall state of the epidemic can be described using these levels. They reflect the degree of SARS-CoV-2 transmission and the pressure on healthcare systems, with each level representing a different stage of the outbreak.
- Level 0: No active cases of COVID-19 in the area. This is the default state before any infection occurs.
- Level 1: There are some active cases, but they are contained. If no new infections occur, the area can quickly return to Level 0.
- Level 2: Local transmission exists, but it’s limited. Cases can be tracked and isolated effectively.
- Level 3: Widespread local transmission has occurred, making cluster tracking difficult. However, medical systems are still functioning well.
- Level 4: The local disease burden is high enough to overwhelm healthcare systems, but not yet widespread across the entire population.
- Level 5: A significant portion of the population is infected, leading to severe strain on public health and social systems.
The boundaries between these levels aren’t always clear-cut, but they provide a useful way to assess the situation in any given location.
So far, many areas have reached Level 3, including major cities in China, parts of Europe, and U.S. cities like Seattle and New York. Only a few regions, such as Hubei, Lombardy, Daegu, and Qom, have reached Level 4. Level 5 has only been observed in confined settings like the Diamond Princess cruise ship.
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 effectively the population responds to the outbreak. Containing the virus and protecting the healthcare system depends on reducing its spread — or lowering its reproduction number (R).
R represents the average number of people each infected person infects. If R is above 1, the virus spreads; if it drops below 1, the outbreak begins to decline. In the long term, the only way to end the pandemic is for R to stay below 1 globally for an extended period. This can happen through three main approaches:
- Natural immunity: When a large portion of the population becomes immune after infection, it reduces the spread of the virus.
- Public health measures: These include isolation, contact tracing, lockdowns, travel restrictions, and hygiene practices. They are most effective when cases are low and manageable.
- Therapies: Vaccines and treatments play a critical role, but their availability is limited in the short term.
Each of these tools 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 depend on early intervention and sustained effort. Therapies, while powerful, are still developing and may not be widely available in 2020.
Understanding how these tools interact is key to managing the pandemic. Public health measures, for example, are more effective when the outbreak is small and localized. As the virus spreads globally, it becomes harder to control, and the effectiveness of these measures decreases.
Changing Levels Over Time
It's important to remember that the pandemic isn't fixed. Areas can move up or down in levels depending on how well they manage the outbreak. China’s experience shows that even a region at Level 4 can be brought back under control with strict public health measures.
Similarly, a Level 3 area can return to Level 2 if testing and isolation efforts are strong and external cases are limited. 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, an area can also escalate rapidly. Without proper intervention, a Level 2 outbreak could surge to Level 5 in just a few months. This means the situation can change dramatically every couple of months.
While the timeline for the pandemic is still uncertain, it’s likely to last several years. That’s why we focus on patterns rather than specific events. The outcome in any given place will depend on how prepared and responsive its people and institutions are.
Conclusion
As the pandemic continues to evolve at different rates around the world, we’ll use this framework to better understand where things stand and where they might go next.
In our next post, we’ll explore three potential future scenarios and examine how the different levels might apply to each one.
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