Anyone can publish on Medium per our Policies, but we don’t fact-check every story. For more info about the coronavirus, see cdc.gov.

Potential COVID 19 Scenarios

The COVID-19 pandemic has left a lot of people in fear and confusion.

Futurist Paul Higgins
Mar 15 · 19 min read

We have made these scenarios free to download and we are regularly updating them. You can get the document at :

http://www.emergentfutures.com/frontpage-article/covid-19-scenarios/

In recent discussions with clients, I realised that there was a need for some foresight-based work to help them clarify what their strategy might be over the next 18 months. I have written some scenarios for specific clients, but I also have a view that disseminating some summary scenarios is useful for a lot of people. Therefore, I created this summary and made it freely available via our blog and our website so people can be better informed, and others can weigh in with critiques.

This is a very long read but I think it is important to disseminate it.

If you want to engage more with these scenarios I will be running a series of webinars at 8 am and 4 pm AEDT ( https://www.eventbrite.com.au/e/covid-19-scenarios-webinar-tickets-99508994080) or you can contact me at @futuristpaul or paul@emergentfutures.com

The central core of my foresight work is that people need to hold multiple pictures of the future in their heads. They can then adjust their strategy depending on which picture seems to be emerging in the real world. An uncertain and rapidly evolving situation like the COVID19 pandemic is the exact situation where such an approach should be used.

I have a unique set of skills in this area. As well as holding a Masters degree in Strategic Foresight and having worked as a consulting futurist across many organisations in the last 20 years, I am also a veterinarian with experience in disease outbreaks in animals. I was also an inaugural director of Animal Health Australia, an entity which was formed to respond to exotic disease threats. I have participated in both preparedness exercises and the real thing as a veterinary participant in the peak response committee in Australia.

I am not claiming expertise in human epidemiology, but I think that my experience allows me to bridge the gap between the science and people trying to run organisations in these challenging times.

I am using Australia and New Zealand as the basis for scenarios which are applicable globally. The scenarios are based on three key drivers:

1. The basic science behind viral transmission in outbreaks.

2. The behaviour of people in response to an outbreak.

3. The political and economic responses to an outbreak.

The scenarios are:

Contained Epidemic/Pandemic

Extreme containment measures work to reduce the Pandemic and eliminate the virus in a country or region.

Acute Epidemic/Pandemic

Containment measures do not work, and cases rise exponentially in individual countries and across the globe.

Extended Epidemic/Pandemic

Containment measures work in a limited way to slow the pace of the epidemic.

Rolling Epidemic/Pandemic

Containment measures work to significantly slow the epidemic, but the reduction of those containment measures allows the epidemic to gain pace again. This repeats several times.

Very Low Rate Extended Epidemic/Pandemic

High-level containment measures work to significantly slow transmission but do not result in the elimination of the virus.

I have also included a Wildcard scenario set that looks at potential for different infection patterns.

It is my belief that the understanding that flows from scenarios like these can achieve three things:

1. A reduction in levels of uncertainty and fear.

2. Increased capacity to create strategy right now.

3. Increased capacity to respond to the inevitable change and shocks will occur.

How to Use Scenarios for your Organisational Strategy

Scenarios are essentially stories about what might unfold in the future.

They should not be taken as gospel even if one closely resonates with your view of the future.

The actual future will be different from the scenarios I describe here but they are still useful because they help you:

1. Understand more of the possibilities and third and fourth-order impacts of changes.

2. Think through the impacts on your organisation if the scenarios come true.

3. Test your organisational strategy in multiple scenarios to think through strengths and weaknesses.

Having said all that, we live in a time of great uncertainty. This is not a time for grand strategic plans to be rolled out and fixed in stone.

It is a time to have plans but continually re-assess them to navigate your way through change.

By holding some of these pictures in your head and continually revising them, you can think through what might be happening and what might happen next.

A Disclaimer

Scenarios are just stories so please treat them like that. Futurist Jim Dator once said that:

“truthful, but not necessarily accurate, statement about the future.”

If these scenarios help you think more clearly then that is great but please do not become fixated on a single viewpoint of the future and take other advice before taking action.

The Science

( An excellent resource for looking at his is: https://ourworldindata.org/coronavirus)

An epidemic/pandemic situation is governed by a few key factors(It is important to note that what we are seeing is research being done on the run. The accuracy of any estimations will change as we get a better handle on the situation.)

1. How infectious is the virus? We have a pretty good handle on that, but we are in a fast-moving environment so our understanding may change.

2. When are individuals infectious? Evidence has emerged that people are infectious before symptoms occur. This differs from SARS (https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30129-8/fulltext). This increases the likelihood of transmission as people will go about their daily business not knowing. The case definition here in Australia encompasses the view that people may be infectious for 24 hours before symptoms occur as well as after symptoms occur (https://www.health.nsw.gov.au/Infectious/diseases/Pages/2019-ncov-case-definition.aspx). The infectious period after symptoms appear is highly variable and are related to the course of the disease(Refer to the isolation criteria here and look for updates: https://www1.health.gov.au/internet/main/publishing.nsf/Content/7A8654A8CB144F5FCA2584F8001F91E2/$File/interim-COVID-19-SoNG-v2.0.pdf).

3. What is the mode of transmission and survival time outside of the human body? There is some confusion. Most informed advice indicates that the main transmission route is via droplets rather than air transmission, but that air transmission is possible. The virus appears to survive better on plastic or steel surfaces than cardboard or clothing and the understanding of the rates is similar to previous similar viruses so that is likely to be reasonably accurate (The non-peer reviewed research from the US NIH shows survival outside of the human body: https://www.medrxiv.org/content/10.1101/2020.03.09.20033217v1.full.pdf. Please note that being able to survive in a suspended aerosol is not the same as person to person transmission via aerosol hanging about in the air).

4. How many people in the general population who are not immune come into contact with infectious people or live virus in the environment? This depends on people’s behaviour, social distancing imposed by governments and others, and the percentage of people who have been infected and recovered. Uncontrolled pandemics tend to naturally reach a peak and subside as the number of potential new patients that have not been exposed falls during the course of the pandemic. This limits transmission. We have no hard evidence of the length of immunity due to the short nature of the outbreak at this point.

5. How effective is social distancing? This includes cancelling events, stopping handshakes, etc. These measures reduce the chance of transmission as fewer people are in contact overall and those that are in contact become less likely to pass on infection.

Important Numbers

The combination of these factors gives us two important things to think about.

1. RO value

2. Doubling rate

The RO value is the number of people who on average become infected from a single infected person. This varies as an epidemic continues because social distancing and care with washing hands, etc reduces transmission. Various estimates of the RO value have been published(This paper gives a good summary of a number of these: https://academic.oup.com/jtm/advance-article/doi/10.1093/jtm/taaa021/5735319). They differ widely because they are in different situations. If everything is uncontained you get higher RO numbers for a virus than if you are able to separate most people from each other. A virus that is highly infectious has a higher RO value than a less infectious virus. This is true across a range of containment precautions.

The RO value is important because it determines the best response to an infection, firstly, on containment measures and secondly on vaccine/immunity. There has been much talk about “herd immunity”. This refers to the time when an epidemic slows as a significant percentage of the population is now immune and cannot get infected. As a veterinarian this is a very familiar concept as it refers to animal populations. The percentage of the community that needs to be immune to slow transmission is higher for a high RO value virus than a low RO virus. That is because the aim is to get the RO value well below one, meaning every case results in much less than one new case and the epidemic drastically slows. The higher the RO value in a susceptible population and an unconstrained pandemic the more effort it takes to get it below one.

The doubling rate is also important. It is the time it takes to get to a doubling of confirmed cases. This is complicated by the fact that as increased testing gets deployed you find more cases faster and that distorts the number.

In some ways the calculation is very simple, in other ways it is complex. The simple equation is that if less than one person is infected for every currently infected person the number of cases will fall. The opposite is true if more than one person gets infected per currently infected person. The actual rate is far more complicated than that and small differences in that infection rate can significantly impact on the overall result. Steady high rates of transmission result in exponential growth in cases which people are generally are not very good at understanding (This video is a great illustration of the principles of exponential growth from an old story: https://www.youtube.com/watch?v=t3d0Y-JpRRg).

Here is a stark theoretical example.

1. If you start at 500 cases.

2. and the number of cases doubles every four days(Cases in Italy more than doubled from March 8th to March 12th. Some of this may be due to increased testing).

3. By day 12, there are 4000 cases.

4. By day 24 it is 32,000 cases.

5. By Day 36 it is 256,000 cases.

6. By day 48 it is 2,048,000 cases.

7. By day 60 it is 16,384,00 cases. That is in two months.

8. 12 days later it is 131,702,000 cases.

This assumes no containment measures or people not voluntarily reducing contact with others. This is not going to happen.

The other important number is the case fatality rate. This is the number of people who die divided by the number of people that are known to be infected. This is the number that concerns people the most and for good reason. This number will change as things progress for many reasons:

· In the early stages, we will be underestimating the number of actual cases because many people only suffer mild symptoms and may not have been tested. Also, early on in an epidemic, the availability of tests may restrict the number of people diagnosed.

· Early in an epidemic (where case numbers are rising rapidly) the case fatality rate may be underestimated. This happens because if people die weeks after getting infected their case is counted in the known cases as soon as they are diagnosed, but their death is not yet in the calculations. Cases rise first, then overall death rates rise later.

· We might get better at diagnosing and treating the disease because health professionals are learning on the job. In China, for example, the mortality rate outside of Wuhan appears to be well below that in Wuhan.

· On the other hand, if medical resources become overwhelmed then mortality rates may rise as people with severe symptoms cannot get treatment. Doctors in Italy are already suggesting that older people may not get access to ICU if things keep getting worse.

What we do know, although with no great degree of accuracy is that the case fatality rate:

· Appears much higher than normal seasonal flu although the flu is moderated by vaccines.

· Is much higher in older people, and people with pre-existing conditions. For this reason, I have been advising that people in these groups should practice far more caution than the average person(You can see my own advice to my elderly parents in this twitter thread: https://twitter.com/futuristpaul/status/1238641615473790976).

· Appears very low in children and young adults and there is some doubt as to whether this is because they are less susceptible to get infected or they are more able to fight off the virus.

It is also highly likely that we will have increased mortalities due to other causes if the medical system is stretched by the COVID-19 cases

The Scenarios

(There are some very good visualisations of various spreading situations at: https://www.washingtonpost.com/graphics/2020/world/corona-simulator/?itid=pm_pop)

Contained Pandemic

Extreme containment measures work to reduce the pandemic and eliminate the virus.

The key story points in this scenario are:

· We have already seen that extreme control measures can limit an outbreak in a region or country as shown by the responses in China, Korea and Singapore.

· If the infection number (RO) can be reduced below one then you can potentially eradicate the virus from a given population in your city, region or country.

· This is possible because the virus does not last long out of the human body.

· This assumes that people do not have “carrier status”(This means that the virus remains in their body and they can pass it on even though they may have recovered clinically or not had symptoms in the first place I have not seen any evidence of this although it certainly happens in other diseases. As large numbers of people are being infected even a low rate of carrier status would be a problem).

The problem is what happens next. If you eradicate the virus but most people have no immunity, you have to stop the virus re-entering your highly susceptible population until you have a vaccine. Again, this is theoretically possible. You could:

· Ban all people from leaving or entering your country until a vaccine is available.

· Allow people to travel but have full quarantine for anyone entering the country.

· Only allow people to travel to and from selected countries that you believe have the right systems in place.

All of these are possible in theory, but they do not allow for:

· Illegal movement of people which has certainly been the cause of failed disease eradication programs in animals.

· The political pressure which will be applied because of the social and economic impacts. Complete closure of your border to human movement has huge implications in a globalised world.

As an example, New Zealand announced on March 14th that all visitors except those from specific Pacific Nations would have to be quarantined for 14 days when visiting the country(https://www.abc.net.au/news/2020-03-14/jacinda-ardern-new-zealand-travel-restrictions-coronavirus/12056754).

If this system results in New Zealand being able to eliminate the virus from its population then as a small island nation it is less vulnerable to people moving illegally into the country.

However, we can imagine what happens in the following scenario based on two possible criteria:

· The methods take 7 weeks to eliminate the virus.

· No vaccine is available for 18 months.

Imagine what happens in the following time frames:

· One week after no reported new cases there have been virtually no tourists in New Zealand for 8 weeks because hardly anybody is going to come on a holiday if they must first be quarantined for 14 days. All international sporting events have been cancelled because no teams want to come. Business travel is down 99% because hardly anybody wants to come and be quarantined. Hardly any overseas family members can come to weddings, funerals or 60-year wedding anniversaries. Hardly any New Zealand nationals can travel overseas for weddings, funerals or 60-year wedding anniversaries because they cannot afford/want to be to be quarantined for 14 days when they get back.

· One month after no new cases the same applies. It has now been three months.

· Three months after no new cases the same applies. It has now been five months.

· Six months after no new cases, the rules are relaxed to allow people in from specific countries without self-isolation because they have eliminated the virus and New Zealand has confidence in their systems.

· Nine months after no new cases rules are further relaxed due to increasing economic and political pressure on the government. Transmission starts again and spreads initially quickly because people have forgotten to act in a way that reduces the chance of infection.

· A rapid response reduces transmission and reinstates border quarantine procedures.

· Rinse and Repeat?

Several variations on this scenario can be written with different time frames. A vaccine being widely available earlier changes it again. This is also complicated by the fact that New Zealand has a general election on September 19th, 2020 which could be right in the middle of all of this.

Scenario Likelihood

I see this scenario as unlikely on a global scale. I think it is possible for a single country to have the discipline to do this. It is also possible that several countries might do this. However, it is highly unlikely that all the countries in the world will be able to achieve such a result and therefore a large reservoir of ongoing infections will still occur somewhere in a world of over 7 billion people.

Acute Epidemic/Pandemic

Containment measures do not work, and cases rise exponentially.

The key story points in this scenario are:

· Unconstrained transmission causes a massive rise in cases and mortalities.

· Unconstrained transmission rapidly increases case numbers so social isolation measures do not work as well when they are put in place.

· Medical systems are overwhelmed by the large number of cases that require hospitalisation, ventilation assistance, and intensive care.

· Pressures on the system cause high levels of infection in medical professionals, increasing the strain on the health system.

· Some people are refused access to intensive care systems because it is not physically possible to accommodate them.

· There is a massive short-term economic impact as a panicked population results in many people refusing to go to work, travel on public transport, or socialise.

This scenario is shown in Figure 1 as the yellow curve versus a slower pandemic in purple

Figure 1

From https://ourworldindata.org/coronavirus

In this sort of scenario, the Pandemic eventually burns out. This is because so many people get infected that the percentage of people who have immunity rises, and that naturally slows transmission. Once transmission slows then social distancing mechanisms are more effective as well.

In this scenario, the impact has a shortened time frame, but we would have many more mortalities and larger short-term economic impacts due to the medical system being overwhelmed and many people not getting proper treatment.

Scenario Likelihood

I see this scenario being highly unlikely at a large scale. This is because we have already seen that social distancing and test and trace systems can significantly slow the spread of the disease. Even in a country with poor medical services, transmission can be curtailed. The fear engendered by reports of high infection and death rates will lead people to act independently of governments. Misinformation and irrational behaviour will cause all sorts of variations.

Extended Epidemic/Pandemic

Containment measures work in a limited way to slow the pace of the epidemic.

This is the epidemic/pandemic shown in the purple curve in Figure 1

The key story points in this scenario are:

· Social distancing methods such as cancelling events, restricting large scale gatherings, closing schools etc work well.

· Good testing and contact tracing (tracking people who have been in contact) and quarantine procedures reduce transmission.

· Transmission continues at a low but significant level.

· The community manages to adjust, initial panic buying and fear subsides.

· Government manages to convince people that ongoing measures are necessary.

· Most severe measures for transmission reduction are relaxed but periodically re-instated when new case levels rise to a pre-determined level which is widely communicated and accepted by the community.

· Increased testing capacity and tracing capacity is developed.

· Finally, a vaccine is developed, and things go back to normal.

If we assume a vaccine is available in 18 months, a scenario like this could go on for as little as 5–6 months as currently modelled in New South Wales. If transmission is at a lower rate, it could go on for 18 months.

I do not have the capacity or expertise to model a range of such transmission scenarios and many people are working on that. It is important to remember that any model is just that, a set of possible numbers that will be continually adjusted as things occur. It is still important to do this work, especially for resource planning. It is just as important that people do not rely on any particular model.

Scenario Likelihood

I see this scenario being one of the three most likely scenarios of those that I describe here. This is because we have already seen that social distancing and test and trace systems can significantly slow the spread of the disease. The risk is seeing measures to reduce transmission removed too early, or community complacency causing more transmission which moves us to the next scenario.

There will be considerable political and economic pressure to relax controls as the economic impact grows.

Very Low Rate Extended Epidemic/Pandemic

High-level containment measures work to significantly slow transmission but do not result in the elimination of the virus

This is really a variation on the Extended Epidemic/Pandemic scenario on the previous page. It fits between that scenario and the contained pandemic scenario. It means that the curve in Figure 1 is much lower and flatter. It also means that the key story points are very similar.

The key story points in this scenario are:

· Social distancing methods such as cancelling events, restricting large scale gatherings, closing schools, etc work well. More severe and longer-lasting systems and requirements are put in place.

· Good testing, and contact tracing (tracking people who have been in contact) and quarantine procedures reduce transmission.

· Transmission continues at a very low level.

· Community manages to adjust, initial panic buying, and fear subsides.

· Government manages to convince people that ongoing measures are necessary.

· Most severe measures for transmission reduction are relaxed but periodically re-instated when new case levels rise to a pre-determined level which is widely communicated and accepted by the community.

· Increased testing capacity and tracing capacity is developed.

· Herd immunity (a high enough percentage of the general population that is immune to reduce transmission below an RO value of one) is slower to develop.

· Finally, a vaccine is developed, and things go back to normal.

Scenario Likelihood

I see this scenario being one of the three most likely scenarios of those that I have described here. This is because we have already seen that social distancing and test and trace systems can significantly slow the spread of the disease. The risk is seeing measures to reduce transmission removed too early, or community complacency causing more transmission when large percentages of the population are still susceptible to infection

There will be considerable political and economic pressure to relax controls as the economic impact grows.

Rolling Epidemic/Pandemic

Containment measures work to significantly slow the epidemic, but the reduction of those containment measures allows the pandemic to gain pace again.

The key story points in this scenario are:

· Containment measures such as social distancing, tracing and quarantine work well enough to bring the number of new cases down.

· This results in a general population where there are still a large percentage of people who have not been infected and therefore are vulnerable if exposure increases.

· Political and economic pressure steadily increases to reduce restrictions such as travel bans and the banning of large gatherings.

· Arguments will be mounted that the disruptions to the economic system are more important than holding transmission rates down and may even be causing more deaths than the disease itself.

· People who have been infected but have recovered want to get back to their normal daily lives and fret against restrictions.

· As cases reduce people become more complacent about social distancing.

· An effective vaccine is not available.

· Every time restrictions are removed cases rise again.

This results in a series of rolling increases in cases that are lower over time because:

· We are much better equipped to deal with the problem if cases start rising again.

· Political and economic pressure will be lowered after the second and third time that cases increase.

· In the third or fourth iteration, the percentage of non-infected people in the population will be reduced, which slows infection rates.

Scenario Likelihood

I see this as the most likely scenario based on my experience and on the economic and political pressures that will come to bear to remove extreme social distancing measures that are hurting people’s livelihoods. The nature of the changes could also be affected by seasonality issues. If the COVID-19 disease transmission is worse in winter and less so in summer it may be much more difficult to get a handle on what is happening.

Wildcards

There are a number of possible wild cards that can change the scenarios that might happen.

There are a small but significant number of people who are asymptomatic but infectious carriers

This means that there are people who either show no signs or have had signs and recovered but are capable of passing on the virus for an extended period. This increases the complications in trying to reduce transmission. This will show up as weird clusters of infection that nobody can explain, and it will sow much more widespread panic. There have been some reported cases of biphasic infection. This is when people are still testing positive after being thought of as recovered. This could be an issue with:

· false positives on the test

· maintenance of a carrier state

· people becoming re-infected.

An effective vaccine is developed earlier than thought

An effective vaccine being rolled out earlier than expected will create widespread immunity and rapidly reduce transmission. It will take a while to ramp up production and there are already reports of companies fighting over intellectual property rights and future economic gains so supply may be patchy. If early batches are distributed to the vulnerable first (as they should be) then mortality risks will rapidly fall. This will lead to a rapid reduction in forced social distancing as younger people become less concerned. There may be considerable conflicts oversupply between countries and groups.

The virus ends up being far more capable than the flu at mutating and changing

More than one strain has been identified already. If the virus is capable of mutating into new strains that allow it to bypass existing immunity and any vaccine that is developed, then we are in a whole new ball game. The best-case scenario there is we are able to produce a new vaccine variant as we already do with the flu.

Please Note: None of this is based on any hard evidence or science at this point. We are in a rapidly evolving situation with rapidly increasing knowledge. These wildcard scenarios are not meant to panic people or give them false hope. They are intended to demonstrate that surprises are possible, and we should be as prepared as we can for them.

My Personal Philosophy

My personal advice is based on my view that the most likely scenario is an ongoing rolling epidemic pandemic with a significant percentage of the population infected over 18 months.

In that situation it is best to be infected as late as possible in the cycle if you do get infected for a number of reasons:

· Early in an outbreak you may be in a situation where medical facilities are overwhelmed, and you do not get proper treatment.

· Later in an outbreak, the health professionals will have learnt a lot about how to treat the disease. No two diseases are the same, so it is not possible to have best practice treatment early in an outbreak of a novel disease.

· If you have a pre-existing condition you have a chance to get healthier before you get infected. Especially if you smoke or are pre-diabetic. Of course, this does not apply to some conditions.

· The longer you go before becoming infected the greater chance that there will be an effective vaccine.

Futurist Paul Higgins

Written by

Futurist & Speaker @ www.emergentfutures.com Partner SVP Melbourne. Chair, Future Business Council Advisory Board. Churchill Club Committee Member (Melb).

Welcome to a place where words matter. On Medium, smart voices and original ideas take center stage - with no ads in sight. Watch
Follow all the topics you care about, and we’ll deliver the best stories for you to your homepage and inbox. Explore
Get unlimited access to the best stories on Medium — and support writers while you’re at it. Just $5/month. Upgrade