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5 COVID Predictions for 2023

Health experts weigh in on new coronavirus variants, treatments, vaccines and more

COVID-19 Petri Dish Drawing
Eugene Mymrin / Getty Images

The U.S. is heading into its fourth year of the coronavirus pandemic, and though COVID-19 cases and deaths are climbing once again, many physicians and public health experts are hopeful that 2023 will be a better year than previous ones. World Health Organization (WHO) Director Tedros Adhanom Ghebreyesus has even hinted at the possibility of COVID no longer being a global health emergency sometime in the coming year.

Much of the optimism boils down to immunity. At this point in the pandemic, most Americans (about 70 percent) have the primary series of vaccinations — plus many are boosted — and the majority have had COVID, some multiple times. “And those things do offer some protection,” says Preeti Malani, M.D., professor of medicine in the Division of Infectious Diseases at University of Michigan Health.

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Compared with this time last year, there’s also more widespread access to at-home COVID-19 testshigh-quality masks, lifesaving treatments and updated vaccines that can help to protect against some of the more recently circulating coronavirus variants.

“COVID isn’t gone,” Malani says, “but we have the tools to move forward, to do all the things that are important to us.” Still, the virus could throw some curveballs in 2023, like it’s done before. Here’s what infectious disease experts are keeping a close eye on in the new year.

1. New coronavirus variants

As long as the coronavirus continues to circulate, new versions of the virus are expected to occur. What’s unknown, however, is how these future variants will impact the course of the pandemic.

Omicron and its subvariants have been dominating the scene for more than a year now. And though the highly contagious omicron variant came in with a fury, cases and hospitalizations eventually dropped and evened out by the fall of 2022. (It’s important to note, however, that even when overall hospitalization rates dipped, the rate of hospitalizations among adults 65 and older still towered over younger Americans, data from the Centers for Disease Control and Prevention [CDC] shows.)

If omicron and its descendants continue to reign, it’s possible that COVID-19 becomes a more predictable seasonal illness, similar to the flu and other human coronaviruses that cause cold-like symptoms, says Steven Lawrence, M.D., a professor of medicine in the Division of Infectious Diseases at Washington University School of Medicine in St. Louis.

However, if an entirely new, more immune-evading variant of the virus — one with its own Greek letter, like delta or omicron — makes its way to the top, we could see another surge of illness, no matter the time of year, Lawrence says.

The coronavirus strain everyone is watching right now is XBB.1.5, which is a close relative of XBB, a recombinant (or hybrid) of two BA.2 sublineages. Together these omicron offshoots account for nearly 45 percent of COVID-19 cases in the U.S., the latest CDC data shows. That proportion is closer to 75 percent in some areas, such as New England.

XBB.1.5 may be more transmissible than others, the CDC says, but it’s not yet known if it causes more severe disease than previous strains. “We’re closely watching this variant to see how well our vaccines [and] treatments are working against it,” the CDC said in a Dec. 30 tweet.

2. COVID-19 treatments

The Food and Drug Administration (FDA) recently shortened its list of treatments available to fight COVID-19, knocking off the last monoclonal antibody, bebtelovimab, “because it is not expected to neutralize omicron subvariants BQ.1 and BQ.1.1.,” which together account for a significant share of infections in the U.S. (Research suggests it’s also no match for XBB.)

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When it comes to the effectiveness of antiviral treatments Paxlovid (nirmatrelvir), Veklury (remdesivir) and Lagevrio (molnupiravir), Dean Blumberg, M.D., professor of medicine and chief of the Division of Pediatric Infectious Diseases at UC Davis Health, says “so far, so good.” But, he adds, “there's always the risk that there could be development of resistance to any of the antivirals that are used,” which is why others are in the pipeline. 

He predicts that the focus in 2023 will be less on development of new monoclonal antibodies and more on antiviral therapies and anti-inflammatory therapies, “because a lot of the morbidity and mortality related to COVID is due to inflammation that occurs,” he says.

William Garneau, M.D., assistant professor of medicine at Johns Hopkins Medicine, recommends that anyone 50 and older who tests positive for COVID-19 talk to a health care provider about antiviral treatment options to prevent a severe case of COVID. “I feel like there are a lot of people who can benefit [from the at-home treatment Paxlovid] who maybe aren’t getting it,” he says.

Studies have shown that the prescription pill can reduce the risk of hospitalization by 51 percent in adults with COVID-19. Its effect has been shown to be even greater in high-risk individuals, including older adults and people who are immunosuppressed.

3. Making progress on long COVID

“I am hopeful that we’ll understand this better,” Malani says about long-haul COVID, the term used to describe a range of symptoms that can emerge or linger long after a coronavirus infection fades. Millions of Americans have been affected by long COVID; many are battling debilitating effects.

Studies are underway to better understand long COVID and its causes, and also how it can potentially be treated. “I don’t suspect that it’s going to be like, ‘Here's a pill and you’re better.’ I think this is a very complicated condition,” Malani says.

Already there is some evidence to suggest that vaccinated individuals have a lower risk for developing long COVID, Lawrence says. “So if you're concerned about long COVID, be up to date on your vaccines. Even if it doesn’t prevent you from getting COVID, it certainly prevents severe illness and then it also looks like it may reduce the risk of long COVID as well,” he adds.

4. A new generation of COVID vaccines

The current suite of vaccines has saved millions of lives. In fact, a recent report from the Commonwealth Fund says that the shots have prevented more than 18.5 million additional hospitalizations and 3.2 million additional deaths. Still, some public health experts say a new generation of vaccines is needed for more durable protection against both severe illness and infection across a wide range of potential variants. “That could have a really dramatic impact on transmission,” Blumberg says.

It's unlikely we’ll see these new vaccines in 2023, but they could be here soon, as research is already underway. “There are several promising candidates,” he adds.

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5. Combatting COVID fatigue

In the meantime, there are new versions of the Pfizer-BioNTech and Moderna COVID-19 vaccines that target some of the more recently circulating coronavirus variants and can significantly reduce people’s risk of hospitalization, recent studies show.

These so-called bivalent vaccines have been available to adults in the U.S. since early September, but only about 17 percent of adults have gotten one, CDC data shows. Just over one-third of adults 65 and older have received an updated booster.

UC Davis Health’s Blumberg blames COVID fatigue for the less-than-ideal uptake and says what we need to keep “an eye on is the level of COVID fatigue that’s out there” as we enter our fourth pandemic year. “I would encourage people to pay attention and to realize that COVID is still a danger,” he says.

To help lessen the danger, health officials are recommending that Americans stay up to date on their COVID-19 vaccines, mask up in crowded indoor settings and avoid poorly ventilated spaces (and improve ventilation when inside). Also, if you do get COVID-19, make sure you ask about treatment options.

“You can do a lot of things to decrease risk, and that's the name of the game,” Malani says.​