Medium-term scenarios of COVID-19 as a function of immune uncertainties and chronic disease

Chadi M. Saad-Roy, Sinead E. Morris, Rachel E. Baker, Jeremy Farrar, Andrea L. Graham, Simon A. Levin, Caroline E. Wagner, C. Jessica E. Metcalf, Bryan T. Grenfell

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


As the SARS-CoV-2 trajectory continues, the longer-term immuno-epidemiology of COVID-19, the dynamics of Long COVID, and the impact of escape variants are important outstanding questions. We examine these remaining uncertainties with a simple modelling framework that accounts for multiple (antigenic) exposures via infection or vaccination. If immunity (to infection or Long COVID) accumulates rapidly with the valency of exposure, we find that infection levels and the burden of Long COVID are markedly reduced in the medium term. More pessimistic assumptions on host adaptive immune responses illustrate that the longer-term burden of COVID-19 may be elevated for years to come. However, we also find that these outcomes could be mitigated by the eventual introduction of a vaccine eliciting robust (i.e. durable, transmission-blocking and/or 'evolution-proof') immunity. Overall, our work stresses the wide range of future scenarios that still remain, the importance of collecting real-world epidemiological data to identify likely outcomes, and the crucial need for the development of a highly effective transmission-blocking, durable and broadly protective vaccine.

Original languageEnglish (US)
Article number20230247
JournalJournal of the Royal Society Interface
Issue number205
StatePublished - Aug 30 2023

All Science Journal Classification (ASJC) codes

  • Bioengineering
  • Biophysics
  • Biochemistry
  • Biotechnology
  • Biomedical Engineering
  • Biomaterials


  • Long COVID
  • immuno-epidemiology
  • mathematical model
  • medium-term projections


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