One year ago today, on Feb. 1, 2021, the Daily Briefing first ran an article titled "When will the Covid-19 epidemic end? Here are the good, bad, and ugly scenarios."

The question resonated with our readers, to say the least. It became one of our most-read articles of 2021, and we revisited the ideas of forecasting (relatively) good, bad, and ugly scenarios for the pandemic several times since.

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A lot has happened since we started offering these predictions—some in line with what we expected, and some not even close. Now, one year later, I gathered some of the experts who participated in writing these pieces to reflect on what they've learned.

One big takeaway? These pieces were very helpful as a way to ground our analyses and think through scenarios that the health care industry might encounter as the pandemic progressed. But at the end of the day, the future was never going to be purely "good" or "bad" or "ugly." It was always going to have pieces of all three.

An edited and condensed transcript of the conversation follows below.

Participants:

• Brandi Greenberg, Vice President, Optum Life Sciences (previously VP at Advisory Board)
• Thomas Seay, Managing Director, News Division
• Solomon Banjo, Managing Director, Life Sciences
• Pam Divack, Consultant, Life Sciences

What we got right

Question: It's been a full year since we started mapping out the possibilities for Covid-19's spread. Some of our speculations quickly became outdated or inaccurate, but others proved to be quite helpful and accurate. What do you think we got right in those early attempts?

Thomas Seay: I think it's helpful to start by remembering where America stood in early 2021. Vaccines were rolling out and had proven close to 95% effective in stopping Covid-19. Case counts were collapsing. And there was a general sense that the epidemic was almost over. Remember "hot vax summer"? So one of our core goals was, I think rightly, to lay out "good," "bad," and "ugly" possibilities to underscore the incredible amount of uncertainty about the pandemic's future.

Brandi Greenberg: We also tapped early on into how interconnected this fight against Covid-19 was going to be, portraying how critical worldwide efforts would be in reaching a "good" scenario. There was a lot of insularity and monolithic reporting a year ago, and we were quick to say that the localized view of Covid-19 is antithetical to slowing the pandemic down.

Seay: And I think we accurately foresaw some of the major challenges in ending the pandemic, even if we initially rated them as low-probability. As early as last February, we talked about the risk that "a significant portion of the public remains unvaccinated by fall, and Covid-19 surges as the weather cools." We talked about a "mixed-bad" scenario where some communities were highly vaccinated, and others were much less protected. And we described an "ugly" scenario where "existing vaccines don't effectively protect against new coronavirus variants, or … the immunity conveyed by infections or vaccinations turns out to fade quickly." That looks pretty prescient!

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What we got wrong—and why

Q: Another thing the early articles got right, I think, was emphasizing how vaccine nationalism increases our collective risk that resistant variants will emerge across the globe. But let's pivot to talking about the other side of the coin: What did we get wrong?

Greenberg: Looking back to our first speculations in February of 2021, we framed the question around how long America would take to reach herd immunity. Well, nobody even talks about herd immunity anymore—it is no longer a metric.

Seay: That's been a big shift in how public health leaders talk about the virus. When the pandemic began, experts said we'd hit herd immunity when 70% of the population had been vaccinated or exposed. That estimate was based on the transmissibility of the original coronavirus strain—but delta and omicron are so much more transmissible. Waning immunity and immune escape are also big issues. And if you add all of those things up, herd immunity just seems out of reach. We weren't alone in failing to appreciate how important those factors were going to be. But it means the conversation now is wildly different.

Greenberg: I removed herd immunity from my speculative goals when delta emerged and surged. It was a clear lesson that variants were going to move faster than any of our efforts to vaccinate the world. And when omicron exploded around the world, it was clear to me that we needed to shift our efforts toward managing a virus that will become endemic for the rest of our lives.

Pam Divack: Early on, our hopeful predictions relied upon vaccines providing stellar protection against breakthrough infection. Vaccines have worked incredibly well against hospitalizations and death, but omicron has shown that anyone can get infected. That changed the calculus.

Solomon Banjo: A year ago was an entirely different world. We placed ample emphasis on vaccine uptake being the determining factor, but in some ways, we deemphasized other tools like better masks, rapid tests, and treatments. When the pandemic evolved, our goals shifted from containing the pandemic to managing it.

Seay: Right, and we realized just how utterly unpredictable things are. Looking forward, it makes me want to widen my probability bands on anything that seems really unlikely. As we have seen, so many unlikely things could happen and have massive consequences.

Divack: It's also fair to say we didn't account for the confusion surrounding public health communication and guidance. Every day, our understanding of the virus, vaccines, and public health measures changed as new data and evidence emerged. On the one hand, we saw the benefits of having more real-time data and insight that could guide decision-making. On the other hand, this created a lot of confusion as the general public struggled to keep up with changing information – actually fueling further mistrust.

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Greenberg: I love that you brought that up, Pam, because our pieces didn't discuss projections about what people will actually do. We had ideas about what needed to happen, but we maybe didn't give enough credit to the psychosocial aspect of fighting a pandemic amid mass division and confusion in messaging.

Where we stand today

Q: From the vantage point of a year ago when we first discussed our projections, are we living in a "good," "bad," or "ugly" future now? Or is that even a meaningful question to ask anymore?

Greenberg: It is difficult to narrow in on where we are at right now because it is constantly evolving. There was a window in the spring and summer of 2021 where things were wonderful, relatively speaking. Now? Not so much.

Seay: Relative to our expectations last year, I'd say we've seen really "good" protection from vaccination against hospitalization/death. We've seen relatively "bad" protection against symptomatic infections from the initial vaccine course once it's waned. We've also seen relatively "bad" vaccine uptake in some communities. And I'd say we've seen "ugly" vaccine escape from omicron and "ugly" transmissibility from delta/omicron.

Banjo: I vote "ugly." It is shocking how much has snowballed leading up to this moment, beyond the grueling death tolls. Consider the effects on mental health, for one. Not only are people fatigued, but they are also excessively depressed and lonely. And then you add on the impacts on the health care workforce which we are going to be addressing for many years to come.

Banjo: When I think about Covid-19 today, I am thinking a lot about the silent impacts of Covid-19, which speaks to the interconnectedness of this all. Some days, unfortunately, I am reminded of the quote from T.S. Eliot, "This is the way the world ends. Not with a bang but a whimper."

Greenberg: Agreed. It's like a shrug. And while that sounds depressing, I think a lot of people are sharing a collective sense of apathy and numbness. In many ways, I am scientifically hopeful but socially numb.

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Banjo: It feels like the entire world could really use a month off to recover.

Divack: And think about the reputation of scientists, doctors, and public health leaders. It has been damaged beyond measure. Trusted communication and accurate information are incredibly hard to come by these days. So, people are reckoning with how to make individual choices, and there is no agreed upon "right" or "wrong" decision. Medical ethics is no longer reserved for a subset of individuals but instead the entire population who are weighing the impact of their decisions daily.

Banjo: We know how bad humans are at probabilistic thinking, which is what we are asking everyone to do. And since we can't fully embrace that framework with agreement, individual choices are extremely widespread.

Where we go from here

Q: As we look toward the future, one challenge is that there's not a lot of consistency between different groups of people, various regions, and even various health care leaders about how to measure or act on risks. How are you all thinking about next stage of the pandemic?

Divack: We've learned that the trajectory of Covid-19, just like any other disease or condition, is impacted by a myriad of factors, such as social, economic, political, and more. So when I think about the future, I am thinking about everything on top of just what variants emerge and how we treat them. I am thinking about the critical interconnectedness involved in our battle against Covid-19 and journey to accept the realities of the world we live in.

Greenberg: We have some promising treatments, like the antivirals and monoclonal antibodies. I think these will play a massive role in managing Covid-19 if we can figure out the supply and access problems. In general, the pace of promising scientific discovery and development gives me continued reasons to hope.

Seay: I think there will be a ton of individual variation in assessing how "good" or "bad" things are. A self-centered way of defining good/bad/ugly might be, "How much time do I have to spend thinking about Covid-19 each day?" Can I dine indoors without fretting? Go see my parents? Do I have to deal with bare store shelves? It's hard to define clear distinctions there, but very fuzzily, I'd consider a "good" scenario one where I just don't worry about Covid-19, a "bad" scenario is one where I have to mask up or limit some activities, and an "ugly" scenario is one where Covid dominates important life choices. And for me at least, 2021 included patches of all three. I think that's likely to remain the case in 2022, although with more "good" over time.

Parting thoughts

Following this conversation, in full transparency, we all felt a bit drained. It's difficult to chat about these things over two years into the pandemic.

Amid the continued chaos of Covid-19, it's OK to pause and acknowledge the collective grief and numbness that many of us are experiencing. But despite the ongoing challenges, I don't think we're back to where we started—no matter how harsh the déjà vu may feel at times.

So if you feel some anxiety about the current Covid-19 surge, think about how large our toolbox has grown over the past two years. We've come a long way, and yes, we still have a long way to go. But it is our hope that 2022 brings even more fruitful developments and progress in the fight against Covid-19.