Although the United States may now be out of the acute pandemic phase, many health experts say the coronavirus is still not endemic, and the country will likely see more surges in the future. Here are Covid-19 scenarios America may experience this summer and fall.

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What to expect this summer

During the past two summers, the United States experienced a surge in Covid-19 cases, hospitalizations, and deaths, but health experts say the country may be able to avoid such a surge this year, unless a new, dangerous variant emerges.

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"A full surge over the summer is going to be really dependent on a variant fully emerging. That tends to be the biggest trigger that will send us into a surge," said Keri Althoff, professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health. "Those transmissible variants are good at finding pockets of unvaccinated people and those people are more at risk of hospitalization and death."

According to USA Today, increased population immunity from vaccines, boosters, and prior infections, as well as access to antiviral treatments, are likely to help blunt any potential surge during the summer. However, experts say that some areas of the country, particularly those with less immunity, will be more affected by the virus in the coming months.

"I expect this next wave to be much smaller than the one we had in January," said Julie Swann, a professor and public health researcher at North Carolina State University. "In the U.S., there are communities that have had less exposure to this virus and so (they will) likely have a large impact from the virus in the next few weeks and months."

In particular, the South could see larger increases in Covid-19 cases this summer than other regions of the country, primarily due to its lower vaccination and booster rates.

"For some reason, we see a seasonality in these peaks. We're seeing a very high rate of cases in the South during the summer months, possibly because so many people are inside because [it's] so hot there," said Mercedes Carnethon, epidemiologist at the Northwestern University Feinberg School of Medicine.

A significant surge is likely in the fall, experts say

Based on several models, the country could see 100 million coronavirus infections, as well as a significant surge of hospitalizations and deaths, during the fall and winter, according to a senior Biden administration official. However, many factors have the potential to change the pandemic's trajectory.

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"What they're saying seems reasonable — it's on the pessimistic side of what we projected in the covid-19 scenario modeling run,” said Justin Lessler, an epidemiologist at University of North Carolina Gillings School of Global Public Health. "It's always hard to predict the future when it comes to covid, but I think we're at a point now where it's even harder than normal. Because there's so much sensitivity, in terms of these long-term trends, to things we don't understand exactly about the virus and about [human] behavior."

According to several health experts, a major surge in cases during the fall and winter is possible as immunity from vaccines and infections wane and pandemic restrictions continue to loosen. In addition, new, more dangerous variants could also emerge.

"Predicting new variants that are going to spill out — that's total guesswork," said Jeffrey Shaman, an epidemiologist at Columbia University. "Predicting that they're going to be successful, that's guesswork as well."

Currently, the Biden administration is trying to secure more coronavirus funding to purchase tests and therapeutics. So far, funding remains stalled, largely due to a debate over the administration's decision to loosen pandemic restrictions at the U.S. border.

Without more coronavirus funding, White House officials have said much of the United States' supply of antivirals and tests will likely be gone by the end of summer, which could leave the country largely unprepared for a fall and winter surge.

When will the US reach endemicity with Covid-19?

Although many health experts agree that the United States may finally be moving away from the acute pandemic phase, it still has a way to go before reaching endemicity. "I know we all want to be done with COVID, but I don't think it's done with us," said Jessica Justman, an associate professor of medicine in epidemiology and senior technical director of ICAP at Columbia University's Mailman School of Public Health.

"We're in the middle," said Justman. "I hope that we are moving towards endemic but I can't say that we're endemic because I don't feel like things are predictable, yet."

According to Justman, the first step toward endemicity is to prevent severe illness so that a surge in cases does not necessarily lead to a surge in hospitalizations and deaths. To do this, Americans should stay up to date with Covid-19 vaccinations and practice precautions to keep vulnerable people, such as the immunocompromised and the elderly, safe from infection.

"I'm hopeful that we're approaching the point where we can disconnect the surge in cases from a surge in hospitalizations," she said. "That's where we want to go." (Rodriguez, USA Today, 5/9; Abutaleb/Achenbach, Washington Post, 5/6)