While much uncertainty remains over the COVID-19 pandemic, the scenario that University of Minnesota infectious disease expert Dr. Michael Osterholm would prefer to avoid is a situation in which the disease backs off over the summer, before exploding again in the fall.
"This may sound terribly insensitive and I surely don't mean it to be, but as I have said before, I would actually be much more concerned if over the course of the next 4-6 weeks around the world we saw the virus activity begin to drop somewhat precipitously," Osterholm said on the Osterholm Update, a podcast for the Center For Infectious Disease Research and Policy (CIDRAP).
"If that's the case, I think we have much more of a reasonable [chance] that this could be an influenza-like pandemic experience, where as we saw in the early waves and all of the other influenza pandemics in the last 250 years, sporadic activity around the world and then have the virus suddenly disappear for anywhere from 2-4 months and then come back with vengeance in a large wave. That would make me nervous."
It's the second scenario of three possible scenarios Osterholm and his team of researchers at CIDRAP suggested could occur over the course of the pandemic, which is expected to last 12-18 months or until a vaccine becomes available to all.
Scenario 1: Peaks and valleys
First wave in spring 2020 (now) followed by a series of smaller waves that last through the summer and consistently over the next year or two, gradually diminishing in 2021.
This scenario could feature outbreaks that vary by location and would depend on what types of mitigation are enforced.
Scenario 2: Fall peak
After the spring 2020 peak, a larger wave arrives in the fall or winter of 2020 with one or more additional waves in 2021. The research says this scenario would be similar to what happened with the 1918-19 Spanish Flu.
Influenza pandemics in 1957-58 and 2009-10 followed a similar pattern.
Scenario 3: Slow burn
Cases and deaths continue to occur but it would likely not require continued mitigation but could result in hot spots of outbreak in certain locations. Past influenza pandemics didn't follow this pattern, but the research says this could happen with COVID-19.
While Osterholm is nervous about Scenario 2 becoming reality, he also said "we will very likely see a substantial increase in cases over the next 4-6 weeks" in America.
"It will be tied back to this kind of reopening as we call it," he added, noting that 42 of 50 states are reopening economies to one degree or another, including Minnesota where the peak of the first wave of the COVID-19 outbreak has yet to arrive.
Gov. Tim Walz announced Wednesday that the Stay-at-Home order will expire after this weekend, followed by more customer-facing retail businesses being allowed to open at 50 percent capacity beginning Monday, May 18.
Many such businesses have been shuttered since mid-March. Restaurants, bars, fitness centers and other high-contact operations like hair salons and barbershops remain barred from opening, though the state plans to offer formal reopening guidance by May 20 with hopes of allowing them to get back to work in June.
2 in 5 Minnesotans could have underlying conditions
Even with social distancing and other mitigation tactics, scientists from the Minnesota Department of Health and University of Minnesota released a model Wednesday that estimates 16,000 to 44,000 people in Minnesota could die from COVID-19 in an approximate 12-month period.
Perhaps a significant factor in the estimates are the underlying health conditions affecting Minnesota residents.
"We now know ... when we look at the comorbidity (having two chronic underlying health conditions) risk factors, which exist in several studies in terms of increasing the risk of severe disease and dying ... they are substantial," Osterholm said.
"Even here in Minnesota, we've looked at this information as related to a recent study put out by the Kaiser Foundation, and it turns out that upwards of 40 percent or more of population actually has underlying risk factors that could put them at increased risk for disease."
The Kaiser Foundation research found that approximately 1.4 million Minnesota adults over the age of 18 are at a higher risk of serious illness if infected with the coronavirus. That's approximately 33 percent of the state's population, which falls in line with the national average.
"The majority of people who become infected with coronavirus are not expected to become seriously ill, but a large segment of the U.S. adult population – one third (37.6 percent) of adults ages 18 and older – have a higher risk of serious illness if they do become infected due to their age or underlying medical condition."
Gov. Walz has said that he will act swiftly to re-close businesses in the event that an outbreak erupts and threatens the state's ICU capacity. As of Wednesday, 1,007 of a maximum 2,595 ICU beds are in-use, including 204 by COVID-19 patients.