How the next variant could strike

First, the evasive option. SARS-CoV-2 now faces huge pressure to find an immunological escape hatch. With so many people having been infected, vaccinated, or both, the coronavirus’s success has started to lean heavily on its ability to sidestep our shields. This future could be an even more dramatic version of the recent Omicron wave: None of us, no matter how many shots we’ve gotten, would truly be impervious to infection, or maybe even to serious illness. Through sheer numbers alone, this variant would be poised to land a huge swath of people in the hospital, even if it wasn’t, particle for particle, a more deadly threat. Depending on the extent to which the variant eroded vaccine effectiveness, especially against hospitalization and death, we might still need to update our shots and launch a massive revaccination campaign. From the view of the White House, a variant would have to “pass a fairly strong threshold to want to do that,” Quillian told me. “It’s a pretty extensive effort to go back and revaccinate the entire population.”

In some ways, a more virulent variant that was still susceptible to vaccine-induced defenses could be simpler to deal with. We could expect that people who were up-to-date on their shots would be very well protected, as they were against, say, Delta. The focus would be on shielding the most vulnerable: the unvaccinated, the elderly, the immunocompromised, those with heavy or frequent exposures to the virus—all of whom would likely benefit from more vaccine doses, and additional focused measures around masking, distancing, testing, and treatments. And perhaps our responses would remain siloed in these groups. “It would probably take a while for us to reimpose restrictions on the general population,” Watson, of Johns Hopkins, said.