How would the COVID-19 pandemic play out in 2021?

With most of the world still susceptible to SARS-CoV-2 infection, it is unlikely that acquired immunity is currently a major factor in the virus’ evolution.

But as immunity rises in the general population, either through infection or vaccination, there is likely to be a gradual trickle of immune-escaping mutations that could help SARS-CoV-2 to establish itself permanently in the population, primarily causing mild symptoms when it infects individuals with some residual immunity from a previous infection or vaccination.

In this regard, there is the likelihood that the virus would eventually be maintained as a merely common, cold-causing coronavirus.

It’s also likely that our collective immune responses to SARS-CoV-2, aren’t robust and long-lasting enough to generate a robust selection pressure that leads to significantly altered variants in the population.

Harmful mutations could also emerge if antibody therapies are not used wisely – for example, if COVID-19 patients receive one antibody, which could potentially be inactivated by a single viral mutation.

In such a scenario, a cocktail of monoclonal antibodies, each of which can recognize several regions of the SARS-CoV-2 spike protein, might reduce the odds that favour such a mutation through natural selection.

Vaccines arouse less concern on this basis because they tend to elicit a range of antibodies just like the body’s natural immune response.