Two years after the pandemic began, the virus that causes COVID-19 is becoming a little easier to live with, thanks to medical innovations.

Vaccines, new medications, more testing options and natural immunity among those who have recovered from the disease have prompted infectious disease specialists to prepare for how COVID-19 will continue to affect our lives over the coming years.

There are a few possibilities, said Soniya Gandhi, MD, associate chief medical officer and vice president of Medical Affairs at Cedars-Sinai.

"Best-case scenario is that between immunity conferred by infections or the vaccines, we get to herd immunity, and COVID-19 truly becomes endemic—present in the community at a stable rate over time," Gandhi said. "There is a middle scenario in which COVID-19 becomes seasonal, and we see surges in the fall and winter, or we continue to have localized outbreaks in specific areas, depending on local rates of vaccination and immunity."

Worst-case scenario, Gandhi said, would be if SARS-CoV-2 continues to mutate and somehow combines the contagiousness of the omicron variant with the virulence of the delta variant. "I don't think most of us feel that will happen," Gandhi added. "But there is really no guarantee, and if there's been one consistency throughout this pandemic, it's that it's been very unpredictable."

A taste of normal

As the omicron surge dies down and scientists monitor the spread of a new omicron subvariant, called BA.2, Gandhi said she's hopeful that the nation will see fewer cases of COVID-19 throughout the spring and into the summer.

"By the end of the recent surge, 90% to 95% of Americans are predicted to have been exposed to the virus in some way, shape or form—whether through infection or through vaccines," Gandhi said. "I think we can expect a respite for at least a few months, hopefully. If it takes us into the spring and summer, then we also have some environmental factors that at a population level can decrease transmission—more people being outside, kids out of school."

But Gandhi cautioned that it's still unclear how long immunity from booster shots will last. So while she thinks that we'll enjoy a nice break from surges, how long that will continue remains to be seen.

Masking and quarantines based on risk

While we're still in a pandemic, Gandhi said everyone needs to continue wearing masks in certain situations, like being indoors, traveling on a plane or in healthcare settings.

And even if COVID-19 becomes endemic or seasonal, Gandhi thinks some in the community will choose to continue wearing masks in the fall and winter when respiratory viruses circulate more widely.

"If transmission becomes stable or more predictable, I don't think we'll see broad quarantines or mask mandates," Gandhi said. "I think that will probably be an individual's decision based on their own risk tolerance. But I think it's completely linked to what happens next, which is really unknown."

Better access to better testing

To help mitigate risk of exposure to COVID-19, easy access to reliable testing is critical. Gandhi believes better options are coming.

"Current test sensitivities to variants should improve as we learn which areas of the virus to target, and hopefully, manufacturing will increase, making at-home tests more broadly available across all segments of society," she said. "It would really provide a nice reassurance if you were interacting with vulnerable individuals or in large groups. Depending on whatever happens with COVID-19, there are plenty of scenarios in which you could incorporate testing to really continue to do those things we love safely."

However people choose to live their lives in a post-pandemic world, Gandhi hopes we retain a sense of social responsibility.

"I hope we realize that our individual actions collectively impact the broader public health," she said. "I would love to see people recognize that their actions really impact everyone else around them in the broader community."