Table 1.

Implications of different scenarios for resistance

Scenario	Central prediction on COVID-19	Sustainable	Push towards more treatment in the community with oral, OPAT and long t½ agents	Surge of hospital activity to clear backlog	Travel; import of resistance
Vaccine overwhelmingly successful, and perceived as such	Burden no greater than seasonal influenza with this politically acceptable	Yes	Brief: until population vaccinated	Early	Briefly reduced, then normalized
Vaccine failure or perceived failure. Prolonged emphasis on track and trace	Control requires eternal vigilance but is achieved and maintained	Doubtful	Brief (if successful): until COVID-19 reduced to low incidence	Early (if suppression successful)	Reduced for prolonged period
Vaccine failure. Acceptance that virus is established, endemic and that lockdowns are ineffective or cause unacceptable collateral damage	Successive COVID-19 waves, ending in herd immunity; significant further direct mortality	Yes	Extended: until population immunity dominates	Delayed	Steady reversion to normality

Arrows indicate predicted change in selection pressure from the pre-COVID-19 situation: upward, increased selection pressure; horizontal, reversion to status quo ante; downward, reduced selection pressure.