Two years after the COVID-19 virus turned our world upside down, life is slowly returning to normal.

But it’s not the pre-COVID day-to-day we used to know. We won’t leave the virus behind; rather, we’ll live with it. This normal looks different. And we’re not there yet.

“There will be accommodations to it,” said Dr. George Rutherford, infectious disease expert at UC San Francisco.

On the second anniversary of the nation’s huge shutdown, what does living with COVID look like? Here’s the short version: In the best case scenario, our immunity holds up, the virus doesn’t evolve, and we catch trouble early. In the worst case scenario, immunity wanes, a more deadly variant emerges, and we’re caught by surprise.

There’s reason for optimism, say experts. An expanding arsenal of tools — such as better wastewater surveillance to spot outbreaks, more genetic sequencing, abundant tests and improved hospital care — is reducing risk to a level national health experts find acceptable.

If these tools fail and cases surge, we’re better poised to react. Under the state’s “SMARTER” plan, there may be times when we all need to wear masks indoors, get boosted with improved vaccines, do all non-essential work from home and promptly shift medical workers to hard-hit areas. If well funded, this “always on” response system could scale up quickly.

“We now know how to respond to make sure things don’t get out of hand,” said Dr. Angela Rogers, an expert in pulmonary and critical care medicine at Stanford Hospital. “We can do it, if we all stick together.”

This week, our COVID cases, hospitalizations and deaths are continuing their descent after a deadly omicron variant surge in December and January.

But there’s still reason to be vigilant. A new wave of infections is spreading in Asia and Europe, blamed on loosening restrictions, waning immunity and growing prevalence of a more transmissible form of the omicron variant, called BA.2. That foreshadows future trouble here. So far, BA.2 accounts for 23% of all U.S. infections. And there’s an uptick in virus found in some U.S. wastewater systems.

Wastewater surveillance of Covid is relatively sparse in the US, but 62 (15%) sites have a >1000% increase in viral RNA detected in the past 15-day periodhttps://t.co/bc8crKZDHu pic.twitter.com/aOSmkR9C7E

— Eric Topol (@EricTopol) March 15, 2022

Meanwhile, on Tuesday Pfizer said it will seek emergency authorization for a second booster shot of its vaccine for people 65 and older, an effort to bolster waning immunity. Next month, the FDA plans to gather its outside advisers to debate whether future shots should be the same as the current vaccine or retooled to counter new variants.

A lot has happened since March 2020. Back then, tests were scarce. The CDC advised against face masks, yet some doctors wore ‘moon suits.’ We donned gloves at the supermarket and wiped down groceries. When sick, we quarantined for 10 days — and when we were hospitalized, our families couldn’t visit. There were no vaccines to build immunity or antiviral drugs to kill the virus. Doctors were wary of giving immunosuppressant drugs to counter lung inflammation, fearing it could cause the virus to spread.

“In the early days, there was a lot of uncertainty,” said Rogers. “Now things are drastically different.”

Now masks and tests are more plentiful. Hand sanitizer, while pleasant, is not essential. If diagnosed, we stay home for five days, then wear a mask for another five days. High-risk people can be protected by antivirals or monoclonal antibodies.

Because so many Bay Area residents are vaccinated, hospitalization rates are low. For patients who need help breathing, doctors now know to fine-tune ventilator settings. Patients’ deadly “cytokine storm,” caused by an overzealous defensive response, can be prevented by steroids and two re-tooled drugs, Baricitinib and Tocilizumab.

To get early warning of a possible spike in cases, wastewater employees hold their noses, open manhole covers and test wastewater in Alameda, Contra Costa, Fresno, Imperial, Kern, Lake, Los Angeles, Orange, San Bernardino, San Diego and San Francisco counties. Genome sequencing is done on about 20% of viruses, which will help catch new variants.

But further improvements are needed. Random “sentinel” sampling of a representative part of the population at public venues, like grocery stores, could give us a more accurate picture of the virus’s prevalence, said infectious disease epidemiologist Dr. George Lemp.

Pfizer and Moderna have said that omicron-targeted vaccines could be available in the coming months, but we don’t yet know how well, or how long, they’ll work. Rather than playing whack-a-mole with vaccines, we could seek to design a vaccine that targets many variants, said Rutherford. The timing of shots also needs to be refined.

Cheaper, easier and accurate antibody tests could tell us how well our immune system is holding up, said Rogers. “People could be checked and realize, ‘OK, I’m still safe’ or ‘Gosh, no, I’ve really plummeted. I need to have a booster,’ ” she said.

In the most optimistic scenario, according to a major new Rockefeller Foundation report, we’ll continue the trend that we see today, with less dangerous new variants and mild infections. While the coronavirus will never be completely benign, vaccines will largely protect us. Getting sick may be unpleasant, but it would be no reason for worry, embarrassment or long seclusion. Outbreaks would cluster in pockets of the under-immunized. Annual COVID deaths would range from 15,000 to 30,000, a lower toll than from influenza in moderate seasons.

A school vaccine mandate, expected this summer, will help, said Rutherford. “That’s a big thing. It will ensure that we’ll get some level of protection for children,” which will boost protection for the rest of us.

In the most pessimistic scenario, a highly mutated virus emerges that is more transmissible, more deadly and evades some immunity. Because so many people are unvaccinated, this scenario could result in 100,000 to 300,000 deaths annually and put major stress on the health care system.

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What’s most likely? Over time, in the new normal, we’re probably somewhere in between, where 30,000 to 100,000 Americans die of COVID on average every year. This “intermediate” scenario requires accurate real-time information about new variants, high immunity and a quick response to pockets of high viral spread, according to the Rockefeller report.

We’re not there yet. At this week’s pace, with 1,250 Americans dying of COVID every day, we’re on target to lose 456,000 people this year. That is about eight-fold higher than normal for major respiratory diseases.

“We can’t stop the spread of this virus,” according to the Rockefeller Foundation report, but we can learn to live with it.

“The United States cannot resort to its old habits,” it said. “The nation cannot let this COVID moment pass and move on.”