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Dr. Mark Dybul has been accurately predicting COVID-19 trends for a while.

In the spring of 2020, the CEO of Enochian BioSciences and professor at Georgetown University Medical Center’s Department of Medicine told The Hill that the following fall could see another wave, and it would likely be “more virulent.” He’s also spoken out about the need to equally distribute resources when it comes to fighting the COVID-19 pandemic, and the need for a globally “coordinated response.”

And he doesn’t like what he’s seeing in Europe right now, which has higher rates of vaccination than the U.S. but is experiencing a record-breaking number of cases, he told Fortune at a conference earlier this week.

“Germany, Holland, Austria have higher rates [of hospitalization and death] than they ever have in the course of the pandemic,” Dybul said. “A month from now, we’re quite likely to look like those countries.”

These are three potential scenarios Dybul can imagine in the U.S. as we continue to push through the second winter of the global COVID pandemic.

Option 1

“By March, April, May we will have a fully vaccine resistant variant,” said Dybul.

The good news? There’s treatment available, like Pfizer’s antiviral pill, which Dybul said can “reduce hospitalization by 90%.” That means that while we might not be able to prevent a wave of cases fueled by a vaccine-resistant strain (which already exists in Latin America), we can reduce the severity.

“Vaccines and therapies don’t stop transmission,” Dr. Dybul noted, but new treatment options in development, like a prophylactic nasal spray that can also stop transmission, could lead us out of the worst of the pandemic.

Option 2

Another scenario is that COVID-19 becomes like “influenza” or the flu for wealthy nations but will be more severe in poorer countries.

Richer countries have a surplus of treatments to transform a health crisis into a seasonal problem, but even now, he said, malaria and tuberculosis still plague some African nations.

Option 3

The worst option is that the virus will mutate faster than we can chase it, and even treatment options won’t affect it.

“The third possibility is that it’s a mess for the foreseeable future everywhere because the virus will mutate so much,” Dr. Dybul said, but he thinks this is “really unlikely.”

Dr. Dybul’s opinion is that we’re heading toward the second option, but it will take two to three years to get there. While we’re en route to some sort of solution, he’s worried that the “in between” years could be “pretty rough.”