Abstract
Coronavirus disease 2019 (COVID-19) will likely remain a major public health burden; accurate forecast of COVID-19 epidemic outcomes several months into the future is needed to support more proactive planning. Here, we propose strategies to address three major forecast challenges, i.e., error growth, the emergence of new variants, and infection seasonality. Using these strategies in combination we generate retrospective predictions of COVID-19 cases and deaths 6 months in the future for 10 representative US states. Tallied over >25,000 retrospective predictions through September 2022, the forecast approach using all three strategies consistently outperformed a baseline forecast approach without these strategies across different variant waves and locations, for all forecast targets. Overall, probabilistic forecast accuracy improved by 64% and 38% and point prediction accuracy by 133% and 87% for cases and deaths, respectively. Real-time 6-month lead predictions made in early October 2022 suggested large attack rates in most states but a lower burden of deaths than previous waves during October 2022 - March 2023; these predictions are in general accurate compared to reported data. The superior skill of the forecast methods developed here demonstrate means for generating more accurate long-lead forecast of COVID-19 and possibly other infectious diseases. AUTHOR SUMMARY: Infectious disease forecast aims to reliably predict the most likely future outcomes during an epidemic. To date, reliable COVID-19 forecast remains elusive and is needed to support more proactive planning. Here, we pinpoint the major challenges facing COVID-19 forecast and propose three strategies. Comprehensive testing shows the forecast approach using all three strategies consistently outperforms a baseline approach without these strategies across different variant waves and locations in the United States for all forecast targets, improving the probabilistic forecast accuracy by ∼50% and point prediction accuracy by ∼100%. The superior skills of the forecast methods developed here demonstrate means for generating more accurate long-lead COVID-19 forecasts. The methods may be also applicable to other infectious diseases. ONE SENTENCE SUMMARY: To support more proactive planning, we develop COVID-19 forecast methods that substantially improve accuracy with lead time up to 6 months.