Faster-than-ever COVID-19 proliferation makes us wonder if it’s inevitable to get Omicron – and what it means for the virus’ long-term future

One of the defining characteristics of the Omicron wave here in Canada may be our sense of the virus’ unstoppability.

During the first wave of the pandemic, public health measures often limited the spread of the virus to isolated outbreaks, which tragically claimed lives in vulnerable places such as long-term care homes. With Beta- and Delta-type COVID-19, the spread of the virus in the local community was significantly slowed down as the vaccination ticked up.

Now that the COVID-19 curve is turning into an almost vertical line, and more provinces are setting strict limits on who can get a test because so many people are being exposed, our collective sense of being able to avoid infection is shaken. Omicron seems really unstoppable.

That was the expression that came to mind when Karen López learned that dozens of her friends had caught the virus in three weeks – a number that exceeded what she had seen in any of the previous waves many times.

After nearly two years of carefully avoiding COVID-19, López does not let go of his caution. But the Toronto woman said she thinks differently about what it might mean to catch COVID-19 now, especially with indications that the virus is less serious for vaccinated individuals like her, and a level of spread that seems much harder to avoid for forever.

“I think I’m thinking a little bit: I should just expect to get it sometime next year and it will not be a terrible thing,” she said. “Maybe I can return to thinking about other risks, such as car accidents.”

The emergence of the Omicron variant with its widespread transmissibility has led some to ask: Is this a preview of what life will be like when the pandemic phase of COVID-19 ends and the virus continues to spread, endemically, in society for the rest of our lives?

Colin Furness, an infection control epidemiologist and assistant professor at the University of Toronto, agrees that the public and officials trying to deal with the pandemic treat the Omicron wave as more “inevitable” than previous waves – doing less to prevent cases than in former. waves as restaurants and schools were closed with far fewer cases in circulation.

“I do not really know what drives it, but for everything in the world it is as if there was a decision to say: Let it go, let it spread,” he said, referring to the decision that schools should return on jan. 5 and to keep restaurants and events open (albeit with capacity constraints).

For Furness, it is a level of acceptance that comes too soon, as children under five cannot be vaccinated yet, and Omicron may still pose a significant risk to vulnerable populations.

COVID-19 is not yet endemic – technically defined as a disease that exists consistently in a population over time, typically does not exceed a reproductive value of one – but the feeling of Omicron’s unstoppability, combined with hope for its milder properties, seems to be encouraging officials and sections of the public to behave as if it were something less acutely threatening, such as the flu or a bad cold.

“So I’m not sure that endemic is the right word, even though in common parlance I think (people who use that term) means COVID-19 is there and will never go away,” he said.

At this point in the pandemic, the decision to call it “endemic” rather than “pandemic” can be as much a social and ethical issue as a scientific one.

It is worth noting that there is more agreement that COVID-19 will last long-term (become endemic) than there is about what kind of threat the virus will pose when it does.

In a survey of more than 100 immunologists published in February last year by Nature, there was almost consensus that COVID-19 would become endemic, with 89 percent saying it was “likely” or “very likely” to continue to circulate indefinitely in at least some pockets of the global population.

The reason is that as more and more people are exposed to the virus and more people gain protection against vaccines, the researchers expect the transmission of the virus to reach some kind of equilibrium. With endemic disease, we would not expect any massive waves and crashes, but a predictable cycle or constant disease over time.

This does not mean that endemic COVID-19 will be harmless. Other endemic diseases are not.

In the case of the 1918 flu, this equilibrium meant living with an ugly seasonal illness (for which we can get an annual vaccine today). In the case of four human coronaviruses, which are also thought to have caused pandemics in the past, they have become some of the viruses leading to the common cold. A less common result is near-extinction of a disease, which seems to be a remote possibility in the case of COVID-19.

“Right now one can say that coronavirus is endemic – it is among us that there is no indication that we will be able to get rid of it locally or around the world,” Shaman said.

But the virus is still rising in dramatic waves, putting the health care system under pressure, so it cannot be said to have reached a stable equilibrium, he said.

Although we think of influenza, which is endemic to most people’s understanding, the disease kills 500,000 people a year worldwide.

“We have accepted 25,000 deaths a year as a result of influenza (in the United States),” he said. “And maybe we should not have been.”

The complication is that the COVID-19 we have come to know mutates faster than the flu and causes more serious illness. Still, it may be that populations who are tired of pandemic restrictions and eager to get back to normal life and all their close contacts may be eager to get to treat COVID-19 as endemic faster.

“We want to normalize and socialize the idea of ​​getting back to work, getting back to life,” Shaman said. “You can frame it like making the virus endemic.”

A remaining question is whether Omicron could help COVID-19 reach its endemic phase.

Data available so far show that Omicron infections are less likely to result in hospitalizations compared to Delta infections, although Omicron spreads much faster.

The shaman is skeptical, meaning the pandemic will end after a massive number of people have been infected with Omicron.

“The question is, is this Omicron the beginning of a milder and more transmissible virus we are going to fight with?”

He said he was not sure. Although he believes the data that Omicron itself appears to be milder than Delta, he said there is no guarantee that the virus will continue to develop into a milder form. It could instead evolve to be more virulent and just as transferable as Omicron.

Such a result would keep COVID-19 in a pandemic phase much longer.


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