How will the pandemic end? Omicron Clouds playoffs

Pandemics eventually end, though omicron complicates the question of when this will. But it will not be like turning on a light switch: It world will have to learn to coexist with a virus that does not disappear.

The ultra-infectious omicron mutant pushes things to the heights of all time and creates chaos, while an exhausted world once again struggles to stem the spread. But this time we are not starting from scratch.

Vaccines offer strong protection against serious illness, although they do not always prevent a mild infection. Omicron does not appear to be as deadly as some previous variants. And those who survive it will have a refreshed protection against other forms of the virus that are still circulating – and maybe next mutant also to come forward.

The latest variant is a warning of what will continue to happen, “unless we get really serious about the playoffs,” said Dr. Albert Ko, an infectious disease specialist at the Yale School of Public Health.

People line up during the rain for a free COVID-19 test outside the Lincoln Park Recreation Center in Los Angeles on Thursday.
People line up during the rain for a free COVID-19 test outside the Lincoln Park Recreation Center in Los Angeles on Thursday.

“Surely COVID will be with us forever,” Ko added. “We will never be able to eradicate or eliminate COVID, so we have to identify our goals.”

At some point, the World Health Organization will determine when enough countries have mitigated their COVID-19 cases sufficiently – or at least hospitalizations and deaths – to declare the pandemic officially over. Exactly what this threshold will be is not clear.

Even when that happens, some parts of the world will still struggle – especially low-income countries that lack enough vaccines or treatments – while others more easily move on to what scientists call an “endemic” condition.

They are fuzzy distinctions, said infectious disease expert Stephen Kissler of the Harvard TH Chan School of Public Health. He defines the endemic period as reaching “a kind of acceptable steady state” for dealing with COVID-19.

The omicron crisis shows that we are not there yet, but “I think we will reach a point where SARS-CoV-2 is endemic, just as the flu is endemic,” he said.

“We will never be able to eradicate or eliminate COVID, so we have to identify our goals.”

– Dr. Albert Ko, Specialist in Infectious Diseases at Yale School of Public Health

By comparison, COVID-19 has killed more than 800,000 Americans in two years, while influenza typically kills between 12,000 and 52,000 a year.

Exactly how much persistent COVID-19 disease and death the world will endure is largely a social issue, not a scientific one.

“We are not getting to a point where it is 2019 again,” said Dr. Amesh Adalja, a senior researcher at the Johns Hopkins Center for Health Security. “We need to get people to think about risk tolerance.”

Dr. Anthony Fauci, the top American expert on infectious diseases, looks forward to controlling the virus in a way that “does not disturb society, which does not disturb the economy.”

Already now the United States is sending signals that it is heading towards what will be the new normal. The Biden administration says there are enough tools – vaccine enhancers, new treatments and masking – to deal with even the omicron threat without the shutdowns of the pandemic’s earlier days. And the Centers for Disease Control and Prevention has just reduced to five days the time people with COVID-19 need to stay in isolation so they do not make others sick, saying it has become clear that they are most contagious early on.

A sign reminds airline passengers to wear face masks while waiting to pick up bags from a luggage carousel at Harry Reid International Airport on January 2 in Las Vegas.
A sign reminds airline passengers to wear face masks while waiting to pick up bags from a luggage carousel at Harry Reid International Airport on January 2 in Las Vegas.

PATRICK T. FALLON via Getty Images

India gives a glimpse of what it is like to reach a stable level of COVID-19. Until recently, daily reported cases had stayed below 10,000 for six months, but only after a cost of living “to traumatically calculate” caused by the former delta variant, Dr. T. Jacob John, former head of virology at Christian Medical College in southern India.

Omicron is now fueling an increase in cases again, and the country will roll out vaccine boosters to frontline workers in January. But John said other endemic diseases, such as the flu and measles, periodically cause outbreaks, and the coronavirus will continue to flare up at regular intervals, even after the omicron passes through.

Omicron is so hugely mutated that it slips past some of the protection of vaccinations or previous infection. But Dr. William Moss of the Johns Hopkins Bloomberg School of Public Health expects that “this virus will somehow max out” in its ability to make such great evolutionary leaps. “I do not see this as an endless cycle of new varieties.”

A possible future sees many experts: In the post-pandemic period, the virus causes colds to some and more serious diseases for others, depending on their general health, vaccine status and previous infections. Mutations will continue and may eventually require boosters at regular intervals that are updated to better match new variants.

But the human immune system will continue to get better at recognizing and fighting back. Immunologist Ali Ellebedy at Washington University in St. Louis finds hope in the body’s amazing ability to remember bacteria it has been seen before, and create multilayer defenses.

Masked travelers walk through Miami International Airport on December 28 in Miami.
Masked travelers walk through Miami International Airport on December 28 in Miami.

Joe Raedle via Getty Images

Memory B cells are one of these layers, cells that live for years in the bone marrow, ready to go into action and produce more antibodies when needed. But first, these memory cells are trained in the boot camp of the immune system called germinal centers, where they learn to do more than just make copies of their original antibodies.

In a new study, Ellebedy’s team found Pfizer vaccinations for “T helper cells” that act as drilling sergeants in these training camps, driving the production of more diverse and stronger antibodies that can work even if the virus changes again.

Ellebedy said baseline population immunity has improved so much that even if breakthrough infections inevitably continue, there will be a decline in serious illness, hospitalizations and deaths – regardless of the next variant.

“We are not the same population as we were in December 2019,” he said. “That’s another reason now.”

Think of a wildfire tearing through a forest after a drought, he said. It was 2020. Now, even with omicron, “it’s not completely dry land”, but wet enough “that made the fire harder to spread.”

He predicts a day when someone gets a coronavirus infection, stays home two to three days, “and then you move on. It will hopefully be the endgame.”

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