Unless a substantial and intense new variant appears after the short, acute shock of Omicron, the COVID-19 pandemic phase appears to be coming to a conclusion for most regions. This update highlights all the things we understood from the Omicron variant, the outlook for 2022, and three possible endemic criteria for COVID-19. It has moved at breakneck speed since WHO named the Omicron form of COVID-19 on November 26, 2021.
Omicron has swept over the world in less than three months, causing record highs in cases in many places, and then rapidly diminishing. The worst of the Omicron wave has passed in most places, allowing some regions to relax public-health regulations to levels, not seen in nearly the past two years. In contrast, certain places, like Hong Kong, are seeing their highest peak yet and are tightening restrictions.
What Have We Learned?
The Omicron wave has taught us a lot about the efficacy of different societal responses.
- First, having current vaccinations, including a recent booster, was found to be particularly useful in protecting against Omicron. Hospitalizations were significantly decoupled from cases in countries where a considerable fraction of patients at risk had acquired 3 doses of vaccine, including a minimum of 1 dose of vaccine mRNA.
- Second, there is a significant disconnect between cases and behavioral changes. Data reveals that, due to their vaccination status, youth, or a desire to move on from the pandemic, an increasing number of people have judged that the health hazards of COVID-19 are not serious enough to force them to modify their behavior.
- Third, and in line with this trend, some governments have judged that, at this stage of the pandemic, the entire societal costs of lockdowns, economic restrictions, or masking outweigh the advantages.
The Next Ten Months
The rest of the year and beyond will be determined by if and when further varieties appear. According to our scenario analysis, Omicron-related hospitalizations in the United States are anticipated to continue to fall and remain at low levels throughout the spring and summer. We might see a seasonality-driven surge of illness next autumn and winter, though hospitalizations would most likely be much lower than they are now.
As usual, the coming phase will be experienced differently in different parts of the planet. Countries with high current immunity rates and broad booster adoption will be better protected.
New Variants: The Big Unknown
In many countries, the six-month forecast is stronger than it has been in the previous two years. However, a number of uncertainties, starting with the length of immunity, might dampen the mood. Both natural and vaccine-induced immunity, particularly against infection, appears to diminish over time. While the exact amount of decreasing Omicron immunity is unknown; current evidence suggests that those who have received three vaccine doses may benefit from medium-term protection.
In many countries, however, booster uptake has been much lower than first and second-dose coverage. While 215 million Americans have received their entire vaccination, just 93 million have received a booster dosage. Two fundamental questions concerning the duration of immunity remain as we investigate subsequent waves: how much will immunity wane? Will booster uptake decrease with each subsequent boosting cycle?
The next generation of medical breakthroughs will likewise raise concerns. Modified vaccines targeting Omicron may be available in the next months, according to Pfizer and Moderna, but we don’t yet know their efficacy, length of protection, or regulations governing fourth doses. It’s also unclear what the approval criteria for multivalent vaccines will be. On the other hand, increased usage of the oral treatments paxlovid and molnupiravir may reduce the frequency of severe cases, but the real-world impact of their use at scale is unknown.
Omicron is already one of the most contagious human viruses ever discovered. While even more infectiousness is possible, in order to become dominant, a new variety would have to partially or totally circumvent past immunity, including that provided by Omicron infection.
The worst-case situation is “Delta-cron“, a variant that evades previous immunity by combining Omicron’s infectiousness with Delta’s average severity. This could happen if immunizations prove ineffective in avoiding severe disease, resulting in the worst wave in many places.
Pandemic To Endemic: Where Does One End And The Other Begin?
There are several alternative definitions for the transition, from pandemic state to endemic state. COVID-19 is considered endemic when it is present at a predictable level that does not necessitate society-defining measures. While we all hope it to be zero, no country with open borders can completely eradicate the disease.
Previously, the burden of COVID-19 was compared to that of other diseases including influenza. The risk of COVID-19 might be regarded as normal, just as the risk of flu is. Furthermore, what is regarded as acceptable by society varies, per country. Countries that are reopening during Omicron wave downswings are doing so with extremely diverse COVID-19 burden experiences. For example, the United States’ COVID-19 death rate per capita in the previous month was 50% higher than Argentina’s and ten times higher than the Philippines’.
When fluctuations in illness load generate only minor changes in individuals’ economic and social behavior, a behavioral threshold for endemicity is reached. Individual challenging factors ( such as age, underlying ailments, and so on) and risk appetite play a role in this.
Finally, when epidemiology decouples from economic activity and secondary economic consequences are mostly resolved, an economic threshold for endemic COVID-19 will be reached.
Although COVID-19 is endemic, that does not mean it is harmless. We should aspire for a global “always-on” response system that can scale quickly. And, as we previously stated, to properly manage COVID-19 during the endemic phase, every civilization must do four things:
- Choose a comprehensive collection of health, economic, and social markets to manage.
- Monitor and track their progress in ways that allow for targeted reaction escalation as necessary.
- Vaccines, medicines, and other countermeasures are effective in limiting disease.
- Slow transmission through testing and changes to the environment/workplace
A new variety could bring the COVID-19 pandemic to a new chapter, and society must be ready to respond if and when that happens. For the time being, though, the pandemic appears to be coming to an end.