How will the pandemic end? Omicron cloud predictions for the endgame


Pandemics end at some point, even if omicron complicates the question of when this will be the case. But it won’t be like flipping a light switch: The world have to learn to coexist with a virus that won’t go away.

The ultra-contagious Omicron mutant is driving cases to all-time highs and wreaking havoc as a depleted world struggles again to contain the spread. But this time we’re not starting from scratch.

Vaccinations offer strong protection against serious illnesses, even if they do not always prevent a mild infection. Omicron doesn’t appear to be as deadly as some previous variants. And those who survive will have new protection against other forms of the virus that are still floating around – and maybe the next mutant show up too.

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The latest variant warns of what will happen next, “unless we take the endgame really seriously,” said Dr. Albert Ko, an infectious disease specialist at the Yale School of Public Health.

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

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

Even if that happens, some parts of the world will still struggle – particularly low-income countries that lack adequate vaccines or treatments – while others will more easily migrate into what scientists call an “endemic” state.

The distinctions are fuzzy, said Stephen Kissler, an infectious disease expert at Harvard TH Chan School of Public Health. He defines the endemic period as the achievement of a “somehow acceptable steady state” in dealing with COVID-19.

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The Omicron crisis shows we’re not there yet, but “I think we’re going to get to a point where SARS-CoV-2 is endemic, much like the flu is endemic,” he said.

To compare, COVID-19 has killed more than 800,000 Americans in two years, while the flu usually kills between 12,000 and 52,000 a year.

Exactly how many persistent COVID-19 illnesses and deaths the world will endure is largely a social question, not a scientific one.

“We’re not going to get back to where it’s 2019,” said Dr. Amesh Adalja, a senior scientist at the Johns Hopkins Center for Health Security. “We have to get people to think about risk tolerance.”

Dr. Anthony Fauci, the leading US expert on infectious diseases, foresees the fight against the virus in a way “that doesn’t disrupt society, that doesn’t disrupt the economy.”

The US is already sending signals that it is on its way to what will become the new normal. The Biden administration says there are enough tools – vaccine boosters, new treatments, and masking – to tackle even the omicron threat without the shutdowns of the early days of the pandemic. And the Centers for Disease Control and Prevention are just cutting the time people with COVID-19 need to stay in isolation to five days so they don’t make others sick and saying they are most contagious early on.

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India offers a glimpse of what it’s like to reach stable levels of COVID-19. Until recently, the daily reported cases had stayed below 10,000 for six months, but only after a “too traumatic to calculate” loss from the earlier Delta variant, said Dr. T. Jacob John, former head of virology at Christian Medical College in South India.

Omicron is now driving a surge in cases again, and the country will introduce booster vaccines for frontline workers in January. However, John said that other endemic diseases like flu and measles cause outbreaks on a regular basis, and the coronavirus will keep flare up even after passing through Omicron.

Omicron has mutated so badly that it fails to provide any protection from vaccinations or previous infection. But Dr. William Moss of the Johns Hopkins Bloomberg School of Public Health expects that “this virus will somehow exhaust its ability to make such great evolutionary leaps”. “I don’t see this as an endless cycle of new variants.”

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Many experts see a possible future: In the period after the pandemic, the virus causes colds and more serious illnesses in some colds and in others, depending on general health, vaccination status and previous infections. Mutations will continue and may eventually require boosters from time to time that are updated to better suit new variants.

But the human immune system will continue to recognize better and fight back. Immunologist Ali Ellebedy of Washington University in St. Louis hopes for the body’s astonishing ability to remember germs it has seen before and to build up multilayered defense mechanisms.

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

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In a new study, Ellebedy’s team found that Pfizer vaccinations boost T-helper cells, which act as drill sergeants in these training camps, fueling the production of more diverse and stronger antibodies that may even work if the virus changes again.

Ellebedy said the population’s basic immunity has improved so much that even if breakthrough infections persist, serious illness, hospital admissions, and deaths will inevitably decline – regardless of the next variant.

“We are no longer the same population as we were in December 2019,” he said. “It’s a different floor now.”

Think of wildfire ripping through a forest after a drought, he said. That was 2020. Now, even with Omicron, “it’s not completely dry land”, but wet enough “that the fire couldn’t spread.”

It stipulates a day when someone becomes infected with the coronavirus, stays at home for two to three days, “and then it goes on. Hopefully that will be the final.”

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The Associated Press Health & Science Department is supported by the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

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