Picture a not-too-distant future when you can book that summer trip to Italy or you don’t have to remember to take off your mask for graduation photos. After the past 25 months, forgetting the pandemic for even a little while may sound like a fantasy – after all, the coronavirus has gotten our hopes up before.
But infectious disease experts say there just may be an end in sight. Maybe.
Well, let’s say it’s not outside the realm of possibility for 2022.
“I think if we do it right, we’re going to have a 2022 in which Covid doesn’t dominate our lives so much,” said Dr. Tom Frieden, who was director of the US Centers for Disease Control and Prevention under President Obama and is now the CEO and president of Resolve to Save Lives.
What the next part of the pandemic looks like and when it will get there are what Dr. Yvonne Maldonado, an epidemiologist and infectious disease specialist at Stanford Medicine, and experts at federal agencies, academic colleagues and local public health leaders spent the holidays trying to figure out.
There was a general consensus among the experts about what happens next: “We really don’t know exactly,” Maldonado said.
There are disease models and lessons from pandemics past, but the way the highly infectious Omicron variant popped up meant the scientists’ proverbial crystal ball got a little hazy.
“None of us really anticipated Omicron,” Maldonado said. “Well, there were hints, but we did not expect it to happen exactly the way it did.”
Omicron has done a lot. More than a quarter of the Covid-19 pandemic’s total cases in the United States have been reported in the past month, during the Omicron surge, according to data from Johns Hopkins University.
As of Thursday, cases dropped at least 10% compared with last week in 14 states, but 26 states saw cases rise at least 10%, according to Johns Hopkins data.
The wave seems to have peaked in some areas where the Omicron variant first hit in the US, like Boston and New York. But it’s still raging out of control in other parts of the country.
In Georgia, for instance, medical leaders in metro Atlanta said hospitals remain overwhelmed. With so many staff out sick, the National Guard now fills in the health care gaps in states like Minnesota. Louisiana Gov. John Bel Edwards said the “tremendous” amount of Covid-19 cases, hospitalizations and deaths has resulted in “as much as we’ve ever had in the state of Louisiana.”
Infectious disease experts, however, see hope in what has happened in South Africa.
“South Africa’s kind of our canary in the coal mine because they were able to pick up the Omicron variant first,” Maldonado said.
South African scientists first spotted the variant in November. Cases there peaked and fell off quickly. They did the same in the UK. And that’s what experts think will happen everywhere.
“I anticipate in the short run – being the next six weeks, four to six weeks – that it’s still going to be pretty rough,” said Dr. John Swartzberg, an expert in infectious diseases and vaccinology and clinical professor emeritus at the University of California, Berkeley’s School of Public Health. “It will be about the middle of February before we start to really see that things are getting better.”
If this spike flames out quickly, many experts think, there could be a “quiet period.”
Swartzberg believes March through spring or into summer will be like last year, with a continued decline in the number of cases. “There will be a sense of optimism, and then we will be able to do more things in our lives,” Swartzberg said. “I think May or June is going to really look up for us. I’m quite optimistic.”
Part of his optimism stems from the fact that there will be a much larger immune population, between the increasing number of people who are vaccinated and boosted, and those who’ve caught Covid-19 during the Omicron surge.
“Generally speaking, the level of immunity in our population is going to be much higher than it was going into the Omicron pandemic, and that’s going to help us not only with Omicron and Delta, if they’re still circulating, but it will also help us with any new variants,” Swartzberg said. “To what degree will depend on the availability of medicines to intervene.”
That’s because the coronavirus will probably never go away completely.
“I fully anticipate another version of the virus to come back,” Maldonado said. “Those are the scenarios that really bring uncertainty to what comes next.”
The next variant
The next variant could be equally or even more transmissible than Omicron. It could give people more severe symptoms – or no symptoms at all.
“It’s not at all clear what comes next,” said Dr. George Rutherford, an epidemiologist at the University of California, San Francisco. He said the virus could mutate gradually, like what happened with the Alpha and Beta variants. Or it could make a really large jump, like with Delta and Omicron. “What’s next? It’s a crapshoot.”
The H1N1 flu virus, for example, was a novel virus when it started one of the worst pandemics in history in 1918 – it infected one-third of the world’s population and killed 50 million of them.
That pandemic eventually ended, but the virus is still with us today.
“That was the great-great-grandparent of all the H1N1 viruses we see every year,” Maldonado said. “They’ve had many mutations since then, but it is from the same strain. So it’s possible that this virus will do a similar thing.”
The US still loses an average of about 35,000 people a year with the flu, according to the CDC. “And we go on with our lives,” Swartzberg said. “I don’t think it will ever go back to what it was, exactly.”
Maldonado says “that’s the best-case scenario.”
With this flu-like scenario, the world needs to focus on protecting those vulnerable to severe disease, on making sure they get vaccinated and have access to monoclonal antibodies and antivirals, Maldonado said. Vaccine companies would need to make variant-specific vaccines so people can get a Covid-19 shot every year. The country also has to make testing better.
“The oral drugs and the monoclonals are no good unless you know you’re Covid-positive,” Swartzberg said.
The in-between scenarios would be if there aren’t enough antivirals or monoclonals to treat the people who get sick, or if vaccine manufacturers can’t make variant-specific vaccines fast enough.
The worst-case scenario is if a variant escapes the protection of vaccines and treatments.
“I think that’s less likely to happen,” Maldonado said.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said he hopes that scenario doesn’t come to pass. “I can’t give you a statistic what the chance of that happen, but we have to be prepared for it.
“So we hope for the best and prepare for the worst.”
‘Choose Your Own Adventure’ out of the pandemic
The US already has the tools to limit new variants and end the pandemic quickly, Dr. Panagis Galiatsatos says.
“I don’t think we need any more scientific breakthroughs, we know how to stop severe Covid: vaccines,” said Galiatsatos, an assistant professor of medicine and expert in pulmonary and critical care medicine at Johns Hopkins Medicine.
Face masks and testing also help.
Galiatsatos does hundreds of talks each year with community groups to encourage more people to get vaccinated. He thinks scientist will have to continue this outreach.
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“We have the weapons to transform Covid into nothing but a bad cold,” Galiatsatos said. “We have the science. All people will need is access to the interventions, and we need to regain trust.”
Only about a quarter of the US population is fully vaccinated and boosted, according to the CDC. The more people who are unvaccinated, the more end up in the hospital. The more cases, the more opportunity for dangerous new variants.
“That’s why it’s like a ‘Choose Your Own Adventure,’ ” Galiatsatos said. “And I am choosing the kind that puts us in a better frame of mind that we reach people and get more people vaccinated and can end this pandemic and learn to adapt to this.”