Editor’s Note: Kent Sepkowitz is a physician and infection control expert at Memorial Sloan Kettering Cancer Center in New York. The views expressed in this commentary are his own. View more opinion on CNN.
For the fourth time in two years, things are beginning to settle down after a terrifying wave of the latest Covid-19 variant.
Though much of the country is still in the teeth of the Omicron surge, the experience in other countries, as well as the improvements seen in many US states, has led to a familiar phenomenon: various experts in infectious disease, epidemiology, public health, pandemic modeling and perhaps crystal ball interpretation being trotted out to give their two cents on what lies ahead.
This seems logical enough – we do need to have an idea of what to expect tomorrow and next week and beyond so that we can recalibrate our worry index, visit family we haven’t seen and even plan a trip. But given the collective track record of predictions by the same well-meaning individuals (myself among them), all of these fortune-tellers should agree to provide the following disclaimer with each prediction: “Though trying my best, I really am clueless regarding what’s ahead.”
Surely this great humbling is the lesson of the Omicron variant. It broke every “rule” of pandemic behavior we thought we had established. With unprecedented swiftness, it went from a variant of concern on November 26, 2021 to millions and millions of cases in less than two months and now it’s receding quickly in many countries (and in parts of the US) – though still a growing threat in others. Also unexpected were the differences in the symptoms caused by Omicron (milder than other variants, though not mild) and the fact that Omicron partially evaded vaccine-induced immunity (though booster doses do help to bump up immunity against Omicron).
But after accepting that we are trapped in a phenomenon we still can’t reliably predict, what else is there to do but to try and forecast the post-Omicron world?
Here is my prediction. There will be more surges. Some will be mild, some won’t be so mild. Some will escape vaccine-induced immunity, some won’t. And everyone will blame someone for something.
My thinking is this: After four distinct surges, each with a lead viral variant, why would there not be five? Yes, we are a much more immune public with primed T-cells from disease or vaccine or both, but this immunity failed to blunt the Omicron surge just a few months ago. What is different now?
Many turn to the story of the 1918 flu, a 15-month, three-wave experience, to inform their predictions regarding Covid-19, hewing to the Santayana adage that “those who do not remember the past are condemned to repeat it.”
But the 1918 flu occurred in a very different moment in history: The first world war was being fought, leading to global displacement of people from here to there, death and debility on a massive scale, populations – soldiers and others – crowding together and strains on food, health care and sanity.
We should leave behind any hopes based on what happened in 1918. There is no “three strikes and we’re out” rule in infectious disease. It turns out that the past, in infectious disease predicting, isn’t so helpful. Yes, there are several old reliables for which we can anticipate everything from the start to the end: Norovirus, for instance, which causes outbreaks of diarrhea on cruise ships and day-care centers, always behaves more or less the same way. And hepatitis A virus typically stays within the boundaries of expected behavior. Even influenza virus, though it explodes unexpectedly a few times a century, is mostly the same year after year.
During my career, however, I have seen many outbreaks that were not by the book: sudden appearances of new viruses, such as HIV and hepatitis C, drastic changes in the distribution and severity of other viruses, including Zika and Ebola virus, and now the unexpected appearance of SARS-CoV-2.
The unpredictable nature of the current pandemic is likely because it has the numbers. As Maria Van Kerkhove, the World Health Organization technical lead for Covid-19 response, said this week, “This virus is circulating at a very intense level around the world,” vastly increasing its opportunities to spin off new variants. Already we are hearing of a mysterious-seeming Omicron sub-variant that seems maybe a little more contagious and less easy to diagnose but otherwise pretty similar.
Despite being battered by a coronavirus for two years, there is reason for some optimism. The world’s herd is adding bit upon bit of immunity as people receive vaccination or become infected. Eventually, though not soon, the 7.8 billion people constituting the global herd will have enough immunity of one type or another – especially if we intensify our vaccination efforts across the globe – to dampen the reach and intensity of whatever variant is driving the wave of the moment.
Indeed, though the theatrical chaos of the anti-vaxxers dominates much of the discussion in the US, it is the need to vaccinate billions of people around the world that is the key next step to subduing the relentless expansionist push of SARS-CoV-2. A year into vaccine availability, stark inequities persist globally in Covid-19 vaccine distribution, a problem that can take decades to resolve, as demonstrated by the world’s response to providing vaccines for other vaccine-preventable illnesses such as measles and human papilloma virus.
Plus, our current generation of vaccines is focused too narrowly on preventing the earliest viral variants and will need a broadening to include past, current and future variant targets, a product referred to as the “universal vaccine.” This already is something that scientists are developing albeit with perhaps overly hopeful timelines.
Even this won’t be perfect either. As the H1N1 influenza pandemic of 2009 demonstrated, once in a while, a viral strain can appear that that lies completely outside our immune repertoire. The result was the H1N1 pandemic that infected about 60 million people in the US, according to estimates from the US Centers for Disease Control and Prevention, and – importantly – faded into the rearview mirror.
In the meantime, we are stuck with living the new abnormal, making decisions based on today’s facts, not yesterday’s predictions, and doing our best to dodge whatever is coming at us.