With omicron rates skyrocketing, you may find yourself asking in despair when – or even about – this pandemic will ever end.
The good news is that will end. Experts agree. We are not going to eradicate Covid-19 completely, but we will see it move out of the pandemic phase and into the endemic phase.
Endemicity means that the virus will continue to circulate in parts of the global population for years, but its spread and effect will come down to relatively manageable levels, so it ends up more like the flu than a world-stopping disease.
In order for an infectious disease to be classified in the endemic phase, the number of infections must more or less stabilize over the years instead of showing large, unexpected increases, as Covid-19 has done. “A disease is endemic if the reproductive rate is stable at one,” Boston University epidemiologist Eleanor Murray explained. “It means that an infected person on average infects another person.”
We’re nowhere near that right now. The highly contagious omicron variant means that each infected person infects more than one other person, with the result that cases explode all over the globe. No one can look at the following chart and reasonably conclude that we are in endemic territory.
Looking at this data may make you wonder about some of the predictions that hovered around before omicron came on the scene. In the fall, some health experts said they believed the delta variant could represent the last major action for this pandemic and that we could reach endemic by 2022.
The outlook is more uncertain now. So how do you think about the course and timeline of the pandemic that is entering the new year? And how should omicron shape your daily decision making and risk calculation?
When we know we are finally in “endemic” territory
Here’s a big question that you’ll probably want the answer to: Does omicron extend endemicity further into the future? Or could it actually speed up our path to endemicity by infecting so much of the population so quickly that we more quickly develop a layer of natural immunity?
“That’s really the million-dollar question,” Angela Rasmussen, a virologist at the University of Saskatchewan in Canada, told me. “It’s really hard to say right now.”
This is in part because endemicity is not just about getting the virus’ reproduction rate down to one. This is the absolute minimum for achieving the endemic classification, but there are other factors that come into play: What is the number of admissions and deaths? Is the healthcare system overburdened to the point that there is an abrupt shortage of space or staff? Are there treatments to reduce the number of people who become seriously ill?
In general, a virus becomes endemic when we (health experts, government agencies, and the general public) jointly decide that we are okay with accepting the level of impact that the virus has – that in other words it no longer constitutes an active crisis.
With omicron rising right now, and many governments reintroducing stricter measures as a result, it is clear that we are still in a state of crisis. “But so much depends on the burden it will place on the health system,” Rasmussen said. “And it will be different from community to community.”
Even though it turns out to be true that omicron tends to result in milder disease than previous variants (we do not yet have enough data to say definitively), a massive increase in cases may still lead to a large increase in hospitalizations and deaths. It can further stress health systems that are already in serious difficulty. That is why Rasmussen concludes that “omicron certainly has the potential to delay endemicity.”
But there are also some hopeful things to keep in mind. “The incredible number of infections is building immunity at the population level. It will be crucial in curbing future waves,” said Joshua Michaud, associate director of global health policy at the Kaiser Family Foundation.
In addition to the fact that omicron potentially builds some immunity in the large number of people who become infected with it, vaccinations and boosters also contribute to “a significant immunity wall that is being built,” he said. But he warned that “it is a wall to the variants we have already seen. There could be another variant which could evade immunity along the way.” Some experts already assume that getting infected with omicron may not give you much cross-protection against other variants.
That’s why Ramussen says the “key determinant” of when the pandemic will end is how long it will take to make vaccines available around the world (and to combat the ongoing reluctance to get vaccinated). Currently, we are not vaccinating the globe fast enough to starve the virus of opportunities to mutate into something new and serious. “If only a very small proportion of people get access to vaccines, we will just continue to play variant whack-a-mole indefinitely,” Rasmussen said.
In the meantime, we have another ace up our sleeve, which will hopefully also be available across the globe sooner rather than later: new treatments – as well as Pfizer’s paxlovid, recently approved by the Food and Drug Administration, and Merck’s molnupiravir, also approved by the FDA – which reduces the number of admissions and deaths from Covid-19.
“Very important in the context of endemic is the antiviral pills,” Michaud said. “If we have these tools, we’re looking at a very different state going into 2022. People should not feel like we’re back to square one.”
We are not back to March 2020. But it makes sense to change our behavior during the omicron rise.
Despite terrible headlines, we are in much better shape than we were at the beginning of the pandemic. We have discovered much more information on how Covid-19 works. We have manufactured effective masks, vaccines, boosters, treatments and quick tests.
We have also learned that having to sit down has a real cost to our mental and financial health and well-being. The cost of a strict lockdown may have been worth it in March 2020, but by and large, that’s not what US experts are advising now.
However, they urge us to take more precautions than we could have been in the weeks leading up to omicron.
Take, for example, Bob Wachter, chairman of the Department of Medicine at the University of California San Francisco. In the fall, he switched from being very careful with Covid-19 to taking some more calculated risks, including dining indoors at restaurants and even hosting a personal medical conference with 300 attendees. But now that omicron is causing things to skyrocket, he is once again more cautious.
“I see the next few months as a time to strengthen one’s security behavior,” he said wrote on Twitter. This is how he explained his reasons:
… and most importantly people (many doctors / RNs are sick too). Believe me, you want to avoid getting sick when the system is stressed. Thirdly, I see Pfizer oral antiviral as a very big thing and it will not be available for 4-6 weeks (even then it will be in short supply). (10/25)
– Bob Watcher (@Bob_Watchman) December 17, 2021
The other experts I spoke to agreed that now is the time to limit risky activities.
“I had taken my foot off the brake in relation to my own behavior. But I have now started to put it on again, ”Michaud told me. “I canceled plans to go to New Jersey to visit my family over Christmas. I’m avoiding more indoor environments. Right now, it makes a lot of sense for me to take further steps to prevent yourself and those around you from getting infected. “
After the omicron wave passes, he said, he imagines relaxing precautions again. Modeling suggests that omicron could peak in mid to late January in the US, with case rates falling sharply – and activities becoming similarly safer again – in February.
Rasmussen also changes her behavior in light of omicron, though she stresses that it is not the same as going back to a spring 2020-style lockdown. Even though she canceled an international flight during the holidays, she still felt comfortable taking over to her colleague’s house for a Christmas meal. This is because she and they had vaccinations, boosters, quick tests and good ventilation that worked to their advantage.
“We have many more tools at our disposal to deal with this than we had in March 2020,” she said.
We know that endemic has arrived when these tools – and the long, painful experience of the pandemic itself – have enabled us to fully adapt to the virus as the virus has adapted to us.