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Saturday, March 15, 2025

How will pandemic end? Omicron clouds forecasts for endgame

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1167 days ago
20220103

By LAU­RAN NEER­GAARD and CAR­LA K. JOHN­SON | AS­SO­CI­AT­ED PRESS

 

(AP) — Pan­demics do even­tu­al­ly end, even if omi­cron is com­pli­cat­ing the ques­tion of when this one will. But it won’t be like flip­ping a light switch: The world will have to learn to co­ex­ist with a virus that’s not go­ing away.

The ul­tra-con­ta­gious omi­cron mu­tant is push­ing cas­es to all-time highs and caus­ing chaos as an ex­haust­ed world strug­gles, again, to stem the spread. But this time, we’re not start­ing from scratch.

Vac­cines of­fer strong pro­tec­tion from se­ri­ous ill­ness, even if they don’t al­ways pre­vent a mild in­fec­tion. Omi­cron doesn’t ap­pear to be as dead­ly as some ear­li­er vari­ants. And those who sur­vive it will have some re­freshed pro­tec­tion against oth­er forms of the virus that still are cir­cu­lat­ing — and maybe the next mu­tant to emerge, too.

The newest vari­ant is a warn­ing about what will con­tin­ue to hap­pen “un­less we re­al­ly get se­ri­ous about the endgame,” said Dr. Al­bert Ko, an in­fec­tious dis­ease spe­cial­ist at the Yale School of Pub­lic Health.

“Cer­tain­ly COVID will be with us for­ev­er,” Ko added. “We’re nev­er go­ing to be able to erad­i­cate or elim­i­nate COVID, so we have to iden­ti­fy our goals.”

At some point, the World Health Or­ga­ni­za­tion will de­ter­mine when enough coun­tries have tamped down their COVID-19 cas­es suf­fi­cient­ly — or at least, hos­pi­tal­iza­tions and deaths — to de­clare the pan­dem­ic of­fi­cial­ly over. Ex­act­ly what that thresh­old will be isn’t clear.

Even when that hap­pens, some parts of the world still will strug­gle — es­pe­cial­ly low-in­come coun­tries that lack enough vac­cines or treat­ments — while oth­ers more eas­i­ly tran­si­tion to what sci­en­tists call an “en­dem­ic” state.

They’re fuzzy dis­tinc­tions, said in­fec­tious dis­ease ex­pert Stephen Kissler of the Har­vard T.H. Chan School of Pub­lic Health. He de­fines the en­dem­ic pe­ri­od as reach­ing “some sort of ac­cept­able steady state” to deal with COVID-19.

The omi­cron cri­sis shows we’re not there yet but “I do think we will reach a point where SARS-CoV-2 is en­dem­ic much like flu is en­dem­ic,” he said.

For com­par­i­son, COVID-19 has killed more than 800,000 Amer­i­cans in two years while flu typ­i­cal­ly kills be­tween 12,000 and 52,000 a year.

Ex­act­ly how much con­tin­u­ing COVID-19 ill­ness and death the world will put up with is large­ly a so­cial ques­tion, not a sci­en­tif­ic one.

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

Dr. An­tho­ny Fau­ci, the top U.S. in­fec­tious dis­ease ex­pert, is look­ing ahead to con­trol­ling the virus in a way “that does not dis­rupt so­ci­ety, that does not dis­rupt the econ­o­my.”

Al­ready the U.S. is send­ing sig­nals that it’s on the road to what­ev­er will be­come the new nor­mal. The Biden ad­min­is­tra­tion says there are enough tools — vac­cine boost­ers, new treat­ments and mask­ing — to han­dle even the omi­cron threat with­out the shut­downs of the pan­dem­ic’s ear­li­er days. And the Cen­ters for Dis­ease Con­trol and Pre­ven­tion just re­duced to five days the time that peo­ple with COVID-19 must stay in iso­la­tion so they don’t sick­en oth­ers, say­ing it’s be­come clear they’re most con­ta­gious ear­ly on.

In­dia of­fers a glimpse of what it’s like to get to a sta­ble lev­el of COVID-19. Un­til re­cent­ly, dai­ly re­port­ed cas­es had re­mained be­low 10,000 for six months but on­ly af­ter a cost in lives “too trau­mat­ic to cal­cu­late” caused by the ear­li­er delta vari­ant, said Dr. T. Ja­cob John, for­mer chief of vi­rol­o­gy at Chris­t­ian Med­ical Col­lege in south­ern In­dia.

Omi­cron now is fu­elling a rise in cas­es again, and the coun­try in Jan­u­ary will roll out vac­cine boost­ers for front­line work­ers. But John said oth­er en­dem­ic dis­eases, such as flu and measles, pe­ri­od­i­cal­ly cause out­breaks and the coro­n­avirus will con­tin­ue to flare up every so of­ten even af­ter omi­cron pass­es through.

Omi­cron is so huge­ly mu­tat­ed that it is slip­ping past some of the pro­tec­tion of vac­ci­na­tions or pri­or in­fec­tion. But Dr. William Moss of Johns Hop­kins Bloomberg School of Pub­lic Health ex­pects “this virus will kind of max out” in its abil­i­ty to make such big evo­lu­tion­ary jumps. “I don’t see this as kind of an end­less cy­cle of new vari­ants.”

One pos­si­ble fu­ture many ex­perts see: In the post-pan­dem­ic pe­ri­od, the virus caus­es colds for some and more se­ri­ous ill­ness for oth­ers, de­pend­ing on their over­all health, vac­cine sta­tus and pri­or in­fec­tions. Mu­ta­tions will con­tin­ue and might even­tu­al­ly re­quire boost­ers every so of­ten that are up­dat­ed to bet­ter match new vari­ants.

But hu­man im­mune sys­tems will con­tin­ue to get bet­ter at rec­og­niz­ing and fight­ing back. Im­mu­nol­o­gist Ali Ellebedy at Wash­ing­ton Uni­ver­si­ty at St. Louis finds hope in the body’s amaz­ing abil­i­ty to re­mem­ber germs it’s seen be­fore and cre­ate mul­ti-lay­er de­fens­es.

Mem­o­ry B cells are one of those lay­ers, cells that live for years in the bone mar­row, ready to swing in­to ac­tion and pro­duce more an­ti­bod­ies when need­ed. But first those mem­o­ry cells get trained in im­mune sys­tem boot camps called ger­mi­nal cen­ters, learn­ing to do more than just make copies of their orig­i­nal an­ti­bod­ies.

In a new study, Ellebedy’s team found Pfiz­er vac­ci­na­tions rev up “T helper cells” that act as the drill sergeant in those train­ing camps, dri­ving pro­duc­tion of more di­verse and stronger an­ti­bod­ies that may work even if the virus changes again.

Ellebedy said base­line pop­u­la­tion im­mu­ni­ty has im­proved so much that even as break­through in­fec­tions in­evitably con­tin­ue, there will be a drop in se­vere ill­ness­es, hos­pi­tal­iza­tions and deaths — re­gard­less of the next vari­ant.

“We are not the same pop­u­la­tion that we were in De­cem­ber of 2019,” he said. “It’s dif­fer­ent ground now.”

Think of a wild­fire tear­ing 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 made the fire hard­er to spread.”

He fore­sees a day when some­one gets a coro­n­avirus in­fec­tion, stays home two to three days “and then you move on. That hope­ful­ly will be the endgame.”

COVID-19HealthUnited StatesUnited Nations


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