The world feared the worst when a
worrying new coronavirus variant emerged in late November and ripped through
South Africa at a pace not seen before in the pandemic.
But two months later, with Omicron dominant across much of the globe, the narrative
has shifted for some.
"Levels of concern about Omicron
tend to be lower than with previous variants," Simon Williams, a
researcher in public attitudes and behaviors towards Covid-19 at Swansea
University, told CNN. For many, "the 'fear factor of Covid' is
lower," he said.
Omicron's reduced severity compared to previous variants, and the
perceived likelihood that individuals will eventually be infected, have
contributed to that relaxation in people's mindsets, Williams said. This has
even caused some people to actively seek out the illness to "get it over with" -- a
practice experts have strongly warned against.
But some within the scientific
community are cautiously optimistic that Omicron could be the pandemic's last
act -- providing huge swathes of the world with "a layer of
immunity," and moving us closer to an endemic stage when Covid-19 is
comparable to seasonal illnesses like the cold or flu.
"My only view is that it's
becoming endemic, and it will continue to stay endemic for some time -- as has
happened with other coronaviruses," said David Heymann, professor of
infectious disease epidemiology at the London School of Hygiene and Tropical
Medicine.
"All viruses try to become
endemic, and to me this one looks like it's succeeding," he said.
Covid-19 has evolved with great
unpredictability, and the variant that superseded Delta could have been more
sinister, experts say; but the world ultimately got a dominant strain that is
sweeping through populations with ease, without causing the same degree of
hospitalizations, severe illnesses and deaths that previous variants have done.
Experts caution that there may be
setbacks along the way -- just as Omicron's make-up was unexpected, the next
variant could present a more serious public health risk and delay the end of
the pandemic.
And many countries, particularly where
vaccination coverage is low, could still face overwhelmed hospitals due to the
current Omicron wave.
But a political urgency is appearing
in much of the West to return societies to a sense of normality -- with the
transmissibility of Omicron forcing leaders to choose between rolling back
public health measures or seeing their workforces and economies risk grinding
to a standstill.
And for the first time since the
spread of Covid-19 stunned the world in early 2020, some epidemiologists and
leaders are willing to entertain the prospect that the virus might be making
steps toward endemic status.
'The rules of the game have changed'
The question that scientists and wider
society will grapple with throughout 2022 is when Covid-19 will leave its
current stage and enter endemicity.
A disease that is endemic has a
constant presence in a population but does not affect an alarmingly large
number of people or disrupt society, as typically seen in a pandemic.
Experts don't expect Covid to fully
disappear in any of our lifetimes. Instead, it will eventually reach a period
similar to several other illnesses, where "most people will be infected as
children, possibly multiple times, and as those infections accumulate, they build
up an immunity," according to Mark Woolhouse, professor of infectious
disease epidemiology at the University of Edinburgh and the author of a book
about the early stages of the pandemic.
"That's the situation we're
heading towards," he said. "Omicron is another dose of virus. We will
all be on average less susceptible to disease having had that dose, or having
had the vaccine."
That's why Omicron's reduced severity
is so key -- it adds an extra layer of immunity, but doesn't come with the same
risk of hospitalization that Covid-19 held for most of last year. Omicron is
associated with a two-thirds reduction in the risk of hospitalization compared to Delta,
according to a Scottish study. A separate paper from South Africa put the same
figure at 80%.
"Well over half the world has now
got some exposure to the virus or the vaccine. The rules of the game have
changed from the virus's point of view," Woolhouse said.
And underlining experts' confidence is
history -- though comparing the current scenario to previous pandemics is not
an exact science, there is evidence from the past that viruses can be expected
to evolve into less severe versions and eventually disappear into the arsenal
of annual colds and influenzas.
"There are four other
coronaviruses that have become endemic," Heymann said. "The natural
history of infections" indicates that Covid-19 will be the fifth, he
added.
"People have reinterpreted
'Russian flu' in the late 19th century as the emergence of a common cold-type
coronavirus," added Woolhouse, referring to the 1889-90 outbreak that is
estimated to have killed around a million people, but which ultimately became a
common cold.
"The 'Spanish Flu' basically gave
the whole world a very nasty dose of an H1N1 influenza virus" in 1918, he
said. Now, "we get a wave of that virus pretty much every year."
Experts generally agree that Omicron
moves us closer to that stage with Covid-19. But there is a big caveat that
determines how fast we'll get there -- and it depends not on the current
strain, but the one that comes next.
"It is an open question as to
whether or not Omicron is going to be the live virus vaccination that everyone
is hoping for, because you have such a great deal of variability with new
variants emerging," Dr. Anthony Fauci, director of the National Institute
of Allergy and Infectious Diseases, said Monday.
"I would hope that that's the
case," Fauci told the Davos Agenda, a virtual event this week held by the
World Economic Forum, mirroring the cautious optimism that many epidemiologists
are expressing. He added that the world was "fortunate" that Omicron
didn't share more of Delta's characteristics.
But for all the positive indications,
it "doesn't mean a new variant won't come up and force us backwards,"
Woolhouse said.
"I would not like to call which
way the next (variant) would go, he added. "The next variant has to
outcompete Omicron, and the main thing it will have to be able to do is evade
natural immunity, and to evade vaccine-induced immunity," he said.
"What we can't say in advance is how bad (it) will be."
An arms race towards endemicity
Epidemiologically speaking, Omicron
has delivered some cause for optimism -- but much depends on how the virus
evolves from here.
Pandemics do not move merely with the
whims of a virus, however; they are also directed by human behavior and
political acts. And as the pandemic's two-year anniversary in March edges
closer, signs are emerging of an arms race towards endemicity.
Spain's Prime Minister Pedro Sanchez,
who presided over one of the West's most effective vaccination rollouts, told
radio station Cadena Ser earlier this month that it's time "to evaluate
the evolution of Covid from pandemic to an endemic illness." His health
minister said she has put that viewpoint to fellow European Union leaders.
Britain's education secretary Nadhim
Zahawi, who previously oversaw the UK's vaccine rollout, added to Sky News that
he wanted the UK to "demonstrate to the world how you transition from
pandemic to endemic."
And that move is already well underway
in countries such as Denmark, where Covid rules were ditched and then
re-introduced last year. Tyra Grove Krause, an official at the Statens Serum
Institut (SSI) that deals with infectious diseases in the country, told local
network TV2 this month that Omicron could "lift us" out of the
pandemic and return Danes to normalcy within two months.
"Those governments that have
achieved a high degree of population immunity through the privilege of
vaccination or the burden of infection now have a wider range of choices than
they did at the start of 2021," said Thomas Hale, associate professor at
Oxford University's Blavatnik School of Government, and the academic lead of
its Covid-19 Government Response Tracker.
Many countries are starting to act as
if Covid is already endemic. England resisted new restrictions despite
record-breaking infection figures in recent weeks, and though hospitalizations
and deaths have risen, its health care sector appears to have survived the peak
of the Omicron wave without recording the high admissions seen during previous
variants.
Early real-world examples like this
could give other nations the confidence to strip back restrictions and, as
British Prime Minister Boris Johnson proposed this month, "ride out"
the Omicron wave. "Many countries have looked to the UK, because they see
that the UK has some degree of permissibility" in restrictions, Heymann
said.
That approach is quickly becoming more
commonplace. Covid-related financial aid is soon set to end in France as
restrictions are eased; "We are announcing [to people in France] that the
pandemic will perhaps be behind us by mid-February," French Prime Minister
Jean Castex announced Thursday.
Driving this push is the ravaging
impact that Omicron is having on essential workforces -- a development that has
changed the calculus of governments. Faced with dilemma of tackling
transmission or keeping their countries running, leaders have swiftly moved to
slash isolation periods.
"Clearly taking people out of the
workforce -- particularly schools and healthcare -- is one costly impact,"
of Omicron, Hale said. "Of course it is preferable to prevent widespread
transmission in the first place, though for many countries now facing Omicron
this point is now moot."
That means that an increasing number
of countries are looking to "transfer the risk assessment to their
populations," Heymann said -- relaxing rules and encouraging self-testing,
personal decisions on mask-wearing, and even individual assessments among
infected people of how long they need to isolate.
Many experts still encourage
restrictions to reduce transmission, at least while the Omicron wave is with
us. But Williams noted that populations are increasingly moving away from that
view.
"The way Omicron has been
represented in some media reports, and even indirectly by some politicians --
who were a bit too quick to emphasize the 'we need to learn to live with it'
message -- have contributed to this now quite widespread view that Omicron is
less worrisome," he said.
The problem with that approach, many
warn, is that some parts of the world are less able to take on a relaxed
approach.
"By definition a pandemic is not
over until it's over, for everyone, everywhere," Williams said. "Our
attention now should increasingly focus on getting enough vaccines to those in
low- and middle-income countries."
Vaccination coverage is lower in many
poorer regions of the world -- particularly in eastern Europe, central Asia and
large parts of Africa -- leaving those places especially susceptible to
worrying new variants or more severe waves of hospitalizations.
"A pandemic has various
components to it in various countries," Heymann said. "I think
countries will become endemic at different rates."
And that adds an extra layer of
uncertainty to the question of whether Omicron will hasten the end of the
pandemic.
"Health systems around the world
will have to be cognizant" of the risks of Covid even if it soon starts to
act and feel more like a seasonal cold, Woolhouse said.
"The world has changed -- there's
a new human pathogen there, and it's going to continue to cause disease for the
foreseeable future," he concluded. "We were always going to be living
with Covid. it was never going to go away -- we knew this from February 2020."
"What we didn't know, and still
don't fully, is exactly what that looks like."
