With omicron rates soaring, you may find yourself despairingly asking when — or even if — this pandemic is ever going to end.
The good news is that it will end. Experts agree on that. We’re not going to totally eradicate Covid-19, but we will see it move out of the pandemic phase and into the endemic phase.
Endemicity means the virus will keep circulating in parts of the global population for years, but its prevalence and impact will come down to relatively manageable levels, so it ends up more like the flu than a world-stopping disease.
For an infectious disease to be classed in the endemic phase, the rate of infections has to more or less stabilize across years, rather than showing big, unexpected spikes as Covid-19 has been doing. “A disease is endemic if the reproductive number is stably at one,” Boston University epidemiologist Eleanor Murray explained. “That means one infected person, on average, infects one other person.”
We’re nowhere near that right now. The highly contagious omicron variant means each infected person is infecting more than one other person, with the result that cases are exploding across the globe. Nobody can look at the following chart and reasonably conclude that we’re in endemic territory.
Looking at this data might make you wonder about some of the predictions that were floating around before omicron came on the scene. In the fall, some health experts were saying that they thought the delta variant might represent the last big act for this pandemic, and that we could reach endemicity in 2022.
The outlook is more uncertain now. So how should you be thinking about the trajectory and timeline of the pandemic going into the new year? And how should omicron be shaping your everyday decision-making and risk calculus?
When we’ll know we’re finally in “endemic” territory
Here’s one big question you’d probably like the answer to: Does omicron push endemicity farther off into the future? Or could it actually speed up our path to endemicity by infecting so much of the population so swiftly that we more quickly develop a layer of natural immunity?
“That is 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.”
That’s partly because endemicity isn’t just about getting the virus’s reproductive number down to one. That’s the bare minimum for earning the endemic classification, but there are other factors that come into play, too: What’s the rate of hospitalizations and deaths? Is the health care system overburdened to the point that there’s a precipitous space or staffing shortage? Are there treatments available to reduce how many people are getting seriously ill?
In general, a virus becomes endemic when we (health experts, governmental bodies, and the public) collectively decide that we’re okay with accepting the level of impact the virus has — that in other words, it no longer constitutes an active crisis.
With omicron surging right now and many governments reimposing stricter precautions as a result, it’s clear we’re still in crisis mode. “But so much depends on the burden it’ll place on the health care system,” Rasmussen said. “And that’s going to be different from community to community.”
Even though omicron so far seems to result in milder disease than previous variants, a massive increase in cases could still lead to a big increase in hospitalizations and deaths. That could further stress health care systems that are already in dire straits. That’s why Rasmussen concludes that “omicron certainly has the potential to delay endemicity.”
But there are also some hopeful things to bear in mind. “The incredible number of infections is building up population-level immunity. That’ll be crucial in terms of muting future waves,” said Joshua Michaud, associate director for global health policy at the Kaiser Family Foundation.
In addition to omicron potentially building up some immunity in the vast numbers of people who are becoming infected with it, vaccinations and boosters are also contributing to “a significant immunity wall that’s being built,” he said. But he cautioned that “that’s a wall to the variants we’ve seen already. There could be another variant which could evade immunity down the road.” Some experts are already conjecturing that getting infected with omicron may not give you much cross-protection against other variants, though a small early study showed positive signs on that front.
This is why Ramussen says “the key determinant” of when the pandemic ends is how long it will take to make vaccines accessible around the world (and to combat ongoing vaccine hesitancy). Currently, we’re not vaccinating the globe fast enough to starve…