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One of the defining characteristics of the Omicron wave here in Canada may be our sense of the virus’s unstoppability.
During the first wave of the pandemic, public health measures often limited the virus’s spread to isolated outbreaks, tragically claiming lives in susceptible places such as long-term-care homes. With Beta- and Delta-type COVID-19, community spread of the virus was substantially curbed as vaccination ticked up.
Now, as the COVID-19 curve morphs into a near-vertical line, and several provinces put strict limits on who can get a test because so many people are getting exposed, our collective sense of being able to avoid infection is being shaken. Omicron really seems unstoppable.
It’s the term that came to mind when Karen López learned that dozens of her friends had caught the virus in three weeks — a number that outstripped what she had seen in any of the previous waves many times over.
After nearly two years of carefully avoiding COVID-19, López is not letting go of her caution. But the Toronto woman said she is thinking differently about what it may mean to catch COVID-19 now, especially with indications that the virus is less severe for vaccinated individuals such as her, and a level of spread that seems much harder to avoid forever.
“I guess I am sort of thinking: I should just expect that I’m going to get it sometime next year, and that won’t be a terrible thing,” she said. “Maybe I can go back to thinking about other risks, like car accidents.”
The emergence of the Omicron variant, with its rampant transmissibility, has caused some to ask: Is this a preview of how life will be, when the pandemic phase of COVID-19 ends, and the virus continues to spread, endemic, in society for the rest of our lives?
Colin Furness, an infection control epidemiologist and assistant professor at the University of Toronto, agrees that the public and the officials trying to manage the pandemic are treating the Omicron wave as more “inevitable” than previous waves — doing less to prevent cases than in previous waves, when restaurants and schools were closed with far fewer cases circulating.
“I don’t really know what’s driving it, but for all intents and purposes it’s as if there was a decision to say: Let it go, let it spread,” he said, referring to the decision for schools to return on Jan. 5 and to keep restaurants and events open (albeit with capacity limits).
To Furness, it’s a level of acceptance that comes too soon, since kids under five cannot be vaccinated yet, and Omicron may still pose a significant risk to vulnerable populations.
COVID-19 is not yet endemic — which is technically defined as a disease that exists consistently in a population over time, typically not exceeding a reproductive value of one — but the sense of Omicron’s unstoppability, combined with hopes about its milder properties, seems to be prompting officials and parts of the public to act as though it is something less acutely threatening, like the flu or a bad cold.
“So I’m not sure endemic is the right word, though in common parlance I think (people who use this term) mean COVID-19 is there and never going away,” he said.
Indeed, at this point in the pandemic, the decision to call it “endemic” rather than “pandemic” may be as much a social and ethical question as a scientific one.
It’s worth noting that there is more agreement that COVID-19 will last long-term (become endemic), than there is about what kind of threat the virus will pose when it does.
In a survey of more than 100 immunologists published last February by Nature, there was near consensus that COVID-19 would become endemic, with 89 per cent saying it was “likely” or “very likely” to continue circulating indefinitely in at least some pockets of the global population.
The reason is that, over time, as more and more people become exposed to the virus, and more people gain protection from vaccines, scientists expect transmission of the virus to reach some kind of equilibrium. With endemic disease, we would expect no massive waves and crashes, but a predictable cycle or steady tick of illness over time.
That doesn’t mean endemic COVID-19 will be innocuous. Other endemic diseases are not.
In the case of the 1918 flu, that equilibrium meant living with a nasty seasonal malady (for which we can today get an annual vaccine). In the case of four human coronaviruses, which are also believed to have caused pandemics in the past, they have become some of the viruses leading to common colds. A less common outcome is near-eradication of a disease, which seems a distant possibility in the case of COVID-19.
“Right now, you could say coronavirus is endemic — it’s among us, there’s no indication we’re going to be able to get rid of it locally, or around the world,” said Jeffrey Shaman, professor of environmental health sciences at Columbia University Mailman School of Public Health.
But the virus is still surging in dramatic waves and placing the health-care system under strain, so it can’t be said to have reached a steady equilibrium, he said.
Even if we think about influenza, which is endemic by most people’s understanding, that disease kills 500,000 people per year worldwide.
“We’ve been accepting 25,000 deaths a year from flu (in the U.S.),” he said. “And maybe we shouldn’t have been.”
Complicating things is the fact that the COVID-19 we have gotten to know mutates more quickly than the flu, and causes more severe illness. Still, it may be that populations tired of pandemic restrictions and eager to get back to regular life and all their close contacts may be keen to get to treating COVID-19 as endemic more quickly.
“We’re going to normalize and socialize the idea of getting back to work, getting back to living,” Shaman said. “You could frame that as making the virus endemic.”
A remaining question is whether Omicron could help COVID-19 reach its endemic phase.
Data available so far shows Omicron infections are less likely to result in hospitalizations compared to Delta infections, although Omicron spreads much more quickly.
Shaman is skeptical that means the pandemic will end after a massive number of people become infected with Omicron.
“The question is, is this Omicron the beginning of a more mild and highly transmissible virus we’re going to contend with?”
He said he’s not sure. While he believes the data that Omicron itself seems to be more mild than Delta, he said there’s no guarantee the virus will continue evolving to a milder form. It could, instead, evolve to be more virulent, and just as transmissible as Omicron.
Such an outcome would keep COVID-19 in a pandemic phase much longer.
Clarification — Dec. 31, 2021: This article was edited to add the first name and title of Jeffrey Shaman, professor of environmental health sciences at Columbia University Mailman School of Public Health.
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