Is This the End of the Road for COVID-19?

Are we getting closer to the finish line? Is this the much-anticipated light at the end of the tunnel? In other words, will Omicron be the final SARS-CoV-2 variant, and the current wave the last big one we are ever going to experience? This seems to be a prediction that some experts around the globe are favoring lately, but is it wishful thinking or do we have enough data to back it up?

There's little doubt that COVID-19 will eventually end up incorporated in our list of endemic diseases, likely following a seasonal pattern as many other respiratory illnesses do. Because of this, it's being proposed that it will look something like a flu, a viral infection that comes back to haunt us every winter. Flu infects up to 20% of the worldwide population and kills over half a million people every year, hardly something to be trifled with; but it doesn't disrupt our daily routines in any way or feature constantly in every news outlet. This will probably mean having to periodically vaccinate certain groups (the elderly and frail, mostly), but the rest will not have to worry about having yet another jab or not being able to enter certain countries because their COVID pass is not up-to-date. The main question is: When is this going to happen?

The only logical answer you can give to such precise queries, as we have learned over the past couple of years, is a sincere "We don't know." There's not sufficient information available at the moment to provide a fireproof roadmap for the final months of COVID-19, and there are too many uncertain variables that can throw a spanner in the works of the most carefully thought estimates. But at least we can speculate a bit.

This may lead us to two main hypotheses. The first one, preferred by the most optimistic, considers that this is it. Omicron is probably one of the most infectious viruses we've ever seen on this planet, second only to the measles virus, and this will prevent more aggressive versions taking over in the future. (It will be difficult to imagine that a mutation grants a higher R0 to any new SARS-CoV-2 variant.)

Also, the fact that the whole planet is now surfing an out-of-control wave as Omicron becomes dominant will confer a "natural immunity" to the potentially high percentage of people that will become infected. (WHO recently estimated that more than half of Europe will soon fall into that category.) This, together with booster shots becoming widespread, would mean that once the wave is over, and just in time to receive some help from the warmer months of the year, the pandemic will fizzle out not to return ever again.

There's a more cautious second hypothesis that, while recognizing that most of these forecasts are probably right, doesn't necessarily reach the same conclusion. In short, there's no way to know for sure that COVID-19 will go from pandemic to endemic during the next months. It's unlikely that in the Western countries we will see another wave as big as the current one before next winter, but we don't know what will happen when the cold weather returns. Even without worse variants in the mix, the end of 2022 could prove to be yet again challenging times due to the higher levels of social contact in enclosed spaces.

Let's not forget the dismal percentages of vaccination in many parts of the world, which will likely mean an uneven distribution of cases that transfers the main burden of the pandemic to those who can least afford it, and the still large pockets of anti-vaxxers in some countries, which will surely complicate things. As we said many times before, nobody is safe until everybody is.

What should be our conclusion, then? I would probably advocate for hopeful vigilance. 2022 should be a better year than 2021 (as 2021 was already much better than 2020), but this does not necessarily mean that it will see the end of the pandemic. If everything holds up, in the central months of this year we should reach record low cases in the Northern hemisphere (although some experts are predicting mild summer waves), but the other side of the world will still be struggling with immunization.

We can't guarantee that a new variant will not emerge to change the rulebook once again, even if this may seem unlikely. The real litmus test will likely come in the fall, with the return to schools and work, crowded public transportation, and the cold weather. If we manage to achieve good immunization levels before that, maybe we will see just a small bump instead of the tsunami we are experiencing this year. And this may indeed mean the beginning of the endemic phase.

Note all the conditionals in the previous paragraph. I believe that this is a must for everyone who ventures to predict how the next months will be: Don't trust anyone who offers a confident and unequivocal answer. All we have right now are doubts. Doubts and hope. But don't let hope get in the way of caution. We still face a few tough months (at least), and it's critical that everyone do their best to contribute to keep the cases as low as possible and thus reduce the number of complications. Masks, distance, vaccines, and common sense are once more our best weapons. This and lots of patience. This is why I don't think it is wise to start talking about "living with COVID-19," a mantra that is dangerously spreading in Europe and America while hospitals are still filling up, and means something like "let's stop worrying and carry on with our lives." That time will certainly come, but it doesn't look like we are there yet.

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About Dr Salvador Macip

Salvador Macip, MD, PhD is a doctor, researcher and writer. He obtained his MD/PhD at the University of Barcelona (Spain) in 1998, then moved to do oncological research at the Mount Sinai Hospital (New York). Since 2008, he has led the Mechanisms of Ageing and Cancer Lab at the University of Leicester (UK). Macip has published over 30 books, including Where Science and Ethics Meet (2016) and Modern Epidemics (2021). Connect with him on Twitter: @DrMacip

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