'Very nice spring, very nice summer': Omicron will bring us closer to normal, experts say – National Post

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Anna Bershteyn says there are absolutely no guarantees, of course, but if asked to read the tea leaves, she sees “a very nice spring, a very nice summer, where people can let loose,” see others and not worry so much about COVID-19 .

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It’s just a hope, “but if I had to make a guess, I would say that what Omicron will probably give us is a period of respite,” said Bershteyn, an assistant professor in the department of population health at New York University Grossman School of Medicine. Immunity gained through vaccination, infection or a combination of the two, could move populations closer to controllable levels of COVID, she and other scientists said. The hope is that the virus “sort of vaccinates itself” — that a milder strain gives us immunity to a later, potentially more severe one.

While hospital and ICU numbers are rising nationally, Omicron infections may have peaked and the country could be on a downward slope, federal health officials said Friday.

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COVID is here to stay. SARS-CoV-2 will continue to live in the human population, Dr. Theresa Tam, Canada’s chief public health officer said. While we must prepare for more potential unusual variants, “we do need to lay out a strategy and a plan towards moving back toward something that is nearer normality,” Tam said . In England, mandatory masking in public spaces and vaccine passports will be dropped beginning next week, while Spain is moving toward treating SARS-CoV-2 much like seasonal flu.

Many questions linger: It’s not clear how long immunity to Omicron will last, whether we could see a second wave, or whether infection with a milder stain will indeed provide immunity against whichever Greek letter-named version of SARS-CoV-2 comes next. The virus has already proven whip smart — scientists didn’t see heavily mutated Omicron coming — and it’s still evolving.

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“The big game changer is indeed the moment when nearly everybody will have had some sort of immunity,” Dr. Peter Juni, of Ontario’s COVID-19 science table  recently told a COVID research consortium . “I can’t guarantee endemicity relatively soon, but I can guarantee we can move much closer to endemicity after the Omicron wave.”

Here’s what we know about where we are now and where we need to go.

Rapid rise, rapid descent?

“Our modelling suggests that we are at the peak around now, with some provinces (Ontario and Quebec, which experienced Omicron earliest) just past the peak and others just behind it,” said Caroline Colijn, an associate professor of mathematics at Simon Fraser University and COVID-19 modeller.

In Ontario, the rate of hospitalizations and intensive care admissions is slowing. Restaurants and gyms will reopen starting Jan. 31, with all remaining restrictions to go by mid-March, Premier Doug Ford announced Wednesday. British Columbia is seeing a slowing in transmission rate. “That’s partly the end of the holidays, but I think it partly is  a lot  of people have COVID right now,” said Colijn and that’s having a dampening effect. More people are isolating “or cancelling things if they hear five of their friends have COVID.” That, combined with a shorter course of infections, can drive a speedy decline, she said.

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Our modelling suggests that we are at the peak around now

But Canada might also have a more rounded peak, or double peaks, because of the timing with schools and universities reopening and the lifting of restrictions, Colijn said. “We may not see the very rapid decline that has been seen in South Africa, for example.”

Official case counts are almost irrelevant, with testing systems so overwhelmed. “But it’s important if the number of actual infections happening starts to go down quickly, because that’s going to decrease the burden on everybody — fewer people sick, fewer people in hospital, fewer workplace closures, fewer schools affected,” Colijn said.

Why not just get infected and get it over with?

Famed cardiologist and author Dr. Eric Topol isn’t thrilled with the “Omicron will ultimately find just about everybody,” messaging. “Let’s not invite an unpredictable virus that can cause long COVID,” or secondary attacks, where people who may not be particularly at risk of a bad infection themselves unwittingly pass the virus to someone who can wind up very sick,” Topol said, during a recent University of California, San Francisco Department of Medicine Grand Rounds Q&A. 

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In Australia, “COVID chasers” are hoping to time infections when it’s less inconvenient to isolate. Their thinking runs the lines of, “It’s going to happen anyway, I want to live my life, I’m sick of trying to avoid COVID and it’s likely to be mild in someone like me.”

It’s not a terribly brilliant idea, Topol, founder and director of Scripps Research Translational Institute, and other scientists said. Omicron can cause severe disease. It’s not uniformly mild. With hospitals grappling with shortages of staff and COVID-19 drugs, people who do end up in hospital risk ending up with less-than-optimal care, Juni said. And while it will take months before it’s known whether Omicron can cause long COVID, the phenomenon typically follows mild infections.

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Vaccines are still the best shot at making COVID manageable

The vaccines are still holding their own against severe disease with Omicron, and a third dose boosts immunity even higher. Still, demand for third doses appears to be slowing, and while Pfizer has said it should have a vaccine that targets Omicron specifically by March, Topol and others said what’s needed is a universal, “pan” coronavirus vaccine that would protect against all variants and make it harder for the virus to mutate its way around. Omicron proved that SARS-CoV-2 can take huge leaps in evolution, “and get all these mutations all in one jump,” Bershteyn said. “You really can’t place Omicron on the family tree of variants that we’ve seen before. It sort of came out of nowhere, and as far as I can tell there’s no biological rule that says that it couldn’t do this again  and  be very contagious and very deadly at the same time.”

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“The unvaccinated who do not have a boost to their immunity from vaccine are likely to become susceptible again to whatever variant comes next,” she said, and regulatory discussions should be happening now, including, would manufacturers have to do a full clinical trial of a new vaccine, or a small, short trial, looking at the antibody response? How long to monitor for safety? A vaccine against Omicron is three months away. If a more dangerous variant emerged, “we couldn’t wait three months. You’d have to completely lock down everything. It’s just not feasible.”

What’s the endgame?

“Waning immunity and the emergence of new variants will shape the long-term burden and dynamics of COVID-19,” Colijn and colleagues wrote in a pre-print.

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“If we can get another infection in a couple of months, that’s not a good thing for where this virus settles out,” Colijn said. “But if we’re well protected for a year, that’s pretty good news. And what that means is that (COVID) will decline to hopefully pretty low levels and stay at those levels.”

But endemic doesn’t mean “not a problem,” she said. “It just means that it’s stable — it’s not having this huge wave that goes through the population.”

Waning immunity and the emergence of new variants will shape the long-term burden and dynamics of COVID-19

She doesn’t think there’s pressure on the virus to get more severe. Transmission is where the virus is having “its reproductive opportunities. We have the high transmissibility without it carrying along a really high severity. So, hopefully, we don’t get the big, bad new variant,” Colijn said.

Hospitalizations will never be reduced to zero. “There are always going to be frail vulnerable people who succumb to this virus,” McMaster University infectious diseases specialist Dr. Martha Fulford said in an earlier interview. Once past this hump, and with more protection because of boosters, more immunity from infections and more effective treatments, a broader conversation will be needed about the risks posed by COVID and the risks that exist from locking down “forever and a day,” she said.

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