Is this the beginning of the end of the pandemic?

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click to enlarge Omicron was the mass vaccination campaign the unvaccinated didn’t know they signed up for. Will it be enough to end the pandemic phase of COVID-19? - Shutterstock
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Omicron was the mass vaccination campaign the unvaccinated didn’t know they signed up for. Will it be enough to end the pandemic phase of COVID-19?

It’s easy to forget what the “19” at the end of COVID-19 stands for…2019, the year SARS-CoV-2 first emerged in Wuhan, China. We’re now firmly into the fourth calendar year of the pandemic, the third year since it’s been wreaking havoc in our lives.

With the advent of the wildly transmissible omicron variant, most of the pandemic era records for cases and hospitalizations have been set in 2022. Indeed, omicron has been so efficient at exploiting holes in our immune armor that it has acted as a sort of natural vaccination campaign with a predilection for the unvaccinated.

So today, as omicron ebbs, I want to answer the question on all of our minds: could this finally be the end of the COVID-19 pandemic?

Let’s look at what history and science have to say.

Learning from 1918

A good place to start is with history’s last major global pandemic: the 1918 flu pandemic. There are, of course, important differences between the 1918 flu and COVID-19. For one, it’s been 100 years — and 100 years of scientific advancement — since 1918, and our predecessors couldn’t have dreamed of developing a safe and effective vaccine within a year of the virus’s emergence. COVID-19 is airborne whereas influenza is spread via aerosols. COVID-19, for the most part, has spared children and young people whereas the flu spiked mortality among children and young adults. Thankfully, global pandemics of this magnitude are uncommon, so the flu pandemic a century ago offers the best context for what we may be going through right now. But there are also clear similarities: Importantly, both viruses store their genetic codes in RNA, equipping them with the capacity for high speed viral evolution that vastly lengthens pandemics.

We often forget that, like COVID-19, the flu pandemic wasn’t limited to 1918. There was a small first wave in the spring of 1918 among military personnel. The second major wave occurred in the fall of 1918. But one of the largest waves occurred in the spring of 1920. If you lay that timeline onto the COVID-19 pandemic, that last major curve maps rather well to the massive omicron wave we’re now emerging from.

I had the privilege of interviewing historian John M. Berry, who wrote the authoritative account of the 1918 pandemic, The Great Influenza, on my podcast “America Dissected” back in early 2021. I asked him how the 1918 pandemic ended. His response:

Herd immunity [developed]. And at the same time, the influenza virus, like all viruses and particularly RNA viruses, mutates. The influenza virus is one of the fastest mutating viruses of all… the virus mutated in the direction … mildness, like most influenza viruses, it’s very clear that the 1918 virus could bind to cells deep in the lung. Which is pretty uncommon for an influenza virus in that you’re starting out with a fairly serious viral pneumonia when that happens. It’s not a good place to start. And apparently it lost that ability.

What we’re learning is that omicron may have undergone a similar mutation. Whereas previous variants have targeted the lungs, omicron appears to inhabit the throat, accounting for the reduction in severity. Make no mistake, viruses face no evolutionary pressure toward mildness, but there isn’t much evolutionary pressure toward severity either. The fact that omicron has been less severe is a matter of felicity.

The omicron immune barrier

But there is evolutionary pressure toward transmissibility, which is why each variant has been more transmissible than the last. To spread, it has to be. That’s because every variant leaves its mark on the population, leaving behind a short-lived barrier of immunity among those whom it has infected. Based on our evidence from COVID-19, it can last as little as three months — though repeated exposure may lead to longer-lasting immunity overall. So the next variant has to be able to evade the lasting immune barriers of each of the previous variants before it. The more efficient the previous variant, the bigger the barrier it leaves in the population.

Unlike in 1918, however, we now have safe and effective vaccines that can immunize people without infection. That’s the whole point of vaccines. So in order to spread efficiently, the next variant would have to penetrate both our vaccine-mediated immunity and the immune barrier left by the previous variants.

Once this surge is over, omicron will have left quite the barrier behind it. Indeed, this has been, by far, the most efficient COVID-19 variant we have faced. It’s impossible to know how many people were infected with omicron; it’s been so widespread that it has overwhelmed our testing capacity. It’s highly likely that the vast majority of those infected with omicron never had a confirmatory PCR.

What happens now?

Will omicron signal the end of the pandemic? Right now, the answer is that we just don’t know. What we do know is that this pandemic will end, and the omicron wave will have been an important turning point to ending the pandemic. What we don’t know is how soon that end will come.

This virus will evolve. There will be more variants. The question is whether there will be more variants that can penetrate both our vaccine-mediated immunity and the immunological barrier omicron has left behind to continue mass spread.

But we’re not helpless. The first and most obvious thing we should do is increase vaccinations. That is looking far harder as 2021’s vaccine hesitancy has hardened into outright vaccine denial. It’s much easier to do abroad, where the effort to triple vax the globe is hampered by supply. It doesn’t just mean shipping vaccines abroad, it means empowering local manufacturers in lower- and middle-income countries to produce them by waiving those manufacturers’ patents. That seems all the more justified when you consider the fact that Moderna deliberately left NIH scientists off of their patents to erase the contribution our tax dollars have made to the development of their cash cow.

Toward that end, there are efforts toward achieving a “pan-coronavirus” vaccine. The Army is expecting phase 1 trial results on their new technology that uses nanoparticles to expose our immune cells to up to 24 different spike proteins at a time. Other efforts are underway.

We should also stockpile tests and masks. The fact that omicron left us without the PCR and rapid antigen tests we needed is unconscionable. That cannot happen again. We know that N95 masks outperform the measly cloth masks many of us were wearing well into 2021. We should have literally a billion of them stockpiled for easy transfer to schools, essential workers, and others.

We should ramp up the manufacturing and accessibility of oral anti-COVID-19 pills like Paxlovid. Though these medications are easy to administer and 90% effective at preventing hospitalization from COVID-19, there simply isn’t enough to go around.

Lastly, we can begin to frame COVID-19 differently for when this pandemic does, finally, end. I wrote more about this in these pages just prior to the omicron surge. I argued that rather than focusing on case rates, we should focus on hospitalization rates. That’s because as we ramp up vaccines, masks, tests, and treatments, the risk of serious illness, hospitalization, and death from COVID-19 will decline, decoupling themselves from the incidence of cases. And yet into our third year of the pandemic, learning to live with the risk of infection will require us to make peace with the trauma of the last few years.

All of this will require us to forge some unity around the pandemic. Political polarization is like an inferno that feeds on the issues of the day. There may have been a time when a major global pandemic would have united Americans, but, unfortunately, we don’t live in that time. Rather, COVID-19 has become yet another substrate for our polarization. One side wants to close schools, the other to ban the mask or vaccine mandates that can keep them open safely. One side wants zero COVID-19, the other wants zero COVID-19 safety measures.

If endemicity is the endpoint of this pandemic, it’ll require us to understand three things: (1) COVID-19 cases will continue to occur, (2) that we have to learn to live with the virus, and (3) that COVID-19 remains a serious, lethal illness from which we ought to take reasonable precautions to protect ourselves. That takes nuance and perspective, not all or nothing negative partisanship.

If this pandemic has been a long, winding tunnel, we’re not out of it yet — but we can finally see the light at its end. The days of traveling, or eating out, or taking your kid to a movie without the nagging worry over getting COVID-19 — those will return. We’ll have to embrace them cautiously at first, perhaps in a mask from time to time. But they’re coming back. To get there, though, we’ll have to get out of our own way to both do what we need to in order to keep them safe, and choose to believe that they really can be again.

Originally published Thursday, Jan. 27 on The Incision. Get more at abdulelsayed.substack.com.

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About The Author

Abdul El-Sayed

Dr. Abdul El-Sayed is a physician, epidemiologist, public health expert, and progressive activist who served as Detroit’s health director and ran for governor in 2018. He is the author of Healing Politics: A Doctor's Journey Into the Heart of Our Political Epidemic and Medicare for All: A Citizen's Guide, as well...
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