After Omicron, we could use a break. We may just get it


By month 25 of the Covid-19 pandemic, we all probably should have learned not to try to anticipate what the SARS-CoV-2 virus is going to do next. It has so consistently defied predictions.

But the tsunami that is the Omicron wave is tempting us all the same, in large part because of an inescapable fact: By the time it crashes, the immunological landscape in this country — and in much of the world — is going to be profoundly altered. Far more people will have some immunity to Covid-19 than was the case before the wave began. Many will have what is effectively hybrid immunity, from vaccination and infection.

As a result, some experts think we may get a bit of a break from the Covid roller coaster after Omicron. It could be a respite, if you will, after the punishing months of the Delta and Omicron waves, with their millions of cases, that began at the beginning of last summer.

Caveats abound, and most experts who spoke to STAT weren’t ready to predict that a reprieve, if it comes, will be an actual end to the pandemic — the point where SARS-2 pivots to becomes endemic. But they generally agreed that the accumulation of population immunity could slow things down, at least for a while.

“I think we will have a relative lull,” said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy. He warned, though, that that lessening of Omicron’s grip is weeks away in most parts of the country. Even in places where case counts have started to decline, there are still a lot of infected people transmitting the virus. More will be infected before the wave ends.

“Few people will be naïve — completely naïve, no protection from either vaccination or natural infection — when the Omicron wave is over,” said Cecile Viboud, an infectious diseases epidemiologist and modeler at the National Institutes of Health’s Fogarty International Center.

That should lessen the spread of SARS-2 and take some of the heat out of the outbreak, said Scott Hensley, a vaccines researcher at the University of Pennsylvania’s Institute for Immunology.

Hensley is one of the people who believes Omicron is the final wave of the pandemic. If he’s correct, after this there will be so much immunity in many populations that transmission rates will drop and SARS-2 will transition into something more akin to the influenza-like illnesses that sicken people during the winter months, but are far less disruptive than the pandemic has been.

If transmission slows, hopefully so too will the virus’s accumulation of mutations.

“None of us think the virus is going to go away, but the virus will have less opportunity to change because there will be fewer hosts that it can replicate in,” said Hensley. “And in an immune population, due to immunity, disease severity will be less.”

It’s clear now that protection conferred by either vaccination or prior infection can wane over time. It’s also clear that SARS-2 viruses can mutate to at least partially evade the immune protections we acquire; that’s been a hallmark of Omicron. Both waning and immune evasion can lead to breakthrough infections among the vaccinated or repeat infections among those who have contracted the disease in the past…Read more>>