Ómicron changed the shape of the pandemic. Will it end forever?

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(CNN) --

The world feared the worst when a worrisome new strain of the coronavirus emerged in late November and swept through South Africa at a rate never seen before in the pandemic.

But two months later, with omicron dominating much of the world, the narrative changed for some.

"The levels of concern about omicron tend to be lower than with previous variants," Simon Williams, a researcher on public attitudes and behaviors towards Covid-19 at Swansea University, told CNN.

For many, "the 'Covid scare factor' is minor," he said.

The reduced severity of omicron compared to earlier variants and the perceived likelihood that people will eventually become infected contributed to that relaxation in people's mindsets, Williams said.

This has even caused some people to actively seek out the disease in order to "get it over with," a practice that experts have strongly warned against.

But some within the scientific community are cautiously optimistic that omicron could be the last act of the pandemic, giving large swaths of the world "a layer of immunity" and moving us closer to an endemic stage when covid-19 is comparable to diseases. seasonal, such as cold or flu.

"My view is that it is becoming endemic and will remain endemic for some time, as has happened with other coronaviruses," said David Heymann, a professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine.

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"All viruses try to become endemic, and to me this one looks like it's succeeding," he said.

Covid-19 evolved with great unpredictability, and the variant that replaced delta could have been more sinister, experts say;

But the world finally got a dominant strain that is wiping out populations with ease, without causing the same degree of hospitalizations, serious illness, and deaths that earlier variants did.

Experts warn that there may be setbacks along the way: just as the composition of omicron was unexpected, the next variant could present a more serious risk to public health and delay the end of the pandemic.

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And many countries, particularly where vaccination coverage is low, could still face overwhelmed hospitals from the current wave of omicrons.

But a political urgency is emerging across much of the West to return societies to a sense of normalcy, with the transmissibility of omicron forcing leaders to choose between rolling back public health measures or seeing the risk that their workforces and economies they become paralyzed

And for the first time since the spread of Covid-19 shocked the world in early 2020, some epidemiologists and leaders are willing to consider the possibility that the virus is taking steps toward endemic status.

'The rules of the game have changed'

The question that scientists and society in general will be faced with throughout 2022 is when covid-19 will leave its current stage and enter endemicity.

A disease that is endemic has a constant presence in a population, but does not affect an alarmingly large number of people or disrupt society, as is often seen in a pandemic.

Experts don't expect covid to completely disappear in any of our lifetimes.

Instead, it will eventually reach a period similar to that of several other diseases, where "most people will be infected as children, possibly multiple times, and as those infections build up, they will develop an immunity," according to Mark Woolhouse, professor of infectious diseases.

epidemiology at the University of Edinburgh and author of a book on the early stages of the pandemic.

"That's the situation we're heading toward," he said.

"Omicron is another dose of virus. We will all be, on average, less susceptible to the disease if we receive that dose or if we get vaccinated."

That's why omicron's reduced severity is so key: It adds an extra layer of immunity, but doesn't carry the same risk of hospitalization that Covid-19 did for most of last year.

Omicron is associated with a two-thirds reduction in the risk of hospitalization compared to delta, according to a Scottish study.

A separate document from South Africa put the same figure at 80%.

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"Well more than half the world now has had some exposure to the virus or the vaccine. The rules of the game have changed from a virus standpoint," Woolhouse said.

And underscoring expert confidence is history: While comparing the current scenario to previous pandemics isn't an exact science, there is evidence from the past that viruses can be expected to evolve into less severe versions and eventually disappear into the arsenal of annual colds. and flu

"There are four other coronaviruses that have become endemic," Heymann said.

"The natural history of infections" indicates that covid-19 will be the fifth, he added.

"People reinterpreted 'Russian flu' in the late 19th century as the emergence of a common cold-type coronavirus," Woolhouse added, referring to the 1889-1890 outbreak that is estimated to have killed around a million people, but that eventually turned into a common cold

"The 'Spanish flu' basically gave the whole world a very nasty dose of an H1N1 influenza virus" in 1918, he said.

Now, "we get a wave of that virus almost every year."

Experts generally agree that omicron brings us closer to that stage with covid-19.

But there's a big caveat that determines how quickly we'll get there, and it doesn't depend on the current strain, but the one that comes after.

“Whether or not omicron will be the live virus vaccine that everyone is hoping for is an open question, because there is a lot of variability with new variants emerging,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said Monday. .

"I hope that's the case," Fauci told the Davos Agenda, a virtual event held this week by the World Economic Forum, reflecting the cautious optimism expressed by many epidemiologists.

He added that the world was "lucky" that omicron did not share more features with delta.

But despite all the positive indications, "it doesn't mean a new variant won't come along and force us back," Woolhouse said.

"I wouldn't want to say which way the next (variant) would go," he added. "The next variant has to outperform omicron, and the main thing it's going to have to be able to do is evade natural immunity and evade induced immunity," he said." What we can't say in advance is how bad it will be."

An arms race towards endemicity

In epidemiological terms, ómicron generated some cause for optimism, but a lot depends on how the virus evolves from here.

However, pandemics do not simply move on the whims of a virus;

they are also driven by human behavior and political acts.

And as the second anniversary of the pandemic approaches in March, signs are emerging of an arms race toward endemicity.

The President of the Government of Spain, Pedro Sánchez, who presided over one of the most effective vaccination launches in the West, told radio station Cadena Ser earlier this month that it is time to “evaluate the evolution of covid from a pandemic to a disease endemic".

His health minister said he has raised that point of view with other European Union leaders.

Britain's education secretary Nadhim Zahawi, who previously oversaw the UK's launch of the vaccine, added to Sky News that he wanted the UK to "show the world how you go from pandemic to endemic".

And that movement is already underway in countries like Denmark, where covid rules were abandoned and then reintroduced last year.

Tyra Grove Krause, an official at the Statens Serum Institut (SSI) that deals with infectious diseases in the country, told local channel TV2 this month that omicron could "get us out" of the pandemic and return Danes to normality in two months.

“Those governments that have achieved a high degree of population immunity through vaccination privilege or infection burden now have a broader range of options than they did in early 2021,” said Thomas Hale, associate professor in the School Blavatnik of the University of Oxford, and the academic lead of its Covid-19 Government Response Tracker.

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Many countries are beginning to act as if covid is already endemic.

England weathered the new restrictions despite record infection numbers in recent weeks, and while hospitalizations and deaths rose, its health care sector appears to have survived the peak of the omicron wave without registering the high admissions seen during variants. previous.

The first real-world examples like this could give other nations the confidence to remove restrictions and, as British Prime Minister Boris Johnson proposed this month, "ride out" the omicron wave.

"A lot of countries looked at the UK, because they see the UK as having a certain degree of permissiveness" on restrictions, Heymann said.

That approach is rapidly becoming more common.

Covid-related financial aid will soon end in France as restrictions ease;

"We are announcing [to people in France] that the pandemic may be behind us in mid-February," French Prime Minister Jean Castex announced Thursday.

Driving this momentum is the devastating impact omicron is having on essential workforces, a development that changed the calculus of governments.

Faced with the dilemma of tackling transmission or keeping their countries running, leaders have moved quickly to reduce isolation periods.

"Clearly, taking people out of the workforce, particularly schools and health care, is a costly impact" of omicron, Hale said.

"Of course, it is preferable to prevent widespread transmission in the first place, although for many countries now facing omicron, this point is now moot."

That means an increasing number of countries are looking to "transfer risk assessment to their populations," Heymann said, relaxing the rules and encouraging self-assessment, personal decisions about mask-wearing, and even individual assessments among infected people about how long they need to isolate.

Many experts still encourage restrictions to reduce transmission, at least while the omicron wave is with us.

But Williams noted that populations are moving further and further away from that vision.

"The way in which omicron was portrayed in some media reports, and even indirectly by some politicians, who were too quick to emphasize the 'we have to learn to live with it' message, contributed to this now fairly widespread view that omicron is less of a concern," he said.

Many warn that the problem with such an approach is that some parts of the world are less able to take a relaxed approach.

"By definition, a pandemic isn't over until it's over, for everyone, everywhere," Williams said.

"Our focus now should increasingly be on getting enough vaccine to people in low- and middle-income countries."

Vaccination coverage is lowest in many poorer regions of the world, particularly Eastern Europe, Central Asia and much of Africa, making those places especially susceptible to worrying new variants or more serious waves of hospitalizations.

"A pandemic has various components in various countries," Heymann said.

"I think countries will become endemic at different rates."

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And that adds an extra layer of uncertainty to the question of whether omicron will hasten the end of the pandemic.

"Health systems around the world will have to be aware" of the risks of Covid, even if it soon kicks in and feels more like a seasonal cold, Woolhouse said.

"The world has changed: there is a new human pathogen out there and it will continue to cause disease for the foreseeable future," he concluded.

"We were always going to live with covid. It was never going to go away, we knew that since February 2020."

"What we didn't know, and still don't fully know, is exactly what it looks like."