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A humble prediction of what comes after omicron (Opinion)

2022-01-26T17:04:33.108Z

For the fourth time in two years, things are starting to calm down after a terrifying wave of the latest variant of coronavirus, omicron.



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Editor's note:

Kent Sepkowitz is a physician and infection control expert at Memorial Sloan Kettering Cancer Center in New York.

The opinions expressed in this comment are his own.

Read more opinion columns from CNNEE here.

(CNN) --

For the fourth time in two years, things are starting to calm down after a terrifying wave of the latest strain of coronavirus, omicron.

Although much of the country is still in the teeth of the omicron surge, experience in other countries, as well as improvements seen in many US states, has led to a familiar phenomenon: various experts in infectious diseases, epidemiology, public health, pandemic modeling and perhaps crystal ball interpretation are being brought up to do their bit on what lies ahead.

This seems quite logical: we need to have an idea of ​​what to expect tomorrow and the next week and beyond so that we can recalibrate our worry index, visit family we haven't seen, and even plan a trip.

But given the collective history of predictions from the same well-intentioned people (myself among them), all of these fortune tellers should agree to provide the following disclaimer with each prediction: "Although I do my best, I really have no idea. about what will happen later."

Surely this great humiliation is the lesson of the omicron variant.

He broke all the "rules" of pandemic behavior that we thought we had established.

With unprecedented speed, it went from being a variant of concern on November 26, 2021 to millions and millions of cases in less than two months and is now rapidly receding in many countries (and parts of the United States), although it remains a growing threat in other countries.

Also unexpected were the differences in symptoms caused by omicron (milder than other variants, but not by much) and the fact that omicron partially evaded vaccine-induced immunity (although booster doses help boost immunity against omicron). .

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But after accepting that we are trapped in a phenomenon that we cannot yet predict with certainty, what else is there to do but try to predict the world after omicron?

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This could be the world after omicron

This is my prediction: there will be more waves of coronavirus.

Some will be mild, some will not be so mild.

Some will escape vaccine-induced immunity, others will not.

And everyone will blame someone for something.

My way of thinking is this: after four different waves, each with a main viral variant, why wouldn't there be five variants?

Yes, we are a much more immune public with T cells primed by disease or vaccine or both, but this immunity failed to mitigate the rise in cases of the omicron variant just a few months ago.

Why is it different now?

Many turn to the story of the 1918 flu, an experience of 15 months and three waves, to inform their predictions about covid-19, following Santayana's saying that "those who do not remember the past are doomed to repeat it."

But the 1918 flu occurred at a very different time in history: World War I was raging, causing the global movement of people to and fro, death and debilitation on a massive scale, populations—soldiers and others—overcrowding and strains on food, health care, and sanity.

We should leave behind any hope based on what happened in 1918. There is no "three strikes and we're out" rule in infectious diseases. It turns out that the past, in predicting infectious diseases, is not that useful. Yes, there are several old standbys that we can anticipate all from start to finish: Norovirus, for example, which causes diarrhea outbreaks on cruise ships and day care centers, always behaves more or less the same way. And the hepatitis A virus generally stays within the bounds of expected behavior. Even the influenza virus, though it breaks out unexpectedly a few times in a century, is mostly the same year after year.

During my career, however, I have seen many outbreaks that were not in the book: sudden appearances of new viruses, such as HIV and hepatitis C, dramatic changes in the distribution and severity of other viruses, including Zika and Ebola, and now the unexpected appearance of SARS-CoV-2.

The unpredictable nature of the current pandemic is likely because it has numbers.

As Maria Van Kerkhove, the World Health Organization's technical lead for the Covid-19 response, said this week, "This virus is circulating at a very intense level around the world," vastly increasing its opportunities to generate new variants.

We're already hearing of a mysterious-looking sub-variant of omicron that seems perhaps a bit more contagious and less easy to diagnose, but otherwise pretty similar.

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Is there reason to be optimistic?

Despite being hit by coronavirus for two years, there is reason for some optimism.

The global herd is slowly adding immunity as people get vaccinated or become infected.

Eventually, though not soon, the 7.8 billion people that make up the global herd will have enough immunity of one kind or another, especially if we step up our vaccination efforts around the world, to dampen the scope and intensity of whatever variant is driving the wave of the moment

Indeed, while the theatrical chaos of anti-vaccines dominates much of the discussion in the US, the need to vaccinate billions of people around the world is the key next step in quelling the relentless expansionist drive of SARS- CoV-2. A year after the availability of the vaccine, marked inequities persist around the world in the distribution of the covid-19 vaccine, a problem that may take decades to solve, as the global response to the supply of vaccines for other vaccine-preventable diseases, such as measles and human papillomavirus.

In addition, our current generation of vaccines is too focused on preventing early viral variants and will need to be expanded to include targets for past, current and future variants, a so-called "universal vaccine" product.

This is already something that scientists are developing, albeit perhaps with overly optimistic timelines.

Even this won't be perfect either.

As the 2009 H1N1 influenza pandemic demonstrated, from time to time a viral strain can appear that is completely outside of our immune repertoire.

The result was the H1N1 pandemic that infected an estimated 60 million people in the US, according to estimates by the Centers for Disease Control and Prevention, CDC, and, more importantly, disappeared in the rearview mirror.

In the meantime, we're stuck living in the new abnormal, making decisions based on today's facts, not yesterday's predictions, and doing our best to dodge whatever comes our way.

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Source: cnnespanol

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