Yes, Omicron is easing its holdings. But the pandemic is not over yet.

After a frantic few weeks when the Omicron variant of the coronavirus seemed to infect everyone, including vaccinated and vaccinated people, the United States is finally seeing signs of good news.

As cases decline in some parts of the country, many are beginning to hope that this increase is the last major battle with the virus – that because of its unique characteristics, the Omicron variant will take Americans away. out of the pandemic.

This variation spikes in South Africa and the UK, then rapidly declines. Twitter is interested in charts showing declining levels of the virus in wastewater in Boston and San Francisco. On Monday, the World Health Organization’s top European regional official said that “Omicron offers legitimate hope for stability and normalization”.

“Things are looking good,” Dr. Anthony S. Fauci, the Biden administration’s top adviser on the pandemic, said Sunday. “We don’t want to be overconfident, but they look like they’re on the right track right now.”

What drives optimism? The idea is that so many people are gaining immunity through vaccination or Omicron infection that the coronavirus will soon be unable to find a place in our communities and will disappear from our lives. we.

But in interviews with more than a dozen epidemiologists, immunologists, and evolutionary biologists, the evolution of the virus in the United States seems more complicated — and a little less rosy.

By infecting so many people, Omicron will certainly bring us closer to the end of the pandemic, they said. The current increase in infections is falling again, and there is reason to hope that hospitalizations and deaths will follow.

The path to normalcy can be short and direct, the goal is just weeks away, and horrendous outbursts can be a thing of the past. Or it can be long and bumpy, pitted with outbreaks for months to years as the virus continues to find its way.

In any case, it is unlikely that the coronavirus will disappear completely, and herd immunity is now just a dream, many scientists say. Population immunity against viruses will not be perfect, for a variety of reasons.

“It’s probably a short while before we can reach that goal,” said Shweta Bansal, an infectious disease modeler at Georgetown University. “But at this point, we’re beyond that.”

Instead, the coronavirus seems to have become an epidemic — a permanent part of American life, a milder illness, like the flu, that everyone must learn to live with and manage.

But the future also depends on one wild card: new variations. Omicron only appeared in late November. Most researchers believe other variants are on the way, because so few people around the world are vaccinated. Finally, some can be both highly contagious and capable of short-circuiting the body’s immune system, prolonging misery for everyone.

“This is an adventure story of your own choosing and the ending is yet to be written,” said Anne Rimoin, an epidemiologist at the University of California, Los Angeles. “No one can tell us what will happen.”

As of Wednesday, the US reported an average of more than 650,000 new cases per day, down from more than 800,000 two weeks ago. The number of deaths continues to rise, averaging more than 2,300 per day, but hospitalizations appear to be nearing a high, averaging around 155,000 per day.

In the best-case scenario, when these numbers drop, many Americans could soon regain most of their pre-pandemic lives. Perhaps in the spring in the Northeast, and possibly later in other regions, many Americans may not need to wear masks to work, send their children to school, and socialize with family and friends. no need to worry.

Only those at high risk of illness from Covid – because of age, health condition or occupation – need regular boosters that are tailored to the latest variation.

“If we can keep people out of the hospital and not get very sick, I think we can get back to physical normal,” said Michel Nussenzweig, an immunologist at Rockefeller University in New York. copies with tests and vaccines”.

In the long run, many of us can get a mild infection every few years, as with the coronavirus that causes the common cold, but won’t become seriously ill.

The idea of ​​Omicron as the final headquarters of the coronavirus has great appeal. That’s what every scientist wants, every scientist hopes for. But to get there, Americans need both luck and intelligence.

An endemic virus does not necessarily represent a small threat. Tuberculosis is endemic in India and other countries, and kills more than a million people each year. In African countries, measles is endemic. That virus is constantly circulating at low levels and periodically causes large outbreaks.

Earlier in the pandemic, health officials estimated that for the coronavirus, vaccinating about 70% of the population could help us cross the threshold of herd immunity, meaning the coronavirus becomes a threat. negligible threat.

But the more contagious a variant is, the higher the percentage of people who get vaccinated needed to hit the threshold. When the Alpha variant appeared, the scientists adjusted the level to 90 percent.

How big of a threat the coronavirus remains depends in part on how much immunity a country maintains over time. That is a difficult assessment to make.

There are still millions of people in the United States and elsewhere that are not protected from the virus and do not have a vaccination plan. Booster shots are needed to prevent Omicron infection, and only about half of eligible Americans get the shot.

Furthermore, scientists know very little about the strength or duration of immunity left behind by Omicron infections, and they do know that the protection against infections offered by vaccines wanes after a few days. relatively short time. (Protection against hospitalization and death remains strong for a long time.)

If people’s protection against the virus is weak or transient, Americans could continue to experience outbreaks large enough to flood hospitals for years. To prevent them, people will have to line up for their annual coronavirus shot, perhaps in the fall, just like when they get a flu shot.

If the virus persists as an endemic threat, the number of people susceptible to the virus will also change over time. Young people will become groups at higher risk or develop conditions that put them at risk, and infants will arrive without immunity.

Adam Kucharski, an epidemiologist at the London School of Hygiene and Tropical Medicine, said: “Whether it’s evolutionary, whether it’s waning or population rotation, we have has a wide range of susceptibility to allow future transmission. .

The lack of widespread vaccination, in the United States and worldwide, coupled with the uncertainty about immune strength left behind by Omicron, opens the door for new variants. One day, one of them can evade the immune defenses, or even better than Omicron can.

“I see Omicron as an example of what an endemic Covid-19 species looks like,” said Kristian Andersen, a virologist at the Scripps Research Institute in San Diego. “But this doesn’t end with Omicron, because future variations will emerge.”

Neither the vaccine nor the infection provide so-called sterilizing immunity, which means the protection they provide seems to wane over time. The protection achieved with a Delta or Omicron infection may not be effective against new variants, because the virus is changing rapidly and in unusual ways.

Viruses often evolve in a laddered pattern, with each new variant evolving from the previous one. But the three riskiest variants of the coronavirus – Alpha, Delta and Omicron – have evolved independently. So to speak, the coronavirus doesn’t build on previous work – it constantly reinvents itself.

As more and more people around the world get vaccinated, evolution will favor forms of coronavirus that can bypass antibodies and other immune defenses.

“We were able to generate a different kind of variant that responds to selection pressures that we haven’t really thought about or to mutations that we haven’t really thought of,” said Emma Hodcroft, a molecular epidemiologist at the University. not really put together,” said Emma Hodcroft, a molecular epidemiologist at the University. of Bern in Switzerland.

Contrary to popular myth, coronavirus is not guaranteed to transform into a milder form over time. The virus can evolve to be less virulent if it kills its host before spreading to others, or if it runs out of hosts to infect. Not true for coronavirus.

“It doesn’t kill enough of us, to put it perfectly, to really deplete the reservoir of people to infect,” said Jeffrey Shaman, an epidemiologist at Columbia University. “And it’s certainly been passed on from an infected person long before the virus kills.”

Even if the next variant is as mild as Omicron or even milder, a highly contagious variant can still wreak havoc on the healthcare system.

“When you have something that can be transmitted through Omicron, you don’t need it to be too serious to really mess things up,” said Bill Hanage, an epidemiologist at the Harvard TH Chan School of Public Health.

The future will also depend on our ability to take risks, both as individuals and as a nation. The most relevant comparison is with the influenza virus, which has existed with humans for hundreds of years.

Like the coronavirus, the flu is primarily a threat to certain groups of people – in this case older adults, children under the age of 5, and people with weaker immune systems.

The rest of the population takes some precautions. Businesses and schools don’t require negative testing for people who already have the flu, and people don’t have to wear masks to protect themselves from the flu. Only about half of American adults choose to get vaccinated each year.

With the coronavirus, public health officials are now grappling with what normal will look like, including what trade-offs are acceptable. But they acknowledge that trade-offs are coming.

“We don’t have a vision of the level of control we’re aiming for,” said Jennifer Nuzzo, an epidemiologist at the Bloomberg School of Public Health at Johns Hopkins University. “I just don’t think there’s a case for any of us to be targeted.”

This month, a group of former President Biden advisers urged the administration to plan for a “new normal” that includes living with coronavirus and the flu for the long term. Like Dr. Nuzzo, they argued that authorities should set targets for the number of hospitalizations and deaths that would trigger emergency measures.

As the coronavirus frequently has overblown expectations, Americans should hope for the best – but be prepared to live a little longer with something falling short.

“We all want this to end,” Dr. Shaman said. “But I think we have to be a bit more agnostic in our approach to this whole issue.”

“We don’t know,” he added. “We just don’t know.” Yes, Omicron is easing its holdings. But the pandemic is not over yet.

Fry Electronics Team

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