Pandemic Lessons: What happens after Omicron?

This started 22 months ago, when the coronavirus spread and we sheltered. Then masked. Then got vaccinated. And unmasked. Then remasked. Now boosted.

Not everyone did all of those things, but many of us did most of them. When we did, we expected better.

Many of us got infected, too. Maybe once, maybe twice. Some of us were lost. Those of us who are here embraced the idea of immunity, and if we’ve been paying attention, we’ve learned that it’s not something that you do or don’t have. It’s something you build – but you don’t always keep.

Just like Covid-19 isn’t something that simply goes away. It evolves, it reemerges, and it is something that, in the words of Dr. Isaac B. Weisfuse, a New York-based medical epidemiologist, “We’re going to live with.”

We just want to live with it a little less than we are now.

“I was originally thinking we’d be on the backside of this sometime in mid- to late January,” said Dr. Thomas Russo, the chief of infectious disease at the University at Buffalo’s Jacobs School of Medicine and Biomedical Sciences.

Russo was hoping the Delta wave that slammed into upstate New York this fall would subside in early 2022. But then another variant crept in, one that is far less lethal, but much more transmissible.

“Omicron showed up,” Russo continued. “Then I said, ‘Ah, Omicron is going to prolong this.’ ”

For this installment of Pandemic Lessons, we asked epidemiologists to project how much longer Omicron will grip us, and what life will look like when it’s done.

How bad is Omicron?

The projections from when it emerged last month are proving to be true. It is extremely contagious, generally (but not always) mild, and because it impacts so many people quickly, Omicron is loading up hospitals.

Almost 4,000 people tested positive in Erie County on Jan. 5, which is a record – and a misleading number, because it doesn’t include unreported at-home tests.

State officials reported on Jan. 7 that across New York, cases among teenagers have multiplied by 10 in the last few weeks, while adult cases have more than doubled. Pediatric hospital cases for Covid-19 have nearly quadrupled since Christmas, rising from 150 to 570, most of them unvaccinated.

While the vast majority of people infected with Omicron aren’t hospitalized, the spike is still causing people to miss school and work and prompting cancellations and closures. The continued spread also puts people who are immunocompromised or have other health conditions at increased risk, and it is further delaying our ability to reclaim any semblance of the freedom, openness or normalcy that we crave.

But Omicron could conceivably recede as fast as it is spreading. Once a virus starts running out of potential hosts – or people to infect – it slows. Omicron may run out of hosts quickly.

“The way it’s going, I’m not sure it’s going to prolong it that much more,” Russo said. “I’m hoping it’s only on the order of weeks, and not months. We’ll see.”

Russo’s view is widely shared. During her Jan. 7 press briefing alongside Gov. Kathy Hochul, New York Health Commissioner Dr. Mary Bassett predicted the coming weeks will be intense. But, she added, “Things should be much better by February.”

Why might the situation improve so quickly?

Immunity. Seven of 10 New York residents are fully vaccinated, and about a third of them have booster shots. Thousands of people – vaccinated or not – have had Covid-19. All of those things contribute to the ability of your immune system to fight infection, although Omicron is different enough – and therefore contagious enough – to still break through, albeit sometimes with mild or no symptoms, especially for those who are vaccinated.

Most of the thousands of people in New York and beyond who are dealing with Omicron infection every day will likely emerge with new a degree of immune resistance. On the other side of this curve, the physics of viral spread may work in our favor. Omicron could drop the same way it spiked: fast.

“One likely scenario is that the rapid spread of this virus will leave a large proportion of the population with some immunity to this virus,” said Stephen S. Morse, a professor in the Department of Epidemiology at the Columbia University Mailman School of Public Health. “The immunity to these coronaviruses unfortunately does not seem to last very long, but it should keep the virus at bay for at least several months.”

Only for 'several months'?

Yes, most likely, for a couple of reasons.

First, we already know that immunity is both imperfect and impermanent.

“Reinfection with this or another coronavirus is possible, even in some who are recently recovered and considered immune,” Morse said. “But when this happens, disease may be mild or asymptomatic.”

Second, so long as Covid-19 can keep spreading here or in other parts of the world, it can keep mutating – and that’s how variants emerge. Denis Nash, an epidemiologist and executive director of the CUNY Institute for Implementation Science in Population Health, noted that “we could be vulnerable to another variant that is different enough from Omicron and prior variants that prior immunity won’t prevent a surge.”

This, he pointed out, is precisely what happened with Omicron.

“We won’t be out of these woods until we can reduce transmission through vaccination around the world,” Nash said. “Until then, we will be vulnerable to more Omicron-like surges, or worse if it is more virulent. This is a real possibility that will be lurking until we can reduce transmission in the U.S. and globally.”

Put another way: Omicron driving numbers up – and then down – here in North America isn’t enough to return our life to 'normal'?

No, probably not. Or least not permanently.

Any hope of herd immunity – or effectively snuffing the virus out of circulation – vanished long ago. Covid-19 will ultimately be an endemic virus, like influenza and the viruses that cause the common cold.

“Better vaccine uptake here and outside the U.S. and other high-income countries (and) better global vaccine availability could have helped contain the virus before it got this far along,” Morse said, adding that more robust testing also “could have helped slow it down or stop it sooner. But, at some point, we’ll have to learn to live with it instead, as we do with the many other respiratory viruses with which we already have a kind of truce.”

Will we ever get to live our lives without masks, testing and other protocols?

Hard to say. But here’s another way to look at that question, and we pose it here straight-up, with no nudging or cajoling intended: Knowing that Covid-19 isn’t going away, and realizing that the medical profession (and our immune systems) has had years – but unlike viruses like influenza, not decades – to learn how to deal with it, would you want to drop all protections? Forever? Even if it meant potentially exposing the most medically vulnerable person in your life to a virus that is still somewhat novel?

Your answer to that question is individual – and ultimately, so will be your choice about whether you can return to some version of normal.

“We’ll need to learn to live with it,” said Weisfuse, who is an adjunct professor in public health at Cornell University. “With Omicron, we’re not exactly sure how to handle it.”

Weisfuse, who is also a former deputy commissioner of health in New York City, poses questions of his own: “Do we just live with Omicron, and the fact that it causes mild disease? Or, do we protect ourselves from getting it?”

It is easy to carry a mask in your pocket and “put one on if you’re in a crowded situation,” Weisfuse pointed out, just as you can ascertain whether you feel comfortable and prepared to head into a packed bar, visit your elderly grandparent, or pack into a car with multiple people.

“Most people have already integrated that into their daily thinking, whether they realize it or not,” Weisfuse said. “They have a gut feeling where they stack up personally in terms of risk, and what risks they’re willing to take in different settings.”

The real question, then, isn’t whether we’ll return to normal after Omicron. Rather, it is this: What will you allow your normal to be?

The answer can come only from you.