Friday, January 21, 2022 | Category: Eduvation Insider
Good morning, and TGIF! (Where did the week go?)
After a solid month off, we’ve spent 3 issues already catching up on the pandemic – so what’s one more?
I started by observing how little has changed since December (“It’s 2020, too”) and the new variants, treatments and vaccines that have surfaced (“What’s New for 2022”). Yesterday, I summed up “17 Harsh Winter Lessons” about COVID19, thanks to Omicron. No question, we’re “flying blind” on case counts, and the next few weeks will be “the most challenging yet” for frontline healthcare workers.
Today, though, let’s turn toward the future (appropriate for a futurist, eh?). The world’s greatest epidemiologists and virologists aren’t prepared to stick their necks out just yet, so let me collate all the opinions for you.
Fortunately, the consensus I see forming seems a bit more than cautiously optimistic, which seems like the right note for a Friday edition!
The “next Greek tragedy,” Omicron, hit our shores in December and completely changed the trajectory of the pandemic. Instead of heading into a near-normal holiday break, secure in our 2 doses of vaccine, suddenly we were thrust into lockdowns, Zoom Christmases, and last-minute pivots to virtual delivery for January. (More about that next week, once I have a chance to organize it all.) But will Omicron ebb as quickly as it surged?
Are We There Yet?
Although we really can’t count on case counts (see yesterday’s section on “damned lies”), many epidemiologists out there hope we’ll see the peak of the Omicron wave as soon as this month or early in Feb, making the Omicron wave “short and sweet” compared to Delta. Some think Britain is already through the worst, and will be “out of this by Easter.” This week, politicians in Alberta, Ontario and Quebec started daring to hope that the peak has already arrived there – although the peak for hospitalizations is still weeks away in Saskatchewan and British Columbia. Reaching the peak doesn’t mean we can relax: it’s usually only halfway through the wave. Although hospitalizations and deaths may still be climbing, case counts and wastewater readings appear to be plateauing – leading the Harvard Gazette to predict loosely, “better times are weeks to months away.”
Putting Heads Together
On Jan 4, a multi-university team compiled a meta-forecast based on 30 models that seem to approximate a consensus, and predict that the Omicron wave will subside by mid-March in the US. See the latest projections for US hospitalizations below, assuming low immune escape but high transmissibility. They call this the “pessimistic” scenario, but I don’t think it’s all that unlikely. (Or maybe I’m the pessimist?)
“Omicron will likely be quick. It won’t be easy, but it will be quick. Come the early spring, a lot of people will have experienced Covid.” – William Hanage, epidemiologist, Harvard TH Chan School of Public Health
No Longer “Fully Vaxxed”
Whenever it happens, it seems a given that the 5th wave will subside in North America, and hospitals will back away from the brink of catastrophe. With healthcare safe, governments will lift restrictions and allow us to go back to shopping, working and learning in person. (Some Canadian premiers are itching to do so already, while others are adding precautions instead.) But until 3rd doses are as ubiquitous on campus as 2 doses were last Fall, Omicron poses an even bigger threat of driving breakthrough infections and outbreaks on campus again, as it did in December.
“While it might be a forever virus, I don’t think it will be a forever crisis.” – Josh Michaud, global health policy, Kaiser Family Foundation
Immune How Long?
We don’t know yet how long the 3rd dose will hold against Omicron, but it’s looking like a 4th will come due before Fall for most of us. Immunity from prior infection looks to be even more fleeting, so the old dream of “herd immunity” has evaporated, no matter how far Omicron spreads. As our immunity wanes, we might well see a resurgence of the Omicron variant. And a “let ’er rip” attitude is not the solution: “vulnerable people will ultimately pay a catastrophic price if others decide to roll the dice on Omicron.”
“The suspicion is Omicron will exhaust the population… so the majority of people will have one or another form of immunity. That’s the hope.” – Tom Koch, UBC
Still at Risk
For many of us, COVID19 will merely cause cold symptoms, and for almost half of us, no symptoms at all – but nonetheless, we can unwittingly put the vulnerable at risk. Even setting aside the antivaxxers (who we can apparently pursue with “pitchforks and torches” and no compunction), there remain plenty of people in the campus community at greater risk from Omicron – whether they have 3 doses of vaccine or not. That includes chemotherapy patients and the immunocompromised, parents with children too young for vaccines, and those with many comorbidities. Unlike seasonal flu, COVID19 sometimes has severe outcomes for those at risk, and the extent of “long COVID” is still emerging: affecting up to 10% of serious cases, it could become a “mass disabling event.” Masks, ventilation and distancing will remain crucial to protect hospitals until their own numbers subside: Harvard Medical’s Andrea Ciarenello urges us to “hang onto these mitigation measures… for even just a few more weeks.”
“A lot of people are still going to die because of how transmissible omicron has been. It unfortunately is going to get worse before it gets better.” – Jason Salemi, epidemiologist, Uof South Florida
Right now, our chances seem about 50/50 that the pandemic state of emergency will fade away by summer, but it’s much more likely that another wave will move the pandemic finish line yet again by Fall…
A Back-to-School Virus?
COVID19 appears to be demonstrating a seasonal pattern, like most airborne respiratory viruses, surging in colder weather as we gather indoors. (Delta and Omicron seemed to time themselves to disrupt exam season or the start of a new term, too, but that’s probably my imagination.) One Harvard expert assures us we will see cases in North America “fall precipitously as the warm weather arrives,” as it did during the previous 2 springs – although for much of Canada, spring still feels a long way away. The downside of that seasonality, of course, is that we’ll likely see another surge of COVID19 next winter.
Remember last summer? With vaccine rollouts going smoothly and the Alpha variant under control, a “summer of joy” seemed just around the corner in July. Then Delta hit, just in time to mess up our plans for September. Late last November, The Atlantic was crowing that “the Pandemic is Ending with a Whimper.” But days later Omicron hit, just in time to mess up our plans again for January. “Semi-credible virologists said Delta was going to be the last variant,” points out UHN prof Andrew Morris, “and they were totally wrong.” Likewise, NYU infectious disease expert Céline Gounder warns, “I would be very careful about jumping to the conclusion that after this Omicron surge, we’re going to hit ‘endemic,’ or we’ll all have enough immunity that it’s just a common cold. I just don’t think we know that right now.”
“I think we should be optimistic… but the pandemic has been incredibly humbling so that it’s impossible really to predict with certainty what’s going to happen now.” – Jacob Lemieux, assoc prof, Harvard Medical School
The COVID19 pandemic has been demonstrating a multi-wave pattern much like the Spanish Flu did in 1918-20, but modern genetic sequencing is giving us a much clearer picture of what is actually happening, in real-time. New waves have been driven as the virus evolves to become more transmissible or evade our previous immunity. Some have been more virulent (like Delta) and some less (like Omicron): “There’s nothing inevitable about a virus becoming milder.” But new strains are inevitable, and to drive a surge, the next one will need to find a way to evade the immunity we get from 3 doses of vaccine – or wait us out, until our immunity wanes. Already, in regions where Omicron is declining, some places are seeing Delta rising again, while others are reporting a new Omicron subvariant, BA.2. Fortunately, few experts seem to believe that COVID19 can keep endlessly mutating to achieve new orders of transmissibility as Omicron did.
“This virus will kind of max out. I don’t see this as kind of an endless cycle of new variants.” – William Moss, Johns Hopkins Bloomberg School of Public Health
Scientists might just develop a multivalent vaccine that could act as a “super shot,” protecting against all the COVID19 variants, past and future. But even if we successfully immunize our population, new variants can still arise from 2 main sources: less fortunate countries and animal hosts. Experts have been clear for more than a year: if we fail to achieve vaccine equity on the planet, “we’ll run out of letters in the Greek alphabet for new variants.” (Omicron may even make things worse, since it apparently causes less severe illness, which gives it more time to linger in immunocompromised people and mutate into something new.) And once we’ve vaccinated all the humans on the planet, COVID19 still won’t give up: there are plenty of nonhuman reservoirs that can harbour it, from bats and rats to puddy tats. And mink. Hamsters. White-tailed deer. (In fact, some SFU researchers suspect the current Omicron variant itself evolved in an animal host.)
“Never underestimate Mother Nature, she’s got all kinds of tricks up her sleeve.” – Tim Sly, prof emeritus, Occupational and Public Health, Ryerson U
Since this pandemic began, we’ve been hoping COVID19 would evolve from a pandemic disease to a less dangerous, endemic one. Omicron finally gives us hope that’s happening, just maybe…
A Forever Virus
Endemicity, explains Anthony Fauci, means a disease has “a non-disruptive presence without elimination,” like many cold-weather upper respiratory infections. It puts the virus in an “acceptable steady state,” as Harvard’s Stephen Kissler puts it. Endemicity “does not mean good,” points out WHO director Mike Ryan, it “just means it’s here forever.” For most of us, it will “disappear out of our conscious mind” and simply become an occasional “nuisance” like the common cold, says infectious disease specialist Gerald Evans.
The Final Wave?
The astounding reproductive rate of the Omicron variant, and its ability to evade immunity, may just have vastly accelerated the onset of endemicity. “After this wave, nearly everybody will have experienced some exposure to the virus and therefore will have developed some sort of immunity,” predicts Peter Jüni, director of Ontario’s COVID19 Science Advisory Table. That could mean that Omicron is “the last wave of corona,” as one expert in Denmark put it. In the best-case scenario, “the net effect” of Omicron could be that millions achieve “natural immunity at the cost of only a few days of cold-like symptoms.”
“The Omicron surge will probably drive us fully into endemicity, where our death rates from COVID are low, where our hospitalizations are low.” – Monica Gandhi, infectious disease specialist, uCalifornia San Francisco
Though we’d all like to think the pandemic will enter its endemic stage this year, many epidemiologists suspect it’s more likely “in the next year or two.” Monica Gandhi at UCSF says endemicity could begin by late February, at least in Canada. uWashington epidemiologist Ali Mokdad says “sometime around March, April – this will be behind us.” If Omicron burns through the population swiftly, and no new breakthrough variant follows on its heels, the spring might well bring us a long-awaited calm in this pandemic storm. But then again, uAlberta public health prof Louis Francescutti is not alone in being skeptical, and emphasizes that it’s too early to predict the outcome: “Now’s not the time to be singing ‘Qué sera, sera.’”
“We won’t end the virus this year. We may never end the virus… What we can end is the public health emergency.” – Mike Ryan, executive director, WHO Health Emergencies Program
The End is Murky
Just as it didn’t have a clear beginning, the COVID19 pandemic won’t have a definitive end. “It won’t be like flipping a light switch.” And sadly, “you will not get closure.” The WHO makes the official call, of course, to start or end a global pandemic, but the timing of endemicity will vary by region. Ultimately, moving beyond pandemic crisis and widespread anxiety to acceptance is a psychological and political process, not something decided by scientific measures.
“There will not be one state of the pandemic. There will be different states for different people and for different regions.” – Robert Wachter, chair of Medicine, UC San Francisco
Living with Risk
As 3 American epidemiologists point out in the Jan 6 JAMA, we’re eventually going to start regarding COVID19 as one of many circulating respiratory viruses, and living normally with it. In 2017-18, the US saw 52,000 deaths from influenza – but didn’t impose emergency measures. In fact, despite recurrent waves of RSV and various flus, “the US has not considered them a sufficient threat to impose emergency measures in over a century.” (In Canada, roughly 12,000 are hospitalized for flu and 3,500 die annually.) It’s going to take a mindset shift, to regard a seasonal deadly virus as merely another daily risk, like crossing the road or boarding a plane.
“We’re not going to get to a point where it’s 2019 again. We’ve got to get people to think about risk tolerance.” – Amesh Adalja, Johns Hopkins Center for Health Security
After 2021’s dual disappointments of Delta and Omicron, we’re all struggling to regain our sense of hope and optimism. 2 years of “daily, unpredictable, malignant stress” are inevitably impacting our mental health. uToronto psychiatry prof Roger McIntyre recommends people take control of what they can, prescribe themselves hedonic, cognitive, and physical activities, and of course get health sleep, diet and exercise. “The greater you rate your level of self-control, the less you report the level of stress and anxiety in your life.” Resilience is all about building up experience coping with disaster – and we’re all getting lots of practice! CBC
“This is not the beginning of the end of the pandemic… It may, however, be the beginning of its endlessness.” – Ian Brown, Globe & Mail
Keeping with the upbeat perspective on the year ahead…
Our Brilliance Undimmed
Centennial College has published a couple of upbeat, 90-sec vids in recent weeks with the same title: “Our Brilliance Will Not Be Dimmed.” This one’s the first, released for New Year’s Eve as an optimistic look ahead at 2022. It features plenty of solo cameos and quick cuts (a popular approach to social distancing in video production this year) and emphasizes “controlling our destiny” and “shaping the future,” addressing world hunger and social injustice, seizing opportunities and “letting our creativity soar.” The acting, sound quality and editing are very good. We are, declare the students emphatically, “here to be a force for the future.” YouTube
On that note, I leave you to have a great weekend!
I’ll be spending mine trying to find a focused way to summarize what CdnPSE has done in response to the Omicron wave, and where we’re at now. (I’m also working with some interesting data from OUAC, and preparing for 4 virtual presentations next week.) For me, at least, the new year has definitely begun!
Stay safe and be well!
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