According to some infectious disease specialists, the COVID-19 pandemic could enter into the "endemic" stage after the rapidly spreading Omicron variant drastically increased the number of people infected by COVID-19.
Stephen Kissler, an infectious disease expert from Harvard T.H. Chan School of Public Health, said while we're not at the point of an endemic yet with the Omicron variant, he does believe the COVID-19 will reach the stage of an endemic "much like the flu is endemic."
Many experts see the virus sticking around and not leaving anytime soon, but they don't expect an endless amount of dramatic mutations like from the Delta to the Omicron variant.
"I don't see this as kind of an endless cycle of new variants," said Dr. William Moss of Johns Hopkins Bloomberg School of Public Health.
The end of the pandemic will be determined when the World Health Organization decides enough countries have a handle on COVID-19 cases, hospitalizations and deaths. However, it is unclear when that will be.
Kissler said he believes the endemic period will happen when dealing with COVID-19 becomes "some sort of acceptable state."
Immunologist Ali Ellebedy at Washington University in St. Louis said he believes a day will come in the future when someone gets infected with COVID-19 and only has to stay home for a couple of days "and then you move on. That hopefully will be the endgame."
The newest variant is a warning about what will continue to happen "unless we really get serious about the endgame," said Dr. Albert Ko, an infectious disease specialist at the Yale School of Public Health.
"Certainly COVID will be with us forever," Ko added. "We're never going to be able to eradicate or eliminate COVID, so we have to identify our goals."
When the WHO declares the end of the pandemic some parts of the world still will struggle—especially low-income countries that lack enough vaccines or treatments—while others more easily transition to what scientists call an "endemic" state.
For comparison, COVID-19 has killed more than 800,000 Americans in two years while flu typically kills between 12,000 and 52,000 a year.
Exactly how much continuing COVID-19 illness and death the world will put up with is largely a social question, not a scientific one.
"We're not going to get to a point where it's 2019 again," said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. "We've got to get people to think about risk tolerance."
Dr. Anthony Fauci, the top U.S. infectious disease expert, is looking ahead to controlling the virus in a way "that does not disrupt society, that does not disrupt the economy."
Already the U.S. is sending signals that it's on the road to whatever will become the new normal. The Biden administration says there are enough tools—vaccine boosters, new treatments and masking—to handle even the Omicron threat without the shutdowns of the pandemic's earlier days. And the Centers for Disease Control and Prevention just reduced to five days the time that people with COVID-19 must stay in isolation so they don't sicken others, saying it's become clear they're most contagious early on.
India offers a glimpse of what it's like to get to a stable level of COVID-19. Until recently, daily reported cases had remained below 10,000 for six months but only after a cost in lives "too traumatic to calculate" caused by the earlier delta variant, said Dr. T. Jacob John, former chief of virology at Christian Medical College in southern India.
Omicron now is fueling a rise in cases again, and the country in January will roll out vaccine boosters for frontline workers. But John said other endemic diseases, such as flu and measles, periodically cause outbreaks and the coronavirus will continue to flare up every so often even after Omicron passes through.
Omicron is so hugely mutated that it is slipping past some of the protection of vaccinations or prior infection. But Dr. William Moss of Johns Hopkins Bloomberg School of Public Health expects "this virus will kind of max out" in its ability to make such big evolutionary jumps.
One possible future many experts see: In the post-pandemic period, the virus causes colds for some and more serious illness for others, depending on their overall health, vaccine status and prior infections. Mutations will continue and might eventually require boosters every so often that are updated to better match new variants.
But human immune systems will continue to get better at recognizing and fighting back.
Ellebedy said he finds hope in the body's amazing ability to remember germs it's seen before and create multi-layer defenses.
Memory B cells are one of those layers, cells that live for years in the bone marrow, ready to swing into action and produce more antibodies when needed. But first those memory cells get trained in immune system boot camps called germinal centers, learning to do more than just make copies of their original antibodies.
In a new study, Ellebedy's team found Pfizer vaccinations rev up "T helper cells" that act as the drill sergeant in those training camps, driving production of more diverse and stronger antibodies that may work even if the virus changes again.
Ellebedy said baseline population immunity has improved so much that even as breakthrough infections inevitably continue, there will be a drop in severe illnesses, hospitalizations and deaths—regardless of the next variant.
"We are not the same population that we were in December of 2019," he said. "It's different ground now."
Think of a wildfire tearing through a forest after a drought, he said. That was 2020. Now, even with Omicron, "it's not completely dry land," but wet enough "that made the fire harder to spread."
The ultra-contagious Omicron mutant is pushing cases to all-time highs and causing chaos as an exhausted world struggles, again, to stem the spread. But this time, we're not starting from scratch.
Vaccines offer strong protection from serious illness, even if they don't always prevent a mild infection. Omicron doesn't appear to be as deadly as some earlier variants. And those who survive it will have some refreshed protection against other forms of the virus that still are circulating—and maybe the next mutant to emerge, too.
The Associated Press contributed to this report.
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