From pandemic to endemic: Can 2022 succeed where 2021 failed?

Health experts, however, are preaching caution, saying there's too much uncertainty about how virus will evolve, how much immunity society has built up, potential damage if people stop being careful

After two years of contagion and death, Covid is shifting again. Omicron is spreading faster than any previous variant, but it’s also proving less malevolent. There’s growing talk that the worst pandemic of the past century may soon be known in another way — as endemic.

Spain threw out the idea this week, when Prime Minister Pedro Sanchez said it’s time to think about new ways of living with Covid long term, such as the world does with the flu. Other countries jumped in, saying they may be moving toward a new chapter of the disease.

Health experts, however, are preaching caution, saying there’s too much uncertainty about how the virus will evolve, how much immunity society has built up and potential damage if people stop being careful.

It’s inevitable that governments will eventually need to regard Covid as one of many public health challenges that can be managed — rather than one requiring the urgency and focus devoted since early 2020.

The appetite for economically damaging lockdowns is long gone. Vaccines are protecting swathes of the population, and there’s even hope that omicron, with its frenetic spread and less powerful punch, may be hastening the path to the pandemic’s exit.

“We probably are starting to see a transition phase toward this becoming an endemic disease, which doesn’t mean that we have to stop being very prudent,” Spain’s deputy prime minister, Nadia Calvino, told Bloomberg Television. “But it does signal that we should take measures that are very different to the ones we had to take two years ago.”

It’s not just governments hoping 2022 is the year Covid can finally move to the back burner of public discourse. A weary public is also desperate to escape, and Internet searches for the term “endemic” have jumped in recent weeks.

Endemic would mean the disease is still circulating, but at a lower, more predictable rate — and with fewer people landing in hospitals. 

The term sometimes means a disease is limited to a specific region, but that doesn’t have to be the case with Covid, just as the flu regularly crisscrosses the globe. Seasonal patterns can happen, too, with higher cases in winter, as well as local outbreaks above the expected norm.

At the least, there are reasons to hope that the pandemic’s grip is loosening. The world has more tools than before, from rapid tests to the ability to update and mass produce vaccines, plus rising levels of immunity through inoculation and earlier bouts of Covid. While antibodies may dwindle, or even fail to stop infections from new variants, the other major weapon of the immune system — T cells — appears to be robust enough to prevent serious disease.

Multiple studies, meanwhile, point to omicron as being less severe than previous strains. Beyond that, it appears to already be burning out in some places. The rate of new infections in South Africa is falling after December’s surge, while hospital admissions in the U.K. are leveling off. 

Such evidence is “encouraging in some ways, but we have to stay very vigilant,” said Noubar Afeyan, co-founder of Moderna Inc. 

The vaccine maker is preparing an omicron-specific booster that could be ready to enter trials within weeks, he said. Reaching the endemic phase is possible this year, but there’s “still uncertainty.”

The World Health Organization, for one, is urging caution. Despite the global vaccine push -- now approaching 10 billion doses administered -- there are massive gaps. More than 85% of the population of Africa hasn’t received any dose, while 36 WHO member states haven’t even reached 10% coverage.

It’s even an issue — albeit to a lesser degree — in some developed countries. Germany still has 3 million people over the age of 60 that haven’t been fully vaccinated, in most instances by personal choice. 

Uncontrolled spread of Covid would therefore lead to too many otherwise avoidable deaths, Health Minister Karl Lauterbach said Friday. “There is still no reason to sound the all-clear,” he said. 

In the U.S., it’s also too soon to start talking about the next phase. While countries where omicron spiked earlier are seeing some numbers ease, the U.S. isn’t there yet, according to Chris Beyrer, a professor at Johns Hopkins Bloomberg School of Public Health.

It’s also possible that people infected with omicron aren’t building up much immunity in the face of what’s to come. The harder-hitting delta could surge back, or combine with omicron to create a new hybrid.  

“We still have a virus that’s evolving quite quickly,” said Catherine Smallwood, senior emergency officer at WHO Europe. “It may become endemic in due course, but pinning that down to 2022 is a little bit difficult at this stage.”

Even without an official declaration downgrading the health emergency, governments may soon start behaving as if that were the case. While China’s zero-Covid policy is an outlier, most countries are keen to step back from intrusive measures, with many citing low fatalities relative to previous waves.

Governments are also coming around to the idea that draconian measures just don’t work the way they used to. France closed its borders to the U.K. in mid-December to try to protect it from omicron, to little effect. The country recorded almost 370,000 cases one day this week, and the restrictions are being eased.

As governments pull back, the onus will increasingly fall on individuals, through self-testing, mask-wearing and calls to voluntarily limit social interactions. 

The U.K., which has long had a light touch for restrictions, is among the countries pushing in this direction. This week, England joined others by cutting the Covid self-isolation period to five days.

David Heymann, professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine, this week highlighted the U.K. as a good example of living with the virus, but he noted that there isn’t a single timeframe for everyone because countries are moving at very different speeds.

“We can’t predict where variants will occur, and we can’t predict what their virulence or their transmissibility will be,” he said. “It could certainly be a bumpy road. We just don’t know.”