The course of the pandemic has changed so often over the past almost-two years that many of us are experiencing a kind of whiplash. The most recent upheaval came with the Omicron variant, which quickly drove case counts up yet again. Although the symptoms caused by this variant seem to be less severe than in past iterations such as Delta, particularly among vaccinated people, hospitals and other health care facilities are still being overwhelmed again, to the point of postponing elective surgeries and calling in the National Guard. As World Health Organization Director-General Tedros Adhanom Ghebreyesus, PhD, put it in a recent press conference: “Make no mistake, Omicron is causing hospitalizations and deaths, and even the less severe cases are inundating health facilities. The virus is circulating far too intensely with many still vulnerable.”
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While we’re still in the midst of this wave, its seemingly sudden arrival and distinctly contagious nature has naturally brought up questions about what might be coming next. When will we know more about the true impact of Omicron? Is there the risk of another variant rising up and taking its place? And could that new variant cause more severe symptoms than Omicron?
In some states, Omicron seems to have already peaked. COVID-19 case counts have dropped by more than 30% in Maryland, New Jersey, and New York have since early last week, according to The New York Times COVID Tracker. “The peak [in the U.S.] was predicted to be the third week of January,” says Jessica Malaty Rivera, MS, an infectious disease epidemiologist and science communicator. There are variables: Case counts may spike again in states where they’re currently declining, and while predictive models indicate cases will drop in other states too, it’s hard to say exactly when. “The expectation is that probably by February, the peak will die down,” Malaty Rivera says. That said, there tends to be a lag between positive cases and hospitalizations, and hospitalizations and deaths, she notes. All in all, while the surge won’t last forever, “it’s going to be a rough two months,” says Malaty Rivera.
What’s more, once the Omicron spike does pass, another variant is likely to follow, says Paul Pottinger, MD, a professor specializing in infectious diseases at the University of Washington School of Medicine. “I think this surge will pass, and we’ll then have another and another,” he says. “The hope is that they’ll get less and less bad each time, but the reality is we may have ups and downs. People should prepare for the fact that this isn’t the end of the show, although I wish it were.”
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It’s impossible to know for sure whether subsequent variants will cause less or more severe symptoms, but what we know about natural selection offers some hope.
Every time a virus — or any living organism, for that matter — divides, there will be genetic alterations, sometimes called mutations, which may benefit or harm the organism, Dr. Pottinger says. The mutations that benefit the SARS-CoV-2 virus are the ones that make it more contagious but less severe, like Omicron. “From the virus’ perspective, being able to spread more is good,” Dr. Pottinger says. “But hurting the host is bad — if the patient dies, the virus won’t spread as much. That’s why we figure natural selection favors attenuation,” the process of something becoming less severe and less dangerous over subsequent generations. “At the moment, that attenuation process is headed in the right direction, but I don't think we’re there yet,” he adds.
To be clear: There’s no guarantee that the COVID-19 virus will continue to attenuate. “It’s not necessarily accurate to assume that as the virus evolves, it will automatically become weaker and weaker,” stresses Malaty Rivera. “That’s not how that evolution always goes… It’s not linear.” The next major variant of the virus could be more contagious and cause more severe illness than Omicron. In a worst-case scenario, the current vaccines wouldn’t work effectively to prevent hospitalization and death the way they do now, says Glen Nowak, PhD, co-director of the University of Georgia's College of Journalism's Center for Health and Risk Communication, who spent six years as the communications director for the Centers for Disease Control and Prevention’s National Immunization Program.
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Until we have more information, it’s essential to keep wearing masks (especially KN95s and N95), avoiding large gatherings, getting vaccinated and, when you’re eligible, boosted, and staying home when you’re feeling sick or if you’ve been exposed. “Now is not the time to slack off [on pandemic safety measures], it’s the opposite,” Dr. Pottinger says. “It’s time to step up and do what’s right, even if it feels like a drag.”
Regarding the best prevention and safety practices, some experts are advising more caution than others: Dr. Pottinger suggests reinstating your COVID pod, and avoiding seeing people outside of it, for instance. But others are saying that fully vaccinated people with no comorbidities that make them vulnerable to severe COVID symptoms who feel safe doing so can continue to take part in low-risk activities like dining outside or in well-ventilated restaurants that require proof of vaccination.
Whatever your own personal risk tolerance, experts agree that with the Omicron variant raging, we must be more prudent regarding what we do and who we see than we were this past summer and even this fall.
It’s especially critical to be considerate of the people in your community who are at higher risk of developing severe symptoms as a result of COVID. If you’re going to visit your elderly parents, for instance, quarantine and get tested beforehand, and consider wearing a mask when you do see them, suggests Preeti N. Malani, MD, chief health officer at the University of Michigan and an infectious disease physician. Getting out of this pandemic is a group effort — we have to protect ourselves, but we also have to take steps to protect the people around us.
You probably heard the pandemic compared to a global group project at some point, and the analogy stands. We’re in this together. And now isn’t the time to let the doctors and health care workers bear all the burden. We’ve all got to show up, educate ourselves, and do the work to help us get out of this pandemic.