“So many people will be infected with omicron that it could spell the end of the pandemic“. The phrase is by Javier Zulueta, a pulmonologist at Mount Sinai in New York; But we could choose many other experts who, in recent days, have been defending on televisions, radios and newspapers that the very high incidences of the omicron variant could hide that “good news” in the medium-long term: the end of the COVID crisis -19.
But it is not the first time we hear about the possible end of the pandemic. In fact, in the last two years, optimism has already played tricks on us. That is why we have asked ourselves if we are really in a scenario of this type. Considering that “it is difficult to make predictions, especially of the future” … What arguments are used by those who argue that omicron is the “unexpected vaccine” that we needed And what are those who argue that it is still too early to be trusted?
A lucky break
And it is that, despite the fact that for months we’ve heard that evolutionary forces would reduce the virulence of SARS-CoV-2, if we go to available scientific evidence we see that that trend does not exist: it is false. “There is no general normal towards attenuation, virulence or stable maintenance.” In fact, we have historical examples such as rabies that, despite having an almost absolute lethality, was not affected by this supposed attenuation and we only got rid of it thanks to vaccines.
The case of smallpox is also interesting. For centuries, various forms of the virus with different virulence coexisted (up to ten times less, for example) and the selection did not favor the least aggressive. And I say that it is interesting because smallpox is also a historical precedent for the logic behind the Omicron hypothesis as a catalyst for the end of the pandemic. With smallpox, finding a less virulent version of the virus, but capable of generating immunity, was the key factor in its disappearance.
So, the inoculation of the virus was intentional (and was the “official” birth of modern vaccination) and in the case of Ómicron it would not be: but, as I say, the logic is similar. If the new variant (which produces mild symptoms in most of the population) infects enough people, natural immunity could create the much sought after “group immunity”. It would only be necessary to protect the elderly or those with immunodeficiencies (something that, with current vaccines, is viable) and wait for the inevitable.
Without forgetting all the people who will suffer problems from this variant, the appearance of Ómicron, taking into account that the “tendency to attenuation” does not exist, can be seen collectively as a “stroke of luck”. Of all the possible scenarios, we are in one that is relatively favorable to our interests. However, it is not all good news. Or, at least, there are many unknowns still on the table to consider the issue resolved.
Are there reasons for skepticism?
There are many technical reasons to be cautious, but we can start with two of them. The first set of unknowns refers to what we still do not know about the variant. And it is that although the figures are increasingly reassuring (and, therefore, the hypothesis of the “end of the pandemic” has gained strength) as recognized by the European CDC, “even if the severity of the disease caused by omicron is equal to or less than the severity of the delta variable [que, como digo, parece serlo en los países en los que tenemos estadísticas fiables], increased transmissibility and the resulting exponential growth ” could quickly outweigh any benefit potentially reduced severity. “For now, saturation seems not to be reaching hospitals and ICUs as on other occasions (and is concentrating on Primary Care), but it is a problem to be aware of and monitor very closely.
Second, Ómicron is also a lesson on how “fast and easy” a new variant can change the global pandemic scenario. On paper, nothing prevents the emergence of another variant with greater vaccine escape and greater virulence that puts us “back in the starting square”. The inequalities that still exist in the international response to the virus leave us in a situation of great exposure.
Of course, it is true that if Ómicron manages to impose itself on a planetary scale, it can achieve what international vaccine delivery systems have failed to: high rates of immunity to SARS-CoV-2 (limiting circulation and variability of the virus). This may sound good in countries like ours – with high vaccination rates and a consolidated health system – but in many other parts of the world it can cause big problems.
From ‘pandemic’ to ‘endemic’
Ultimately, the meaning of the “end of the pandemic” has a lot to do with what we understand by ‘pandemic’. In recent days, many experts are talking about the fact that Ómicron may play an important role in the transition from pandemic disease to endemic disease. It was inevitable: the difference between these two types of diseases is related to our ability to anticipate and control their evolution. At a theoretical level, when a disease becomes endemic it “loses” its ability to surprise us and we can estimate the evolution of waves and cases throughout the year.
But also, a disease becomes endemic when we consider that it is no longer an active public health threat. That is, when we collectively assume that we have done everything possible to combat the pandemic and that we have to live with what remains: there is a scientific part, of course; but, above all, there is a social part. Therefore, the generalized return to restrictions is perhaps the best indicator that the pandemic is not over; but the controversies related to the reintroduction suggest that the end is not far away.
What is certain is that the way in which this wave is resolved (along with our ability to bring vaccines to all regions of the planet) will be a key factor in seeing what happens with the following waves: to see if COVID it becomes endemic. And it is that the “immune wall” that is raising the enormous number of infected with Ómicron makes the circulation of the virus more limited and, therefore, the emergence of new variants less likely. But, as I say, it remains to be seen how the wave develops globally and how the efficacy of vaccines evolves in the coming months. Meanwhile, the “end of the pandemic” is a possibility that is on the table, but (at the same time) it is far from being the only possible scenario.
Imagen | Vladimir Fedotov