Covid-19 pandemic as we have known it is going to be behind us soon

Analysis: Protection through vaccination and dominance of less severe Omicron variant have changed the game

Chief medical officer  Dr Tony Holohan and other members of the National Public Health Emergency Team (Nphet).  Once Nphet had vaccines as insurance last year, members relaxed considerably in their approach to Covid-19. Photograph: Colin Keegan/Collins

Chief medical officer Dr Tony Holohan and other members of the National Public Health Emergency Team (Nphet). Once Nphet had vaccines as insurance last year, members relaxed considerably in their approach to Covid-19. Photograph: Colin Keegan/Collins

 

The pandemic is over, long live Covid-19!

Confused?

Well, that is understandable, because we are moving into a new phase of dealing with the virus, where new rules apply.

The pandemic as we have known it for two years is going to be behind us very soon. Covid-19 will still be a threat but not to the all-encompassing extent we have grown used to.

Let’s start with the decision by the National Public Health Emergency Team (Nphet) to approve the lifting of almost all Covid-19 restrictions, which is based on three key factors.

The first is the existence of effective vaccines against the disease that have been taken by the vast majority of the population. Though these do not prevent transmission, they work very well to stop people getting seriously ill.

Ministers are reportedly surprised at the willingness of public health officials to lift restrictions so quickly, but they shouldn’t be.

Once Nphet had vaccines in their back-pocket as insurance last year, its members relaxed considerably in their approach. Yes, fresh restrictions were imposed in the second half of last year, but these were dictated primarily by the threat to a creaking health service.

That has now passed. The second factor is the evidence, apparent for some weeks, that the current Omicron wave is not overwhelming hospitals. The peak of cases is behind us and all the indicators are currently pointing in the right direction.

Omicron favour

Thirdly, Omicron has done us all a favour by decimating the previous, more virulent Delta variant. It has also clarified the approach needed from public health officials around the globe; there’s little point in trying to duck and dive with Omicron, as it is so transmissible that almost everyone is going to get it.

Every day, about 125 million people are getting infected with Omicron, the US-based Institute for Health Metrics and Evaluation (IHME) has estimated. This is 10 times higher than the Delta peak last year. By the end of March, more than half the world’s population is expected to have been infected, in just four months.

But how can a disease so widespread be a good thing?

As many as 90 per cent of these infections will be asymptomatic; people will hardly notice them but they are benefitting from increased immunity.

Throughout the pandemic, IHME models have been pessimistic yet accurate, and the institute has repeatedly called for higher levels of mask-wearing to protect against the virus.

Yet this is what its director Prof Christopher Murray wrote in The Lancet this week: “The transmission intensity of Omicron is so high that policy actions-eg, increasing mask use, expanding vaccination coverage in people who have not been vaccinated, or delivering third doses of Covid-19 vaccines-taken in the next weeks will have limited impact on the course of the Omicron wave.”

Mask use

Increasing use of masks to 80 per cent of the population, for example, will only reduce cumulative infections over the next four months by 10 per cent, his modelling suggests.

“The speed of the Omicron wave is so fast that policy actions will have little effect on its course globally in the next four to six weeks,” Murray adds.

This is the new ball-game, in which the return on enforcing restrictive measures in the context of a milder illness is so diminished as to be of little value.

A combination of vaccine-induced (preferable for most people, because less risky) and infection-induced immunity is protecting against Covid-19 in Ireland, and will soon do the same in many other countries whose Omicron waves have yet to peak.

The World Health Organisation was not wrong to say this week that the pandemic is “nowhere near over”. Other countries will see the number of patients in hospital rise, just as Ireland did after Christmas, but this should not last very long.

So what will happen now? It won’t be all plain sailing. Our case numbers may rise as people get back to mixing more freely with others and colleges re-open.

New variants will pop up, and we’ll have to deal with them. Even Delta hasn’t gone away completely. BA.2, a sub-lineage of Omicron, may already be contributing to rising cases in Denmark, and will have to be watched closely.

Waning immunity

Waning vaccine immunity is a problem, one that could be solved in time for next winter by better vaccines. Winter 2022/23, when cases rise again and hospitals come under pressure, will be a challenge anyway.

Covid-19 will be around for some time to bother us. We’ll be able to treat the vulnerable with antivirals and prevent them getting infected with masks and physical distancing. Improving ventilation and air quality in schools and other busy locations seems like a no-brainer. More genomic sequencing will be needed to spot AY.2 and emerging threats more quickly.

Without realising it, many people have become “institutionalised” during the pandemic; some will struggle with the freedoms offered as it ends. All of us will have to find the right balance that allows us to live again while feeling safe.

That balance will vary hugely according to our perception of risk; 20 years after the SARS outbreak, many people in Asia continued to wear masks in public places.

For now, though, this phase is over. As Murray concludes, “after the Omicron wave, Covid-19 will return but the pandemic will not”.

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