Is Omicron the Beginning of the End of the Pandemic?

Issue 42 / May 2022

COVID-19 Special

Is Omicron the Beginning of the End
of the Pandemic?

In a few short months, the Omicron variant of SARS-CoV-2 has become the dominant variant around the world. In fact, Omicron is now responsible for all of the COVID-19 cases in the United States, according to the Centers for Disease Control and Prevention (CDC).¹

Although the number of COVID-19 cases has gone back up (>400 million globally as of 9 February, 2022²) due to the extremely high rate at which the Omicron variant spreads, the infections appear to be milder than in previous phases of the pandemic. According to the World Health Organization (WHO) COVID-19 dashboard, the number of deaths per week around the world fell by half from 76,000 on 7 February, 2022 to 34,000 on March 7, 2022.³ In the US, the seven-day average number of hospitalisations due to COVID-19 dropped from 21,091 in January 2022 to 3,152 in March 2022.⁴

Moving to an endemic infection?

As the new SARS-CoV-2 variants arising in recent months have caused fewer severe infections than before, some experts predict that we may be moving away from a pandemic and towards an endemic situation where we would live with the virus circulating in the community, the way we do with influenza and the common cold.⁵ The milder cases of COVID-19 are at least partly due to the uptake of vaccinations in the developed world and, to an increasing extent, in the developing world as well. However, modeling or predicting how the pandemic will play out and whether it will transition to endemicity is difficult.

“We must work together to bring the acute phase of this pandemic to an end. We cannot let it continue to drag on, lurching between panic and neglect.”

Dr Tedros Adhanom Ghebreyesus, Director General of the WHO

Other experts think it is premature to be discussing a transition to endemicity now. Professor Paul Tambyah, infectious diseases senior consultant and President-elect of the International Society of Infectious Diseases (ISID) said, “The Omicron variant is now dominant globally and this suggests that the SARS-CoV-2 virus is behaving like all other pandemic viruses in that it is becoming more transmissible and less virulent. Even the deadly “Spanish flu” pandemic virus which killed more than one in 30 people worldwide in 1918-19 simply became the dominant strain of seasonal influenza from 1920 to 1957.

We are likely to see more and more less virulent but more transmissible variants until the virus becomes just like the other seasonal coronaviruses which mainly affect children but occasionally cause outbreaks in nursing homes which can be severe, as seen locally and in various countries such as Melbourne, Australia, the United Kingdom and US at the peak of the pandemic and the subsequent months. I personally think it is too early to talk about herd immunity until we know more about what is going to happen with the virus in other settings,” Prof Tambyah cautioned.

WHO too warns that this may not be the end of the pandemic after all. For one thing, other variants could arise that are more pathogenic than Omicron.⁶

More Than One Omicron

different variants
named B.1.1.529,
BA.1, BA.1.1, BA.2
and BA.3

In US,

74%

of COVID-19 cases
is due to BA.1.1¹

15%

of COVID-19 cases
is due to B.1.1.529

12%

of COVID-19 cases
is due to BA.2

“It’s dangerous to assume that Omicron will be the last variant and that we are in the end game,” said Tedros Adhanom Ghebreyesus, Director General of the WHO, in a Reuters news article, “Conditions are ideal for more variants to emerge.”

For example, reports have emerged of variants that combine parts of the Delta and Omicron variants.

Another issue is that despite Omicron infections being milder and associated with fewer hospitalisations, the sheer number of cases could place a large burden on healthcare systems.

Cautious optimism rather than complacency

Even as the number of COVID-19 cases and hospitalisations decline around the world, the WHO cautions countries against settling into complacency. A case in point is the initial strong success of Asian and Pacific Rim countries such as Hong Kong, South Korea, Japan and New Zealand in controlling COVID-19 cases. More recently, the number of cases in these countries has soared due to Omicron, causing their hospitals to become overwhelmed.⁷

As the US and Europe are gradually opening up again to travel, going back to offices and loosening masking regulations, experts at the WHO and other organisations recommend tempering our eagerness to return to normal with appropriate care.

“We must work together to bring the acute phase of this pandemic to an end. We cannot let it continue to drag on, lurching between panic and neglect,” said Dr Ghebreyesus.

COVID Data Tracker Weekly Review. March 11, 2022. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html.
Abraham R, Kavya B. COVID cases surpass 400 million as Omicron grips world. Reuters. February 9, 2022. https://www.reuters.com/business/healthcare-pharmaceuticals/covid-cases-surpass-400-mln-omicron-grips-world-2022-02-09/.
World Health Organization (WHO). WHO Coronavirus (COVID-19) Dashboard. https://covid19.who.int/.
Centers for Disease Control and Prevention (CDC). COVID Data Tracker. https://covid.cdc.gov/covid-data-tracker/#new-hospital-admissions
Adam D. Will Omicron end the pandemic? Here’s what experts say. Nature. 2022;602(20-21). doi:10.1038/d41586-022-00210-7.
Farge E, Roy M. Do not assume COVID pandemic reaching ‘end game’, warns WHO. Reuters. January 24, 2022. https://www.reuters.com/business/healthcare-pharmaceuticals/who-chief-says-world-critical-juncture-covid-pandemic-2022-01-24/.
Stevenson A. Hong Kong hospitals can’t keep up with the deaths amid an Omicron surge. The New York Times. February 27, 2022. https://www.nytimes.com/live/2022/02/27/world/covid-19-tests-cases-vaccine#omicron-surge-covid.

Issue 42 / May 2022

COVID-19 Special