Is Omicron the beginning of the end of the pandemic?

Doctors weighed in on how hopeful we should be.

An illustration of the Covid-19 bacteria, sweating with red eyes inside someone's mouth
Maxine McCrann
The Pandemic Season 3

You’ve probably noticed that Omicron is everywhere right now, hammering the globe with yet another wave of COVID-19, filling our hospitals, depleting our healthcare system, and threatening lockdowns for the third year running. Vaccines are doing an excellent job at preventing serious illness and death, but it’s hard to feel much joy about that when Omicron can still make you ill, even if you’re fully vaccinated and boosted. But among some experts (and many non-experts) there’s a glimmer of hope that this variant may help put the pandemic behind us.

Long story short, the hypothesis goes like this: Though it’s still early in the game for the Omicron variant, experts have been watching its every move, and it’s now clear that the variant is decidedly milder and significantly more contagious than previous strains. If enough people, particularly unvaccinated people, come down with infections, we may have enough collective immunity to make person-to-person spread unlikely. If the virus can’t hop from host to host, it will eventually become a rare occurrence, like measles or ebola, only breaking out in small clusters from time to time. This phenomenon is called herd immunity, and it’s a seductive theory given how difficult mass vaccination has proven to be.

Let’s face it, though: We’ve all been living in a nightmare since March 2020, and any signal that it could be ending soon is like spotting an oasis on the desert horizon. Doctors are understandably cautious when it comes to making any predictions, but experts who spoke with Mic say there’s at least some reason to hope that Omicron could contribute to a shift in the pandemic’s trajectory.

Studies suggest that Omicron spares the lungs, a reason to celebrate considering that upper respiratory infections are much less dangerous than infections that embed themselves in the lower respiratory tract, as previous COVID strains have.

This milder form of the disease is excellent news overall, but may have a downside when it comes to future protection, according to George Abraham, chief of medicine at Saint Vincent Hospital and president of the American College of Physicians. Weaker infections tend to lead to weaker, shorter-lived immunity, he says. “People with more severe illness tend to get more robust immunity, which may last longer. People who have milder infections tend to have less robust immunity,” Abraham adds.

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That means there’s a chance that people who catch Omicron and experience it as a mild upper respiratory illness might not gain much protection against more severe forms of the virus (although early studies suggest Omicron antibodies offer some protection against the Delta variant).

And getting a mild (or even a severe) case of COVID won’t protect us forever. Any immunity from an Omicron infection, or from any other variant, is fleeting; our bodies destroy antibodies over time, Abraham says, and viruses continually mutate, hence the need to continue boosting, rather than taking a single vaccine and being done with it. Eventually, the combined effects of a declining immune response and future mutations will allow the virus to elbow its way back into previously-infected cells.

We see this with the common cold, which we can catch over and over, but which we rarely catch back to back, and with the breakthrough cases of COVID-19 that are currently all around us. People who’ve already caught the virus can catch it again after some time passes, as can people who’ve been vaccinated.

No spike in Omicron cases will change the potential for breakthrough cases, apparently. But we can hope that when most people have some level of immunity, either from vaccination or previous infection, relatively mild cases will become the norm and the spread will slow.

Simply sitting back and waiting for the virus to peter out, like the 1918 influenza virus, which transitioned into our seasonal flu, is not a great option. It’s possible that a strain more deadly than Omicron could take hold before we achieve herd immunity, and we could once again see a wave of severe illness and death. The best way to prevent this? Widespread vaccination, Abraham says, not only in our country, but around the globe.

While Omicron is objectively milder for the majority of patients, a doctor’s idea of a mild infection may not be your idea of a mild infection, notes David Cennimo, associate chief of staff education at the VA New Jersey Health Care System and professor of medicine at Rutgers University. He says many people are surprised by just how debilitating a “mild” case of COVID-19 can be, and for how long.

“There’s such a vast range between intubated or dead, and no symptoms whatsoever,” Cennimo says. “We’re saying this is a lot more mild, because if you look at our hospitals now, they’re full to capacity, but some of the only rooms we have open are ICU rooms.”

Rather than remaining totally cloistered as you wait for the pandemic to flick off like a switch, or attending a face licking convention mid Omicron surge, Cennimo suggests a middle ground. It might not make sense to avoid indoor socializing indefinitely, but masking whenever possible is a no-brainer, as are vaccines.

The coronavirus pandemic won’t so much “end,” but the virus will become endemic, circulating at low levels for the foreseeable future, but with less damaging consequences as we build immunity.

He likens our approach to avoiding COVID to trying to lose weight. “It’s almost like why diets fail,” he says. “People have this idea that it’s all or nothing. We have to be totally locked down, or absolutely running wild. Maybe you can’t take all of these precautions continuously, but you can take some of them.”

As many experts have drilled in already, the coronavirus pandemic won’t so much “end,” but the virus will become endemic, circulating at low levels for the foreseeable future, but with less damaging consequences as we build immunity. That will come about because of a confluence of factors, Abraham speculates. A combination of higher global vaccination rates and previous infections could gradually reduce the caseload from an inferno to a smolder.

In the meantime, Abraham urges precautions. Everyone’s body mounts a different immune response to COVID-19, and even among the vaccinated, some patients are coming into the hospital severely ill from the Omicron variant, particularly those with underlying conditions.

And for the unvaccinated? “All bets are off,” Abraham says.