On Monday, the US recorded over a million new covid-19 cases, a new record, largely driven by the Omicron variant, and we may have not yet reached the peak, which is expected to be reached around mid-January. That statistic is a bit misleading since it includes corrections for delays in reporting over the holidays. In general, I do not pay attention to the daily numbers but instead focus on the averages taken over seven days. But that too has reached a record level of around 575,000, easily surpassing the previous high of around 250,000 set back on January 11, 2021.
Given this grim news, it may be hard to find a silver lining but there is one in that the death and hospitalization rates have not kept pace with the rise in case rates, even allowing for the usual two-week lag. The seven-day average of the death rate is currently around 1,200, compared to its previous peak of 3,400 a year ago. That may be an indication that Omicron is the first phase of the virus transitioning to an endemic, flu-like virus of the kind that we are accustomed to. Some indications of this are that the earlier symptoms of Covid-19, such as loss of a sense of smell and taste and low blood oxygen levels, are no longer as common with the new variant. It also appears that Omicron affects the upper respiratory tract more and is less like to affect the lungs.
Pandemics do end, not with a bang but a whimper. There will not come a day when we can declare that we are virus free but there will come a time when the danger posed by the virus takes its place alongside other everyday risks that we have learned to live with. The Spanish flu that caused a pandemic a century ago made such a transition and is now part of the flu strains that we deal with. Thus we should start thinking about how to recognize when we are shifting to a new state and one way would be to shift the focus on the data. We may need to start thinking about what statistic is the best measure to describe the situation.
Pandemics do eventually end, even if omicron is complicating the question of when this one will. But it won’t be like flipping a light switch: The world will have to learn to coexist with a virus that’s not going away.
“Certainly COVID will be with us forever,” Ko added. “We’re never going to be able to eradicate or eliminate COVID, so we have to identify our goals.”
At some point, the World Health Organization will determine when enough countries have tamped down their COVID-19 cases sufficiently – or at least, hospitalizations and deaths – to declare the pandemic officially over. Exactly what that threshold will be isn’t clear.
Even when that happens, some parts of the world still will struggle – especially low-income countries that lack enough vaccines or treatments – while others more easily transition to what scientists call an “endemic” state.
They’re fuzzy distinctions, said infectious disease expert Stephen Kissler of the Harvard T.H. Chan School of Public Health. He defines the endemic period as reaching “some sort of acceptable steady state” to deal with COVID-19.
The omicron crisis shows we’re not there yet but “I do think we will reach a point where SARS-CoV-2 is endemic much like flu is endemic,” he said.
For comparison, COVID-19 has killed more than 800,000 Americans in two years while flu typically kills between 12,000 and 52,000 a year.
Exactly how much continuing COVID-19 illness and death the world will put up with is largely a social question, not a scientific one.
“We’re not going to get to a point where it’s 2019 again,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. “We’ve got to get people to think about risk tolerance.”
With the flu, although the CDC collects data on the number of cases, hospitalizations, and deaths, the figure that the media and public pays attention to is the annual number of deaths, which in the last decade ranged in the 12,000-52,000 range. The number of hospitalizations was between 140,000-710,000 while the number of symptomatic cases ranged from 9 million to 40 million. Since seasonal flu is not a reportable disease and not everyone who gets sick goes to a doctor, the number of hospitalizations and symptomatic cases are estimates based on models. It would be good to keep these numbers as benchmarks.
Health experts are already suggesting that we begin to focus on the death and hospitalization rates instead of infection rates.
Some US infectious disease experts and public health officials are questioning whether to continue using the number of coronavirus cases as a metric for determining which mitigation efforts are appropriate, as data suggests Omicron is less severe but much more contagious than previous variants.
Those experts argue that the US has reached a stage in the pandemic where reports of dramatic surges in case counts prompt unnecessary worries and that government officials and the public should instead review death and hospitalization data when considering precautions.
Case counts “are causing a lot of panic and fear, but they don’t reflect what they used to, which was that hospitalizations would track with cases”, said Dr Monica Gandhi, an infectious disease specialist and professor of medicine at University of California, San Francisco.
On ABC’s This Week, Fauci, director of the National Institute of Allergy and Infectious Diseases, was asked if it was time to focus less on just the case count, which has soared close to 500,000 reported new daily infections.
A number of experts have questioned if such reports cause unnecessary worry, and suggest deaths and hospitalisation data should better inform mitigation efforts.
“The answer is, overall, yes,” Fauci said. “This is particularly relevant if you’re having an infection that is much, much more asymptomatic and minimally symptomatic, particularly in people who are vaccinated and boosted.
This is not to say that covid-19 has become like the flu. Far from it. It is still much more lethal. And we should not forget that flu can be lethal too but the point is that that level of risk is something we are comfortable taking. By focusing on the death and hospitalization rates, we may be in a better position to gauge when we have transitioned from a pandemic state to an endemic state.
It will not be easy to get the public and the media to shift its focus from infectious case counts to death and hospitalization counts. Once an indicator becomes fixed in the public mind as an important marker, it is not easy to change the perception. Take the case of the stock market. News reports tend to lead with the Dow Jones Index even though most market watchers think that it is not a good indicator since the number of stocks involved is so small and prefer more broad-based indicators like the S&P. So the transition to a new benchmark for the pandemic will be slow.