March 15, 2023 – Three years after COVID-19 rocked the world, the pandemic has turn into a gentle Condition of frequent infections, fewer hospitalizations and deaths, and protracted fear and isolation amongst older people and people with weakened immune systems.
After about 2½ years of requiring masks in healthcare facilities, the CDC lifted its suggestion for a general mask requirement in hospitals in September 2022.
Some statistics show how far we have now come. Weekly COVID-19 cases dropped to just about 171,000 on March 8, an enormous drop from the 5.6 million weekly cases reported in January 2022. COVID-19 deaths, which peaked at greater than 23,000 per week in January 2021, were 1,862 per week on March 8.
Where we are actually
Because omicron is so contagious, “we believe that most people in the world are infected with omicron,” says Dr. Christopher JL Murray, professor and chair of health metrics science on the University of Washington and director of the Institute for Health Metrics and Evaluation in Seattle. Seroprevalence studies — the proportion of individuals in a population who’ve antibodies to an infectious disease, or on this case, the omicron variant — support that reasoning, he says.
“The vaccination rate was higher in developed countries, but we see in the data that Omicron infected most people in low-income countries,” says Murray. Currently, he says, the pandemic has reached a “steady state.”
At New York University Langone Health System, overall clinical testing is trending downward and hospitalizations are low, says Dr. Michael S. Phillips, an infectious disease physician and chief epidemiologist for the health system.
In New York City, there was a transition from a pandemic to a “respiratory virus season/wave,” he says.
In addition, there may be a move away from universal source control – where every patient encounter within the system entails wearing masks, social distancing, etc. – to a concentrate on essentially the most vulnerable patients “to make sure they are well protected,” Phillips said.
At Johns Hopkins Hospital in Baltimore, the number of individuals entering the intensive care unit for COVID has “decreased significantly,” says Brian Thomas Garibaldi, MD, an intensive care physician and director of the Johns Hopkins Biocontainment Unit.
“This is proof of the amazing power of vaccines,” he says.
The respiratory failures that characterised many critical COVID cases in 2020 and 2021 are much less common today, a change Garibaldi calls “refreshing.”
“In the last four or five weeks, I've only seen a handful of COVID patients. In March and April 2020, our entire ICU – actually six ICUs – were full of COVID patients.”
Garibaldi now also assesses his own risk otherwise.
“Personally, I'm not worried right now about getting COVID, getting seriously ill and dying from it. But when I have a shift in the ICU next week, I'm worried about getting sick, potentially having to miss work and passing that burden on to my colleagues. Everyone is really tired right now,” says Garibaldi, who can be an associate professor of medication and physiology within the division of pulmonary and demanding care medicine on the Johns Hopkins University School of Medicine.
What gives experts sleepless nights?
The possibility that a more powerful variant of SARS-CoV-2 will emerge is a priority for some experts.
A brand new sub-variant of Omicron could emerge, or a very latest variant.
One of the most important concerns isn’t only a variant with a special name, but one which can evade current immune protection. If that happens, the brand new variant could infect people who find themselves resistant to Omicron.
If we return to a more severe variant than Omicron, Murray says, “then we’re suddenly in a completely different situation.
Keep an eye on COVID-19 and other viral diseases
We have better genomic surveillance of circulating SARS-CoV-2 strains than we had at the start of the pandemic, Phillips says. More reliable, daily data also recently helped with the respiratory syncytial virus (RSV) outbreak and in tracking flu cases.
Monitoring wastewater as an early warning system for COVID-19 or other respiratory virus outbreaks can be helpful, but more research is needed, Garibaldi says. And as more people get tested at home, positive test rates are likely underestimated. So hospitalization rates for COVID and other respiratory illnesses remain one of the more reliable community-based metrics, at least for now.
One limitation is that it is sometimes unclear whether the primary reason a person is hospitalized is COVID-19 or whether they are a person who is admitted for another reason and happens to have a positive test result upon admission.
Phillips suggests that using multiple measures may be the best approach, particularly to reduce the chance of bias from a single strategy. “You need to look at a whole range of tests to get a good sense of how this is affecting all communities,” he says. Moreover, if there is a consensus across different measures – sewage surveillance, hospitalizations and positive test results – “that is clearly a sign that something is going on and that we need to adjust our approach accordingly.”
Where we could go
Murray predicts a steady rate of infection and “no major changes.” However, waning immunity stays a cause for concern.
That means when you haven't had an infection within the last six to 10 months, you must take into consideration getting a booster shot, Murray says. “The most important thing for people, for themselves and for their families, is to really think about maintaining their immunity.”
Phillips hopes that improved surveillance systems will help health authorities make more precise recommendations based on the extent of respiratory disease within the population.
When asked what the long run holds for COVID, Garibaldi says, “I can't tell you how many times I've been wrong in answering that question.”
Instead of constructing a prediction, he prefers to concentrate on hope.
“We've come through the winter storm that we were concerned about, and we've had RSV, flu and COVID all at the same time. Some places have been hit harder than others, especially pediatric RSV cases, but we haven't gotten anywhere near the levels we had last year and before,” he says. “So I hope that continues.”
“We have come a long way in just three years. When I think about where we were in March 2020, when we were caring for the first round of COVID patients in our first unit, the so-called biosafety unit,” says Garibaldi.
Murray discusses whether the term “pandemic” remains to be appropriate at this cut-off date.
“In my opinion, the pandemic is over,” he says, because we are not any longer in an emergency response phase. But COVID will likely be around in some form for a very long time, if not perpetually.
“So it depends on how you define a pandemic. If you mean an emergency response, I think we're out. If you mean the formal definition you know of an infection that's spreading everywhere, then we're going to be in it for a very long time.”