Omicron is fading. What does the future of COVID look like?

Just about everyone will catch the omicron variant.

That’s the grim declaration Dr. Anthony Fauci, the White House’s top medical adviser, made earlier this month. He’s not alone.

”The likeliest (scenario) is that everybody’s going to get it,” said Tampa Fire Rescue Chief Barbara Tripp, the city’s emergency manager, at a Jan. 4 news conference.

That has sparked speculation about whether the contagious omicron variant could hasten the end of the 2-year pandemic. The theory is that its record infection rates could confer immunity to those unable or unwilling to get the vaccine.

The pandemic could then become an endemic — akin to the flu, a more manageable virus that will keep circulating.

Many experts, however, warn that the end of the pandemic won’t be that simple. They say COVID-19 and its future variants will continue to pose a deadly threat to the medically vulnerable and unvaccinated.

They say that allowing it to spread unchecked is a mistake, and that vaccines and booster shots — not mass infection — remain the best way to protect people and end the pandemic.

At the heart of this debate lies important questions: What does the end of omicron look like? What happens next?

‘Positive trends peeking out’

There is a scientific basis for hoping the omicron wave could hasten the end of the pandemic. An infectious disease survives by spreading among a susceptible population, said University of Florida epidemiologist Thomas Hladish.

The sooner the virus exhausts the population of susceptible individuals, the sooner the pandemic burns out. That’s why some health experts see potential benefits to omicron’s record infections.

“Positive trends peeking out behind the fog of gloom,” is how Robert Wachter, the chief of medicine at the University of California at San Francisco, described it in a Dec, 29 series of tweets. He noted he was seeking a silver lining as omicron infections took off.

Unvaccinated people who endure the virus gain COVID-19 antibodies, he said, while vaccinated people who get infected should acquire an even stronger immune response. Add the millions who have been infected to those already vaccinated, Wachter said, and the nation could emerge from this wave with more people than ever having some protection.

“By early February, we could be in a place where (COVID-19) is, in fact, ‘like the flu’ — with the vast majority of the U.S. protected through vaccines or recent infections,” Wachter wrote on Dec. 29.

’A really dangerous thing’

It’s true that for many, contracting COVID-19 now is not as dangerous as it was two years ago. The omicron variant appears to cause severe symptoms in fewer people than did previous variants while a larger percentage of the population has been vaccinated.

But experts say that doesn’t make it safe, or desirable, to contract the virus.

Nearly 1.6 million Floridians have tested positive for COVID-19 in the seven weeks since the omicron variant first was detected in the state, according to the Centers for Disease Control and Prevention. That’s a third of the state’s 5.3 million total infections, generated in record time by omicron.

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More than 56,000 Floridians have been hospitalized with COVID-19 during this period and 1,300 have died. Deaths will continue to rise even as cases recede.

Those who would risk infection rather than get vaccinated, Hladish said, are gambling that they won’t suffer serious side effects.

“You weren’t guaranteed to get infected anyways,” he said, “and getting infected is a really dangerous thing compared with vaccination.”

The long-term effects of COVID-19 remain a big unknown.

Studies already have shown infection increases the risk of heart attack or stroke symptoms. It also entails the risk of long-haul COVID, a condition with symptoms that include fatigue, shortness of breath and joint pain that persists for months, according to the Mayo Clinic. An early 2021 study suggests that as many as a third of infected people develop long-haul symptoms.

Increasing the number of infected individuals means more risk for others. A substantial portion of the population still has little or no protection against the virus. In the U.S., 24 percent of the population, or 80.7 million, remain unvaccinated. The figure in Florida is 31 percent of the state’s residents, or 6.8 million.

Children ages 4 and under are at risk because there still is no vaccine for them. Those with compromised immune systems and underlying health conditions are at high risk too.

The omicron wave, like past infection surges, has stressed hospitals and schools. Illness and fatigue have depleted their staffing.

“We have healthcare and education systems that are stretched very, very thin,” said Hladish.

Endemic end-game

Mask and vaccine mandates would slow the spread of omicron, but Gov. Ron DeSantis opposes them. Last year Florida lawmakers banned these mitigation strategies and local emergency restrictions that were used to slow COVID-19 when the pandemic started in 2020.

Stopping the spread of omicron doesn’t require a return to limiting capacity at businesses or banning indoor drinking and dining at bars and restaurants, said Kami Kim, the director of infectious disease research at the University of South Florida.

“We have treatments, and we have vaccines,” Kim said. “So, how we approach things is a little bit different versus two years ago when we had nothing, and it was basically: Avoid the virus as much as you can.”

Scientists have long agreed that the coronavirus is here to stay, but that it will likely become endemic in the near future. That means it will still circulate in pockets of the world’s population, but may no longer cause massive and widespread infection spikes.

But it’s not yet clear what the post-pandemic world will look like, or how many infections will still occur.

Cases in South Africa receded almost as quickly as they appeared in late November, falling by nearly 90 percent in six weeks, according to data collected by the New York Times. But infections still are hovering at about 100 times pre-omicron levels.

Before the current surge, Florida was reporting an average of 11,000 infections per week in early December — the lowest rate since June 2021. The most recent state data shows the Sunshine State averaging 41,300 infections a day. The pattern of infections in South Africa suggests the state’s caseload won’t drop to December’s level anytime soon.

Eventually, Hladish said, infections no longer will imperil the stability of the nation’s healthcare system.

The best-case scenario is that COVID-19 becomes a manageable condition that the world learns to control and live with. That won’t be easy for a virus that killed at least 459,617 Americans last year. But the world has learned how to blunt the impact of other viruses.

“Something like 30,000 people in the U.S. die from the flu every year,” Halish said. “But it’s mostly out of the public consciousness.”

Fauci told ABC News last week that he expects omicron to peak in most states in February, and then decline sharply. COVID-19 won’t be eliminated, he said, but it could be managed and reduced to the point where it no longer disrupts society.

But what if the coronavirus throws another curveball at humanity?

A new normal?

Viruses mutate. Omicron has already done so.

A subvariant of omicron known as BA.2 has become the dominant strain in Denmark, NBC News reports. It’s being called “stealth omicron” because it’s harder to distinguish in laboratory tests from the original omicron strain, known as BA.1.

It has also been detected in India, Norway, the Philippines, South Africa and the U.K. Several U.S. states have found low percentages of the new strain. For now it accounts for a small share of infections in the U.S. and abroad.

Danish scientists believe BA.2 may be even more contagious, reports NBC News. Early evidence from the U.K. shows vaccines are about as effective against it as against the original omicron variant. It’s too soon to tell whether the subvariant will affect hospitalizations and deaths in the U.S.

The world has likely not seen the last of the coronavirus or its variants.

The enzymes that replicate viruses are not perfect so when it makes reproductions, mutations occur, said Susan Weiss, a professor of microbiology at the University of Pennsylvania who has spent her career studying coronaviruses.

When a mutation gives the new version of the virus an advantage over earlier variants, natural selection makes it more likely it will become the dominant variant.

It’s not advantageous to a virus’ survival to make more people severely ill. People in hospitals are unlikely to spread it to others. Another coronavirus that caused an outbreak of severe acute respiratory syndrome in 2004 was contained because infected patients had symptoms that made it easier to isolate them and prevent further spread. The virus disappeared after just eight months, Weiss said.

Omicron’s reduced severity may be one reason it has been so prolific. In the U.S., a pandemic record of 5.7 million cases was recorded in a single week around Jan. 15.

But there’s no scientific consensus that future variants will be less virulent like omicron. Different lineages of coronaviruses still are being spread among animals, particularly bats, and humans, creating opportunities for other variants to emerge, said Florida International University professor Aileen Marty, an infectious disease specialist.

She’s concerned that the antibodies the body produces after COVID-19 infections typically don’t last beyond a year. Without a vaccination program that reaches close to 95 percent of the U.S. population, the number of people susceptible to re-infection will grow.

Getting quality vaccines to as much of the world as possible remains the best hope for returning to a world akin to “normal,” she said. That new normal could mean handshaking is less common and donning a mask in public is more accepted.

Marty is optimistic about efforts to produce a so-called universal vaccine that can provide immunity against all coronaviruses. In September, the National Institute of Allergy and Infectious Diseases awarded $36.3 million to three academic institutions in the U.S. to develop vaccines that can protect against “multiple types of coronaviruses and viral variants.”

Medical science developed vaccines, treatment protocols and treatments like antiviral drugs and monoclonal antibody infusions that prevented an even greater death toll than the 5.6 million worldwide who already have lost their lives to COVID-19.

But omicron negated some of those advances. It was different enough to evade the immune response of both vaccinated and previously infected individuals. And the Food and Drug Administration this week barred deliveries of two out of three available antibody treatments it determined were ineffective against the variant.

“These things can recombine in ways that become more aggressive, more virulent,” Marty said.

Editor’s note: A section addressing the omicron subvariant known as BA.2 was added on Jan. 28.

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How to get tested

Tampa Bay: The Times can help you find the free, public COVID-19 testing sites in Citrus, Hernando, Hillsborough, Manatee, Pasco, Pinellas, Polk and Sarasota counties.

Florida: The Department of Health has a website that lists testing sites in the state. Some information may be out of date.

The U.S.: The Department of Health and Human Services has a website that can help you find a testing site.

• • •

How to get vaccinated

The COVID-19 vaccine for ages 5 and up and booster shots for eligible recipients are being administered at doctors’ offices, clinics, pharmacies, grocery stores and public vaccination sites. Many allow appointments to be booked online. Here’s how to find a site near you:

Find a site: Visit vaccines.gov to find vaccination sites in your ZIP code.

More help: Call the National COVID-19 Vaccination Assistance Hotline.

Phone: 800-232-0233. Help is available in English, Spanish and other languages.

TTY: 888-720-7489

Disability Information and Access Line: Call 888-677-1199 or email DIAL@n4a.org.

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More coronavirus coverage

OMICRON VARIANT: Omicron changed what we know about COVID. Here’s the latest on how the infectious COVID-19 variant affects masks, vaccines, boosters and quarantining.

KIDS AND VACCINES: Got questions about vaccinating your kid? Here are some answers.

BOOSTER SHOTS: Confused about which COVID booster to get? This guide will help.

BOOSTER QUESTIONS: Are there side effects? Why do I need it? Here’s the answers to your questions.

PROTECTING SENIORS: Here’s how seniors can stay safe from the virus.

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