Ask the Expert: Could Omicron Signal the End of the Pandemic, and Start of an Endemic?

By Amichai Perlman, PhD, PharmD
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January 18, 2022

The beginning of 2022 marks two years to the early media reports of a new SARS-coronavirus outbreak.

In these past two years, we’ve witnessed a global and concerted effort to develop successful vaccines and treatments for the new disease with unprecedented speed.

We’ve also experienced much frustration and confusion due to failed and erroneous predictions, assumptions, and policies.

By this point, it has become apparent that everybody, across the political and scientific spectrum, was wrong about one aspect or another of the COVID-19 pandemic.

Predictions related to the future of the COVID-19 pandemic and interpretations of the early data related to the Omicron wave should therefore be viewed cautiously.

How Is Omicron Different?

Early data on the Omicron variant clearly shows it is much more contagious.

It spreads rapidly through the population and leads to unprecedented numbers of COVID-19 cases.

Antibodies generated by previous vaccination, or previous infections, are also significantly less effective at neutralizing Omicron, leading to lower efficacy of vaccines in preventing infection.

Though the chance of infection with coronavirus has grown dramatically with the Omicron variant, infections are now often (but not always) milder.

Many studies now show that the vaccines continue to confer high levels of protection from severe disease among those infected with the Omicron variant, so the lower rates of hospitalization with Omicron can be attributed to a combination of the variant’s intrinsic qualities and the proportion of the population who are vaccinated (particularly those at risk).

Why Might Omicron Mark A Change In the Course of the Pandemic?

These three differences have given rise to the discussion of COVID-19 transitioning from a pandemic to an endemic disease.

Many expect a large proportion of the population to catch the Omicron variant due to its high level of contagiousness.

The significant reduction in vaccines’ ability to prevent infection with Omicron has dashed the hopes that, like with measles, vaccines may lead to the near eradication of COVID.

The reduction in disease severity with Omicron, and the continued effectiveness of vaccination in greatly reducing the risk of severe disease, have led to the rise in discussions about a future where COVID-19 remains an endemic disease.

What Does Endemic Mean?

Diseases are said to be “endemic” when they exist at a relatively constant level with no expectation of them being eradicated in the foreseeable future.

The ability to eradicate a disease depends both on the tools available and on the effort society is willing to expend to achieve this goal.

Omicron’s high level of contagiousness and apparent lower level of severity, the vaccine’s high level of efficacy against severe disease but low efficacy against infection, and likely general fatigue, are currently coalescing into discourse and expectation it might be feasible to manage COVID-19 as an endemic disease sometime following this wave. 

What Developments and Changes Might Impact the Future of COVID-19?

It is important to recognize the COVID-19 pandemic is by no means over.

Cases and hospitalization due to COVID-19 in the US and elsewhere are sky high and will result in significant levels of illness and death. Omicron is not the common cold, and measures we take to protect ourselves and those around us, and reduce or even slow the spread of COVID-19, will reduce the burden of disease.

These measures would also be expected to be key to creating a reality where COVID-19 might be regarded as “endemic”. 

Keeping up to date on vaccinations and boosters, isolating when ill, minimizing crowded indoor events, and wearing masks during outbreaks – could all facilitate a reality where COVID-19 would cause fewer and smaller waves of disease and could be regarded as “endemic”.

Indeed, in a recent press conference, a representative of the European Medicines Agency discussed the need to move towards giving COVID-vaccine boosters together with flu vaccines on an annual basis. 

Some additional promising developments are expected to help contribute to reducing the health risks of COVID-19.

These include a growing number of effective treatments for COVID-19, such as the new oral antiviral medications which will become progressively available in coming months.

Advances in the development of vaccines that are more effective against new variants are also on the horizon, and perhaps sometime in the future these will provide the possibility of eradicating the virus. 

A lot has been learned about the coronavirus over the past two years, and there have been amazing advances in our ability to treat and reduce the risk of COVID-19.

However, we continue to encounter surprises, such as new variants (and sometimes scare-variants). Predicting the future of the world remains a rather elusive goal, so take care before relying too heavily on such predictions.  

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Amichai Perlman, PhD, PharmD

Dr. Perlman is a clinical pharmacist and pharmacoepidemiologist, with over 10 years of experience advising patients and clinicians on medication use, personalization, and safety. He has extensively published peer-reviewed research addressing medication safety.

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