Will the pandemic end this year? The timeframe and how Covid will become an endemic disease

By Laura Clements

Will 2022 be the year the pandemic comes to an end? With reduced hospital admissions, new medicines and stronger vaccines there are certainly reasons for real optimism.

It's difficult to believe there might be light at the end of the tunnel when 2022 has begun much like 2021 did, but we are actually in a much better position now than then.

Arguably, this time last year was perhaps the darkest time of the entire pandemic in Wales and the UK. Thousands were being admitted into hospital and thousands were losing their lives every week.

Read more on Covid and omicron: Six things you need to know to cut through all the claims

Now, with the majority of us well protected with highly effective vaccines, we have a much lower individual risk of ending up in hospital – or even death – if we catch Covid. The combination of vaccines and a better knowledge of how to treat Covid means both hospitalisation and death rates are now much lower.

Covid isn't going to go away permanently, we know that. But can we expect to see an end point, and if so, will it be in the coming 12 months?

We asked the same question at the beginning of last winter, in November 2020: How long will it last and when could we finally be back to normal? Back then, we'd not heard of omicron but even then, the most widely held view was the virus would still be around for years to come - as what's known as an endemic infection. And that prediction is largely coming true.

We are certainly not out of the woods yet - cases are at unprecedented levels and rising (though more slowly now) and Covid is still a serious threat to the most vulnerable. But arguably, the data is pointing to 2022 being the year the pandemic ends and coronavirus becomes an endemic disease. This is what the experts think.

'The million dollar question is how long until we get there'

Dr Roland Salmon, a retired epidemiologist who led the response to the E-coli outbreak in south Wales in 2005, admits that he thought the last wave would peter out sooner than it did. With the omicron variant causing cases to surge over the New Year, he's hopeful cases might drop off more quickly than the previous alpha and delta peaks.

He's also more optimistic this time round because the vaccine turned up much earlier than he ever thought it would. The previous record to develop a vaccine and get it out was around four years but the Covid vaccine was turned around in just nine months.

"The pandemic spreads around the world much like a series of sine waves," he explained, albeit slightly out of phase with each other. Restrictions in each country affect how it spreads through that population.

"We now have a series of more transmissible viruses which have succeeded each other," he continued. "We have a virus with less severe consequences for people who are infected."

"It's not an unlikely thing to have taken place," he added, saying previous pandemics have followed similarly with viruses becoming mostly relatively benign.

"We're probably on a trajectory where Covid will go that way," he said. "The million dollar question is how long until we get there and how much happens in between."

This winter should "just about do it," he said, adding: "It just might take a little bit longer in a more global world." He's certain that the general trajectory of travel will be towards a more transmissible, less severe form of virus.

The vaccine protects us against severe illness but not infection. He believes we will come into adulthood with much better protection having been exposed to the virus in childhood, although annual boosters may still be required. And it's possible that the older population will still be vulnerable next winter.

"The uncertainty lies in what's on the horizon - a large proportion of the world are still unvaccinated so there will be the emergence of new variants," he warned. "They will likely be more transmissible and less lethal ones, but that's not a given."

New treatments and vaccines will ultimately make a "major contribution" to manage the problem of the virus in the future, he added. The virus is always going to be with us then, but it's possible the omicron variant will cause so much immunity that it will quell the pandemic.

The question is how you define pandemic

There was a period during the 2021 summer where we were almost back to normal (Gareth Everett/Huw Evans Agency)

Omicron is likely to peak during January and has "probably" peaked already in London, said Dr Andrew Freeman, an expert in infectious diseases at Cardiff University's centre for medical education.

"It will likely fall of rapidly," he said about the rising infection rate. "Things will be better after January."

"Without this omicron variant, we would be in a very good situation, but you can't say what is on the horizon. But given how many people have already had it and had their boosters, omicron as a major threat will disappear."

He added: "I don't think we will get another variant quickly. The question is how you define pandemic. Covid will never go away. It will be a winter respiratory virus like any other." We should expect seasonal winter peaks, like with flu, and an annual booster jab will probably be needed to deal with new variants and waning immunity.

Vaccination has made a huge difference and at the very least we can expect winter annual boosters, he thinks. However, globally, only 10% of people are vaccinated in the developing countries meaning there's always the risk of variants coming along.

Dr Freeman said: "Viruses tend to evolve into less virulent forms. That's what we've seen with omicron, which is milder but not yet mild enough to stop people getting ill." A virus evolves as it has to get around immunity, he explained and so a key factor is not so much the virus itself but the degree of population immunity.

"Whether we have a new variant next year, I don't know," he said looking forward to the next 12 months. "It was always a concern before omicron and it came out of the blue. It had more mutations than previous variants making it more transmissible. They [viruses] have to evolve to continue to exist but often the virus is weakened in the process."

Like many, Dr Freeman believes omicron will ultimately become like be a common cold, like we're already seeing in the vaccinated and boostered population.

"Whether that will happen during 2022 is another question," he said, unable to pinpoint exactly how long that might take. "But case numbers become less important. What matters more is hospitalisations."

There are now a total of 994 Covid-19 patients in hospitals in Wales. This is a rise of 43% compared to last week and the highest number since last March. However, this number is significantly below the peak of last year when it reached 2,800.

In an interview with WalesOnline, Mark Drakeford revealed that the figure of 994 included patients who were in hospital for other reasons but had tested positive for Covid. In fact, the number of people catching Covid-19 in Welsh hospitals is at its highest level in almost a year - read more here. But that's not the same as being hospitalised because of Covid.

It depends on peoples' behaviour

The ICU Covid ward at the Royal London Hospital (Jonathan Buckmaster)

"We're in the midst of the omicron wave that that's still increasing," said Professor Ronan Lyons, a Professor of public health at Swansea University.

Because of its geographical location, Wales is behind London in terms of the spread of the virus. The omicron peak will be later in Wales than London, while elsewhere, we're currently seeing it peaking in north western England. Meanwhile, the latest ONS survey showed 8% of population had omicron in the week leading up to the New Year.

"It's very prevalent and still on upward trajectory with a peak in mid- to late-January," Prof Lyons said. "The question is how quickly the wave will decline. Probably by the end of February, infection rates will be substantially lower than now. There's lots of uncertainty about how quickly it will tail off. It depends on peoples' behaviour."

However, the information from South Africa and the early data from the UK gives us a realistic hope that this wave will be over quicker than previous ones, and with much less loss of life.

There is also some uncertainty around exactly how long the boosters will work for, but ultimately, vaccination is a key part to bringing the pandemic to an end.

Read more: Unvaccinated dad left family heartbreaking final messages before dying in hospital with Covid

"When one virus replaces another, it becomes more transmissible but becomes milder and causes less severe damage," said Prof Lyons. "The impact on the population will be a lot less. When we get to that stage the interventions to protect the population will also be a bit less."

We were already nearly there before omicron was discovered: "If you look back at a couple of months ago, we had several months where it felt like we were back to normal almost," Prof Lyons said. "Omicron didn't exist and it came along and surprised us. You do expect one to come along, particularly when large parts of the world remain unvaccinated. The proportion of the population who are compromised increases."

The immediate priority then must be to ensure that our existing and very effective vaccines are distributed more equally across the globe. To date, 8.5bn doses have been delivered but there are still millions – especially those at high risk and frontline healthcare workers in low-income countries – who've not even received their first dose.

While the "vast majority" of viruses go nowhere, omicron is still causing hospitalisations and is still very much a factor of the pandemic. What's really key is for people to get vaccinated and boostered, Prof Lyons urged.

'It won't be as bad as we necessarily think'

Prof Watkins said there was "no rise in cases, hospitalisations or deaths" despite huge crowds descending on Cardiff for the rugby Autumn Internationals (Mark Lewis)

Last week, senior epidemiologist Professor John Watkins of Cardiff University called for the Welsh Government to ease restrictions to pre-omicron levels. He said while the variant is more transmissible than the delta strain, its threat is less severe and those who contracted the virus are less likely to die.

He believes we have "moved ourselves back to that position where we were in the autumn" and that all the evidence, together with protection offered by vaccine boosters, means that restrictions should return to what they were in the autumn.

He thinks that during 2022 we could tentatively say the pandemic, in the real sense of the word, is over.

"Up to this particular pandemic, people weren't aware that coronavirus already existed but suddenly it's on everybody's mind," Prof Watkins said. "We will probably be having eternal vigilance of coronavirus. People will have to learn to live with it. It won't be as bad as we necessarily think. Viruses of all kinds tend to move to being endemic. You get occasional flurries but they are largely controlled by various measures."

Like many, he says coronavirus will develop into common cold like symptoms.

"The original vaccine for the original virus is still effective against omicron," he explained. "Variants are single letter changes in the genetic code of the virus. Most of those are completely inert. It's not a change in the virus structure but a subtle change in the way it plies its trade.

"Once you have been exposed to a particular virus, you protect with two things: antibodies, so the virus doesn't cause you problems, and T-cells and B-cells." T-cells are responsible for attacking a virus once it makes its way into the body’s cells if antibodies fail to prevent infection in the first place.

"They're likely to offer lifetime protection for people who've had the virus before," Prof Watkins continued. "That's what happens with most mutant viruses - it becomes endemic because most of the population has been exposed to it.

"Once we reach the endemic phase it's always going to be around. That's when we stop testing people."

It's clear that continual testing hasn't stopped omicron going up, he added. "At some point someone has to turn around and say okay, we just have to live with it," he said. "That point will come when hospitalisations are not going through the roof, ICU isn't getting full up and people aren't dying. Then you can say the pandemic is over."

It has to be at some point this year because we "can't live with this hanging over our heads forever", he said.

As of Friday January 7, there were 39 people in Welsh hospitals in intensive care suffering from Covid. This is an increase from 32 people in ventilated intensive care beds with Covid-19 on December 30, but significantly lower than in the first week of January 2021 where 140 people were in ICU.

Prof Watkins continued: "From a global point of view, it's often said you're not safe until we are all safe. In reality to be safe, that means vaccinating maximally and making sure everybody has taken up that level of protection from the vaccine."

It's likely to be another couple of years before the rest of the population has been vaccinated in the developing world. But it is also notable that half of the world's population is under-30. We know that with coronavirus and serious illness, one common factor is age and demographics, with the majority of deaths with Covid among those in the upper age brackets. There'll come a point where populations will develop high levels of immunity through a combination of vaccination and natural infection.

"We'll get to a stage where coronavirus is more symbiotic with the population in the future," said Prof Watkins. "There's got to be a point, which is driven by politics, but also people saying it's no big deal anymore."

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