Can I be the bearer of bad news? 

You’re not here to answer and the news won’t surprise you anyway, so I’ll just go ahead: The World Health Organization tells us that the pandemic’s not over. 

How do I know? Because Tedros Adhanom Ghebreyesus, WHO’s director general said, “This pandemic is nowhere near over.”

That’s a subtle way of putting it, but if you pay close attention you can tease out the message.

He also said, “Omicron may be less severe, on average, but the narrative that it is a mild disease is misleading. Make no mistake: Omicron is causing hospitalisations and deaths, and even the less severe cases are inundating health facilities.”

And if that’s not enough, “While Omicron causes less severe disease than Delta, it remains a dangerous virus—particularly for those who are unvaccinated. We mustn’t allow this virus a free ride or wave the white flag, especially when so many people around the world remain unvaccinated.”

The “overwhelming majority” of people admitted to hospitals are unvaccinated, he said.

 

Has Covid gone endemic?

But what about the idea that Covid’s changing from a pandemic to an endemic disease and that we need to stop whining and learn to live with it? 

Let’s start by figuring out what that means: An endemic disease is “consistently present but limited to a particular region. This makes the disease spread and rates predictable.” 

Sorry, but I need to step in here. That last sentence doesn’t mean that being consistently present and limited to one region makes the disease spread. It means those things make the disease’s spread predictable.

Which was probably already clear, but I couldn’t help myself. I used to misunderstand people for a living, and old habits are hard to break.

So how do we measure up to that definition? We’ve blown it on the “limited to a particular region” part, but let’s not be fussy. Are the spread and rate predictable? 

Nope. Not only do we have sharp spikes, we have no idea when a new variant will come along or how dangerous or benign it’ll be. We do know that the climate’s right for creating new variants.

Another defines an endemic disease as constantly present but not causing the upheaval or massive number of infections that an epidemic does. Covid hasn’t become endemic by that definition either.

But again, let’s not be fussy. Even if Covid doesn’t fit either definition, couldn’t we pretend it does, get over our fear, and learn to live with it?

Well, it depends on how we want to live. Or die. Being endemic doesn’t mean it’s no threat. Before penicillin, tuberculosis was endemic. [Late correction: Penicillin has nothing to do with tuberculosis. See the comments below. It’s the things you think you know that trip you up.] So was syphilis. They wrecked a lot of lives. They killed a lot of people. People learned to live with them because they had no choice, but I wouldn’t make a virtue of it. 

It would be interesting to look at how much resistance measures to control their spread met. But that’s another post.

Learning to live with Covid is one of those phrases that, when you look at it, means nothing. Does it mean we tear off our masks, join a germ exchange, and relearn the lyrics to that Country Joe and the Fish song with the line “Whoopee, we’re all going to die”? Or does it mean we wear masks religiously, invest in some serious ventilation, and pass vaccine mandates? They’re both ways of living with a virus.

Does it mean learning to live with a constant threat, not just of death but of disability from long Covid–a threat that no one’s been able to quantify yet? If so, how will we decide to live with it?

Michael Ryan, the head of emergencies at WHO, said, “Endemic malaria kills hundreds of thousands of people; endemic HIV; endemic violence in our inner cities. Endemic in itself does not mean good. Endemic just means it’s here forever.”

Okay, he skipped the predictable part, but we did say we weren’t going to be fussy.

“What we need to do is get to low levels of disease incidence with maximum vaccination of our populations, so nobody has to die,” Ryan said. “The issue is: It’s the death. It’s the hospitalizations. It’s the disruption of our social, economic, political systems that’s caused the tragedy—not the virus.”

And in case you’re betting on the next variant being milder than Omicron, mutation isn’t a one-way street. The direction of travel is random. 

 

Could you scrape up some good news, please?

Possibly, but let’s whisper so we don’t spook it: Some experts say that once the Omicron wave recedes we may get a period of quiet. The theory is that we’ve built up widespread immunity that could keep future waves from hitting as hard as they have in the past. 

Do waves hit? Is that a mixed metaphor? Do we care?

Probably, but let’s focus on the important stuff.

That’s not a unanimous opinion and other experts are more cautious, reminding us that it’s not clear how long Omicron immunity will last or whether a new variant will evade it. Omicron has demonstrated that even a relatively mild version of Covid can put a huge strain on health systems–and on the people who work in them. 

And as Boghuma Titanji, a virologist at Emory University School of Medicine, put it, “Wealthy countries moving on, I fear, will push the issues of access to vaccines and therapeutics access down the global priority list.” Which would mean not only more deaths in poor countries but (self-interest alert here) more variants loose in the world.

On the other hand, data suggests that the human immune response becomes better and broader every time it’s exposed to Covid’s spike protein. 

On the third hand, however, Leif Erik Sander, an immunologist at the Charité University Hospital, says that Omicron’s spike is so different from the spike in earlier variants that it’s not clear just how much immunity the Omicron wave will leave us with.

At which point we’re out of hands and it’s time to talk about what the next variant might look like. One possibility is that Delta could stage a comeback tour. Omicron was able to spread so quickly in part because the earlier versions hadn’t left us immune to it. Once that advantage fades, it may die back, leaving Delta room to work. Or they could work out their disagreements, move in together, and have babies, which could easily be uglier than either parent.

And, since a handful of antibodies does not an immune system make, what happens if a new variant evades not just our antibodies but our T cell response? (Reminder: T cells are an essential part of your immune system. Don’t leave home without them.) Well, if that happens “we’re dealing with another pandemic,” Shabir Madhi, a vaccinologist at the University of the Witwatersrand, said. But “the likelihood of that happening, I believe, is quite slim.”

 

Let’s try that good news thing again . . .

. . . because my last try didn’t go well.

Researchers in Finland are working on something they call a biological mask–a spray that could (assuming the tests go well) protect a person against Covid for 8 hours. 

It’s not meant to replace vaccines but to supplement them. If a person’s immune system doesn’t respond well to the vaccines, this spray is their friend. Or if they’re faced with a combination of a vaccine-evading variant and too many human beings in a risky setting, then ditto. 

The active molecule in the spray is called TriSb92, a name I forgot as soon as I got past the comma. Never mind. It’s a clever little beast that targets a part of Covid’s spike protein that’s common to all variants–at least so far–and once it makes contact it keeps the virus from going to work. You know what that’s like. It calls in sick and loses its job because spike proteins have no union and therefore no sick leave and no job security. 

If it was anything other than the Covid virus I’d feel bad about that, but it’s got it in for us. Have no mercy.

The developers think the spray might also be effective against new coronaviruses that emerge. Keep your fingers crossed. This sounds promising.