COVID at 3 years old: where are we going?

March 15, 2023 – Three years after COVID-19 shook the world, the pandemic has evolved into a State common infections, less frequent hospitalizations and deaths, and continued anxiety and isolation for the elderly and those with weakened immune systems.

After about 2 and a half years of requiring masks in health care settings, the CDC lifted its recommendation for universal and compulsory masking in hospitals in September 2022,.

Some statistics tell how far we’ve come. Weekly cases of COVID-19 abandoned to nearly 171,000 on March 8, a sharp drop from the 5.6 million weekly cases reported in January 2022. Deaths from COVID-19, which peaked in January 2021 at more than 23,000 per week, s stood at 1,862 per week on March 8.

where we are now

Because Omicron is so contagious, “we think most people around the world have been infected with Omicron,” says Christopher JL Murray, MD, professor and chair of health sciences at the University of Washington and director of the Institute for Health Metrics. and evaluation in Seattle. Seroprevalence surveys — or the percentage of people in a population who have antibodies for an infectious disease, or the Omicron variant in this case — support this reasoning, he says.

“Vaccination was higher in the developed world, but we see in the data that Omicron infected most individuals in low-income countries,” says Murray. For now, he says, the pandemic has entered a “stable state”.

At New York University’s Langone Health System, clinical tests are all trending down and hospitalizations are low, says Michael S. Phillips, MD, infectious disease physician and the health system’s chief epidemiologist.

In New York, there has been a shift from pandemic to “respiratory virus season/surge,” he says.

The change is also moving away from universal source control – where every encounter with a patient in the system involves masking, distancing, etc. – to focus on the most vulnerable patients “to make sure they’re well protected,” says Phillips.

Johns Hopkins Hospital in Baltimore has seen a “marked reduction” in the number of people going to the intensive care unit because of COVID, says Brian Thomas Garibaldi, MD, critical care physician and unit director. Johns Hopkins biocontainment.

“It speaks to the incredible power of vaccines,” he says.

The respiratory failures that marked many critical COVID cases in 2020 and 2021 are much rarer now, a change Garibaldi calls “refreshing.”

“Over the past 4 or 5 weeks, I’ve only seen a handful of COVID patients. In March and April 2020, our entire ICU – in fact, six ICUs – were full of COVID patients. .

Garibaldi also sees his own risk differently now.

“I am not now personally worried about getting COVID, getting seriously ill and dying from it. But if I have a shift in intensive care next week, I worry about getting sick, possibly having to miss work, and placing that burden on my co-workers. Everyone’s really tired now,” says Garibaldi, who is also an associate professor of medicine and physiology in the division of pulmonary and critical care medicine at Johns Hopkins University School of Medicine. Medicine.

What keeps experts awake at night?

The potential for a stronger variant of SARS-CoV-2 to emerge worries some experts.

A new sub-variant of Omicron might emerge, or an entirely new variant might appear.

One of the main concerns is not just a variant with a different name, but one that can evade current immune protections. If this happens, the new variant could infect people who are immune to Omicron.

If we go back to a more severe variant than Omicron, says Murray, “then suddenly we’re in a very different position.

Keeping tabs on COVID-19, other viral illnesses

We have better genomic surveillance of circulating strains of SARS-CoV-2 than at the start of the pandemic, Phillips says. More reliable daily data has also recently helped fight the respiratory syncytial virus (RSV) outbreak and track flu cases.

Wastewater monitoring as an early warning system for COVID-19 or other respiratory virus outbreaks can be helpful, but more research is needed, Garibaldi says. And with more people testing from home, test positivity rates are likely underestimated. So hospitalization rates for COVID and other respiratory illnesses remain one of the most reliable community metrics, for now, at least.

One caveat is that sometimes it is unclear whether COVID-19 is the main reason someone is admitted to hospital versus someone who comes for another reason and tests positive. at admission.

Phillips suggests that using more than one measure might be the best approach, especially to reduce the likelihood of bias associated with a single strategy. “You need to look at a whole range of tests so that we have a good idea of ​​how this affects all communities,” he says. Moreover, if a consensus emerges between different measures – sewage monitoring, hospitalization and test positivity, all on the rise – “it is clearly a sign that things are moving forward and that we would have to modify our approach accordingly” .

where we could go

Murray predicts a steady rate of infection without “big changes”. But declining immunity remains a concern.

This means that if you haven’t had a recent infection – in the last 6-10 months – you might want to think about getting a booster, says Murray “The most important thing for people, for them- themselves, for their families, is to really think to maintain their immunity.

Phillips hopes the improved surveillance systems will help public health officials make more accurate recommendations based on community levels of respiratory disease.

When asked to predict what might happen with COVID in the future, “I can’t tell you how many times I was wrong to answer that question,” Garibaldi says.

Rather than making a prediction, he prefers to focus on hope.

“We weathered the winter storm that had us worried in terms of RSV, flu and COVID at the same time. Some places have been hit harder than others, especially with pediatric RSV cases, but we’ve never seen the level we saw last year and before that,” he says. “So hopefully it will continue.”

“We have come a long way in just 3 years. When I think of where we were in March 2020 caring for our first round of COVID patients in our first unit called the biocontainment unit,” says Garibaldi.

Murray wonders if the term “pandemic” still applies at this point.

“In my mind, the pandemic is over,” he says, as we are no longer in an emergency response phase. But COVID in one form or another is likely to be around for a long time, if not forever.

“So it depends on how you define the pandemic. If you’re talking about emergency response, I don’t think we have any more. If you mean the formal definition you know of an infection that spreads everywhere, then we’re going to stick with it for a really long time.