Is the COVID-19 pandemic over?

In the well over two years of the COVID-19 pandemic, we have gone through lockdowns, punitive economic restrictions, and irksome impositions on our physical and social lives.

Not surprisingly, the population and the community are rapidly becoming COVID-19 fatigued. It’s time for a reality check where we are with the pandemic.

Reassurances that the status of the pandemic is greatly improving have come from two sources, and they have been latched onto to provide much-sought-after comfort.

The one is that the level of immunity in the population, from both vaccination and past infection, appears to be very high. The second is the advent of the Omicron variant of the SARS-CoV-2 virus, now a much tamer version of the virus than its predecessors.

Thankfully, what we saw in the earlier stages of the pandemic – hospitals barely coping with the mass of severely ill and dying individuals – is now a painful memory.

And yet, we all know that COVID-19 infection and illness hasn’t disappeared. The plague is still pretty much alive in the community and celebratory functions are still all but guaranteed to be superspreading events. Fortunately, the great majority of current COVID-19 illnesses are now mild.

Where are we with the pandemic? Is it, indeed, burning itself out and are we now in the last throes of its grip? Do we still need to wear masks and practice social distancing? What are our expectations for the future?

On the positive side, there’s little doubt that widespread population immunity has played a significant role in the mildness of the Omicron-driven fourth wave. There’s also a great deal of scientific evidence that the Omicron variant is intrinsically significantly milder than its predecessor variants. This has certainly been supported by a number of scientific studies, both in animals and in the laboratory.

However, can these two encouraging signs bring us comfort that we’re out of the woods? Realistically, we do need to look at the other side of the coin.

First, there are some doubts and concerns about the effectiveness of the demonstrated immunity. What was shown quite graphically with Omicron is the ease with which this virus could scythe through the widespread immunity of the population and even overcome the protective immunity of highly vaccinated individuals.

Clearly, the rapidly mutating coronavirus can quite speedily and very effectively acquire the ability to evade the immune defences of individuals, albeit causing mild or even silent infections. (It’s quite apparent that many in the community are still falling prey to Omicron infection.)

It is, of course, too early to assess the durability of immunity. Nevertheless, there are accumulating signs that it may well wane, even in the medium term.

Second, many people are comforted by a common narrative that viruses evolve towards becoming more transmissible, (infectious), together with causing less severe disease, (less virulent). It would certainly appear to be in the virus’ “interest” to do so – to keep the host as healthy as possible in order to spread more widely. According to this narrative, Omicron could certainly be the harbinger of the virus marching on its evolutionary pathway towards a less severe and more transmissible end-product. Hopefully this will indeed turn out to be the case.

Unfortunately, however, this rosy narrative, while it has been demonstrated in some animal models, lacks any supporting evidence in the case of human viruses. In fact, Omicron is the only variant of concern which dropped its virulence when it became more transmissible. All the preceding variants of concern, while progressively becoming more transmissible, didn’t reduce in virulence.

The reality is that it does appear that transmissibility and virulence are two independent and unrelated properties of the virus. The advent of a rather tame Omicron virus was, in all probability, simply a fortuitous lucky coincidence

Where does that leave us?

There’s clearly a pervasive air of complacency in the general population and in the community. Two of the highest risk environments, celebratory functions and shuls, are too often being treated with carefree abandon. Mask wearing is being totally abandoned in all-too-many closed indoor environments, in spite of it being against the law.

Furthermore, this mindset that the pandemic is now all but over and precautions are no longer necessary does little to address the worrying apathy and indifference to vaccination and booster doses.

It needs to be made clear that there will undoubtedly be a fifth wave, and perhaps even more after that. There will also be new variants, and we have seen that we cannot be immunologically and virologically comforted that the virus won’t evolve a new variant which could combine the immune evading capabilities of an Omicron with the virulence of a Delta.

If we abandon precautions, we promote greater virus circulation even if the infections themselves may be mild, or in most cases even silent.

It’s these silent transmissions through the community which may initiate a chain of transmission which could eventually land up at the doorstep of a vulnerable elderly or otherwise compromised individual.

Most importantly, every effort should be made to keep the transmission of this virus as low as possible in order to minimise the opportunities for it to mutate and evolve into more threatening variants.

Unfortunately, let’s be clear, we cannot at this stage say that the pandemic is over. What we do now and the precautions we continue to take, could well affect the COVID-19 future we face in the short to medium term.

There will be an end to the pandemic. Perhaps it will come from a new generation of more broadly effective vaccines. It could be advances in preventative drugs or other instruments of coping with a pandemic. Perhaps the virus will run out of genetic space to evolve more threatening variants.

But, for now, it’s too premature to throw caution to the wind.

• Barry Schoub is professor emeritus of virology at the University of the Witwatersrand and was the founding director of the National Institute for Communicable Diseases. He chairs the Ministerial Advisory Committee on COVID-19 Vaccines. This article is written in his private capacity. He reports no conflicts of interest.