What awaits us beyond omicron in 2022?

The holidays are now behind us. Over 100 million people hit the airports and roads to enjoy holiday gatherings with family and friends. 

There were thousands of flight cancellations due to airline personnel infected with the highly contagious omicron variant of COVID-19. Ironically, warnings months ago of pilot shortages due to vaccinations and President Biden’s vaccination mandate never materialized.

TSA screeners experienced a surge of new infections, with active cases amongst them reaching 2,609 on Jan. 3, representing over 5 percent of their workforce. This is likely due to omicron’s contagiousness, in spite of all the precautions taken.

Now that everyone has returned home and getting ready to settle into 2022, what can we expect to see with omicron, the dominant variant now circulating?

In the short term, there will be a surge of new infections, already topping peak daily numbers last seen around a year ago. A daily spike of 1 million cases or more is not out of the question.

Some believe that measles may be the only virus more contagious than omicron. This could explain why omicron quickly overtook delta as the dominant variant in the United States and other countries, with omicron recently accounting for 59 percent of U.S. cases as of Dec. 25.

However, with many people resorting to at-home tests, state public health departments will be unaware of many new infections. This means that the official number of cases will be lower than the actual number of infections. The Biden administration has promised 500 million at-home test kits this month. Even if just 10 percent of these 500 million at-home test come back positive, that could nearly double the official national case count.

At-home test kits provide valuable health information for individuals. They also cloud the national public health data landscape by hiding the true number of infections, making it more difficult to assess the spread of the virus

The math is simple. More infections will stretch hospital resources as more people seek care. Even as omicron infections appear to be less severe than delta infections, the sheer volume of infected patients requiring hospital care will overwhelm many hospital systems, particular in areas with low vaccination and booster rates, and low prior infection rates. Hospital CEOs in Minnesota have gone so far as to ask people to be vaccinated to relieve the demand pressures on their facilities. 

For the 35 million adults who remain unvaccinated, it is worth noting that hospitals are not being overwhelmed with vaccinated people experiencing vaccine complications, but with unvaccinated people sick with COVID-19.    

The challenge faced by hospital systems in some areas may not be the number of beds available, but the health care staff available to manage and treat the patients. Health care workers are at high risk of infection, and this means they become unavailable to provide care once infected. To alleviate such staffing pressures, as well as the availability of people to fill critical roles in society, the Centers for Disease Control and Prevention (CDC) reduced the quarantine period for asymptomatic infections from 10 days to five days.

The silver lining with this surge of omicron infections is that as quickly as it has come, it is likely to just as quickly pass, which happened in South Africa. The unfortunate carnage left behind will be premature deaths as well as people with post-COVID conditions and other lingering effects. The full extent of such damage will remain unknown for many months, or even years.

Given the contagiousness of the omicron variant coupled with the many people with protection from being fully vaccinated and boosted, the stage is set for the virus to become endemic. This means that effective therapeutics are critical to relieve pressures on health systems to manage ongoing new infections that are certain to occur.

This also means that data and statistics on infections quickly become uninformative. The number of people hospitalized would now best capture the nation’s COVID-19 status. Amongst this group, it would be beneficial to categorize hospitalizations by vaccination status, including the type of vaccines they received and whether they were boosted, when they received their last injection, as well as prior infections. Without such information, we will continue to walk blind during the imminent endemic period of the virus.

How long the vaccines will sustain their potency and how long natural immunity will last remain open questions. However, the current surge of omicron infections is poised to bring about a later lull in new cases, as have previous surges. With the virus on a trajectory to becoming endemic, the next phase of the virus is closer than many realize.

Sheldon H. Jacobson, Ph.D., is a founder professor of Computer Science and the Carle Illinois College of Medicine at the University of Illinois at Urbana-Champaign. He applies his expertise in data-driven risk-based decision-making to evaluate and inform public health policy.