This year in COVID, expect a long, cold winter and a hopeful spring

At the end of 2021, the annual reading of the tea leaves and crystal balls began. 

In media interviews and countless conversations over the past few weeks, I’ve been asked how the COVID-19 pandemic will transform our lives in 2022. At this point, it’s becoming pretty clear that we are all going to be exposed and potentially infected with the severity determined by our response to vaccines, including the 3rd dose in the mRNA series. If we had enough accurate tests, I’d not be surprised to see over 3 million cases per day or more in the United States.  

Health decisions are always made against political, economic and psycho-social backdrops. The Centers for Disease Control and Prevention (CDC) new guidelines for isolation and quarantine demonstrate this. We need to maintain a workforce and COVID-19 tests are not easily available right now. Furthermore, polymerase chain reaction (PCR) tests can remain positive for weeks even if someone is not contagious. Not all rapid tests may be able to detect this variant and the timing of the tests during the course of infection can impact the sensitivity  (true positivity) of the results with higher sensitivity at times of peak viral load.  

The CDC’s guidelines were designed to slow the spread, but they now look like a raindrop in the ocean if other public health measures aren’t enacted or mandated. 

Public health measures can help slow the spread of this virus, but we have seen how difficult they are to enforce. Indoor and outdoor mask mandates with masks that fit and are worn correctly, social distancing, closing large venues and encouraging remote work and activities, ventilation (even if it’s just opening windows) and handwashing are all helpful. The politicization of these actions has made it nearly impossible to recommend or even discuss them without vitriol.  

Now add this to the passionate debate on whether schools should stay open or close. 

Everyone would agree that students in school benefit greatly from enhanced teaching, social interactions, nutritional support and safety. But when they are facing an invisible enemy called Omicron, it’s hard to fully protect students and staff. The virus stays suspended in the air and even casual, brief exposures can be infectious.  For some leaders, it’s become a badge of honor and competence to keep schools open in the midst of this tenacious foe. Unfortunately, even our public health measures and vaccinations may not be enough to keep Omicron at bay. 

As this raging inferno burns through our communities, it may make more sense to go back to remote learning for a short time this winter so that we can minimize the collateral damage. It would be an act of offense, not defense, to close schools and allow teachers time to prepare virtual lessons and families time to find support for their children and themselves, rather than to have all parties struggle to find tests and worry about the health and wellbeing of their families.  

Not only are our immediate health care systems and essential infrastructure at risk of collapsing, but we also need to look at long-term risk. With prior variants, more than 30 percent of asymptomatic or mild infections developed into ‘long haulers syndrome’ or post-acute syndrome of COVID-19 (PASC) — which has over 200 symptoms that can last for weeks, months or potentially a lifetime. Research into the cause of the syndrome and how to treat it is ongoing. We need to increase public and professional education and create more clinics to help patients who are impacted.  

It’s too early to tell if this will happen with the Omicron variant, since symptoms can develop weeks after infection, but our health care systems need to be ready if this occurs. I can imagine a generation of patients who are debilitated by an infection that they didn’t even know they had. This may be the everlasting story of this pandemic. 

We don’t know the duration nor the durability of our immune responses to vaccines, nor natural infection. So how long will immunity last and does the wildfire start all over again? On a positive note, could the virus just evolve into being like the common cold — uncomfortable for a few days but with little lasting impact? As viruses spread through a population, they mutate. Imagine if there was a mutation that was just a nuisance or could be treated with a few pills. Hope “springs” eternal. 

This new year will bring better tests, therapeutics and vaccines. Spring is coming. 

Saralyn Mark, MD is the founder of SolaMed Solutions, LLC and iGIANT (Impact of Gender/Sex on Innovation and Novel Technologies. She is the American Medical Women’s Association’s COVID-19 lead and a former Senior Medical and Policy advisor to the White House, the Department of Health and Human Services and NASA.