Covid-19 will still be around for the whole of 2022 but anti-viral drugs and better planning could lessen its impact, experts have said.
The world enters a third year of Covid-19 with case numbers soaring to record-breaking levels because of the highly transmissible Omicron variant. A million confirmed cases in a single day were recorded for the first time on December 30th.
There have now been 290 million cases worldwide with 5.5 million deaths. More than 800,000 cases have been recorded in the Republic of Ireland, with almost 6,000 deaths.
UCD virologist Dr Gerald Barry says the picture looks "muddy" with grounds for optimism, but also a need for the realisation that there may be worse strains of the virus to come.
Dr Barry believes “2022 has to be about planning for those new variants that may or may not come along”.
He expresses alarm that there are plans within the HSE winter plan to wind down testing and tracing in the event of a fall off in numbers.
He suggests the worst case scenario of a variant with the “severity of Delta and the immune evasion of Omicron” is possible and the Government should be preparing for it.
“It’s a random process really. The next virus might be even less severe again than this one (Omicron) or might be more severe,” he says.
“Omicron replicates less efficiently in the lung, but there is no reason why a new variant similar to Delta will not come along and have the ability to overcome prior immunity as Omicron has done.”
If the worst-case scenario does not happen, he believes Government planning will still be worth the effort.
Currently the Omicron strain appears to be putting fewer people in hospital. Because it has become the dominant strain and is infecting tens of thousands of people every day, “you hope good immunity will build in the community against this particular variant”, Dr Barry adds.
He also said the arrival of new anti-viral drugs will have a “big impact” on the numbers of hospitalisations and deaths.
Infectious disease consultant Prof Sam McConkey says hospitals will continue to segregate Covid and non-Covid patients for the foreseeable future.
“It is the case, and I’m sorry to say it, that there is no way of eliminating Covid-19 from the world. At some stage it will become endemic, where it is more like the flu and it is around seasonally,” he explains.
‘Quick surge’
“That will be the endgame with Covid-19. That’s not the end of the world. We live with flu, but what will it take to get there?
“Omicron will be a quick surge with loads of people getting it and then it will quite rapidly disappear. I don’t think it will be a problem that stays with us for months.
“I hate to be the prophet of doom but the next letters in the Greek alphabet are Pi and then there is Rho and Sigma and Tau.”
He expects the antiviral tablets, molnupiravir by Merck and Pfizer's Paxlovid, will help keep people out of hospital.
“People with mild disease will be able to take those tablets to prevent getting severe disease,” he says.
“If you are a close contact, you will be able to take the tablets to prevent even getting the infection. This is the drug companies doing what they are good at.”
TCD immunologist Professor Kingston Mills says Omicron is unlikely to be the last variant, but future mutations are likely to be less dramatic as that between Delta and Omicron.
“The upside of that is that the vaccines will be adjusted to deal with Omicron and anything that mutates from Omicron,” he says.
“That’s the positive side of it. If there are no significant new variants, I would be optimistic, but you can’t predict. That’s the biggest unknown.”
The Omicron variant had 30 mutations with the sequence of the spike proteins making it much more infectious.
This allowed it evade the current vaccines and antibodies generated from previous infections in people who had Delta or earlier variants.
“If you look at Omicron from Delta, there was a big drop in the ability of the antibodies from previous infection and the vaccines to neutralise it,” he says.
“It will depend on how significant the changes are. Delta changed things a bit, but the Omicron changes really had a big impact on the ability of the vaccines and previous infections to protect people.”
‘Most optimistic scenario’
Prof Mills says the changes in the mutation from Delta from Omicron was “very unusual” and may not occur again.
“The most optimistic scenario is that changes in the virus won’t have much of an effect on the antibodies that are generated.
“One of the big positives of so many people getting infected at the moment is that people will be primed by vaccine and then boosted by infection. They will have very good immunity from prior infection.
“The three doses of the vaccine seem to be dealing very well with moderate to severe disease.”
He predicts there will be a vaccine available to deal with Omicron by the end of March.
He believes it is “very unlikely” that a virus will emerge that is more infectious and also more dangerous than Omicron.
“I don’t think we are going to see such a huge change again. I am optimistic rather than pessimistic.”
However, infectious diseases consultant Dr Clíona Ní Cheallaigh says that unless vaccines are sorted out for developing countries, it could lead to “more mutant strains - potentially ones as fatal as the original SARS”.
The original SARS, which occurred in 2003, killed 14 per cent of those infected - or one person in 7.
