When will the COVID-19 pandemic end? Past diseases, and how they played out, offer some clues

Are we there yet?

Everyone is hoping we finally reach one destination in the new year: an end to the pandemic.

But with two years of lockdown cycles, exponential case counts, a testing shortage, and an Omicron curveball few saw coming, it can sometimes seem like that point keeps moving further and further away on the horizon.

Experts agree it's tough to predict the year ahead, but they can offer up some of their hopes and fears, and lessons from past pandemics.

It's unlikely, they say, that the virus will just disappear. But the sharp uptick of new cases could mean they fall quickly before hopefully settling into some kind of low-grade, constant, less overwhelming presence.

Cases have doubled about every few days at the end of 2021, with Omicron quickly overtaking Delta to become the dominant variant in Canada.

But sometimes when that happens we also see a really fast decline," said Cynthia Carr, a Winnipeg-based epidemiologist, adding that whether this happens will define the first few months of 2022.

It kind of burns through a great portion of the population."

There are still so many unknowns, said Dr. Syra Madad, an infectious disease epidemiologist at Harvard's Belfer Center for Science and International Affairs.

Data is coming out fast and furious from all different angles, different countries, I think there's good and bad," she said, speaking over the phone from New York City, one of the epicentres of Omicron. Madad is also the senior director of the system-wide special pathogens program at NYC Health and Hospitals.

The good news right now that we're seeing is that the Omicron variant seems to be more mild in terms of causing severe illness, compared to other variants of concern," she added.

But because it's much more transmissible, you're going to see many more people get infected with this virus."

Already there have been some concerning reports of a rise in hospitalizations, mostly among the unvaccinated, including children, in the U.S.

In Ontario, where there are so many new cases that lab polymerase chain reaction (PCR) tests are now limited to high risk people, hospitalizations are also rising.

A recent report from Public Health Ontario found that the risk of hospitalization and death from Omicron was about 54 per cent less than with Delta, adjusting for vaccination status and region. However, the number of hospitalizations and impact on the health-care system is still likely to be significant" because it is so contagious.

The variant appears to have peaked in South Africa, where it was first detected, said Madad, who was featured in Netflix's early 2020 documentary series, Pandemic."

The best way to put it is crash and burn," she added. But there are different factors" to consider; for example South Africa may have hit a ceiling in terms of testing capacity," and there may still be asymptomatic cases not being picked up."

Carr doubts that COVID will just go away, like Severe Acute Respiratory Syndrome (SARS), which killed almost 800 people from about 30 countries, including Canada, in the mid-2000s.

Instead, Carr said COVID could become seasonal, like a flu, which could still have very severe impacts on certain people, vulnerable people in the population," or what's called endemic (a stable, but not overwhelming presence in certain areas).

If we continue to see again that people aren't getting that shortness of breath or very clinically severe cases, this could be a good news story that we are turning toward an endemic situation where perhaps this strain is now moving toward being more like other strains of coronavirus," said Carr.

These strains cause about one in four" common colds, she said. Although it's too soon to say with certainty, that is my hope, that this actually could be moving us in this direction given how quickly it's taking over."

No one would have predicted the efficacy and just the rate of transmission," of Omicron, said Tim Sly, a professor emeritus, at the School of Occupational and Public Health at the university formerly known as Ryerson.

Never underestimate Mother Nature, she's got all kinds of tricks up her sleeve."

Sly agrees that COVID will probably not just disappear" as SARS did, as everybody is going to be exposed" eventually. Instead he thinks it will conform more to the model we've seen with influenza viruses, over the years."

The 1918-19 flu, which swept the globe after the First World War, eventually ended with infected people either dying or getting some immunity. But new strains of that virus have emerged over time, including in 2009 with the swine flu pandemic, Sly said.

So these things do enter the population and if they stay there, then they pop up a few years later as part of the normal seasonal influenza virus that's going around," he added.

We'll probably be looking at a yearly flu shot that contains also a coronavirus antigen as well, just to keep us topped up every year."

From where she's sitting, New York City's Madad hears a lot of fear, a lot of anxiety," and flashbacks to March 2020." But, she said, it's important to remember that we now have a lot of tools to fight the virus, including vaccines, masks and even new promising treatments.

Days before Christmas, the U.S. Food and Drug Administration (FDA), approved a new antiviral pill from Pfizer, called Paxlovid, for emergency use. It is not yet authorized in Canada.

It's kind of that ray of sunshine that we all needed amid a viral blizzard," said Madad, and certainly will be a game changer." Before people can get the treatment though, she added, they need to be diagnosed.

Unfortunately, the surge and the demand for testing is quite astronomical," both in the U.S. and Canada, and many people can't get access to tests.

Madad is hopeful the virus will transition into more of a seasonal pattern," with fewer deaths and serious outcomes. But that's really that's just a hope and a wish. I'm not going to say that's going to happen in 2022 right away."

And what about the possibility of future, even worse, variants? Eric Arts, a professor in the department of microbiology and immunology at Western University, said that most of the time" when a virus mutates, it does so to find a way to transmit more easily between people, as it seems Omicron has done.

Going forward, we hope that that's what's going to happen, but again we don't know. You could get a mutation that helps transmission and it could cause really severe consequences in disease, but that's a mutation that comes along for the ride."

The best way to prevent this scenario, he said, is to make sure everyone has access to vaccines.

We have focused on our own situation way too much in Canada and in the U.S., country by country, let's get us our vaccines, let's protect ourselves. This world is way too small, for that," he said.

If we really want to have a good 2022, and we want to see the end of this, we need to do more to vaccinate the world. It's that simple."