What's Next After The Omicron? What Could Come Next In 2022?

After the past 25 months, forgetting the pandemic for even a little while may sound like a fantasy - after all, the coronavirus has gotten our hopes up before. But infectious disease experts say there just may be an end in sight. Maybe.

"I think if we do it right, we're going to have a 2022 in which Covid doesn't dominate our lives so much," said Dr. Tom Frieden, who was director of the US Centers for Disease Control and Prevention under President Obama and is now the CEO and president of Resolve to Save Lives.

What the next part of the pandemic looks like and when it will get there are what Dr. Yvonne Maldonado, an epidemiologist and infectious disease specialist at Stanford Medicine, and experts at federal agencies, academic colleagues and local public health leaders spent the holidays trying to figure out.

There was a general consensus among the experts about what happens next: "We really don't know exactly," Maldonado said.

There are disease models and lessons from pandemics past, but the way the highly infectious Omicron variant popped up meant the scientists' proverbial crystal ball got a little hazy.

Omicron has done a lot. More than a quarter of the Covid-19 pandemic's total cases in the United States have been reported in the past month, during the Omicron surge, according to data from Johns Hopkins University.

Infectious disease experts, however, see hope in what has happened in South Africa.

"South Africa's kind of our canary in the coal mine because they were able to pick up the Omicron variant first," Maldonado said.

South African scientists first spotted the variant in November. Cases there peaked and fell off quickly. They did the same in the UK. And that's what experts think will happen everywhere.

"I anticipate in the short run -- being the next six weeks, four to six weeks -- that it's still going to be pretty rough," said Dr. John Swartzberg, an expert in infectious diseases and vaccinology and clinical professor emeritus at the University of California, Berkeley's School of Public Health. "It will be about the middle of February before we start to really see that things are getting better."

Part of his optimism stems from the fact that there will be a much larger immune population, between the increasing number of people who are vaccinated and boosted, and those who've caught Covid-19 during the Omicron surge.

"Generally speaking, the level of immunity in our population is going to be much higher than it was going into the Omicron pandemic, and that's going to help us not only with Omicron and Delta, if they're still circulating, but it will also help us with any new variants," Swartzberg said. "To what degree will depend on the availability of medicines to intervene."

That's because the coronavirus will probably never go away completely.

The next variant

The next variant could be equally or even more transmissible than Omicron. It could give people more severe symptoms -- or no symptoms at all.

"It's not at all clear what comes next," said Dr. George Rutherford, an epidemiologist at the University of California, San Francisco. He said the virus could mutate gradually, like what happened with the Alpha and Beta variants. Or it could make a really large jump, like with Delta and Omicron. "What's next? It's a crapshoot."

The H1N1 flu virus, for example, was a novel virus when it started one of the worst pandemics in history in 1918 -- it infected one-third of the world's population and killed 50 million of them.

That pandemic eventually ended, but the virus is still with us today.

"That was the great-great-grandparent of all the H1N1 viruses we see every year," Maldonado said. "They've had many mutations since then, but it is from the same strain. So it's possible that this virus will do a similar thing."

With this flu-like scenario, the world needs to focus on protecting those vulnerable to severe disease, on making sure they get vaccinated and have access to monoclonal antibodies and antivirals, Maldonado said. Vaccine companies would need to make variant-specific vaccines so people can get a Covid-19 shot every year. The country also has to make testing better.

"The oral drugs and the monoclonals are no good unless you know you're Covid-positive," Swartzberg said.

The in-between scenarios would be if there aren't enough antivirals or monoclonals to treat the people who get sick, or if vaccine manufacturers can't make variant-specific vaccines fast enough.

The worst-case scenario is if a variant escapes the protection of vaccines and treatments.