With that out of the way, the bad news:All indications from genomic surveillance of the virus, wastewater. and the clinical outcomes that are still being tracked (albeit more limited and less periodicity as time goes on), that we’ve (finally) entered an endemic phase. There are no new SARS-CoV-2 variants that have yet cropped up with a growth advantage over XBB.1.5 (the recombinant with 2 significant mutations added on) which is dominant throughout much of the world, or its cousin, XBB.1.9.1. For all the talk about the convergent “variant soup” that preceded the most recent wave, the XBBs took hold and are not giving way to a long list of Omicron family sub-variants (Table below). Moreover, the XBB.1.5 variant ascent to dominance was not associated with a surge of Covid hospitalizations or deaths in the United States or elsewhere in the world, which might have been predicted based on its properties of enhanced transmissibility and immune evasiveness compared with earlier versions of Omicron.
Then some (reasoned) speculation:First, we sit at a very high baseline of daily Covid hospitalizations and deaths in the United States, over 25,000 and about 400, respectively. This is far beyond (double) where we were in June 2021, pre-Delta, when we got down to close to 10,000 hospitalizations and ~200 deaths per day. There’s still circulating virus (currently XBB.1.5) getting people infected and some of the folks of advanced age and immunocompromised are the ones chiefly winding up with severe Covid. The virus is finding the vulnerable people more easily since their guard is let down, abandoning high-quality masks and other mitigations, and the low rate of keeping up with boosters in the last 6 months (the age 65+ rate is 40%).
So it would seem we've entered a new phase...That brings me to the second concern, which is considerably more important. That we will or might see on “Omicron event.” This likely occurred from the hyper-accelerated evolution of the virus within an immunocompromised host that was then transmitted.
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When 10 scientists who are following the pandemic and the virus evolution closely (including me) were recently asked what are the odds of another Omicron event in the next 2 years, the range was 5-30%, with no one thinking it is zero, and good convergence at the 10-20% level (unpublished data). And that’s in the 2-year window. SARS-CoV-2 will be with us for many years, so over time that likelihood forecast for a Pi new family of variants (and beyond Pi) increases. There are too many routes for us seeing a Pi family of variants as shown in the graphic below. That is why we must prioritize development and validation of next generation vaccines that can achieve variant-proof protection (e.g. against all betacoronaviruses) and have improved defenses against infection that can be accomplished via mucosal immunity with oral or nasal vaccines.
But he does end with some better news potentially regarding Long Covid:
Until now the only way we knew that Long Covid could be prevented was to not get Covid. That’s still the case. But a new randomized, placebo-controlled trial of metformin has yielded exciting results—the first drug to be shown to help prevent Long Covid.