We Might Be Looking At COVID “Seasons” For Years To Come

Every year, the flu kills tens of thousands of mostly older people, but also some children and other vulnerable individuals. A worse future for the pandemic might see the coronavirus ceaselessly bubbling along and causing similar deaths in a kind of permanent COVID season.

“We don’t like to talk about it, but we have lots of everyday illnesses that still kill people,” Fauci said. “RSV (respiratory syncytial virus) kills children as well as the elderly.”

That may be the future of a “settle in” strategy for dealing with the pandemic like we endure colds and flus, Fauci added, which he doesn’t think is a good idea.

“People will still get seriously ill,” he said.

“There is no reason to think this is going to become the cold,” said Worobey, the viral evolution expert. “From what I can see, it’s going to be much more problematic than flu, which is a shitstorm every year, increasingly, killing up to 80,000 people in the US, which is a lot of people. And I think SARS-COV-2 is poised to be considerably worse than that.”

In this future of a perpetual COVID season, people will get very sick unexpectedly from the coronavirus, perhaps ending up with disabling long COVID symptoms, or dying, while others remain unscathed.

“We know some people are just intrinsically more vulnerable,” Temple University pulmonologist Steven Kelsen said.

In a recent JCI Insight study of 61 healthcare workers, Kelsen and his colleagues tested participants’ antibodies after the first of a two-shot Pfizer-BioNTech mRNA vaccine. They found that half of the hospital workers who had prior infections developed stronger antibodies similar to those seen in the fully vaccinated. That’s good news for giving people even just one shot around the world (as well as for vaccinated people who had breakthrough infections in the recent Omicron surge).

But the study also pointed to something more worrisome: a highly uneven waning of those protective antibodies. Some people’s antibodies lasted a long time, while others faded fast. “That suggests there are people out there more vulnerable to infection than anyone might suspect,” Kelsen said.

Without some check on their antibodies to identify who needs a booster, those people might regularly fall victim to COVID, even as most everyone else sees SARS-CoV-2 as less of a problem. The FDA’s March 29 call for people over 50 and those at high risk to get a second booster strikes Kelsen as a good first step for addressing this possibility, but he worries about people outside those categories who, for whatever reason, have antibodies that fade uniquely fast, leaving them more likely to suffer an infection.

“We need to personalize vaccinations for these people,” Kelsen said. “I don’t see that happening right now.”

New Deadly Variants

In a worst-case scenario, variants like Omicron throw cold water on hopes of a long-term lull in the pandemic after BA.2 passes or even settles in like other common diseases, experts say. Lulls followed by eruptions of immune-evading variants could be the new normal, bringing more deaths among the unvaccinated and vulnerable.

“I think we will see ‘blips’ where there are more cases going forward as new variants emerge,” Fauci said.

The Delta variant arose in India and Omicron emerged in Africa, where broad swaths of unvaccinated people gave the virus countless opportunities to mutate, he noted.

“Anywhere you have large pockets of unvaccinated people that give the virus room to evolve we could see dangerous new variants,” he added.

In a recent New York Times essay, experts on viral evolution led by the University of Chicago’s Sarah Cobey suggested that new variants might arrive with the regularity of the flu changing every winter. While Omicron had 15 mutations of its genes that helped it evade current vaccines, there’s room for nearly 2,000 more, they estimate.

“There’s no reason, at least biologically, that the virus won’t continue to evolve,” they wrote.

Even now, scientists are watching BA.4 and BA.5 versions of the Omicron mutation, which possess a mutation called “F486V” associated with even more evasion of current vaccines.