Researched by: Sara Varghese & Prafula Grace Busi 

First, the numbers

While case counts remain negligible in most countries, there are a few hotspots that offer a glimpse of what this new phase of the pandemic might look like.

South Africa: The country has experienced a recent surge in cases—after an Omicron-fueled peak in December. There were 4,610 reported cases last week—a jump of 234%. Positivity rates are up and hospitalizations have also increased. There is now talk of an imminent fifth wave. The silver lining: the number of deaths have decreased by 63%.

The United States: Case count in a number of states has jumped by 50% since last week. Average daily hospitalizations are up about 10%. On average, the US is reporting 56,000 new coronavirus cases each day—up from roughly 25,000 infections in early April. The total number of deaths passed the one million mark this week.

China: On Wednesday, China reported 5,489 cases, including 353 who were symptomatic. Most (4,982) were in Shanghai—which, however, is witnessing a steady decline in cases. All eyes are on Beijing which has reported 400 cases so far—including 51 yesterday. While the counts are low, they are significant given China’s strict zero-Covid policy. Shanghai reported 63 new cases in its low-risk areas despite being under a brutal lockdown for over a month.

India: Our numbers have been slowly ticking up since April—but there is no sign of a wave. The week ending May 1 registered a 41% jump in cases over the previous week. But our overall numbers remain low. On Wednesday, we reported 3,205 new cases and 31 deaths. The Indian Council of Medical Research says there is no sign of a wave, and these numbers represent a “localised blip.” Point to note: Just three states—Delhi, Haryana and Uttar Pradesh—account for nearly 67% of the cases. The upside: There has been no corresponding increase in the number of deaths.

Next, the key global trends

Looking at the spread and severity of cases, we can see these key patterns:

Omicron is king: Omicron—and its subvariants—have emerged as the dominant virus, pushing aside all others including Delta. And all of them appear to have the same profile: far more infectious but rarely cause severe disease. 

In South Africa, the main culprits for the recent surge are BA.4 and BA.5—both sublineages of Omicron. Together, they account for 60% of all new cases. In the US, BA.2 has been dominant, but is being quickly pushed aside by a new variation, BA.2.12.1—which has been growing 25% faster and is now linked to 37% of all cases. BA.2 is still the dominant strain in the UK and in India. 

Data point to note: BA.4 has been reported in 15 countries, while BA.5 has been detected in 13 countries. The tally for BA.2.12.1 is 22 countries—but most cases are from the US.

Recombinant variants: Many were worried about these hybrid versions of the virus—created when this happens:

“Recombinant viruses occur in instances like this when an individual is infected by two different viruses that share similar genetic material… As both sub-variants divide rapidly inside their human host cells, they can swap some of their genetic makeup and form a new ‘hybrid’ sub-variant made up of both parent viruses.”

The most prominent among these is Omicron XE—which combines BA.1 and BA.2 sublineages. While it has been detected in a number of countries—like the UK, Thailand and India—there is no sign as yet of it becoming dominant. Other recombinant variants like XD and XF have also been negligible in their spread.

Main takeaway #1: from the above trends is that we’ve been lucky that a milder strain like Omicron has emerged as the dominant variant. As long as it rules the roost, we can expect to keep moving back toward normalcy:

“The default scenario, in which Omicron remains the dominant variant, represents a continuation of the transition toward managing Covid-19 as an endemic disease that is already underway in many locations. With Omicron as the dominant variant, the pandemic phase will feel like it is over for more and more people, though certainly not all.”

Main takeaway #2: is that vaccinations matter. A preprint study out of South Africa suggests that a previous infection offers little protection from the new Omicron sublineages. The immunity from a Covid infection typically starts to wane after three months. New cases were mostly detected in unvaccinated people with past infections. OTOH, those who had been vaccinated and had a breakthrough infection had the strongest immunity. The conclusion: vaccinations and booster shots are critical to stopping the next wave.

Data point to note: During the omicron wave, vaccination with a booster reduced the chance of hospitalisation and death by more than 90%. But only 6.4 million people in the world are getting their first shot per day. At this pace, it will take another 4 months until 75% of the population has received at least one dose.

In India, 63% of the population has been fully vaccinated so far. The government has authorised booster shots for everyone over the age of 18. Yet, only 27.26 million have been administered as of May 3. This is compared to 101 million in the US.

Is the pandemic over?

The future of the pandemic can be decided either by the virus or humans—and all paths remain open right now.

The big worry: is the emergence of a brand new variant that causes far more serious disease—which cannot be ruled out. The virus continues to mutate, as experts continually warn: “This virus has shown that it mutated slowly, but when it started to pick up good mutations, they just kept coming and coming and coming.”

A Mckinsey report lays out three possible scenarios: ‘Milder-cron’, ‘Omicron’s twin’ and ‘Delta-cron’—the last being a new variant that causes severe disease. The first two assume that we will continue down this milder Omicron-led path. But medical experts say it’s foolish to assume that Omicron has ‘won’ the mutation arms race:

“Thus far, new variants of concern have not evolved from the dominant preceding one. Instead, they have emerged from separate lineages. There is no guarantee that the next dominant variant will sprout from the ‘mild’ Omicron branch of the SARS-CoV-2 family tree. ‘It is possible that a later variant may be back to a Delta or Alpha lineage, with sufficient immune evasion to sweep Omicron away,’ says [virologist Andrew] Rambaut.”

From pandemic to endemic: US Covid czar Antony Fauci was ripped apart by epidemiologists for declaring that the pandemic was past the “full-blown” stage and was making its way to a more “controlled” and predictable phase. He was suggesting that Covid was on its way to becoming endemic—like malaria or tuberculosis—which have “a constant, predictable or expected presence.” Also: they do not overwhelm the healthcare system.

But, but, but: This does not mean that these diseases are any less serious. Malaria killed more than 600,000 people worldwide in 2019, while the flu claimed 200,000 lives. 

As one expert warns: “There’s been a political reframing of the idea of endemic as something that is harmless or normal.” 

And an endemic disease can become an epidemic again. More importantly, what is endemic in more affluent parts of the population is often an epidemic among the poor and marginalised. Example: HIV. The same may be true for Covid—where one-third of the global population is unvaccinated and many don’t have access to life-saving treatments.

Also this: Covid cannot be eradicated unlike, say, smallpox. Ergo: “It’s going to take constant vigilance to keep it… under control.”

Quote to note: Just three weeks ago, a top WHO official declared: “I certainly do not believe we’ve reached anything close to an endemic situation with this virus.”

The human factor: History teaches us that at some point in a pandemic humans decide they’ve had enough—and just move on. As one expert puts it:

“I believe that pandemics end partially because humans declare them at an end… Every time people walk into stores without masks or even just walk into stores for pleasure, they’re indicating they think the pandemic is winding down, if not over… I don’t think anything really has a meaning until, as a society..., we act as if it is.”

In that sense, the pandemic may be already over—even if there is a more serious wave around the corner. Most people and governments have already decided that the risk of infection is lower than the price of Covid restrictions.

Historical fact to note: The 1918 flu pandemic killed 50 million–and came in three waves. The world returned to normal after two years when this happened:

“[A] new variant emerged in 1920 and effectively caused a fourth wave. This wave killed more people in some cities than the second one, even though there was widespread immunity to the virus by then. Although many cities and public institutions imposed restrictions during the second and third waves, virtually none did so during the fourth.”

But by 1921, the flu death toll returned to pre-pandemic levels. Also this: “In 1918 people died of infectious disease all the time, so there was a certain familiarity with the experience.” We 21st century humans don’t have the same resilience when it comes to such widespread loss.

The bottomline: All said and done, we hold the keys to the pandemic’s future. If we remain vigilant—take our boosters, wear our masks—the virus will inevitably run its course, new variant or not.

Reading list

• New York Times looks at what South Africa tells us about the future course of the disease. 
• Scientific American has an excellent piece on how pandemics end. 
• This McKinsey report is very good at laying out where we are—and where we might be headed. 
• Times of India has the latest charts on the state of the pandemic in India. 
• Al Jazeera explains recombinant variants—while CNN lays out the various Omicron subvariants. 
• New York Times explains how and when a disease becomes endemic—and what it would look like in the case of Covid.
• Bloomberg News offers a global vaccine tracker.