The SARS‐CoV‐2 omicron wave is indicating the end of the pandemic phase but the COVID‐19 will continue

The world is going through a massive wave of the coronavirus disease 2019 (COVID‐19) pandemic due to the omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Globally, there were 3.23 million new infections on January 21, 2022, which is four times higher than the peak infection rate of the delta wave. ¹ The omicron wave is tremendously spreading in every corner of the world except some countries in Southeast Asia, North Africa, Eastern Europe, and Oceania, where the omicron wave has not started yet. ¹ In January 2022, the global prevalence of SARS‐CoV‐2 infections has increased by at least 30 folds than November last year according to the assumption of Institute for Health Metrics and Evaluation models. ² However, the reported COVID‐19 cases have increased by only sixfolds in the same period. ¹ This high rate of asymptomatic or mild SARS‐CoV‐2 infections by omicron compared to the previous variants might be the possible reason behind these under‐reported COVID‐19 cases. ³ Also, the current detection rate of COVID‐19 is 5% which was 20% in earlier waves. ² According to the prediction of the World Health Organization, the omicron variant might infect at least 60% of the world's population, meaning an average of five million new COVID‐19 cases per day and about half of Europe's population might get infected by the omicron variant by mid‐March 2022. ⁴

The assumption of asymptomatic SARS‐CoV‐2 infections is important for understanding the global disease burden due to the ongoing pandemic. A study suggests that 40% of the SARS‐CoV‐2 infections were asymptomatic in earlier waves of the COVID‐19 pandemic. ³ However, the proportion of asymptomatic infections due to omicron variant is much higher than previous SARS‐CoV‐2 variants. Garrett et al. ⁵ reported 71 (31%) asymptomatic SARS‐CoV‐2 infections among 230 COVID‐19 cases due to the omicron variant confirmed by reverse transcription‐polymerase chain reaction. ⁵ Hospitalization due to SARS‐CoV‐2 infections have slightly increased in the United States; however, it is 50% reduced in the United Kingdom by mid‐January 2022 compared to the same period last year (SPLY). ¹ Also, the requirement of the intensive care unit (ICU) support for the hospitalized COVID‐19 patients has decreased in the United States and the United Kingdom in January 2022 than SPLY. ¹ Also, the percentage of ICU patients or deaths due to SARS‐CoV‐2 infections have decreased by at least 80% in Canada and South Africa compared to the earlier waves. ⁶ , ⁷ Moreover, the reported average COVID‐19‐related deaths in January 2022 is 40% less than deaths reported in the peak time of the delta wave. ¹

The SARS‐CoV‐2 infections due to the omicron variant emerged when the delta variant was accounted for 99% COVID‐19 positive cases. ⁸ The twin effect of delta and omicron variants of SARS‐CoV‐2 has created a tsunami of COVID‐19 pandemic worldwide. ⁹ The omicron variant is becoming more dominant in the transmission of the SARS‐CoV‐2 day by day. Despite the reduced severity of COVID‐19 symptoms, the massive omicron wave might increase hospital admissions and ICU requirements in many countries. Moreover, if we screen all hospitalized COVID‐19 patients in a country, we will find a significant proportion of COVID‐19 patients admitted into hospitals for non‐COVID‐19‐related reasons. These SARS‐CoV‐2 infections were asymptomatic during the hospital admission due to other diseases. Therefore, infection prevention and control requirements are increasing in many countries. Healthcare workers are testing SARS‐CoV‐2 positive and requiring quarantine that puts double pressure on the healthcare systems in many countries. Also, the omicron variant is spreading so fast that immediate measures such as health safety guidelines, mass immunization, and delivering the booster dose of vaccines have little impact on the prevention and control of omicron wave. These interventions would be effective in the nations or territories where the omicron upsurge has not started yet. The peak of the omicron wave might occur between late January and mid‐February 2022 in most countries. ¹ Also, a later crest might occur in the few countries or territories where the omicron wave has not started yet. ¹

Many variants of the SARS‐CoV‐2 have appeared for the COVID‐19 pandemic. Some variants rage worldwide, while others fade away quickly. The omicron has surpassed previous variants in transmissibility but causes less severity which is very promising. The spike protein of the delta variant possesses more effective cell‐fusion kinetics than the SARS‐CoV‐2 strain. The latest omicron variant is extremely transmissible due to its triple mutations at the furin cleavage site, such as H655Y, N679K, and P681H. ¹⁰ Moreover, a recent study found that the polymorphism of 655Y spike protein is the fundamental determinant of SARS‐CoV‐2 infectivity and transmissibility. The development of viral fitness and adaptation to various hosts through an increased cleavage of the spike protein depends on the assortment and frequency of S:655Y. Therefore, this increased spike in protein processing and facilitating fusion potential ensure adaptative mutation of the SARS‐CoV‐2 omicron variant. ¹¹

Over the past 2 years, different forms of COVID‐9 responses have saved many lives across the world. ¹² , ¹³ , ¹⁴ Now, countries are racing to vaccinate their citizens. ¹⁵ Many countries are giving a third or booster dose of vaccines to their population. However, a cell‐culture‐based study suggests that several therapeutic antibodies might lose protective benefits against omicron SARS‐CoV‐2 variants. ¹⁶ Therefore, we are expecting that the omicron variant will infect a large proportion of people worldwide by the end of March 2022. The global SARS‐CoV‐2 immunity would be at an unprecedented high level due to the combined effect of mass vaccination and infection‐acquired immunity. Also, a South African study reported that omicron infections increase the delta variant neutralization capacity and reduce the ability of delta variant to reinfect. Also, preliminary data indicate that comparatively less pathogenic widespread omicron infections might help to reduce the global disease burden of the COVID‐19 pandemic. ¹⁷ So, the SARS‐CoV‐2 transmission rate will be low after the 1st quarter of 2022, according to our assumption. However, there will have some new variants of SARS‐CoV‐2, and a few of them might be deadly. The sustained SARS‐CoV‐2 might transmit again due to the opportunity created by the diminished immunity. During the winter months, countries will face the potential increase of SARS‐CoV‐2 transmission.

Also, we have learned lessons from the past influenza pandemics how they were brought under control. The 1918 influenza pandemic was highly mysterious and deadly that killed approximately 50 million people worldwide. ¹⁸ After 1918, the world has experienced the 1957 “Asian” influenza pandemic, the 1968 “Hong Kong” influenza pandemic, and the 2009 “swine flu” pandemic before the COVID‐19 pandemic. ¹⁹ The disease severity of earlier pandemics was associated with different factors similar to SARS‐CoV‐2 infections such as viral, host‐related, underlying disease conditions, and social backgrounds. ¹⁹ During the influenza pandemic in 1918, different measures were taken to prevent and control virus spread. Many of those measures had very limited or no benefits at all. Many nations forced stringent quarantine to curb the viral spread. This strategy was unsuccessful in most nations due to the imperfect quarantine time or the quarantine breached by asymptomatic infected individuals. ²⁰ During the influenza pandemic in 1918, avoiding mass gatherings, proper wearing of appropriate facemasks, and proper following of hygiene rules were effective nonpharmaceutical interventions to control viral spread. ¹⁹ Finally, antiviral drugs and mass inoculations demonstrated a vital role in controlling the earlier influenza pandemics. ¹⁹ Therefore, the earlier pandemic responses contain lessons for preparedness and response to the COVID‐19 pandemic. Based on the ongoing and past pandemic control experiences, some COVID‐19 preventive measures are questionable to prevent and control omicron wave. ²¹ Therefore, we need to revise and update the COVID‐19 pandemic responses based on the past lessons, present experiences, and nature of the omicron variant. The healthcare authorities need to prioritize their support for patients for the next few months.

The future SARS‐CoV‐2 infections and COVID‐19 waves will have low impacts on human health due to earlier widespread exposure to the virus, immunization by updated vaccines, availability of improved antivirals, and protective measures taken by the vulnerable population during future waves. Therefore, we hope the COVID‐19 will turn into a regular disease for humans, and healthcare systems will adopt strategies to manage it. We assume the death toll in many countries during the omicron wave will be similar to the deaths caused by evil influenza in the countries of the northern hemisphere region. Therefore, the era of extraordinary safety measures to prevent and control SARS‐CoV‐2 infections will be ended after this massive wave due to the omicron variant. However, the COVID‐19 might be continued as a recurrent disease in the world.

CONFLICT OF INTERESTS

The authors declare that there are no conflict of interests.

AUTHOR CONTRIBUTIONS

Sohel Daria conceptualization, performed literature search, and writing original draft. Md. Rabiul Islam conceptualization, data interpretation, revising the original draft. Both authors critically reviewed the manuscript for intellectual content and agreed on the decision to submit for publication.

DATA AVAILABILITY STATEMENT

Data sharing are not applicable to the current study.