Omicron cases are falling rapidly, and the next few weeks could show where the pandemic is going

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Within the next few weeks, we’re going to reach a critical moment in the COVID-19 pandemic—one that will tell us whether we’re in for that long-awaited near-normal by summer, or whether we’re going to go on fuming and arguing over the appropriate level of social distancing indefinitely.

Over the last week, the United States averaged over 440,000 new cases of COVID-19 per day. That’s almost twice the levels seen at this time a year ago, before the nation settled down into a period where everything seemed “almost over” … before the delta variant rose up and smacked us in the collective face. Still, the rates of new cases have fallen by over 40% in just two weeks. All signs are that the rates are still falling, particularly in New York City and other urban areas that were among the first locations where omicron exploded. 

This is bringing the nation closer to a critical moment. One that could determine whether we’re enjoying our spring, or wearing masks into the new year. And it’s not a matter of whether people are so tired of the pandemic that they’ll simply give up. We’re about to get an answer to a much more interesting question: For all the pain it’s causing, will omicron help us finally clean up this mess?

Almost from the start of the omicron outbreak, journalists and officials have been pointing at South Africa as a model for what comes next. There are good reasons involved. There is also a good deal of wishful thinking. Here’s what the pattern of new cases looks like in South Africa.

Daily new cases of COVID-19 in South Africa show consistently “clean” peaks reflecting equally consistent policy

Like most nations, South Africa has seen four peaks to the pandemic. These include the original onset in spring of 2020, the worldwide surge that came over the 2020-2021 winter, the delta surge the following summer, and the latest omicron-driven wave. But what’s notable about each of these waves in South Africa is that they’re very “clean.” A national policy that was quick to react to the changing threat saw the country issuing school closings, local and regional lockdowns, mask mandates, and required testing to address threats as they came. The result was that, in South Africa, all these waves, not just omicron, saw swift declines to periods in which cases were at low levels nationwide.

Importantly, South Africa went into the omicron surge with the delta wave essentially extinct. Case counts when the new variant appeared were at their lowest since the early months of the pandemic. A nation-wide monitoring program helped locate and isolate omicron cases as they appeared and relatively strict nationwide rules for quarantine remain in effect. Despite an overall vaccination rate less than half that in the United States, South Africa’s omicron peak was only marginally higher than  the winter 2021 and delta peaks.

Another pattern can be seen in Japan. The combination of regulations, high vaccination rate, and social norms that endorsed the use of masks saw that nation ride through the first three waves with significantly lower case counts when compared to other large nations.

COVID-19 case counts in Japan show omicron leapfrogging the protection levels that had thwarted previous waves

Though a society that widely supports the wearing of masks—and overcoming decades of national anti-vaxx sentiments to achieve a vaccination rate almost 10%  higher than the United States—had been sufficient to greatly suppress previous waves, omicron blew past those defenses to peak at a level over 3x greater than the worse of past waves. Israel shows a very similar pattern.  

A very, very different pattern can be seen in the U.K.

COVID-19 cases in the UK clearly show the moment over the summer when the government dropped many protections

Just as the U.K. was going into the delta wave, Prime Minister Boris Johnson carried through on plans for “national freedom day”—the day when many national policies requiring restrictions on businesses, schools, and social gatherings were dropped. As a direct result of this decision, the delta wave in the U.K. … wasn’t a wave. It was more a “sea-level rise,” one that brought the level of cases up to a point 20 times greater than previous to delta, and left them stranded there. 

This pattern isn’t a great match, but it’s somewhat closer to what has happened in the United States, where a cascade of differencing policies, Republican governors out to prove their “toughness” by placing citizens at risk, and an incredible reluctance to impose any rule that might dent business, has resulted in a pattern where there simply was no real end to the delta wave.

Like the U.K., the U.S. went into omicron with delta cases still raging.

The U.S. saw a pattern that emulated, in part, the sharp peaks of Japan and Israel. Its pattern also reflects, in part, the merged waves of the U.K.

But what does it mean? Because of the varying policies on masks, widely different vaccination rates, and the rising tide of anti-vaxxer and anti-science supporters in the U.S. … how do we know what happens next? Is the U.S. headed for a “clean” exit from omicron that will see case rates drop toward the levels seen last summer, or will the end of omicron look more like the non-end of delta, leaving the nation in a confusing, infuriating state where exhaustion could lead to some genuinely awful decisions that only serve to make things even worse?

Here’s the magic number to look for: 75,000.

If the decline in cases falls below that level, then it has broken through the “floor” represented by the case levels from delta going into the start of the omicron wave. That probably represents the results of this early omicron study coming into effect. 

That study, from the Africa Health Research Institute, indicated that while past infection with delta or older variants provides little immunity against omicron, infection with omicron offers a fair level of immunity against near term infection with delta. What’s more, that level of protection was much better if you were vaccinated.

If the U.S. breaks through the 75,000 cases a day level, especially if it does so in the next few weeks, with cases still in rapid decline, it could show that the level of omicron infection, combined with the still increasing level of vaccination (63.8% at two doses, 41% with booster), could be enough to effectively limit community circulation in some areas. Omicron’s ability to provide some one-way protection against delta might actually help to end a wave that was showing no signs of ending on its own.

Of course, the cost for this has been extremely high. In the last ten weeks, the U.S. has seen more cases of COVID-19 than in all of 2020. And there’s one place where the pattern in the U.S. is a poor match for any of the nations mentioned above: deaths. Other nations have seen case fatality rates drop in both the delta and omicron waves. In the U.S., that decline has been much smaller. Over the last month, case fatality rates have actually gone up.

Deaths in the U.S. are now running at a level of over 2,300 a day after rising every week since the beginning of December. Hospitals in many areas are still full to overflowing. And with many of the least vaccinated areas in the nation coming late to the omicron wave, both deaths and hospitalizations may continue to rise for weeks to come.

Don’t make a mistake, omicron was in no sense a “blessing.” It wasn’t the magical “mild” version of COVID-19 that some confidently, and incorrectly, promised would could along to save a nation unwilling to take basic steps to save itself.

The price for omicron’s “assistance” in this matter will be measured in tens of thousands, if not hundreds of thousands of deaths, as well as millions of people debilitated by an illness that may last a lifetime. Whether there is any silver lining in this extremely dark cloud is something we should know very soon. The answer could be a definitive yes, an absolute no, or something more mixed. For example, even as the U.K. as a whole is still seeing a high level of omicron, Scotland, where more stringent rules have remained in place, has seen a much more rapid decline in cases. But even there, the number of daily cases coming out of the omicron surge appears to be higher than it was going in.

Watch this space. And check the numbers.