The rising case counts/Worldometer graphic

As people around the Pacific Rim started the week pondering the largely unpredictable, subterranean forces that spawned a new volcanic island and sent a tsunami racing across the ocean, the entire world was facing a new tidal wave of a different sort.

The SARS-CoV-2 pandemic that has caused wave after wave of Covid-19 infections and death has now sprung the mother of all waves in the form of a variant named omicron.

The Worldometer tracker reported the past week ended with a seven-day average of more than 2.8 million new infections per day.  That simply dwarfed the previous record, a seven-day high of 827,000 in April 2021.

Little countries, big countries, locked down countries, masked up countries, vaccinated countries and those only lightly vaccinated are all being inundated by infections.

The Netherlands, which locked down in mid-December in hopes of blunting the spread of highly infectious omicron, was giving up and reopening stores and schools with some restrictions this week.

“We are taking a calculated risk because we have to. Lockdowns are very hard on everyone and keeping everything closed is also bad for our health,” Health Minister Ernst Kuipers told Reuters. 

The Dutch government reported that more than 89 percent of its citizens had been injected with at least one shot of vaccine as of Jan. 6, more than 86 percent had received the recommended two doses, and more than half had been boosted by the third shot now being widely encouraged to minimize the consequences of the disease if infected.

Though the Worldometer tracker showed the seven-day average of new cases nearly tripling from roughly 12,500 per day at the end of December to more than 32,000 as of Sunday, the seven-day average for daily deaths had fallen from a peak of 62 on Dec. 13 to 11 by Sunday.

Netherlands infections/Worldometer graphic

Netherlands deaths/Worldometer graphic

Many doctors believe the omicron variant presents as a milder form of the disease than the original SARS-CoV-2 found in China in late 2019, the alpha variant that first appeared in the United Kingdom in September 2020 and the deadly Delta variant first identified in India in late 2020.

A South African study published on the website of MedRxiv concluded the same, but public health officials have been reluctant to publicly proclaim the variant less deadly, preferring to take a wait-and-see approach.

The MedRxiv study, which has not been peer-reviewed but was authored by some of the top doctors in South Africa, concluded that “in the Omicron-driven wave, severe COVID-19 outcomes were reduced mostly due to protection conferred by prior infection and/or vaccination, but intrinsically reduced virulence may account for an approximately 25 percet reduced risk of severe hospitalization or death compared to Delta.”

The big concern of the moment in many communities around the world is that even a small number of serious cases of omicron-driven Covid-19 will overwhelm medical facilities given the huge number of infections.

The U.S. Department of Health and Human Services (HHS) reports that on the national level more than 80 percent of the beds in intensive care units (ICUs) are now occupied, and Covid-19 patients are filling almost a third of them. 

Alaska ICUs are at 81 percent of capacity, according to the state Department of Health and Social Services, as infection rates in the 49th state soar like those in most other states and nations around the world.

Although Alaska is among the states least hard hit by Covid-19, the Worldometer tracker graphed much the same picture in the country’s northernmost state as in the Netherlands and much of the rest of the world:

Alaska infections/Worldometer graphic

The good news is that Alaska death rates have remained low. The seven-day average peaked at nine per day in September. Since the end of November, the average has fluctuated between one per day and zero.

Alaska deaths/Worldometer graphic

Milder disease?

There is much debate about what comes next.

Some medical professionals have challenged the idea that omicron is showing evolution toward a milder variant.

“It’s comforting to think there might be some tendency for SARS-CoV-2 to evolve toward a milder form. That’s not what we’re seeing here,”  Dr. Roby Bhattacharyya, an infectious disease specialist at Massachusetts General Hospital and Harvard Medical School, told NPR for a story which pooh-poohed that idea as “a growing narrative in the mainstream media, on social media – maybe even at your dinner table.”

“This narrative has arisen over the past month as scientists and doctors increasingly find evidence that the omicron variant of the coronavirus is less likely to cause severe disease than previous variants,” public radio claimed.

The truth is the narrative dates back to an analysis conducted by some of the world’s top virologists and published in Nature in July.

“Although the trajectory is difficult to predict, the conditions, concepts and variables that influence this transition can be anticipated,” they wrote at the time and offered three possible scenarios for the evolution of the virus.

The first and most worrisome, they wrote, “is that we will…face a future with ongoing manifestations of severe disease combined with high levels of infection that, in turn, could foster further evolution of the virus.

“A second and more likely scenario is the transition to an epidemic seasonal disease such as influenza. Effective therapies that prevent progression of Covid-19 disease (for example, monoclonal antibodies that reduce hospitalization and death by 70 to 85 percent) may bring the burden of SARS-CoV-2 infection to levels that are equivalent or even lower than influenza.

“However, we should remember that the annual mortality burden of influenza, in non-pandemic years, is estimated to be between 250,000 and 500,000 deaths, with up to 650,000 all-cause deaths globally, comprising around 2 percent of all annual respiratory deaths (two thirds among people who are 65 years and older). This is an extremely important health burden and equates to a relatively ‘optimistic’ view of the future of the Covid-19 pandemic.”

There was also the third and even more optimistic scenario that “the transition to an endemic disease similar to other human coronavirus infections that have a much lower disease impact than influenza or SARS-CoV-2.”

Unfortunately, so little is known about those viruses involved in what is called the “common cold” that the scientists said it is hard to make any kind of prediction there. T

Biological evolution is random. It spins off all kinds of mutants all the time. In the case of SARS-CoV-2, the next one could be worse, better or the same.

Natural selection, another key part of the evolutionary process, isn’t quite so random, however. It favors the plants and animals that can best survive. They tend to occupy and fill an ecological niche from which many competitors are then displaced.

The evolutionary argument for a weaker versus a stronger virus is that the weaker has a better chance of survival because it more easily stays in circulation. Infectious pathogens that quickly kill most of the animals they infect reduce their chances of spreading to new hosts.

SARS-CoV-2 so far has proven very good at both spreading and adapting, and that makes it a near certainty that it will not be eradicated.

Endemic

“To date, the World Health Organization has declared only two diseases officially eradicated: smallpox caused by variola virus (VARV) and rinderpest caused by the rinderpest virus (RPV),” notes the American Society for Microbiology.

And smallpox presented a rather unique case.

“Smallpox was a good candidate for eradication for several reasons,” the College of Physicians of Philadelphia records in its History of Vaccines. “First, the disease is highly visible: smallpox patients develop a rash that is easily recognized.”

That made it easy to spot and isolate the infected.

“Second,” the history records, “only humans can transmit and catch smallpox. Some diseases have an animal reservoir, meaning they can infect other species besides humans. Yellow fever, for example, infects humans, but can also infect monkeys. If a mosquito capable of spreading yellow fever bites an infected monkey, the mosquito can then give the disease to humans. So even if the entire population of the planet could somehow be vaccinated against yellow fever, its eradication could not be guaranteed. The disease could still be circulating among monkeys, and it could re-emerge if human immunity ever waned.”

SARS-CoV-2 has many more potential animal reservoirs.

So far, the only documented animal to human transmission has involved domesticated mink, but the U.S. Centers for Disease Control (CDC) reports research to date “shows that many mammals, including cats, dogs, bank voles, ferrets, fruit bats, hamsters, mink, pigs, rabbits, raccoon dogs, tree shrews, and white-tailed deer can be infected with the virus. Cats, ferrets, fruit bats, hamsters, raccoon dogs, and white-tailed deer can also spread the infection to other animals of the same species in laboratory settings.”

There are growing concerns that the white-tail deer – of which there are now an estimated 30 million in the U.S. – could become a serious SARS-CoV-2 reservoir.