There’s not going to be a single moment when COVID-19 becomes just a part of normal life in Colorado — no ball drop when the way we’ve lived with the virus for almost two years changes forever.
Instead, public health experts say, the state likely will face a lengthy in-between period as immunity in the population reaches some sort of equilibrium with the virus, with progress and reversals along the way.
Right now, COVID-19 hospitalizations are dropping in Colorado, though more than four times as many people are receiving care as were in July. New cases also are falling, though they remain at record levels.
The virus’s omicron variant spread so widely that experts project it will give Colorado at least a few months of relative peace, but no one’s quite sure what will happen as people’s recently acquired immunity, through booster or infection, starts to wane.
Political leaders and some scientists have expressed hope that omicron’s pervasiveness means the virus has become endemic, or a permanent part of life that people manage without too much disruption. Before the omicron surge, Gov. Jared Polis reiterated that he believed the pandemic “emergency” was over — a declaration he’d first made last summer — and said Coloradans would learn to live with the virus as they do with the seasonal flu.
Yet omicron infected so many people so quickly as it swept the state in late December and early January that it disrupted everything from hospitals to restaurants. And while that wave has crested, COVID-19 deaths now are increasing in Colorado for the first time since the delta variant’s surge peaked in November.
The emergency phase may be over now that the public has access to vaccines, high-quality masks and timely testing, but the new normal isn’t here yet, said Scott Bookman, the state’s COVID-19 incident commander.
No one knows how long this transitional period will last or exactly what life will be like when it’s over, but the situation has improved dramatically from March 2020, he said.
“We have tools at our disposal to ensure that our society can function and that we do not breach our (hospital) capacity,” Bookman said.
From epidemic to endemic
While China and a few other countries are still pursuing “zero COVID” policies, it’s clear the virus is here to stay in the United States, said Dr. Jon Samet, dean of the Colorado School of Public Health.
“Endemic means it’s there and we live with it,” he said.
Broadly speaking, a virus becoming endemic means two different things: that it sustains itself in an area without being imported, and that it reaches an equilibrium, where cases continue at lower levels as children too young to be vaccinated and those with waning immunity are exposed, said Matthew Ferrari, director of the Center for Infectious Disease Dynamics at Penn State University.
SARS-CoV-2, the virus that causes COVID-19, has been established in the United States for two years now, but the country hasn’t yet reached an equilibrium, he said.
For some vaccine-preventable diseases, the equilibrium point is close to zero new cases each year, because protection provided by childhood vaccines is so durable, Ferrari said. That’s not likely to be the case with COVID-19, since immunity against mild infections wanes relatively quickly.
How severe those cases are is a separate question.
Despite the popular perception that viruses inherently evolve to be less severe, that’s far from guaranteed, Ferrari said. It’s likely that the average case will be less severe in the future because most people will retain some protection against severe illness from being vaccinated or surviving the disease, but the virus would still be dangerous for people who don’t have any immunity, he said.
“There are going to be fewer people seeing this for the first time,” he said.
Equilibrium isn’t here yet
While the omicron wave is abating and Colorado officials have said the emergency phase of the pandemic is over, new cases remain higher than in any previous wave, and more than 90% of general hospital beds and beds in intensive-care units are full.
Pre-pandemic, the average occupancy rate was 80% of beds in intensive-care units and 60% to 80% of general beds, according to the Colorado Hospital Association.
It no longer looks like the state is going to need to implement crisis standards for care rationing, and the squeeze on hospital emergency departments has eased somewhat over the last week, said Dr. Ramnik Dhaliwal, president of the Colorado chapter of the American College of Emergency Physicians.
But that hasn’t solved the underlying problem of not having enough staff to deal with the level of need in the community, which has been a recurring problem since the pandemic began, he said.
“We’re not out of the woods. That won’t happen for a while,” Dhaliwal said.
Hospitalizations and deaths remain well above what Coloradans are accustomed to accepting from respiratory viruses. More people were admitted to hospitals with COVID-19 in the first two weeks of January than were hospitalized with influenza during the entirety of the worst flu year of the last decade.
In the roughly month-and-a-half since Polis reiterated his declaration that the emergency was over during an interview with Colorado Public Radio, more than 1,000 people have died from COVID-19 — a greater toll than the flu had in any single season in recent memory.
The easiest and safest way to reach equilibrium faster is to get more people vaccinated, so they develop immunity without the risk of ending up in the hospital, Ferrari said. Vaccinated people also tend to clear the virus faster, reducing the odds a new variant will develop in their bodies and set back progress against the disease, he said.
“Vaccination is fundamentally a win-win,” he said.
Possible reprieve ahead, but will it last?
Many scientists, including Colorado’s state modeling team, expect at least a temporary lull in COVID-19 infections over the next few months, but disagree on whether the period of massive surges is over.
The omicron variant is so contagious that it ran through populations quickly and has relatively few people left to infect, since so many have at least temporary immunity from a recent booster shot or infection, Samet said.
The human immune system doesn’t tend to form lifelong protection against coronaviruses in the way it does against measles, however, so many of the people who are immune now will once again be susceptible to infection by fall, he said.
Omicron is new enough that there isn’t much data on how long immunity will last after infection, state epidemiologist Dr. Rachel Herlihy said. People who had it will likely be protected in the short-term, as will those who are up-to-date on their vaccines, she said.
Dr. Hans Kluge, director of the World Health Organization’s Europe region, said some “stabilization and normalization” could follow the omicron surge, because so many people will have gained some immunity. But Dr. Tedros Ghebreyesus, the head of the WHO, said conditions remain “ideal” for new variants to emerge because so many people remain unvaccinated, and that the next version of the virus could be better at evading immunity or more likely to cause severe disease.
Of course, if a new variant emerges that can outcompete omicron, all bets are off and the health system may not get any reprieve, Samet said. That’s what happened when omicron arrived just weeks after Colorado’s fall surge, largely driven by the delta variant, peaked in mid-November.
European health agencies are tracking a new descendant of omicron, currently called BA.2, but it’s not clear if that version will take off. Colorado has found one case of BA.2, but it doesn’t appear to be circulating widely, Herlihy said.
“The world will generate (variants) as long as we have not quelled the epidemic,” Samet said.
A chance to prepare
It’s possible, but not guaranteed, that COVID-19 could become more like a seasonal cold in the future, Samet said. If it does, though, the process will likely take years, he said.
While omicron is less likely to cause severe disease than previous variants, the next version of the virus may not be.
“That’s one vision of what could happen,” he said. “One lesson we keep learning is that we know less than we think we do.”
Reaching an equilibrium with a virus doesn’t necessarily mean that everyone can ignore it. While people with healthy immune systems might behave as they did before the pandemic when COVID-19 is circulating at low levels, they could be called upon to mask up again, get another booster shot, or take other precautions during periodic spikes.
Eventually, the health care system will be able to handle COVID-19 like it does other illnesses, with no need for state-run testing sites or buses delivering vaccines, Bookman said. At this point, much remains unknown about the long-term outlook for the virus, and the state is trying to prepare for a variety of scenarios, he said.
“This is going to be a gradual transition,” he said.
If COVID-19 continues to follow seasonal cycles in the way it has for the past two years, that will give states and health systems the ability to prepare as they do for flu season, Ferrari said. Ideally, systems also will prepare to quickly go back to a state of emergency if necessary, whether because of a new variant or another novel virus, he said.
“When we have regular and predictable dynamics, we can plan for them. We can staff for them,” he said.
What the future looks like will depend on how well the health care system retains skilled people and works together during spikes, as well as how large those spikes are, Dhaliwal said. The seasonal flu also causes spikes, but those are generally manageable because enough people are vaccinated, he said.
“The only way we keep ourselves out of crises is by learning from the past few years,” he said.
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