The Lancet surrenders and declares COVID pandemic is almost over
The Lancet, published since 1823, is universally recognized as one of the top medical publications in the world, though it damaged its reputation by publishing and then subsequently retracting a study attacking the use of hydroxychloroquine as a therapy for COVID. Still, the retraction was the right thing to do, and it is hardly unprecedented in the history of academic and medical publishing.
In an article published January 19, The Lancet throws cold water on those merchants of panic who wish to use COVID as an excuse to rob people of their civil rights.
"COVID-19 will continue but the end of the pandemic is near" is the title of the article by Christopher J L Murray. It makes the point that has been made on these pages: omicron is far more contagious and far milder than previous variants, which is what happens when epidemics start to die down. (Footnotes removed for ease of reading.)
The world is experiencing a huge wave of infection with the omicron variant of SARS-CoV-2. Estimates based on Institute for Health Metrics and Evaluation (IHME) models suggest that on around Jan 17, 2022 there were 125 million omicron infections a day in the world, which is more than ten times the peak of the delta wave in April, 2021. The omicron wave is inexorably reaching every continent with only a few countries in eastern Europe, North Africa, southeast Asia, and Oceania yet to start their wave of this SARS-CoV-2 variant. The unprecedented level of infection suggests that more than 50% of the world will have been infected with omicron between the end of November, 2021 and the end of March, 2022. Although IHME models suggest that global daily SARS-CoV-2 infections have increased by more than 30 times from the end of November, 2021 to Jan 17, 2022, reported COVID-19 cases in this period have only increased by six times. Because the proportion of cases that are asymptomatic or mild has increased compared with previous SARS-CoV-2 variants, the global infection-detection rate has declined globally from 20% to 5%.
Understanding the burden of omicron depends crucially on the proportion of asymptomatic infections. A systematic review based on previous SARS-CoV-2 variants suggested that 40% of infections were asymptomatic. Evidence suggests that the proportion of asymptomatic infections is much higher for omicron, perhaps as high as 80–90%. Garrett and colleagues found that among 230 individuals in South Africa enrolling in a clinical trial, 71 (31%) were PCR positive for SARS-CoV-2 and had the omicron variant and no symptoms. Assuming this prevalence of infection was representative of the population, the implied incidence compared to detected cases suggests that more than 90% of infections were asymptomatic in South Africa. The UK Office for National Statistics (ONS) infection survey estimated a point prevalence of PCR positive SARS-CoV-2 infection of 6·85% for England on Jan 6, 2022. Hospital admission prescreening of individuals without COVID-19 symptoms in the University of Washington Medical Center in Seattle, WA, USA, did not exceed 2% throughout the COVID-19 pandemic but exceeded 10% in the week of Jan 10, 2022 (Murray CJL, unpublished). In addition to the much larger proportion of asymptomatic infections, in the USA the ratio of COVID-19 hospitalisations to detected cases hospitalised has declined by about 50% in most states compared with previous peaks. The proportion of COVID-19 patients in hospital who require intubation or are dying has declined by as much as 80–90% in Canada and South Africa. (snip)
The impacts of future SARS-CoV-2 transmission on health, however, will be less because of broad previous exposure to the virus, regularly adapted vaccines to new antigens or variants, the advent of antivirals, and the knowledge that the vulnerable can protect themselves during future waves when needed by using high-quality masks and physical distancing. COVID-19 will become another recurrent disease that health systems and societies will have to manage. For example, the death toll from omicron seems to be similar in most countries to the level of a bad influenza season in northern hemisphere countries. The US Centers for Disease Control and Prevention estimated the worse influenza season during the past decade in 2017–18 caused about 52 000 influenza deaths with a likely peak of more than 1500 deaths per day. The era of extraordinary measures by government and societies to control SARS-CoV-2 transmission will be over. After the omicron wave, COVID-19 will return but the pandemic will not.
Hat tip: James Lewis.