With new cases of COVID-19 soaring and hospitalizations and deaths from the disease ticking up, this winter is starting to feel a lot like last. But it’s important to keep in mind that “we are not in the same place we were last winter,” says Rachael Piltch-Loeb, a preparedness fellow and research associate at Harvard T. H. Chan School of Public Health.
More than 205 million people in the United States are now fully vaccinated against COVID-19, and those who do fall ill have greater access to treatments that can help blunt the impact of the virus. “We're in a better place in terms of what we know about the virus, overall … and we are getting better at understanding what we can do to prevent spread and to protect individuals,” Piltch-Loeb says.
Even with the omicron variant threatening to upend some of these advances, experts expect progress to continue into 2022. Here are five ways the pandemic will likely be different in the new year.
1. Treating COVID could get easier
Americans are heading into the new year with two new treatments for COVID-19. The U.S. Food and Drug Administration (FDA) on Dec. 22 authorized a first-of-its-kind pill from Pfizer that can prevent a coronavirus infection from causing serious illness in people who are most at risk for COVID complications. Another oral antiviral treatment, from drugmaker Merck, got the OK from regulators soon after.
There have been a handful of lifesaving treatments throughout most of the pandemic for people who come down with a bad case of COVID-19. Access to them, however, has been limited since they are only given by injection or IV in a hospital or health facility. The new pills from Pfizer and Merck will be available at pharmacies with a prescription, moving COVID treatment to the outpatient setting, says Ashley Drews, M.D., an infectious disease specialist at Houston Methodist. “It's really very exciting,” she says, adding that early studies show that the pills are expected to be effective against the fast-spreading omicron variant.
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Experts caution that rapid, reliable and accessible testing will be key to the drugs’ success. “The longer [people] wait [to take the pill], the more steam the virus is able to acquire and the less likely it is that these medicines will help,” Mark Rupp, M.D., a professor in the department of internal medicine and chief of the division of infectious diseases at the University of Nebraska Medical Center, told AARP.
Another point to keep in mind: The pills do not prevent COVID-19, so they won't be a substitute for getting vaccinated.
2. At-home testing will play a bigger role in slowing the spread
Demand for rapid at-home tests (also called rapid antigen tests) skyrocketed at the start of delta’s dominance. And now with the emergence of the omicron variant, a growing number of people are turning to self-swabbing before socializing.
Results from a standard PCR test (short for polymerase chain reaction), commonly taken at doctors' offices and testing sites, can take days to come back. Experts say that by then, your status could have changed, because it’s possible to get infected while waiting for your test results.
“What rapid antigen tests do is answer the question ‘Am I infectious right now?’ ” says Joseph Allen, an associate professor at Harvard T.H. Chan. “If you think about it, that's the question we want answered when we visit people.”
Health officials have vowed to make over-the-counter testing more accessible in 2022. The federal government says it is “on track” to quadruple the country’s supply of rapid at-home tests. It’s also paving the way for private insurers to reimburse policyholders for the cost of these tests (about $25 for a box of two) — a change that could come into effect by mid-January — and for health centers and rural clinics to distribute them for free. The Biden administration also announced on Dec. 21 that it plans to purchase a half-billion rapid at-home tests this winter, to distribute for free to Americans who want them.
What will be critical as this expanded at-home testing plan rolls out is for people “to be really clear about what the protocol is,” Harvard’s Piltch-Loeb says. If you test positive, the Centers for Disease Control and Prevention recommends staying away from others for 10 days; people who are asymptomatic or whose symptoms are resolving can shorten that isolation period to five days as long as they continue to wear a mask around others for an additional five days. You should also check in with your health care provider, especially if you have any underlying conditions that put you at risk for complications.
“If you're vaccinated and boosted and you have a negative rapid test, you can feel quite confident that you're not infected and also that you're not a threat to somebody else, even somebody else who is very high risk,” Allen says.
3. With omicron, the focus on boosters will be big
There’s still a lot to learn when it comes to omicron, but one thing health experts say with certainty so far is that a booster shot is key to building the best defense against the highly contagious variant.
The reason? Omicron has several mutations that make it better able to sneak past the safeguards a standard vaccine dose provides. Two shots of Pfizer or Moderna will give you some protection against the new strain, but the standard series “is not as good as you might like — it's not as good as it was against the original virus,” Francis Collins, former director of the National Institutes of Health (NIH), explained during a recent AARP tele-town hall. A booster dose, however, ramps up the antibody response and “gives you much better protection against omicron — up in the space of 80 percent or so. And that's really an encouraging finding,” Collins added.
So far, only about 33 percent of the U.S. population has received a booster shot, even though everyone 16 and older is eligible for one six months after taking the two-dose Moderna or Pfizer vaccines or two months after getting the Johnson & Johnson shot. At the moment, a variant-specific vaccine isn’t needed, health experts say, but that could change down the road. Both Moderna and Pfizer are working to develop boosters specifically designed to stand up to omicron, and these new formulations could be ready as early as spring.
“If you haven't yet gotten that booster, if you've been putting it off or you weren't quite sure if you needed it, this is the moment to get that arranged,” Collins said. “Because omicron is going to be a real challenge for all of us, and the booster is your best protection.”
4. We should learn more about long COVID
Many individuals recover from COVID a few weeks after being infected. But there are millions of others (an estimated 10 to 30 percent of survivors) who, after a COVID-19 diagnosis, suffer for months from lingering effects that can interfere with everyday life, ranging from fatigue to brain fog.
Clinics have popped up nationwide to help people with what is commonly dubbed long COVID. And just recently, the NIH launched a large-scale study “to try to really dig deeply into understanding what's causing this, how to prevent it and then how to treat those people who are suffering from it,” Collins explained to AARP.
The studies under the NIH initiative are expected to provide insights over the coming months, the agency says. A number of other research efforts focused on the phenomenon are also underway.
5. We can expect to see more variants
If you haven’t already done so, now is the time to bone up on the Greek alphabet, because you’re only going to be hearing more of it over the next year. Piltch-Loeb says that new variants of the coronavirus are “definitely” expected in 2022.
“The reality is that variants continue to emerge as the virus continues to spread,” she says. And with less than half of the global population fully vaccinated against COVID-19, its spread is expected to continue, especially with omicron in the picture.
The promise of new variants, however, doesn’t guarantee new dangers. Unlike delta, some strains have emerged and fizzled out. The big question is whether any new variants will be able to evade the current suite of COVID vaccines, treatments and testing capabilities, or cause more severe illness among those who get infected.
Delta and omicron have had some compromising effects on these tools but haven’t rendered them ineffective so far.
To keep the virus from “becoming a more aggressive and menacing pathogen,” Thomas Denny, chief operating officer of the Duke Human Vaccine Institute, says, “we have to use every resource and every tool we have to suppress it.” That includes getting vaccinated and boosted, wearing a mask in public and steering clear of crowded situations.
“Hopefully, we’ll get another generation of vaccines … that will prevent even transmission of the virus or certainly not require us to have so frequent level of boosting. Until then, we’re going to have to remain on guard and utilize good, sensible public health prevention techniques,” Denny says.
Flexibility remains key as we enter another year
One of the greatest challenges that has emerged during the pandemic has been “coping with the uncertainty that comes from tracking an evolving virus,” Piltch-Loeb says. But maintaining a sense of flexibility — be it around new vaccine recommendations or masking guidelines — is critical as we try to fight our way back to normal.
“This has been an ongoing response to an evolving scientific situation and will continue to be that, a little bit, for some time to come,” Piltch-Loeb adds.
Eventually, experts predict that COVID will reach a more manageable state, like the seasonal flu. In order to get to that point, though, Houston Methodist’s Drews says we need to see a dramatic decline in cases, hospitalizations and deaths. Community transmission rates also need to drop, and immunity from vaccination or infection needs to rise.
“And when all of those things occur, then we would really reach an endemic [state], rather than epidemic or pandemic state,” she says.
Editor's Note: This story, originally published on Dec. 21, 2021, has been updated to reflect new information.
Rachel Nania writes about health care and health policy for AARP. Previously she was a reporter and editor for WTOP Radio in Washington, D.C. A recipient of a Gracie Award and a regional Edward R. Murrow Award, she also participated in a dementia fellowship with the National Press Foundation.