In November last year, when reports of a new COVID-19 variant reached our shores, there was a tendency to fixate on what, according to early sketches of the variant, appeared to be a seed of hope: Omicron, we were told, was mild.
Subscribe now for unlimited access.
$0/
(min cost $0)
or signup to continue reading
The self-evident implication, of course, was there was no immediate cause for concern. Cue relaxed restrictions and vigilance.
A firestorm of Omicron infections across Australia has since upended life, occasioning a headlong descent into near-calamity.
Deaths are mounting, the health system is in unprecedented crisis and thousands are entering isolation in droves - the latter of which is crippling supply-chains, with business closures and empty supermarket shelves the most obvious of casualties.
Yet beneath this grim reality a deceptively reassuring narrative has taken hold in some quarters. The inevitable fall of Omicron, many have said, will mark the end of the pandemic and life will resume according to 2019 pre-pandemic settings.
The general tenor of the argument is that COVID-19 will become so prevalent, so widespread within the community, it will assume an endemic state - much like seasonal flu or the common cold.
But even the most optimistic of epidemiologists call this wishful thinking.
Part of the problem owes to a basic misunderstanding of what is meant by endemic in a scientific sense.
Leading epidemiologist Nancy Baxter, head of the school of public health at the University of Melbourne, said the view COVID-19 would soon become endemic was only true so far as it was clear "it's not going to disappear".
"The idea the spread of COVID is going to become predictable and stable - something reliably manageable - is wrong," Professor Baxter said.
"It will never be endemic in that way, in the true sense of the word.
"It's an epidemic disease; you're always going to have these waves of transmission where infections grow rapidly and then fall and that's because of waning immunity, because some people aren't vaccinated and because new variants will emerge."
In other words, the virus will always hunt and find the unvaccinated, the under-vaccinated and the vulnerable.
There's also no biological reason to suppose COVID-19 will necessarily become milder over time, either. Delta was not milder than the original ancestral strain of the virus. And nor is Omicron.
Omicron is milder than Delta, but it didn't evolve from Delta; it developed from the ancestral strain quite independently of Delta.
The reason Omicron gives the appearance of being milder than the original virus is due to a combination of high vaccination and prior infection. The population is simply better defended than it was in 2020 when the Wuhan strain colonised much of the world.
"There's no reason, no guarantee, the next COVID variant is going to be milder," Professor Baxter said.
"And we've seen [with Omicron] that we've been completely unable to cope with a rapid change in the characteristics of the virus."
Smallpox, it's also worth noting, followed the same pattern of transmission as COVID-19 for thousands of years, but it was not the long march of time which made it less toothy or deadly. It was vaccination.
Why is it, then, that new iterations of COVID-19 are bound to emerge for years to come?
The answer, experts say, is twofold. First, we need to remember COVID-19 is a zoonotic pathogen; the original ancestral strain of the virus - which started all of this misery - emanated from one little bat.
And precisely because animals are an alternative source of infection for COVID-19, it's near impossible to eradicate the virus through vaccination, as we did with smallpox.
"Bats were the original source of COVID," Professor Collignon, an infectious disease physician with ANU, recently said.
"The trouble is, whenever you have an animal reservoir [for a virus] - even cats and dogs can get [COVID] to a mild degree - then it's very difficult to get rid of altogether through vaccination.
"That's why I think we just have to accept [COVID-19] is here, and it's not going to go away."
The second part of the equation, in Professor Baxter's view, goes to the uncontrolled spread of COVID-19 around the world, including in Australia.
When a virus infects someone, it automatically starts to replicate in the body (the host). On rare occasions, it makes errors in replication, and sometimes the virus survives those errors. The end result, in these circumstances, is a new variant.
Under normal circumstances, Professor Baxter said, the probability of mutations occurring is remote, and any mutations that do occur, whether or not they make the virus more virulent, are "entirely random".
"Mutations are quite rare, but when you have the virus spreading amongst billions of people, that unlikely event suddenly becomes almost certain to happen," she said.
"That's why if we really want to reduce the chances of new variants occurring, we need to control it everywhere."
It's one of many reasons why it was profoundly wrong to say the spread of Omicron, because it was comparatively milder than it's nasty relative, Delta, didn't matter. Still less that it might even be a good thing because it would engender herd immunity by natural infection.
It's true, experts say, that COVID-19 infection does provide a person some protection against re-infection from the same variant, but there's no guarantee that same immunity will protect against a different variant.
Leading epidemiologist James Trauer, who heads the epidemiological modelling unit at the Monash school of public health, said while there was no evolutionary advantage to a virus becoming more virulent, that wasn't so when it comes to transmissibility - its sheer contagiousness.
"There's no real selection advantage behind the virus getting more or less severe - that part of the equation is random," Associate Professor Trauer said.
"But there's always a clear incentive for it to become more transmissible."
IN OTHER NEWS:
The point is, if a new variant is more transmissible, by definition that means it is more immune evasive. And, as Delta and Omicron have already shown us, the immunity afforded by vaccination and prior infection is less durable, less effective, against new variants.
The good news, say optimists, is that our vaccines have proved to be fairly effective at preventing catastrophic rates of serious illness and death, whatever the variant.
While true, the sobering reality is that nearly half the people with Omicron currently in Victoria's hospitals are double vaccinated.
Moreover, the acute strain caused by even the very small percentage of people who have ended up in hospital, coupled with staff furloughs, has brought the hospital system to its knees. Unprecedented, state-wide "code brown" emergency declarations are hardly issued lightly.
Because the emergence of new variants is inevitable, Professor Baxter said governments and wider society needed to invest in evidenced-based steps beyond vaccination which slow transmission and afford room to sensibly adapt to new variants.
"We can't live with the virus if we ignore the virus, and if we're only focusing on vaccines, that's what we're doing," she said.
"In order to live with COVID, we must modify our behaviours to try to avoid transmitting COVID - so societal acceptance of mask wearing and investment in indoor air quality and mandatory ventilation in all schools and workplaces.
"One of the challenges is government is unwilling to accept things could have been done better, so there's a real danger of a lack of political will to learn and improve. I think you can see that with the booster rollout in aged care, and we also saw it with the whole nonsense of non-urgency around vaccination last year.
"It's good to set a roadmap, but we shouldn't be proud of following a roadmap set eight or nine months ago that is to a destination that we're not even going to anymore."
On that view, perhaps the most significant threat to society is not so much the misery any new variants are liable to unleash, but the reluctance of government to stop grieving for our pre-pandemic equilibrium and look to the future with vision.
History, after all, shows change is upon us. Periods of great turmoil and upheaval - whether war, famine, revolution and, yes, pandemics - have invariably proved a catalyst for profound change.
There's no reason this pandemic should end any differently - which, by the way, experts have suggested could be up to 10 years away.
