The year in Covid-19 and the year ahead.

We've had triumphs and setbacks. Here's what's to expect in 2022.

2022 is upon us and a disease officially known as “Coronavirus Disease 2019” is still wreaking havoc.

Let’s review where we’ve been and where we’re headed.

2021: The year began with the mass rollout of tremendously effective vaccines. Combined with seasonal changes, Covid-19 looked, for a time, to be in retreat. Then came the Delta variant. The year ended with yet another setback, the Omicron variant bursting onto the scene.

Far more contagious (and perhaps slightly less virulent), Omicron is now the dominant cause of Covid-19 in the United States. It seems that it’s only a matter of time before Omicron reaches all corners of the world. Right now, Omicron is tearing through large US cities, often infecting younger populations who are less vulnerable to severe Covid-19. While we await definitive data on how well our vaccines hold up, it looks like infections will be more common, but that the vaccines will provide ample protection against severe disease and other long-term consequences. As I’ve written extensively, the death and suffering the Omicron variant causes may be substantially less than previous waves for those with immunity, be it from infection, vaccination, or both. But the sheer contagiousness of Omicron means that hospitals will soon face a troubling combination: healthcare workers temporarily sidelined with mostly mild Covid-19 (translating to less capacity to care for the sick) and an influx of unvaccinated or under-vaccinated (i.e. unboosted seniors) people who will soon find that this variant is not remotely “mild.”

And perhaps more than anything, that’s the story of 2021. In the United States, over 77% of people ages 5 and up—over 240 million people—have received a dose of an authorized or approved Covid-19 vaccine. And yet, over 125 million US residents are not fully vaccinated; even fewer who need a booster have received one. On one hand, we know that vaccines have already saved millions of lives. On the other, far too many remain vulnerable.

So, we end 2021 in the midst of the Omicron wave. In every state, county, town, and hamlet, the outcome of this mass-casualty-event-in-progress depends upon vaccination rates, the underlying health of these communities, and, scarily, on hospital capacity. If vaccination rates continue to rise, and circuit breakers are used to keep hospitals safe, the mayhem can be minimized. To a great extent, the end results lies in our hands and in our choices.

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2022: Are we destined to live variant-to-variant? For now, it’s reasonable to assume so. But with each variant, we will get better at predicting whether our vaccines will hold up and we’ll have more information about the biology of a variant sooner. Indeed, as Omicron has proven, scientists are up to the challenge of assessing new threats quickly. In just a month, we already know more about Omicron than we know about some other viruses that have been circulating for ages. So, in 2022 and beyond, we can expect more moments of uncertainty, but we should also anticipate that those moments will be briefer and our response swifter and smarter each time.

Here are some things to look forward to, as we continue to use scientific and medical progress to improve our ability to fight Covid-19.

•Pediatric vaccines. Children under age 5 remain the last group to have no protection against this virus—though thankfully the virus causes many fewer severe illnesses in young children than adults. Recently, Pfizer/BioNTech announced disappointing news that its clinical trial assessing its mRNA vaccine in children ages 6 months to under 5 years of age failed to generate adequate antibody responses after two low doses. (Scientists had hoped that giving a lower dose to this younger age group than the dose received by 5- to 11-year-olds would be effective.) Unfortunately, it didn’t work well enough, particularly in children ages 2-5. Now, researchers are testing to see whether a 3rd jab of that same low dose will get those kids over the hump. Is this the right strategy? Given this setback, researchers had two main options: They could either try a 3rd injection at the same dose and hope that would do the trick, or they could start over with an entirely new cohort of kids, this time trying a higher 2-dose series. I’m nervous that they’ve chosen the wrong path. Part of me wonders whether researchers should be trying both strategies in tandem and adopt the strategy that’s found to work best. Pfizer/BioNTech says they hope to have results and an FDA emergency use authorization filing by the middle of 2022. Moderna may have data sooner, perhaps within the first two months of the new year.

•Newer and better vaccines. As well as our vaccines have performed, can we do even better? While it remains early, US Army researchers are conducting trials of a new vaccine that could be effective not just against the variants that we’ve already endured, but future ones. Recently, animal trials showed favorable results. Now small human trials have shown early signs of hope too. The vaccine uses newer technology that allows scientists to program not just one but many “antigens” onto a small “nanoparticle.” That means that when injected, the body is exposed to many aspects of SARS-CoV-2 (and other coronaviruses) at the same time. The thought is that our immune systems will develop a more diverse repertoire of defenses.

•More therapeutics. Both Pfizer and Merck have shared favorable results for their respective Covid-19 pills. Whether they work as well in practice as they did in the trials remains to be seen. Distribution will also be a challenge. Meanwhile, the anti-depressant medication fluvoxamine is being studied further to see if lower doses are as effective as the doses used in the two successful clinical trials published so far. While monoclonal antibodies have faced setbacks, their effects possibly negated by Omicron, new ones may be on the way. That said, intravenous infusions are always more difficult to scale up and are costly.

•More rapid testing, better rapid testing. Any reader of this newsletter knows that I’ve long felt that rapid testing was under-utilized. It’s clear that the Biden administration has finally gotten the memo. That means that if another variant shows up, we’ll be better able to track it and control it. In addition, as more people are vaccinated against Covid-19, this wretched disease will likely take its place alongside a number of other viruses that we routinely encounter. That’s not to downplay them. In fact, in the future, I think rapid testing for a variety of other viruses that cause severe disease in some populations will change the game. If we can detect contagious influenza and other viruses in 15 minutes the way we now can for SARS-CoV-2, we’ll be able to stop outbreaks, whether in schools or nursing homes.

Early in 2020, I told CNN’s Michael Smerconish that if we paid attention and improved our public health responses, at some point we might save more lives than Covid-19 ever claimed. It’s 2022 and we are nowhere near that point, sadly. But that future is ours to capture, and I remain optimistic that someday we will in fact reach that point.

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