Is the Pandemic Over?

Over the course of 18 months starting in early 1918, the Spanish flu pandemic infected about a third of the world’s population, which was then 1.9 billion. It killed an estimated 20 to 50 million, or 1 death per 40 to 100 people.

The U.S. death total was 675,000 in a population of about 100 million, about 1 in 150.

It is difficult to say how accurate these numbers are worldwide as even today the reported worldwide death total is suspect with a reported about 6 million deaths in a world population of nearly 8 billion, or about 1 death per 1,300 people.

In the U.S., we can reliably say the total COVID-19 death total is about 965,000 in a population of about 330 million, about 1 per 350.

Three Waves 

The Spanish flu ran through three waves with the last one starting in the winter of 1919, and running its course by late spring and then it was over. [I will not comment on why it was called the Spanish flu but suffice it to say it did not originate in Spain, which makes for an interesting Google search.]

Today, the Spanish flu virus strains are still with us and is called H1N1 and is defended among many other viruses that we are exposed to by our annual flu shots.

So, is this what we are seeing with the omicron variant of SARS-CoV-2?

Is it really over and by that, I mean have we transitioned from a pandemic to an endemic where we live with the virus in a more normal manner as we do now with so many other viruses?

I wish I wrote this article two months ago because I would have predicted then that this is our last wave given the early data out of South Africa, where the omicron went on a rampage, but deaths did not follow proportionately. The media, as well as governing authorities, would never be quick to pronounce publicly such an optimistic assessment, and rightly so as it might have encouraged complacency that would have magnified the caseloads and the burden on hospitalizations.

And yes, that still happened because caseloads reached unprecedented levels and so even if omicron is much less virulent, hospitalizations and deaths still rose alarmingly, but not at the percentage of the delta variant.

Behind the scenes I think learned bodies believed cautiously that this could be the last major wave.

The Trends 

So let’s look at some trends and see where we are heading. Chart 1 shows that the recent omicron variant struck very hard in Orange County as it did in Los Angeles County and throughout the country and world with peak caseloads nearly tripling from the previous largest wave due to the alpha variant at the beginning of the year, and about 10x that of this summer’s delta wave.

With the nearly vertical growth rate wherever it struck, it came as no surprise that we were bombarded by apocalyptic forecasts that the health care system might collapse yet again.

And in fact, hospitalizations did reach critical levels in many areas around the world, not because of high virulence but because of the sheer volume of cases.

As noted previously, in South Africa where omicron apparently originated, the severity of cases was rather muted relative to previous variants though not much was made of this at the time because of the recognition that South Africa has a young population, 27 years average vs. 38 years in the U.S., which might explain the lower severity.

Still, I made some bold statements back in early December, just as omicron was beginning to rip through the U.S., that this new variant might be our savior. Thankfully I am not (yet) wrong.

Chart Stories 

So Chart 1 tells one story and Charts 2 and 3 for hospitalizations and deaths tell another. Despite the huge omicron caseload, Chart 2 shows the number of hospitalizations peaked at only half that of the alpha wave, but still about double that of the delta wave last summer.

Chart 3 demonstrates that the death rate peaked at about one-fifth of the alpha wave and about even with the delta wave.

All this computes to a probability, averaged over Los Angeles County and Orange County, of being hospitalized and dying from COVID-19:  

• About 6.8% and 1.5%, respectively, for alpha.

• About 7.8% and 0.9%, for delta.

• About 1.8% and 0.15%, for omicron.

Now the high death rate for alpha was mostly due to the unavailability of vaccines at the time. However, delta statistics occurred after a near plateau level of people decided to be vaccinated and so is a better comparison to omicron in terms of virulence and we might then conclude that omicron is about one-fifth as severe as delta at least in Los Angeles County and Orange County.

Even though the death rate is greatly reduced and coming down further, we need to be mindful that omicron is still a killer and sadly as of Feb. 10, the daily death rate in the U.S. was nearly 3,000, close to it all-time peak.

Sadder still is that about 93% of these deaths occurred among the unvaccinated, according to the CDC in January, and arguably were avoidable.

Editor’s Note: Jack A. Syage is CEO and co-founder of Newport Beach’s ImmunogenX Inc., an early stage developer working on clinical trials of celiac disease. Syage, who holds a Ph.D., has published over 130 papers, delivered about 100 invited talks and has over 30 U.S. patents issued or pending.