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After omicron, what's next? Long Island doctors predict COVID-19's path

Dr. Bruce Farber, chief of public health

 Dr. Bruce Farber, chief of public health and epidemiology for Northwell Health, said about COVID-19: "Assuming there is no new variant that changes the trajectory of this pandemic, then I think we can have a reasonable expectation that we will be back to a reasonable life" after the omicron spike. Credit: Danielle Silverman

As the region faces surging COVID-19 cases and hospitalizations, medical experts say Long Islanders should prepare to live with the disease for years to come, but with the likelihood it will become less deadly over time.

Experts agree that variants, vaccination rates and other factors make it impossible to say with any certainty which path the pandemic will take. They foresee a time when most people can attend a crowded concert or sports game without overly worrying about getting seriously ill. But they say the need for precautions like mask-wearing may wax and wane depending on how the virus evolves.

What to know

Medical experts say people should prepare to live with COVID-19 for years to come, but that, as long as new, more dangerous variants don't emerge, the country should be able to return to a semblance of normalcy.

Even so, many people — primarily the unvaccinated will continue to die of COVID-19. Higher vaccination levels and new treatments will help control the number of deaths.

Despite its high level of contagiousness, omicron may in the long run have a silver lining, if it continues to dominate instead of a more virulent variant.

"Assuming there is no new variant that changes the trajectory of this pandemic, then I think we can have a reasonable expectation that we will be back to a reasonable life" after the omicron spike, said Dr. Bruce Farber, chief of public health and epidemiology for Northwell Health. "Even though COVID will be in the background, it won’t be the center of every aspect of every part of our life."

Greater uptake of boosters may help reach that point earlier, likely within the next several weeks, Farber said. If another particularly infectious or lethal variant emerges, then "all your predictions are screwed up in very short order," he said.

Omicron’s high level of contagiousness "may be a blessing in disguise," said Dr. Aaron Glatt, chairman of medicine and chief of infectious diseases at Mount Sinai South Nassau hospital in Oceanside. It’s better that omicron, which tends to cause milder illness than previous variants, is so dominant rather than a more virulent strain, like delta or one that has yet to emerge, he said.

"It’s going to be hard for another virus to overtake it," Glatt said.

That could mean a return to somewhat of a pre-pandemic normal, at least for a while, Glatt said.

"If those numbers start to drop and we don’t see any new variant coming along or any new issues coming along, I do see a return to normal," he said. "I do see a point where it’s reasonable to tell people if you’re vaccinated or maybe even if you’ve had omicron in the last half a year, you’re probably unlikely to get sick with COVID again at least for the immediate future. So it’s reasonable to go out without a mask, and it’s reasonable to conduct our lives as we did pre-COVID."

The next few weeks will be critical in seeing whether — and how low — caseloads drop, he said.

Doctor: 'There will be continuous deaths'

Even so, COVID-19 will, long term, continue to kill, with the level of deaths depending largely on vaccination levels, Glatt said.

"There will be continuous deaths from COVID of unvaccinated people, if COVID is still around," he said.

Farber said that, because COVID-19 is so much more deadly than the flu, the annual number of coronavirus deaths likely will be between the typical number of flu deaths and the current number of COVID-19 fatalities.

"Whether we’re going to accept 75,000 or 100,000 or 200,000 [annual deaths] — it will be some number, because I don’t see this virus going away," Farber said. "But I do think that number will be nothing like what it is now."

Except for several days in the late fall, the number of COVID-19 deaths nationwide consistently has averaged more than 1,000 per day since August, according to the Centers for Disease Control and Prevention.

The flu caused 12,000 to 52,000 deaths a year between 2010 and 2020, and between 140,000 and 710,000 annual hospitalizations, CDC data shows.

Stephen Post, director of Stony Brook University’s Center for Medical Humanities, Compassionate Care and Bioethics, said learning to live with large numbers of deaths is nothing new.

"We accept very significant numbers of deaths in many, many areas of human activity," he said. "That’s why speed limits get adjusted up and down depending on where you might be. No society can function if it is overprotective in a way that diminishes the day-to-day activities of the social world. There is a balance to be struck."

Restrictions in the early months of the pandemic prevented people from dying of COVID-19, but they also stopped others from getting surgeries, and they led to a rise in addiction, social isolation and stunted socialization of children, he said.

Kim Fitzsimmons, 50, of Freeport, said the current approach of not closing restaurants, arenas, gyms and other venues during a surge like the current one, but requiring masks, strikes a good balance between protecting people and keeping society moving.

"We can’t shut the world down," Fitzsimmons said after working out at the Freeport Recreation Center. "We have to learn to live. We can’t lock ourselves up and never leave the house again. So we wear our masks inside and are respectful and try our best not to spread it."

Jim Carney, 54, of Rockville Centre, agreed. The economic and social effects of shutdowns are too great, he said.

"If masks are what it takes to get through this, then so be it," he said. "If there are surges, we’ve got to take extra precautions to protect people who are most vulnerable. But beyond that, we’ve got to get back to normal living."

Luis Carlos, 63, of Freeport, is convinced that "this is going to end, sooner or later," pointing to how other pandemics also ended.

"We can't continue doing this," he said of disruptions to the economy and other facets of everyday life.

Carlos was supposed to return to his native Dominican Republic for Christmas, but his flight was one of the thousands canceled over the holidays, in part because of COVID-19-related employee shortages.

"Today’s my birthday. I was supposed to be there," Carlos said Friday with a laugh.

Cheryl Healton, dean of the NYU School of Global Public Health in Manhattan, said that, long term, new treatments — along with vaccines and a strong surveillance system — will make COVID-19 "largely manageable."

"You’ll be back to a new normal. I call it coronavirus 2.0," she said. "It will be killing a lot less people. It will be a lot less scary for people."

Hundreds of therapies being studied

Hundreds of potential COVID-19 therapies are being studied, according to the Food and Drug Administration, which last month authorized two pills that reduce the risk of hospitalization and death for those with the virus at higher risk of severe COVID-19. Antibody and other treatments have been available for more than a year.

If treatments are effective enough, and COVID-19 numbers fall enough, then even many people at higher risk because of age or medical condition may believe the chance of getting seriously ill or dying is sufficiently low that they’ll venture into crowded indoor settings, Healton said.

"It will lower the risk calculus because you’ll have treatment to turn to," including as a fallback when vaccine protection is less effective, as it often is in older people and those with certain medical conditions, she said.

But Healton, 68, said many older adults like herself likely would continue wearing masks, especially in the winter, and restrictions would still be needed in high-risk places such as nursing homes. If there is a different version of the coronavirus circulating every year, a different annual vaccine would be needed to combat it, she said.

Farber said that, depending on the evolution of the virus, it may be advisable to temporarily reimpose measures such as mask mandates as COVID-19 case numbers rise, and to then withdraw them, after they fall again.

On Thursday, the Journal of the American Medical Association published three opinion pieces from six scientists on living with COVID-19 long term, with one article arguing that "policymakers need to specify the goals and strategies for the ‘new normal’ of life with COVID-19."

Recommendations include improving surveillance of the virus, expanding testing, manufacturing and distributing free or low-cost N95 masks, creating a national electronic vaccination certificate, developing benchmarks on when to impose and relax restrictions, and expanding vaccine mandates, including eventually requiring vaccination for children to attend school.

Increased vaccination levels are critical to helping return society to normalcy, both to prevent serious illness and death, and to help prevent the emergence of new variants, said Dr. Robert Klitzman, director of the masters of bioethics programs at Columbia University in Manhattan.

Workplace "vaccine mandates are crucial to returning us to normalcy," he said. "People should get vaccinated ethically to protect themselves and protect others. People who are unvaccinated say, ‘It’s my right not to get a vaccine if I don’t want to get a vaccine.’ What they’re failing to take into account is that that decision is affecting other people, and that decision is fueling the pandemic and impeding our ability to get to a post-pandemic world."

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