If we've learned anything in the past 18 months it's that the coronavirus can — and often will — surprise us. And experts say that COVID-19 will have an impact on us for at least the next few years and, possibly, the rest of our lives.
While we're not looking that far ahead, we are starting to get an idea of what the COVID-19 landscape might look like in 2022.
Of course, all we have right now are best guesses for what the next year may hold — no one really has conclusive answers and public health experts are still learning as they go. But here's what's on their minds right now for 2022, including what they think life will look like and the mistakes they're hoping we won't repeat.
How worried should we be about omicron?
So far, omicron appears to be more transmissible than the delta variant but it also seems to cause less severe disease, Dr. Bernard Camins, medical director for infection prevention at the Mount Sinai Health System, told TODAY. But it's also emerging right after Thanksgiving when we're already seeing high case numbers, which are fueled largely by the delta variant.
"From the signals that we've seen so far in the U.K. and South Africa, we can expect to see more breakthrough infections with omicron, and there's a good chance that it is probably going to become the dominant strain, at least for now, and overtake delta," Dr. Taison Bell, assistant professor of medicine in the divisions of infectious diseases and international health and pulmonary and critical care medicine at the University of Virginia, told TODAY.
What that means for hospitalizations and deaths down the line remains to be seen, though. "It's hard to know," Bell said, "but I think it'll vary depending on if you're in a community that's highly vaccinated or one that's low vaccinated."
Dr. Wafaa El-Sadr, professor of epidemiology and medicine at the Columbia University Mailman School of Public Health and director of ICAP, echoed this idea: She predicted that we'll see "a divergence" in which countries and communities with high vaccination coverage will be able to find a way to adjust and live with low levels of COVID-19 transmission.
"And that will contrast starkly with other parts of the world and other communities where there will continue to be high levels of transmission as well as, unfortunately, high rates of hospitalizations and deaths," she told TODAY. "I feel we're about to see this divergence very, very vividly happening in front of our eyes."
But it's not just about omicron's potential transmissibility, Dr. Yonatan Grad, associate professor in the department of immunology and infectious diseases at the Harvard T.H. Chan School of Public Health, told TODAY. There are other unknowns here that will also determine the degree to which omicron may overtake delta, including the amount of protection a previous infection with delta variant might provide against the omicron variant.
Will there be more concerning coronavirus variants?
Whatever happens with omicron, know that more variants are always a possibility.
In fact, the emergence of this new quickly-spreading variant "tells us that until everybody in the world is vaccinated and the virus has no place to go, we should expect that new variants are going to continuously emerge," Michael Gale, professor of immunology at the University of Washington School of Medicine, told TODAY.
And with that, we’ll need to make sure as many people as possible are vaccinated everywhere in order to prevent new variants anywhere.
"We have to look at this as a global problem and get everybody protected," Bruce Walker, director of the Ragon Institute of MGH, MIT and Harvard, told TODAY. "Because every time the virus gets into somebody it has a chance to mutate and, potentially, become more lethal," he explained.
Will we need more COVID-19 booster shots?
Whether or not we'll need additional COVID-19 booster shots in 2022 (and beyond) depends on how long the protection from the current round of boosters lasts and how well it protects against new variants that might pop up, Dr. Thaddeus Stappenbeck, chair of the department of inflammation and immunity at the Cleveland Clinic Lerner Research Institute, told TODAY.
Right now we don't have any conclusive answers on either point, but initial lab data from Pfizer suggests that its booster is effective against omicron. And, for now, the boosters we have will likely be enough to protect against this new variant, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and chief medical adviser to President Biden, said this week.
“My sense is that we probably won’t need a new booster that’s omicron-specific, but that there may be other variants coming along that will require that,” Walker said.
"I suspect that at some point if the virus continues to mutate, we will need some new versions of the vaccine that are specific for new mutations," Dr. Megan Ranney, emergency medicine physician and associate dean for strategy and innovation at the Brown School of Public Health, told TODAY. "Whether we will need a fourth shot of the exact same formulation that we got all along, I just really can't say one way or another yet."
Will there be another big surge in the winter? And another drop when the weather warms up?
We are already seeing a sharp rise in COVID-19 cases and hospitalizations, which have put added stress on already understaffed and overwhelmed hospital systems in some states. But experts aren't sure how severe this surge will ultimately be or how the rise of omicron might factor in.
“I’m hoping that the surge this year is not as bad as last year because we do have vaccinated populations already,” Camins said. “This winter, though, things are open. We’re no longer social distancing.”
For Walker, it depends on whether you’re looking at COVID-19 case numbers or hospitalizations. He anticipates more cases of the virus in early 2022 than during the surge we saw in early 2021, but he expects those cases to be less severe.
Remember that the current surge is still mainly fueled by the delta variant, Walker said. But the omicron variant has already been detected in more than 30 states. So will omicron cases combine with those due to delta to create an even bigger surge than we saw at the beginning of 2021? Or will omicron overtake delta entirely? On that, experts are divided.
Some, like Grad, expect to see "exponential growth of omicron cases" in the U.S. similar to what's already been seen in South Africa and the United Kingdom. Others say it's still too early to tell.
When it comes to the warmer spring and summer months in 2022, experts say we are likely to see a drop in cases like we saw this year. But that may not necessarily be the pattern we see everywhere, Stappenbeck explained, pointing to the delta-fueled spike in the southern U.S. we saw recently.
In some areas of the country that get very warm in the summer, COVID-19 rates might go up because people are likely to be spending more time inside where there's air conditioning (and less ventilation). "To me, the patterns make sense," Stappenbeck said.
What does "learning to live with COVID-19" actually look like?
In 2022, experts anticipate that we'll adjust to living with the coronavirus by leaning on vaccination, continuing to mask up in high-risk situations, expanding access to rapid testing and introducing new antiviral tools. Together, these strategies will help us feel more comfortable taking calculated risks.
“If there’s one major frustration that I’ve had so far, it’s that we are not using rapid tests the way that we need to at the scale that we need to,” Bell said. "Rapid testing is one of our totally underused mitigation measures," Grad agreed.
To help address that issue, the Biden administration recently announced a new plan to reimburse people for at-home rapid tests through their health insurance. For those without insurance, free tests will be available at places in their community, like local health clinics, White House coronavirus response coordinator Jeffrey Zients explained earlier this month.
Rapid tests are "terrific for reducing spread whether you're in the workplace, at a gathering or party or if you're feeling sick to get a quick take on whether or not you likely have COVID," explained Ranney, who helped create an online tool that makes it easier to assess and reduce your COVID-19 risks in certain situations. So making them more available and accessible will be key to reducing the risks associated with doing more of the high-risk activities that we used to partake in, such as indoor dining and traveling.
While not perfect on their own, rapid tests are one part of our overall strategy "that can make a difference for us being able to gather safely and go back to normal again," Ranney said. “If we had easy, cheap and abundant access to rapid tests, those would become part of (our approach to keeping safe around) the holidays or other kinds of events, or to keep kids in schools,” Grad added.
How long will we need to wear masks?
The truth is that people and businesses in many areas of the country have already abandoned the COVID-19 prevention protocols we came to rely on during the pandemic, like enforcing social distancing and mask requirements. "I think people are pretty comfortable (attending high-risk gatherings and events) now depending on where they are," Kelen said, noting that he recently attended a conference in San Antonio, Texas at which "virtually none of the guests" wore masks. "It was bizarre," he said.
But masking still works — not just in helping to prevent the spread of COVID-19, but likely for the flu and other illnesses as well. "My motto has been, 'If you can see their full face, don't be in their space,' especially when I'm indoors in public," Bell said. "I still think that's a good strategy."
It makes sense to continue wearing a mask in certain high-risk situations, when you have active COVID-19 or flu symptoms or during certain time periods (like when there's a surge in your area), he said. "When I think about the lives that could be saved by something that's very simple, I think there's power in that," he said. For Bell, "it's something that I definitely think we'll see in 2022" and even beyond that.
What role might new antiviral medications play in 2022?
Both Pfizer and Merck are working on antiviral medications aimed at reducing the severity of COVID-19 symptoms. The Pfizer option (Paxlovid) appears to be 89% effective at reducing hospitalization and death among those most vulnerable, early data suggest.
While neither drug is authorized or approved by the Food and Drug Administration right now, experts anticipate them being available soon — and say they could play a significant role in our fight against COVID-19.
"It's really exciting to potentially have options for oral therapy that act very early," Dr. Judith Currier, professor of medicine in the UCLA division of infectious diseases, told TODAY. The medications will probably be used mainly in the populations where they'll have the greatest potential benefit for reducing hospitalization, she said, which would include those who are older, those who have underlying health issues and those who are unvaccinated.
"The antivirals now are going to be absolutely critical," Stappenbeck said. "Especially if this is something that we're going to have to live with."
Ranney agreed: "This is going to be a really important part of our coming to live with COVID, which is ultimately going to be the reality," she said of the antivirals.
Currier also noted that the ability of these drugs to work effectively is "going to be dependent upon people getting tested early because they need to be given usually within the first five days of the onset of symptoms," she explained. "But it's a game-changer to be able to have an oral treatment, absolutely."
What about kids? Will they be able to continue in-person learning?
"There's an emerging consensus that we just have to keep the schools open, we have to go back to interacting, and that kids are lacking socialization that's really detrimental," Walker said. "We have to use other mitigation approaches to try and keep the schools open."
Those mitigation strategies can include many of the same tools as mentioned above, such as masks, rapid testing and pediatric vaccines. That might also mean adopting some creative solutions. For instance, some schools now use a "test to stay" protocol that takes advantage of frequent rapid testing.
Keeping children in school "has to be one of our top priorities," Ranney agreed. "And masks are a big part of that; getting our kids and our teachers vaccinated is a big part of that too."
What can we do in 2022 to help actually end the pandemic?
If we want to make serious headway in ending the pandemic for good, the experts that TODAY spoke to say these are the areas where we should direct our focus.
First up is tackling vaccine hesitancy and health misinformation. For some people who are hesitant to get vaccinated, being presented with clear explanations of facts about the way vaccines work and are developed may be enough to make them feel comfortable getting vaccinated, said Walker, whose Ragon Institute was involved with the development of the Johnson & Johnson COVID-19 vaccine.
Others may not necessarily be opposed to the idea of getting vaccinated, but they just don't see the urgency in it — until there's a surge or they're personally affected. "Omicron has actually convinced some people who were previously hesitant to get vaccinated," Kelen said.
One way to create a sense of urgency before the virus hits home, Ranney explained, is to implement vaccine requirements for work or activities like concerts, cruises, indoor dining and sporting events.
But, for some, getting vaccinated isn't an issue of not wanting to get the shots — it's an issue of access, El-Sadr said. Even people who would readily get vaccinated may not be able to take time off from work or childcare duties to get the shot and, potentially, recover from the side effects.
We also need to address vaccine access globally, which will save lives around the world and help prevent the emergence of new coronavirus variants. "This is the most urgent global priority that exists now," El-Sadr said. "And I certainly believe there's a way to tackle it ... Vaccination is going to define the future of this pandemic."
Finally, experts reminded us that there are still many outstanding questions about the long-term impacts of having COVID-19, including long COVID and MIS-C, Walker said. And Ranney said she hopes 2022 is the year people get back on track with routine screenings and doctor's appointments.
The virus is going to be here for a while. But experts say things will start to gradually feel more "normal."
It's clear now that the pandemic will not have a simple endpoint and, as many of the experts TODAY spoke to said, we will simply have to adjust to this new phase of life with COVID-19. Although there are still many questions about omicron and the way the virus may mutate in the future, the experts were overall hopeful that we'll make substantial progress towards our new normal in 2022.
"Next year's going to be a lot better," Gale said, noting that the scientific community is particularly focused on scanning for any new emerging variants. "We'll get back to normal. I can't say it'll happen tomorrow, but I would expect 2022 will be a lot more normal than 2021."
This holiday season already feels different from last year thanks to the vaccines, Ranney said. "I think next year will feel even more normal."
"I'm actually an optimist, but there's also a scientific basis for that," Camins said, pointing to the increasing number of people getting vaccinated and boosted as well as those getting some level of immunity through recovering from COVID-19. Although things may never really be the same as they were pre-pandemic, "2022 will be better," he said.