Dr Christopher Murray is considered internationally as the “guru” of projections on the course of the Covid-19 pandemic. He is the director of the Institute for Health Metrics and Evaluation at the University of Washington and has developed models on the evolution of the pandemic for various countries in the world – including Greece.
Dr Murray predicts that about half of the Greek population will be infected with the Omicron variant and believes the peak of the wave will come in mid-January, not at the end, as projected by initial studies. He also believes that the end of the pandemic will come in March, as soon as Omicron is completely gone, and recommends reopening schools as long as there are enough teachers.
But his main conclusion is the need to stop dramatizing the pandemic, saying that it does not make sense to focus on the number of cases. He argues that the key figures are the number of hospital admissions, especially to intensive care units.
What is your prognosis as to how long the pandemic will last?
Well, as far as we can understand from Omicron, we think that it’s so transmissible it will move through the population in Greece and in each country that it shows up in in a pretty short period from introduction to peak in four to six weeks. So most of the Omicron wave should happen in the month of January in Greece.
What percentage of the population do you expect to get infected with this variant?
Well, we expect that probably as much as half of the population or more will get infected with Omicron, and that’s despite vaccination levels and past infection with other variants of Covid. So a very large fraction of both Greece but also the world should get Omicron.
So is there any sense in trying to control Omicron, really?
Well, what do we know about Omicron? We know that it’s very transmissible; it can infect people that have been previously infected; in terms of infection, it can break through in those that are vaccinated or even those that have had a booster. But it is much less severe than past variances, maybe 90% or 95% less severe. So huge numbers are coming, but much less severe. There still will be pressure on the health system, because of the very big number of infections and a smaller fraction going to hospital. So it’s really going to be hard to control infection. But there still will be some consequences on the population.
Do you expect hospitalizations to go up?
We expect hospitalizations to go up, but nothing like past waves, and from what we’ve seen in South Africa now in the United Kingdom and in some of the earlier states in the US, even amongst those that end up in hospital, it’s also 80% to 90% less severe, so many fewer are ending up in the ICU, even amongst those that go to hospital. So all encouraging signs about severity, but just the sheer numbers – half of the population – getting Omicron means that we will see an increase in hospitalizations.
Have you observed any kind of strange effects from Omicron – things you didn’t expect?
I think when it first emerged in November – and we had no real data about severity – there was tremendous concern that we would see this nightmare of mass transmission, and then slightly less severe than Delta, and hospitals would be overwhelmed as the death rate would soar. That hasn’t happened fortunately. It’s turned out to be much less severe and today we’re not really seeing anything particularly unusual except this fact that 80% to 90% of people who get infected have no symptoms at all. So that makes a really big difference in terms of impact on the population.
Is this in a way the beginning of the end of the pandemic, because everybody has been saying that at some point it will become like a flu. A severe flu perhaps, but a flu. Are we reaching that point now with Omicron?
You know it’s a great question and I think very hard to answer in a strictly scientific way. But many people do think that, because there’ll be so many people infected with Omicron, it’ll give a big boost to the immunity level of populations that it will take a new variant to emerge before we see after the Omicron wave more transmission. So it may be the thing that brings us to the point where we go to an endemic stage, where Covid doesn’t go away, but we should see it may become that seasonal disease that we’ve been expecting for quite some time.
The way I understand it is that these viruses have a linear evolution where they become more transmissible but milder. Do you expect the next variant to follow that pattern, or not necessarily?
You know, there’s quite a lot of debate; the people who study the evolution of viruses are saying that there’s no particular reason in the case of Covid that the next strain will be milder than Omicron. If you think about flu from year to year we get bad flu epidemics and we get milder flu epidemics. So it’s not always from year to year that flu is getting milder. And so if you take that analogy, it is possible that we will see a variant in the future that is transmissible or even more transmissible than Omicron but could actually be more severe – we just don’t know. Now, for the future, as we have higher levels of vaccination, we have had exposure to different types of past variants, and with the advent of effective antivirals we do hope that we won’t be seeing the big consequences of Covid that we have in the past.
Regarding the policy conclusions you reached after your study in Greece, would you open schools or keep them closed?
To the extent that you have teachers that don’t need to quarantine because they’ve tested positive, we think schools should be open. Covid has always been very low risk for children and more of the concern was them transmitting back at home to their parents or grandparents. But in a setting where so many people are getting Omicron, that sort of concern probably doesn’t make any sense because Omicron is going to move through the population anyway and going to school benefits children. So we think schools should stay open.
Should people keep wearing masks?
Well, again, at the population level, mask wearing probably will not make a huge difference – it’ll make a small difference. But for individuals who have co-morbidities, who are older, or who just generally think that they’re at greater risk, for the individual it makes a lot of sense, particularly a high-quality mask – N95 or KN95 – because it will reduce your individual risk. But we’re in an era when there’s so much asymptomatic infection, so you just don’t know. And so many people will be out there transmitting. At the population level, wearing effective masks is going to be less impressive than what it was for Delta or previous waves.
Should people keep getting their boosters – a third booster or perhaps even a fourth in some cases?
Oh, absolutely. What we know from the evidence is that vaccines may not be that effective for stopping infection, but they’re very effective at stopping severe disease and death. And having a booster brings your immunity levels back up to what they were after the first two doses, because over time it starts to wane. So boosters are a very effective strategy for individuals to protect themselves – again, even more important for those that are older, or at risk from co-morbidities.
From the European vantage point, you have a pretty much global vantage point. Do you see any major differences in the data between Greece and other countries around the world?
No, not yet. What everybody’s been worried about is the one group that is at greatest risk from Omicron – those that are not vaccinated and have never been infected in the past, because they have essentially no immunity. And we don’t have a lot of data about how bad Omicron can be in that subgroup. But in terms of what we’ve seen so far, the explosive increase in cases, the much smaller increase in hospitalizations and no real increase in deaths yet – that’s so far been what we’ve seen in South Africa in other countries in Europe and in the United States that have had earlier Omicron waves.
Now I understand one of the main conclusions you reached is that there’s a need to de-dramatize the situation in some ways. Could you explain what that means and why you think it’s important?
Well, I think, right now, we have been dealing with Covid for two years, with a much more severe infection, and so it made a lot of sense to focus efforts through mask use, through social isolation, on doing everything we can to reduce transmission. But we’re in a setting where transmission is so strong – take these surveys that showed on New Year’s Day 10% of the entire population of London had an active infection. You know this is a degree where, every day, once you’re in that way, like you are now in Greece, 2% or maybe even 3% of the country is getting infected. So when you’re at that level of transmission, and it’s not that it’s much less severe, we need to rethink our approach.
We probably can’t control infection very much at all. If we follow the strategies we’ve been using of testing and isolation, we will end up with many critical services in the month of January being hard to sustain because you just won’t have the workforce, because they’re all at home isolating, so we need to sort of rethink our strategies on what we should try to achieve. And in the past it was “minimize death, minimize hospitalization, stop transmission.” Now I think it’s “minimize death, minimize hospitalization and stop disruption to essential services.”
So are you suggesting that we shouldn’t be looking so much at the numbers, the actual cases? Should we be looking more at hospitalizations, how many are in ICUs?
Yeah, I think people have to stop being terrified by the huge case numbers because they will be very large. They need to look at hospitalizations, or even more importantly what the Greek government’s been doing already, which is looking at those that are either in the ICU or in required mechanical ventilation or intubation. That number, which tells us about the severely ill with Covid, is the one to watch. Because that tells us the real consequences. The case numbers will be scary because they will set records and they’ll set records day after day until we hit a peak which should come probably faster than we thought two weeks ago. More likely you will see a peak in Greece in the middle of the month. But keep the attention on those severe cases that end up requiring much more aggressive intervention in hospital.
And what’s the number that you’re looking at for the peak in Greece? The actual number of people being infected?
Sorry, I don’t have that right in front of me. We are releasing a new model later today. So we’re just trying to take into account the timing, because when we put out our first model Greece hadn’t started to have the cases go up. We said they would, but now that we’ve seen data for Greece and the case surge which started after Christmas, we’re trying to build that in to our new release, but what it does suggest – previously, we said the peak would be at the end of the month – is that it will be in the middle of the month.
This last question is a kind of a silly question, I know, but when do you think this pandemic will be over?
I think, personally, and this is sort of going from purely the science to sort of more personal reflection… I think the pandemic – as opposed to Covid – will be over once the Omicron wave is over. So probably by the time March rolls around, numbers will be down in most places because Omicron will move so quickly. The pandemic will be over, although Covid certainly won’t be. And we will just need to say: Look, this is like the flu. It’ll be around all the time, we need to keep people vaccinated, boosted over time and, then, when we do have a wave of Covid from a new variant or in the winter each year, those people that are older, or have some co-morbidity that puts them at greater risk, may also want to take further efforts, like wearing a mask. And we just need to see that as the new normal. But I think the pandemic, the notion that requires this societal emergency reaction, will probably be over this coming March.