Virginia’s COVID-19 case rates are plummeting. But experts still can’t predict what’s next.

As Virginia lawmakers debated a bill that would effectively end mask mandates in schools — legislation that Gov. Glenn Youngkin could sign and implement by the end of the week— even some Democrats seemed indifferent to the ongoing COVID-19 pandemic.

“I am convinced that if we defeat this legislation, we will be back here next year having this debate all over again on the latest variant,” said Sen. Chap Petersen, D-Fairfax City, who first amended the bill to conform with Youngkin’s executive order making masks optional for students. “The zeta variant, whatever you want to call it — this argument will never go away.”

Virginia isn’t the only state where pandemic fatigue is shaping politics. Within the last week, liberal governors in New Jersey, Connecticut, Rhode Island, Oregon and Delaware have all announced plans to end statewide requirements for masking in schools. New York is dropping a mask or vaccination requirement for indoor businesses, and California is set to end its universal mandate within the next few weeks.

When it comes to masking in schools, Virginia is going a step farther than counterparts in New Jersey and Oregon, where local divisions will be able to make their own decisions on universal masking policies. But frustration with COVID-19 — and a growing push to go back to life as normal — is increasingly becoming a bipartisan issue.

“I can tell you that we’re now three years into this and I’m not certain that we see any light at the end of the tunnel on COVID,” said Sen. Jill Vogel, R-Fauquier, during a floor debate on the bill. “It will mutate. It will be around.”

What exactly the future holds for the pandemic, though, is still unclear. Much of the optimism in Virginia has centered on case numbers, which have been falling precipitously over the past month, dropping from an average of 18,782 new cases a day in mid-January to 3,783 as of Tuesday, according to data from the Virginia Department of Health. COVID-19 hospitalizations have also declined to pre-surge levels, with just under 1,700 admissions reported across the state.

Those lows, though, are largely relative. The current case average is akin to infection levels in early 2021, as the Virginia was entering its first major winter surge. Hospitalization numbers are still similar to the fall, when the delta variant was overwhelming local emergency rooms. And COVID-19 deaths were still rising last week, when the state reported an average of nearly 140 fatalities a day. Over the last two weeks, Virginia has seen a 260 percent increase in reported coronavirus deaths, according to an analysis by NBC News, 

“It is useful to look back to see what times over the past two years we’ve seen similar rates,” said Bryan Lewis, a computational epidemiologist for UVA’s Biocomplexity Institute. “And it was at times when we were pretty nervous and pretty worried about the pandemic.” While Virginia’s omicron surge appears to be reaching an end, experts say returning to life as normal will largely depend on how the virus evolves and how long immunity will last — two factors that are difficult to predict.

“I expect case numbers should continue to decline,” Lewis added. “But the big question is, what level of protection do we have and how long will that hold into the future.”

Predicting new possibilities

The continued uncertainty means there’s a range of potential outcomes for the pandemic. The Biocomplexity Institute, which has been modeling COVID-19 in Virginia since the early days of the virus, separated them into several categories based on immunity and the potential for new viral variants. 

Under the first, best-case scenario, infection with the omicron variant — which now accounts for virtually all new coronavirus cases nationwide — would lead to strong and lasting protection against the virus. As a result, most Virginians would be protected from reinfection through vaccination or so-called “natural immunity,” or a combination of both. In that case, the virus would essentially run out of hosts to infect, eventually fading away.

“In the long run, we’d expect such an endemic COVID-19 to behave much like the flu,” researchers wrote in a recent report. Seasonal variation and gradually waning immunity could cause cases to swell over the fall and winter, but many Virginians would still be protected against the most severe outcomes.

“Once we have enough population-level immunity, it just can’t grow the way we’ve seen before,” Lewis said. “That’s how I’d think of endemicity — a surge like we just saw with omicron or we saw with delta or we saw with the previous ancestral strain before vaccines, those levels just aren’t going to happen again.”

The problem with that prediction is that it’s still unclear how protective a previous omicron infection will be against future cases. Lewis said it’s been difficult to study natural immunity in general because it can be hugely variable based on the length and intensity of an infection and the unique immune response of any particular patient. Omicron also has the ability to evade both infection and vaccine-induced immunity, complicating the future of the pandemic.

Without that lasting protection, COVID’s trajectory could look very different over the next several months. It’s possible that previous cases could provide moderate immunity against reinfection, leading to a more gradual decline in cases but not a complete drop-off. 

In that scenario, different regions of Virginia could see varying levels of protection depending on vaccination rates and declining immunity among previously infected — and unvaccinated — residents. “This could lead to the virus ‘bouncing’ around the state, causing localized surges, while other areas are recovering,” researchers wrote. Statewide case rates wouldn’t continue to decline, but they also wouldn’t rise dramatically, leading to a steady oscillation of moderate-level transmission.

If omicron only provided limited protection against future reinfections, case rates could continue to remain high — a steady “smolder” among Virginians with waning immunity, researchers wrote. Lewis is hopeful that vaccines, coupled with a more lasting natural immunity, would prevent that from happening, but it’s still not clear how long cases in Virginia will continue to decline.

“What level it flattens out to really depends on whether we’re talking about 20 percent or 60 percent or 70 percent protection against reinfection for all these people who have just had omicron,” he said. Even if COVID-19 does eventually become an “endemic” disease, it’s still not clear when case rates will plateau or how widely the virus will continue to circulate, other infectious disease experts have pointed out.

The potential for future variants is another huge unknown. Many experts predicted that delta would be the country’s last major COVID-19 surge — until omicron, with its immune-evading capabilities, emerged and quickly outpaced previous variants. 

Predictions that the virus will eventually become an endemic disease are largely based on historical patterns from previous pandemics, including the 1918 flu, said Madhav Marathe, director of the Biocomplexity institute’s Network Systems Science and Advanced Computing Division. But with the virus still circulating, it’s possible another variant could emerge with mutations that make it even better at evading existing immunity.

“There’s this notion of a drift and a shift,” Marathe said. Earlier variants, including delta, are closely related to the original “wild-type” SARS-CoV-2 virus that started the pandemic. Omicron, on the other hand, is more like a “distant cousin” to that ancestral strain, according to Lewis. Those genetic differences have helped the variant evade pre-existing immunity. And in a world where more and more people have some degree of protection, there’s more pressure on the virus to continue evolving those characteristics.

“The more different it is, the more we can’t predict what’s going to happen,” Marathe said. “It might be a version that’s so benign it doesn’t do much, or it might become one that is extremely transmissible.”

The current unpredictability is one reason why both Lewis and Marathe said it was premature to move away from existing COVID-19 mitigation measures, including masking and avoiding unnecessary exposures whenever possible.

Keeping those measures, even for the next few weeks, would give the state more time to assess the trajectory of the pandemic, both said. Even as omicron cases decline, a new, closely related subvariant known as BA.2 is accounting for a growing share of the state’s infections — roughly 4 percent, according to the most recent estimates from the U.S. Centers for Disease Control and Prevention. 

It’s likely that the latest version of the disease is similar enough to omicron that previously infected Virginians will still be protected. But its genetic make-up makes it more difficult to detect, and it’s possible continued transmission could slow the current decline in cases.

“The part that has me a little concerned right now is that this subvariant is currently circulating around Europe,” Lewis said. “And some of the countries that have a lot of it are seeing a lot of hospitalizations among young kids.” Even without BA.2, there’s concern that relaxing too quickly — before case rates reach previous lows — could erase some of the progress that’s already been made, especially with so many children either unvaccincated or still ineligible for the vaccine.

“It really feels like in three or four weeks, rates will be down much lower, the weather will be nicer, and it really makes sense to start rolling some things back,” Lewis added. “But we’re still at a high level when it comes to transmission.”