ALBUQUERQUE, N.M. (KRQE) – Another year of the pandemic over — and a new one just begun. Since cases were first found in the state in March 2020, New Mexicans have been through countless ups and downs from COVID-19.

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While nearly everyone probably hoped the virus would be over by now, New Mexico is not only entering a new year dealing with COVID-19, but also a new phase of the pandemic amid the spread of the omicron variant. To learn what New Mexicans can expect in 2022, KRQE News 13 took a look at the latest data and spoke with several public health experts working in New Mexico.

Jagdish Khubchandani, a professor of public health at New Mexico State University previously told us in March 2021 his thoughts after the first year of the pandemic. Now, he’s giving us an update for 2022 after a year of vaccinations, re-openings, and new variants. KRQE News 13 also reached out to Crystal Lee, an associate professor at the College of Population Health at the University of New Mexico (UNM) and Dr. Tracie Collins, the dean of the UNM College of Population Health.

Question: A year ago, did you expect this is where we’d be?

“Yeah, I did,” says Khubchandani. Given the lack of testing in many communities, “which creates an illusion that we are doing OK,” and the issues with global vaccine distribution, “I don’t know why anyone was expecting this to be different,” Khubchandani says.

Lee from UNM agrees that given a lack of health resources and infrastructure, many of the challenges vulnerable populations are now facing were predictable. “I knew that this wouldn’t be resolved right away, even with vaccinations and even with boosters,” she says.

Collins, on the other hand, has a different outlook after an eight-month stint leading New Mexico’s Department of Health through July 2021. She says “it’s not quite what I thought it would be.” She explains that the pandemic is more intense than she hoped it would be by this time and that the need for a third booster shot came sooner than she’d hoped.

Question: How concerned should we be about how fast omicron spreads?

“That it spreads quickly,” Khubchandani says, “is an alarm, because if it continues to spread in weak people — immunocompromised people — given that the United States is an aging nation, things should not be taken lightly.”

Part of the reason why omicron is spreading fast is that it has the ability to evade some of the protection offered by vaccines, according to the CDC. This means there will likely be an increase in case counts, something other countries have already seen. As of January 3, 2022, New Mexico had confirmed 29 omicron cases, but state health experts believe there are many more. The New Mexico Department of Health’s Acting Secretary Dr. David Scrase estimated between 50% to 60% of all new COVID-19 cases in New Mexico during first week of January were attributable to the variant.

But it looks like omicron symptoms may often be less severe than delta, although that could change as more data comes out, according to the CDC. Yet despite being potentially less severe, the CDC predicts that given that more people are expected to get omicron, “the absolute numbers of people with severe outcomes could be substantial.”

And of course, the strain on New Mexico’s hospital system could be immense. In December 2021, KRQE News 13 reported that having over 680 people in the hospital for COVID-19 has caused a dire situation for the state’s hospital system. As of January 5, 2022, there are nearly 500 individuals currently hospitalized for COVID-19 in New Mexico.

“What omicron is showing us is that it’s trying to sustain itself by being highly infectious but it’s not quite strong enough to be very severe,” Collins says. “So it’s a matter of staying the course and doing the things that have been keeping us safe thus far.”

She says that getting vaccinated, wearing a mask, and following quarantine guidelines after exposure are still important at this stage of the pandemic. And Khubchandani reminds us that things could still get worse.

“People are optimistic now that omicron will compete with delta and replace it and become less infectious or less deadly,” Khubchandani says. “But it’s a gamble.”

Question: Will there be more variants? Is that bad news?

“There will be new variants,” Khubchandani says. “A virus goes through thousands and thousands of mutations in its life course, and some of them actually become deadly mutations.” Generally, those deadly — or at least more dangerous mutations — lead to what experts call “Variants of Concern.”

Variants are versions of the COVID-19 virus that have slightly different characteristics from the original virus. As the COVID-19 virus replicates within infected people, there are slight changes to the virus. Sometimes these changes can cause COVID-19 to spread more easily or become more vaccine-resistant.

Since the COVID-19 genome was first sequenced in January 2021, there have been more than 10 key variants, causing varying levels of concern. This summer, the delta variant became the most common version of COVID-19 among New Mexicans, according to epidemiology reports from the New Mexico Department of Health (DOH). The latest data, gathered in the first days of 2022, shows that delta is still the dominant variant, but cases of omicron are rising.

“The virus has to find a fit: Either it has to spread among people or kill people,” Khubchandani says. “That’s happening to omicron. It has a good amount of mutations — more than three dozen — and that has helped it attach to people’s cells easily. And that’s why it’s spreading with more efficacy.”

Khubchandani says that while it’s almost certain that there will be new variants in 2022, these variants could be either more or less dangerous. And there’s no real way to know what threat a variant presents until it arrives and we start seeing its effects.

In the best case, “eventually what will happen is that all these mutations will not remain so effective [at causing serious illness],” he says, and that will make the virus easier to fight. But on the other hand, “you never know if [a variant] will cause death to someone,” Khubchandani says. “It’s like a gamble with the virus.”

Lee from UNM says that the virus will continue to adapt and change. But she says there’s no way to predict whether those changes will make it better or worse.

“I think a good comparison would be the flu,” she says. “There is variance year to year of how transmissible the flu is. Some years there seems to be more flu-related mortality deaths, and some less.”

Question: Are we past lockdowns and mandates?

When it comes to lockdowns, travel bans, and other kinds of restrictions, Khubchandani says they have the strongest positive effect when used early in a pandemic. Now, we are likely past most of these measures.

“Historically, we have seen that they’re only useful to buy time. They actually do no good [at stopping the pandemic]. They just give you more time to see how you can prepare to prevent a surge in the hospitals and how to devise prevention methods and find a new vaccine,” Khubchandani explains. “So I think we are past that stage.”

Collins agrees that we’re probably not going to see an intense lockdown anytime soon. “I don’t see us returning to lockdowns here in the US,” she says. “But every day is a new day with this virus.”

Lee says that whether or not we see new lockdowns could depend on politics as well. “I think it varies, dependent on election time especially,” she says.  The state’s gubernatorial election is set to take place this November, and politics have previously played a role in debates over New Mexico’s mandates and lockdowns.

“It’s a political context,” Lee said, speaking of her thoughts on whether or not lockdowns could return. “I think it varies dependent on election time, especially, and how [the state of the virus] could be playing at the polls.”

Nearly a year ago, back in February 2021, KRQE News 13 conducted a survey of readers to see how long they thought the pandemic would last. The survey isn’t representative off all New Mexicans, but it did show that many people expected closures and masks to last into 2022.

Nearly 40% of the 2,351 people surveyed said they expected we’d have to wear masks through 2021. A little over 25% of people thought we’d have to wear them until April 2022. So far, it looks like they might have been right: The mask mandate has been repeatedly extended and will be in place until at least January 7, 2022. Under the extended mandate, everyone is supposed to wear a mask when indoors in public settings.

KRQE News 13 previously reported that New Mexico Department of Health Acting Secretary Dr. David Scrase wants to see a decrease in the daily case count before the mask mandate is lifted. The magic number he quoted back in October 2021 was 200 or fewer new cases a day. New Mexico is currently seeing three to four times that number.

Mask mandates — or at least recommendations — will likely be around for some time. “There should be no harm in wearing a mask,” Khubchandani says. “That’s the bare minimum you can do.” Additionally Khubchandani reminds us that some parts of the world are reinstating actual lockdowns and curfews as cases surge.

“It depends on how much capacity each zone around the world has [or] if the hospitals are overflowing. Parts of the world are now going into lockdown again: Scotland, Wales — Northern India has a night lockdown. And that means that the district county administrations are not sure if they can handle the surge in the hospitals.”

Question: Will we get more vaccine boosters?

“You will need another dose,” Khubchandani predicts. Especially because vaccine effectiveness tends to decrease a bit over time. “As long as we have the variants, the flu, unvaccinated people, and community spread, vaccines are the only solution,” he says.

Lee from UNM agrees. She says that the present and future threat of variants will likely necessitate another shot. “I think we’ll definitely get a booster that’s more focused on the new variants that are approaching,” she says.

COVID-19 vaccines give relatively high levels of protection from COVID-19 symptoms, recent data from the US Centers for Disease Control and Prevention (CDC) show. But the number of immune cells your body produces in response to vaccination does tend to decrease over time.

The vaccines cause your body to produce antibodies, B cells, and T cells. Each of these help protect from COVID-19 symptoms. Antibodies latch on to the virus to prevent it from replicating. B cells help your body create more antibodies. And T cells latch on to the virus and can directly kill infected cells to stop COVID-19 from replicating.

Recent studies show that the number of antibodies in a person after a two-shot mRNA vaccine decreases by about 50% after 52 to 202 days, depending on the specific antibody and patient. B cells, on the other hand, seem to provide a longer-lasting boost to the immune system, remaining at a stable level for six to eight months after vaccination.

A decrease in the number of antibodies, B cells, and T cells don’t necessarily mean a total decrease in protection, though, according to the CDC. And, given the consistent threat of variant, continued vaccine research is necessary, Khubchandani says. “We have to continue to invest in vaccines and research development.”

Israel recently began offering a fourth shot — i.e. another booster — to some vulnerable populations. Collins says that rollout provides the data and example that the United States may use to decide if, or when, we get another dose.

Importantly, Collins adds, we’ve already seen the pacing of boosters speed up: “last year we thought, ‘OK, this is probably going to be one of those viruses where each year we will need a shot.’ Well, then it turned into six months,” she explains. “We were anticipating the need for an additional dose but the hope was that it’d be more than six months or two months.”

Question: If I’ve already been infected, do I still need to get vaccinated?

Getting infected with COVID-19 does allow the body to produce antibodies and some immunity. Multiple studies from several countries have shown that being infected with COVID-19 does decrease the risk of reinfection for at least six months. But recent info from the CDC suggests that the antibody response from an infection is lower than from mRNA vaccines. So, the CDC recommends getting a vaccine even if you’ve already been infected.

And if you are eligible but haven’t gotten a third dose, the CDC recommends you get a booster. Two doses appear to be roughly 35% effective against COVID-19, research from South Africa and the United Kingdom shows. A third dose, however, brings vaccine effectiveness up to 75% — not perfect protection, but every little bit helps.

Question: What about herd immunity or vaccinating a certain number of people?

“I’ve never believed in it [as a way out of this pandemic],” Khubchandani says. “I’ve worked in the field in different countries going door to door vaccinating people, and herd immunity is calculated retrospectively. You don’t do real-time in the pandemic to know how much we need to isolate people.” Instead, we have to try to vaccinate 100% of the population, he says.

Early in the pandemic, many people were trying to figure out the magic number that would help end the madness. People discussed the “r-naught” (R0) value that represented how many people a single patient would infect on average, what’s often referred to as the “spread rate.” And officials set vaccination targets to try to reach herd immunity, as KRQE News 13 reported in February 2021.

But variants of the virus continue to spread, despite over 65.5% of all New Mexicans being fully vaccinated and over half-a-million New Mexicans over 16 years old having received a booster dose. Vaccines do appear to be keeping New Mexicans alive and out of the hospital: From the beginning of February 2021 to January 3, 2022, over 80% of the state’s hospitalizations and deaths from COVID-19 were among unvaccinated people. That means if you’re fully vaccinated, you are over eight times less likely to end up in the hospital or dead than someone not fully vaccinated, the latest data from the DOH shows.

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Interactive Slider: Recent data shows that unvaccinated people make up a majority of those with cases, those hospitalized, and those who are dying of COVID-19. Fully vaccinated individuals are 3.1 times less likely to get a case of COVID-19 and nearly five times less likely to be hospitalized. Data from NMDOH.

“I’m not sure if we’ll ever reach a level of herd immunity, just based on where we exist with the current population, vaccine status, etc.,” Lee says. “I think ‘herd immunity’ maybe might be a term not as relevant at this point in comparison to a ‘baseline immunity’ and ‘natural immunity.'”

Natural immunity, she explains, is immunity that the body naturally developed in response to an infection or the vaccine. Naturally, New Mexico now has a greater natural immunity than at the start of the pandemic, that’s an increase in the population’s baseline immunity.

Collins agrees that herd immunity looks unlikely given the data. “So really, it’s the fact of ‘How do we learn to live with COVID?'” she says.

Question: How will the pandemic end?

While COVID-19 is obviously a unique pandemic with many remaining unknowns, looking at how previous pandemics have “ended” can be useful for guessing how this one might come to an end. And there are several different ways to define the “end,” Khubchandani says. One type is the “scientific end” of the pandemic.

“There’s a scientific end to a pandemic which is by herd immunity or vaccines,” Khubchandani says. Polio, for example, was essentially eliminated in the United States in 1979 through rigorous vaccination.

Polio is still a threat: It continues to spread in Afghanistan and Pakistan, and travelers, of course, could bring it to the United States. So, we have continued to use vaccines to keep polio at bay. Since 1980, roughly 90% of school-aged children have been vaccinated with three doses of polio vaccine, according to a review from the Institute of Medicine.

For comparison, currently only 62% of the nation’s population has received two doses of COVID-19 vaccines, according to the CDC. Only 33.4% of the nation’s population has received three doses.

“The smallpox polio virus is a different structure [than COVID-19]. It was quite stable,” Khubchandani says. “And so it was easy to vaccinate people and not worry about these variants.” COVID-19, he adds, is more likely to become a seasonal virus that requires an annual vaccine. COVID-19, then, might “end” in a similar way that the 1918 flu pandemic ended, by eventually becoming endemic.

Although it’s often called the Spanish Flu, the first cases of the 1918 influenza were actually found in Kansas. It quickly spread. Six months after the first cases, the flu virus killed an estimated 195,000 Americans in a single month. Shortages of nurses and over-filled morgues ensued — an eerie similarity to the need for cold-storage trucks to hold bodies of New Mexico’s COVID-19 victims back in November 2020.

The 1918 pandemic even prompted shutdowns and mask mandates. “The man or woman or child who will not wear a mask is now a dangerous slacker,” a 1918 Oakland Tribune newspaper ad by The Red Cross said.

Several waves of the 1918 flu swept around the globe. The third wave, in 1919, was the most deadly, according to research published in 2006. The pandemic’s total death toll was at least 50 million people across the globe; that’s equivalent to 175 to 350 million today, adjusted for population increases, according to research published in 2005. For comparison, the current global death count for COVID-19 is roughly 5.5 million, according to numbers from Our World in Data.

There was no vaccine for the 1918 influenza. All people could do was quarantine, disinfect, wear masks, and treat the symptoms. By May of 1919, public officials were declaring the end of the pandemic, what Khubchandani calls a “political end” to the pandemic.

We are already seeing the “political end” of the COVID-19 pandemic

The United States and other countries are currently questioning when the “political end” of the COVID-19 pandemic should be, Khubchandani says. “Economies are being devastated.” So people are asking: “‘How do we control the economy and yet continue to deal with the pandemic?'”

Khubchandani says that the recent guidance from the CDC — to shorten isolation from 10 days to five — is an example of striking a balance between medical caution and supporting economic activity. “It’s almost like a business proposal, that we cannot have workers let go forever,” he says. “And that just seems like a political end to the pandemic.”

And declaring an end to the pandemic too early could be dangerous, Khubchandani says. We saw that happen during the 1918 pandemic.

J. Alexander Navarro, the assistant director for the Center for the History of Medicine at the University of Michigan, has studied the 1918 pandemic in-depth. He told KRQE News 13 that on Armistice Day November 11, 1918 many city officials across the nation declared a political end to the pandemic.

“A great number of cities across the nation decided that they were going to lift their non-pharmaceutical interventions or closure orders. And in many of those cities, it seemed that the pandemic was over because they thought they were coming down the back end of their surge, their peak,” Navarro says.

“And when people started gathering again, especially on the evening of November 11, to celebrate the end of the war,” Navarro says, “there were still a lot of people who were susceptible to influenza, and so you see in, a number of places, a significant second surge of cases. And in some cities, that surge was worse than the first one.”

Case numbers and deaths from the 1918 pandemic did eventually go down, most likely because the those who survived the virus had some immunity and because the virus mutated and eventually became less deadly, Navarro says. But even then, the virus didn’t go away. Instead, it eventually became a seasonal flu — and its mutated descendants have sparked several smaller epidemics since then.

That’s what many researchers think may happen to COVID-19. But no one is certain when — or even if — that will happen.

“Eventually in 10, 15, or 20 years, if this will become endemic, it will become like a regular, seasonal thing,” Khubchandani says. If that ends up happening, “people will prefer not to wear masks. There will be more vaccines that will be given every year,” he adds.

Both Collins and Lee say there’s simply not enough data to predict when COVID-19 could become more like an endemic, seasonal flu. But, Collins adds, going into 2022 we do have more data, more information, and more vaccines than last year, so there is reason for hope.

“I do think we’re in a much better place, even though we see so many cases,” Collins says. “So I think there’s certainly hope, but we have still got to maintain the safe practices and really be a source of support for one another to keep each other safe.”

Question: Is an endemic COVID-19 good or bad?

A seasonal, flu-like disease may sound like good news when compared to what the world has experienced in the last year. But Khubchandani points out that a seasonal COVID-19 would still likely mean suffering for some people.

“I personally am not pleased with the fact that we think of a disease becoming regular or endemic,” he says. “It still will cost some lives.”

Lee points out that if the virus becomes endemic, it’s likely to be a greater burden on our state’s most vulnerable populations and a lighter burden on our healthier populations. “Bad news is that there’s still going to be a lot of vulnerable people,” she says.

In New Mexico, some of the most vulnerable are those in tribal populations. A recent report from the DOH shows that throughout the course of the pandemic, American Indians in New Mexico have had the highest number of cases per capita. The cumulative age-adjusted case rate per 100,000 people is 24,525 cases per 100,000 people identifying as “Native Indian or Alaska Native.” That’s more than double the case rate for people identifying as “White.”

Collins says that as a state, we need to stay focused on getting as many people vaccinated as possible in order to limit the worst effects of the virus. “Ultimately, we’d love for this to become this weak virus that we could just get on with our lives and not have to do all these additional steps to keep ourselves safe,” she says. “But we’re not there yet.”