This pandemic is a wild ride that has brought us highs (yay vaccines!), lows, and loop-de-loops  of ever changing guidelines. We get through one peak of the virus only to face another variant, with each twist and turn bringing new guidance on how and where we should mask and when we should get boosted. The variants are one of the reasons why the rules of the game keep changing, so let’s take a moment to discuss them along with where the pandemic may be going from here.

First, why do variants occur?

• Variants occur when a virus replicates and spreads—it’s simply the nature of the virus. When viruses replicate, they constantly mutate which can lead to the creation of new, distinct variants. 
• Most people will clear the SARS-CoV-2 virus rather quickly (within a week or two). But for some people, viral replication can persist for weeks or months and lead to new variants. 
• Variants can also form as one virus, and then pick up genetic material from other viruses they encounter. When this happens, they may suddenly gain the ability to be more or less infectious, or to cause more or less severe disease. It’s all based on the luck of the draw since viruses can’t actually think and selectively choose how they’d like to mutate. 
• The variants that have mutations which let them spread easier, or evade our immune system better, or cause more severe disease will be the ones that we worry about the most, like Delta and Omicron.

How are variants detected and monitored?

• Through genetic sequencing we create family trees for viruses, showing grandparents, great-grandparents, and all their descendents. This way of organizing helps us detect variants and monitor their spread. 
• Variants are also monitored based on their classified severity of risk. The current classifications are “variants being monitored, variants of interest, variants of concern, and variants of high consequence.” Delta and Omicron are labeled variants of concern. Currently, no SARS-CoV-2 variants are identified as variants of high consequence, the most consequential of the categories.

What variants have occurred during the pandemic and what has changed with each?

• We started with the original SARS-CoV-2 strain, and our original vaccines were targeted to this strain. Later, Alpha appeared, along with a few other variants that emerged across the globe; they all  remained relatively quiet until Delta arrived with a bang. Delta brought the worst combination—it was more transmissible AND caused more severe illness. Thankfully, the vast majority of those who chose to be vaccinated escaped severe symptoms, hospitalization, and death. However, variant-specific vaccines (vaccines that specifically target the variants like Alpha, Delta, or Omicron) have not yet been released, though we may have them in the future.
• Most recently, Omicron caused an outbreak of cases across the United States due to a transmissibility rate that was previously unheard of for COVID-19. Another disappointing aspect of Omicron is that some of our treatment options no longer worked. By the end of February 2022, it is predicted that Omicron may have touched around 40% of Americans. This percentage, along with vaccinations, can help build immunity in the US population, but no one knows how long or how strong that durability will be. Omicron is now presenting a new issue, as a new kind of Omicron variant (or sublineage) called BA.2 has emerged. Scientists are watching this closely. 

Do we need a second booster shot?

• This is a great debate at the moment in the scientific community. Some say there is not enough evidence that we need a second booster because the first one is holding up well in preventing severe disease. Others say it is a good idea. In fact, Israel rolled out its second booster with some success at decreasing severe disease among those older than 60. Some say it is time for an Omicron-specific booster dose. For now, we continue to watch and learn until there’s a clear consensus.

So, the best way to prevent new variants from emerging is by reducing the spread of COVID-19 through vaccination, boosters, masking, social distancing, and good ventilation. And where will the pandemic go from here? No one knows. Nobody can claim to know where the pandemic will go from here. But, it will end eventually, and probably so slowly over time that we only notice in hindsight. Most scientists think that it will become endemic, meaning that it will just hang around in the background, resembling something more like the flu.