What began as an airborne pandemic driven by a single virus has become a viral cloud roiling around the globe thanks to public policies that have allowed unfettered transmission.

As a consequence the pandemic now represents different threats in different regions for different classes of people at different times. The wealthy elite attending Davos may be protected by tests and clean air machines, but the rest of us face contrasting realities.

Consider how the Virus has evolved:

We no longer face one viral foe or a single variant such as Delta. Omicron has produced four lineages of genetically diverse descendants morphing into an ever-growing swarm of 700 subvariants referenced by a confusing jungle of numbers and letters. What was once a single violin has become a complex and expanding orchestra with no discernable conductor. Even virologists now have trouble keeping track of where the variants are coming from, and what their different mutations mean.

And it's what we do -- or don't do -- that drives the evolution of the virus:

Our actions, or inactions, are driving this evolution. Current policies allow unimpeded transmission. And in that context, vaccines and anti-viral treatments, despite their obvious life preserving benefits, have created conditions under which the virus is evolving rapidly.

Some variants have become immune evasive. Others have become more transmissible or adept at binding to human cells. Many mutations have rendered antibody treatments totally ineffective. A study showing the descendants of BA.2 and BA.5 have become more pathogenic. There is no shortage of new variation thanks to a high mutation rate, and variants continue to beget new descendants in an ever-expanding viral family tree.

By naming the latest subvariant XBB. 1.5 “Kraken” after a legendary squid-like sea monster, the Canadian evolutionary biologist T. Ryan Gregory has done the world a small favour. People tend to pay attention to things we name and that name served as a reminder that this new viral swarm is mutating at an accelerating pace. One star has become a viral nebula.

Now we're caught on the horns of a dilemma:

Welcome to our current pandemic paradox. About two-thirds of the world have been vaccinated. These vaccines can prevent death and disease, but not infection. They reduce the risk of long COVID, but only provide partial protection against it. The effectiveness of many vaccines are now waning in many jurisdictions against more immune-evasive variants.

At the same time people’s vaccine hesitancy has sharply increased, despite research that shows bivalent boosters save lives.

So the many subvariant descendants of SARS-CoV-2 have no trouble finding human hosts. As they replicate, they mutate and behave as Darwin would have predicted. Evolutionary pressure on the virus selects variants that can escape drugs or vaccine-prompted immunity in addition to immunity elicited by prior infections.

The pandemic no longer resembles an elegant graph composed of peaks, valleys and occasional lulls in infection, death and disability. The new viral swarm, as evolutionary biologist Gregory has cogently explained in interviews, is producing not one or two waves but a sustained succession of waves, including four last year in Canada and five in the U.K.  

In other words the pandemic has gone from an acute emergency (sudden death and clogged hospitals) to an ongoing chronic reality (chronic disease and clogged hospitals plus waves of excess deaths).

Gregory asks: What are the consequences of a rising sea of infections as opposed to tsunamis? And answers: “Sustained pressure on health-care systems with no major lulls anymore. In fact, the lows over the past Omicron year exceed the peak during Delta.”

Result: Canada experienced its worst death and hospitalization rate for the virus in 2022.

So, no, COVID hasn't gone back into its cave. It's evolved into a multi-headed hydra.

Image: Atlas Wiki Fandom