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US President Joe Biden Departure

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The White House recently received a sobering warning about the potential for the <a href="https://www.washingtonpost.com/coronavirus/" target="_blank" class="contextual_link">coronavirus</a> to come roaring back, with experts reaching a consensus that there’s a roughly 20 percent chance during the next two years of an outbreak rivaling the onslaught of illness inflicted by the omicron variant.

A forecast from one widely regarded scientist pegged the risk at a more alarming level, suggesting a 40 percent chance of an omicron-like wave.

White House officials spoke with about a dozen leading experts in virology, immunobiology and other fields about the prospect that the virus would again develop mutations that allow it to evade protections from vaccines and treatments. Those discussions, not previously reported, came as the administration planned for the May 11 end of the public health emergency that was declared at the dawn of the pandemic.

Some experts based their conclusions on existing research, and at least one, computational biologist Trevor Bedford of the Fred Hutchinson Cancer Center in Seattle, conducted new statistical analysis about the potential for a coronavirus wave.

“No one’s saying it’s zero. No one’s saying it’s 80 percent,” said Dan Barouch, an immunologist and virologist at Harvard Medical School, who spoke with the White House. “It’s more than an infinitesimal chance — and it is by no means a certainty.”

The experts’ analysis was shared in a report among Biden administration leaders this spring, as they weighed how to wind down their coronavirus response team and set up initiatives intended to provide longer-term pandemic protections. Several of those initiatives — including a <a href="https://www.washingtonpost.com/health/2023/04/10/operation-warp-speed-successor-project-nextgen/" target=_blank>next-generation vaccine program</a> and a <a href="https://www.washingtonpost.com/health/2023/04/18/coronavirus-vaccines-free-uninsured-biden-bridge-program/" target=_blank>program to cover coronavirus vaccines and covid treatments for the uninsured</a> — are at risk as Republicans seek to claw back unspent coronavirus funds as part of ongoing <a href="https://www.washingtonpost.com/politics/2023/04/26/debt-ceiling-explained/" target="_blank" class="contextual_link">debt ceiling</a> talks in Congress.

The White House declined to comment about the experts’ analysis.

“The administration has conversations with a broad range of experts, both inside and outside of government, on a number of issues,” a White House spokesperson said in an email.

Senior officials have publicly emphasized the need to implement more public health protections to guard against the next viral threat, even as political will and funding fades along with the threat from the coronavirus.

“One of my biggest worries is that we are losing time in preparing for the next pandemic,” Dawn O’Connell, assistant secretary for preparedness and response at the Department of Health and Human Services, told a Senate committee Thursday.

Rochelle Walensky, the Centers for Disease Control and Prevention director who <a href="https://www.washingtonpost.com/health/2023/05/05/cdc-director-walensky-departure/" target=_blank>announced Friday that she was stepping down</a>, also warned the Senate panel that her agency still faces challenges such as limitations on collecting data from hospitals and local health departments about potential outbreaks.

“We can’t act swiftly, nimbly, robustly if we can’t see what is happening from a data standpoint,” Walensky said.

The World Health Organization on Friday <a href="https://www.washingtonpost.com/world/2023/05/05/who-covid-global-health-emergency/" target=_blank>declared that the pandemic</a> is no longer a global health emergency, but WHO Director-General Tedros Adhanom Ghebreyesus cautioned that the announcement “does not mean that covid-19 is over as a global health threat.”

Confirmed covid cases and deaths have plunged in recent months, with public health experts crediting the immunity conferred by vaccines and prior infections for curbing the virus’s risks.

Fewer than 80,000 <a href="https://covid.cdc.gov/covid-data-tracker/#trends_weeklycases_select_00" target=_blank>confirmed coronavirus cases</a> were reported across the United States last week — the lowest figure since March 2020. But the actual rate of infection is almost certainly far higher than the reported numbers, with many Americans testing at home, if at all, and opting not to report their results.

The potential for large indoor gatherings to fuel coronavirus infections remains high, as illustrated by about <a href="https://www.washingtonpost.com/health/2023/05/02/covid-outbreak-cdc-annual-conference/" target=_blank>three dozen cases linked to a CDC conference</a> last week. The virus remains on pace to be one of the <a href="https://www.washingtonpost.com/health/2023/04/16/covid-deaths-per-day/?itid=lk_inline_manual_14&itid=lk_inline_manual_7" target=_blank>top 10 causes of death</a> this year, with fatalities concentrated among older and immunocompromised individuals.

“What most people don’t understand … this virus isn’t going away,” said Eric Topol, director of the Scripps Research Translational Institute, who also spoke with the White House about its covid projections.

Most of the infections in the United States <a href="https://www.washingtonpost.com/health/2021/12/19/fauci-warns-omicron-variant-will-cause-record-high-coronavirus-hospitalizations-deaths-us/" target=_blank>since December 2021</a> have been caused by omicron and its subvariants, raising the prospect that a new strain of the virus — with a set of novel mutations — could surprise immune systems conditioned to fight omicron.

“This could happen if one immunocompromised person” incubates the virus, accelerates its evolution and spreads the new variant to others, Topol said. “Whether it would be more pathogenic, more virulent … [or] cause more serious disease remains to be seen. But it could just lead to more transmission.”

Bedford said he believes there is about a “40% chance of an Omicron-like event between today and May 2025,” he wrote in an email to The Washington Post this week, citing the analysis he shared with the White House and the logic that there had been one omicron-level event so far during the pandemic, which began in early 2020.

While that projection may seem high, Bedford added, “I don’t see an obvious reason” for why an omicron-like event is much less likely now than in the first two years of the pandemic. Like Topol, he pointed to what is known as the emergence of a cryptic lineage. That happens when a person harbors variants of the virus that diverge from what is widely circulating. If those new variants are transmitted, they can ignite a broader wave of illness.

“We have continued detection of ‘<a href="https://twitter.com/SolidEvidence/status/1652404073839181824" target=_blank>cryptic lineages</a>’ in wastewater surveillance, suggesting that it’s not uncommon to have run-away evolution of a persistent infection within a single individual,” Bedford wrote, cautioning that much is unknown about these variants, including the identities of the individuals harboring the viruses, their symptoms and whether the variants are transmissible. But the existence of these cryptic lineages raises concerns, Bedford added. “This single-individual scenario is still my best explanation for the emergence of Omicron in late 2021.”

Barouch said that even if a variant emerges that evades protections intended to counter omicron, it could still be stymied by the immune system’s T-cells — white blood cells that help fight infections, and which Barouch credited as “the unsung heroes of the pandemic.”

“While the variants escaped antibody responses, so far none of the variants … escaped T-cell response,” Barouch said. “If a new variant emerges and also escapes from T-cell responses, then we will be more back at square one.”

In the short term, the White House coronavirus response is facing a bigger threat than a theoretical virus variant: Washington budget talks.

Xyza Cruz Bacani

The GOP-led House last week passed debt ceiling legislation that would rescind unspent funding set aside for the coronavirus response — a total that some estimate is <a href="https://www.nytimes.com/2023/04/20/us/politics/republicans-unspent-covid-money-debt-limit.html" target=_blank>more than $50 billion</a>.

“Billions of dollars sitting out there [for] covid, never spent, just sitting there. We claw that back so the American taxpayer can save the money,” House Speaker Kevin McCarthy (R-Calif.) said on Fox News last week.

House Democrats counter that the remaining coronavirus funds are necessary to prepare for future pandemics and to fortify the nation’s public health system.

For instance, rescinding the $5 billion set aside for the next-generation vaccine program “would eliminate advanced research and development of vaccines and therapeutics to combat future Covid variants, including intranasal vaccines that could prevent new respiratory infections and ‘universal’ vaccines that could provide protection against all coronaviruses,” Democrats warned in a <a href="https://democrats-appropriations.house.gov/sites/democrats.appropriations.house.gov/files/COVID%20Cuts.pdf" target=_blank>fact sheet</a> last month.

Marc Goldwein, senior vice president at the Committee for a Responsible Federal Budget, a nonpartisan fiscal watchdog, said he supported efforts to reclaim some of that money for other purposes.

“If there is any money the Administration actually needs but hasn’t obligated — for example to make sure we have good COVID vaccines — the burden is on them at this point to explain why that money shouldn’t be rescinded,” Goldwein wrote in an email.

The Biden administration, through a health agency known as the Biomedical Advanced Research and Development Authority, has begun <a href="https://sam.gov/opp/53668acd172e4440a096362247bcea73/view" target=_blank>seeking</a> <a href="https://sam.gov/opp/6f989eb9c421422788a4c3a9133917f0/view" target=_blank>industry</a> partners for its next-generation coronavirus vaccines and treatments initiative. Tom Inglesby, director of the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health and former coronavirus testing coordinator for the Biden administration, argued that longer-lasting, more protective vaccines are needed to blunt future virus surges.

“Rescinding money for COVID response would be a mistake,” Inglesby wrote in a text message. “The country is in such a different, better place now on COVID, but this disease is not gone — there are still 150 Americans dying of COVID every day.”

Bedford, the computational biologist, said he understood why the WHO and the United States were ending their public health emergencies but added that the world is entering a stage of the covid response that will pose new challenges.

“Even if the pandemic is over, endemic covid is still going to be a major public health concern,” he said.

George Polk Award, 2020

Goldsmith Prize for Investigative Reporting finalist, 2021

University of Pennsylvania, BA in history

Dan Diamond is a national health reporter for The Washington Post. He joined The Post in 2021 after five years at Politico, where he won a George Polk award for investigating the Trump administration's response to the coronavirus pandemic.