GRAND RAPIDS, Mich. (WOOD) — COVID-19 cases and hospitalizations continue to drop across Michigan as we slide down the fourth spike of the pandemic.

During the delta and omicron surges, our cases rose faster and reached unprecedented levels. Now, two years into the pandemic, with vaccines, antibody treatments and piles of new information, several questions loom.

One sums them all up: What’s next?

“WE’RE NOT THERE YET”

Many countries around the world have already lifted most of their restrictions, hoping we’re moving past the pandemic stage of COVID-19. While that is possible, new mutations of the virus are already forming and spreading. Despite the sharp drop in cases, it’s too early to declare an end to the pandemic.

“It’s too early to raise the ‘mission accomplished’ banner,” Dr. William Schaffner told Healthline. “We’re not there yet. In public health, there is a great tendency to eradicate the control program before the disease is under control.”

Schaffner, a professor of preventative medicine and infectious diseases at Vanderbilt University Medical Center, says he’s cautiously optimistic, but warns it is way too early to stop taking precautions.

“The virus will continue to spread in its own enthusiastic fashion until it just runs out of susceptibles,” Schaffner told Healthline.

THE BIGGEST THREAT?

The main threat powering the pandemic is the next mutation of the virus. Dr. Suzanne Bradley, a professor of internal medicine and infectious diseases at the University of Michigan, says the problem is we don’t know how the virus will respond next.

“The virus has been unpredictable,” Bradley told News 8. “It mutates, and for it to mutate, it has to be able to infect people. But if we maximally protect ourselves with vaccines, we might be able to prevent this thing from mutating further and die out. I think that’s the hope; that we will get to the point where that will happen or at least become more predictable and more seasonal.”

The longer we spend in a pandemic, the higher the risk becomes for developing more contagious forms of the virus. It’s a trend we’ve seen run from the original strain to the delta variant and now omicron.

“There are multiple mutations happening out there, but it’s a survival of the fittest thing,” Bradley said. “If (one virus) is better at transmitting to other people or other hosts, (the virus is) going to live. If you’re not very good at it, you’re going to die out. So the more contagious ones are going to win.”

THE NEXT VARIANT?

According to Bradley, the worst-case scenario is that we allow another variant of COVID-19 to emerge. Another variant gives the virus more opportunities to figure out how to beat our vaccines and treatments.

“We continue to have vaccines be less effective against variants. Some of our monoclonal antibody and IV therapy treatments (can) become ineffective, our hospitals (can) become overwhelmed again,” Bradley said.

The world’s health experts are keeping a close eye on mutated forms of the virus. Right now, the largest focus is on BA.2. A report from the science journal Nature calls BA.2 is a “sub-variant” of omicron that split off about a year ago and picked up its own mutations. A lab study conducted in Boston found that BA.2 is even more contagious than omicron. However, given the relative similarities between omicron and BA.2, antibodies developed from omicron have also shown to be effective against this variant. Researchers also said a major wave of infections is unlikely in communities that were hit hard by omicron.

“It might prolong the omicron surge. But our data would suggest that (BA.2) would not lead to a brand-new surge,” said Dr. Dan Barouch, an immunologist who led the Boston lab study.

WHAT’S NEXT FOR VACCINES?

While the original COVID-19 vaccines proved very effective against the original strain and the delta variant, they were less effective at preventing infection from the omicron variant. The fear is that the virus will outpace the changes we make to our vaccine formulas.

Both Moderna and Pfizer are actively working on a booster dose specifically tailored to the omicron variant. But can these finely tuned vaccines be developed, tested and approved in time to fend off an outbreak?

“I’m not sure that an omicron-specific vaccine (could be developed in time for real-world needs). I think they’re maybe doing it as a proof of concept that they can do this and turn it around quickly,” Bradley said. “By the time they do that, are we going to be dealing with omicron or are we going to be dealing with its cousin, BA.2? … The beauty of these new vaccines is they can, compared to the old ways, turn things around very quickly.”

Bradley also suggested the COVID-19 vaccine could mimic the same pattern we see during flu season, where health experts track and predict the dominant virus strains and design a booster shot that is effective against multiple variants.

WILL WE NEED ANOTHER BOOSTER?

The omicron variant proved that our vaccines aren’t perfect. They are still effective — even though breakthrough infections are common with omicron, they still sharply reduce the number of hospitalizations compared to people who are not vaccinated. But will we eventually need another booster dose? The early answer is no.

A research team in Israel ran a set of tests on a fourth booster dose. They found that the fourth dose produced roughly the same reaction as the third dose. It brought antibody levels up to a high level, but they slowly dropped, eventually stopping at 50% efficiency. There are short-term benefits, but not long-term.

WHEN WILL WE SEE A VACCINE FOR YOUNG CHILDREN?

Lots of parents have voiced their frustrations that children under 5 years old don’t have access to COVID-19 vaccines. Last month, Pfizer and BioNTech announced they would not yet present their two-dose vaccine regimen to the federal Food and Drug Administration.

According to NBC News, the pediatric dose didn’t generate a strong enough immune response in kids ages 2 to 4 years old. Instead, Pfizer will wait for the final test results of a three-dose regimen, which is expected in the coming weeks.

Bradley says it’s common sense for Pfizer and BioNTech to be extra cautious and ensure their vaccine is safe and effective before moving on in the process, but it’s also the safe play in terms of getting a vaccine approved.

“The approval process takes time,” Bradley said. “And if they turn you down, you’re starting from scratch again. So, I think they decided it was the better part of valor to wait and see how the third dose data looked.”

Pfizer’s pediatric dose was set at 3 micrograms, compared to 10 micrograms for children ages 5 to 11 and 30 micrograms for people 12 and older.