In a Twitter Q&A, the former Microsoft CEO and founder of the Bill & Melinda Gates Foundation predicted that once Omicron surges through a community, the community will then see “far fewer cases,” meaning COVID could be “treated more like seasonal flu.” An Omicron surge would “create a lot of immunity at least for the next year,” Gates said, giving populations a temporary level of herd immunity.

Governments around the world are starting to consider an eventual shift to a “living-with-the-virus” approach that treats COVID-19 like an endemic disease. Such a tactic would manage the coronavirus as a threat to vulnerable populations like children and the elderly, but largely allowing the rest of society to continue life as normal.

Some of the first countries hit by Omicron are already starting to see cases decline. Cases in South Africa—where the variant was first discovered—have decreased significantly since a mid-December peak, with one expert calling the surge in cases “a flash flood more than a wave.” Scientists are starting to see similar trends in the U.K. and the U.S.—in part because the rapid increase in COVID cases means there are fewer people for the virus to infect. 

Gates warned, however, that “health systems will be challenged” by Omicron. Even though the new variant is relatively milder, hospitals may still be overwhelmed by the sheer number of Omicron cases that need medical care. As U.S. COVID-19 hospitalizations hit a record high this week, patients and health staff are reporting longer wait times before being admitted to the hospital.

Hospitals—like airlines and grocery stores—have been hurt by staff shortages as COVID-positive workers stay home. U.S. health authorities are considering allowing COVID-positive health staff to go to work if they have mild or no symptoms to help ease hospitals’ worker shortages.

Gates also touched on the problem of misinformation. Public figures like Gates and Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, have been subject to social media attacks over their public health advice. 

“Putting chips in arms doesn’t make sense to me—why would I want to do that?” Gates asked, referring to one false conspiracy theory that accuses the billionaire philanthropist of implanting tracking devices in humans via COVID-19 vaccines. 

In a Senate hearing on Tuesday, Fauci accused Sen. Rand Paul of using “a catastrophic epidemic” for political gain, pointing to the senator’s use of “fire Fauci” as a fundraising tactic. Fauci said that such rhetoric “kindles the crazies” and had led to threats against him and his family. 

Gates’ hope that COVID would eventually look more like the flu isn’t new. At Bloomberg’s New Economy Forum in Singapore in November, Gates predicted that COVID hospitalization and death rates would fall below seasonal flu by mid-2022—assuming no new, more dangerous variant emerged in the meantime. 

Just a few weeks later, scientists in South Africa announced the discovery of a new, highly transmissible COVID variant: Omicron. 

For now, Gates thinks the emergence of a variant more transmissible than Omicron isn’t likely. But, he says, “we have been surprised a lot during this pandemic.”