COVID is never going away. But the pandemic will inevitably end at some point. Right?
For many, it already has, with masks, social distancing, and frequent handwashing relegated to a traumatic past theyre unwilling to revisit.
This week the Biden administration extended the U.S. public health emergency for another 90 days, though U.S. Department of Health and Human Services officials recently warned states that the emergency status may soon come to an end. World Health Organization officials, too, continue to express optimism that the global health emergency may draw to a close this year. A committee meeting on the matter is set for Jan. 27.
Are weor are we notstill in a pandemic, three years in? There arent consensus definitions for the terms pandemic and endemic, which loosely refer to a disease outbreak affecting the world, and a particular area like a country, respectively. Given the lack of agreement, its impossible to definitively say if the pandemic is ongoing. Personal opinions vary, and shades of gray abound.
At what point will we all agree? Will we ever?
Unfortunately, pandemic is really more of a political and sociological term than a scientific one, Dr. Jay Varma, chief medical adviser at the New York-based think tank Kroll Institute, told Fortune. A 20-year veteran of the U.S. Centers for Disease Control and Prevention, Varma was the principal architect for New York Citys COVID-19 pandemic response before joining the institute in March.
A pandemic tends to transform into an epidemicat least in the court of public opinionwhen society or government reaches a point where its willing to accept a certain number of deaths each day, Varma said.
Its certainly not scientists who decide that. Those in public health would say thats not acceptable.
Dr. Michael Merson, visiting professor at New York Universitys School of Global Public Health, echoed Varmas comments, telling Fortune that the general public has accepted that the pandemic is overat the expense of mass casualties.
Conditions are better than they were in the early days of 2020, he concedes. COVID, however, is still causingto mean unacceptable amount of deaths, he said, adding that societys acceptance of the body counthundreds of thousands annually in the U.S. aloneis disturbing.
Not now, of all times
Of all times to declare the pandemic over, now is not it, many public health experts contend. The reason: the recent unshackling of China from years of zero COVID restrictions. The reopening appears to have occurred without much, or any, planning, leaving the majority of Chinas 1.4 billion residents vulnerable to illness, hospitalization, death, and long COVIDsimultaneously.
The reopening serves as a wildcard for the world, too, putting it at risk of potentially dangerous new variants that are statistically more likely to occur there, given ultra-high levels of transmission. Chinese New Year gatherings on Jan. 22 are likely to further fuel transmission. Whats more, the Chinese government is allowing residents to travel internationally again.
China aside, levels of potentially daunting COVID variant XBB.1.5, dubbed Kraken, are surging in the U.S. They played a role in a recent rise in hospitalizations in the Northeasta trend that could play out in the rest of the country, as the virus expands westward. Other countries could eventually find themselves in a similar situation.
XBB.1.5s rise is just a reminder that as much as he would like this pandemic to be over, its not, Varma said. The virus isnt behaving as if it wants this pandemic to be over.
Still, it may be time to end emergency declarations, Dr. Georges Benjamin, head of the American Public Health Association, a 150-year-old organization of public health professionals that seeks to promote health and health equity in the U.S., told Fortune.
Its got to go away at some point, he said on Tuesday about the U.S. federal health emergency. And I think were quickly approaching that point.
The policymakers dont want to fund it anymore; people dont want to pay attention to it anymore, he said. Its a human behavior thing. If everything is an emergency, nothing is.
But declaring an end to the emergency doesnt mean the pandemics over, Benjamin cautioned.
It doesnt mean anything, he said. Were not in a public health emergency and we still have an HIV/AIDS pandemic.
How to exit the pandemic
There are a few generally accepted paths out of pandemic status, Dr. Bruce Y. Lee, professor of health policy and management at the City University of New York School of Public Health, told Fortune.
One of them: when the level of COVID infections drops sufficiently worldwide. The virus could settle into a pattern of true seasonality, similar to what is seen with RSV and the flu, in which cases are virtually nonexistent in the summer and spike in the winter. Or COVID levels could declinesomewhatto a prolonged high plateau, with a relatively elevated level of cases occurring throughout the year.
A transition to the later scenario could be underway now, Lee contends. Peaks in cases arent as high as they were in early pandemic days. Nor are valleys between spikes as low as they werepainting a potential picture of an endemic COVID future with consistently elevated levels of viral transmission.
A seasonal pattern would be preferable, Lee says.
We dont want to have higher-than-high plateaus or constant levels throughout the year, he said. Thats a lot more difficult to manage than something seasonal.
A glorified cold or flu?
With the U.S. still in the grips of a tripledemic of COVID, RSV and the flu, public health officials are warning those with symptoms like fever and malaise to not assume they have the flu, and to test for COVID. Its virtually impossible to distinguish the two based on symptoms right now, experts say.
Its a reality fueling office water-cooler debates about the continued legitimacy of the pandemic. How can COVID still be of pandemic status if its indistinguishable from the flu or, for some, a cold?
Its a fair question, but one with a simple answer: Cold viruses rarely killand the flu doesnt kill nearly as often as COVID.
Psychologically, Im afraid the public is accepting our current situation as the pandemic being over, despite the fact that we have 250,000, 300,000 deaths a yearfar more than we have with the flu, said Merson, from New York University.
Last season, the flu killed an estimated 5,000 Americans, according to the U.S. Centers for Disease Control and Prevention. It was a mild flu year, to be sure, thanks to pandemic precautions. But annual flu death tolls routinely number in the tens of thousandsnot hundreds of thousands, like COVID deaths. Since the pandemic began, COVID has killed nearly 1.1 million Americans. The flu has killed less than 50,000.
While the public and many public health experts continue to be at odds on the pandemics status, Lee says things are looking upat the moment.
In 2020, many public health experts predicted that the pandemic would last around 2.5-3 years, he saysabout the length of the 1918 flu pandemic and other outbreaks, like the Japanese smallpox epidemic of 735-737, the Black Death, and the Italian plague of 1629-1631.
Were roughly on schedule, plus or minusmore pluscompared to what we originally anticipated, Lee said. This suggests that 2023 may be the big transition year. Were seeing the right trends.
