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Trending:
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IS THE COVID-19 PANDEMIC OVER? THE ANSWER IS MORE ART THAN SCIENCE

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By Helen Branswell Sept. 19, 2022

Reprints
 * 5 Comments
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Some people are eager to call the pandemic over, but Covid deaths have risen in
recent weeks and the disease is still the fourth leading cause of death in the
country. Alex Hogan/STAT
 * 5 Comments
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Is the Covid-19 pandemic over?

President Biden told Scott Pelley of “60 Minutes” it was. The Sunday night
interview aired just days after the director-general of the World Health
Organization, Tedros Adhanom Ghebreyesus, said the end may be in sight — though
Tedros clearly didn’t mean it was days away when he predicted it.

But how confident can we be that the pandemic is or will soon be over? How can
we know we’ve reached “over” when the disease we’ve been fighting isn’t going
away?

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Reaching the end of a pandemic is not like driving out of one county into the
next. There is no fixed demarcation between a pandemic and post-pandemic period,
especially for the first recorded pandemic caused by a coronavirus. It’s not
like we know it’s over if cases drop to a certain level for a prescribed length
of time.


RELATED: YOUR QUESTIONS ON THE NEW COVID VACCINE BOOSTERS ANSWERED

Experts say there are no accepted metrics or defined international rules that
tell us when we can call the code on this horrible event. In reality, things are
much more ephemeral when it comes to knowing when a pandemic is over.

advertisement



“It’s over when people decide that it’s over. … And most people seem to have
decided it’s over,” said John Barry, author of “The Great Influenza,” a history
of the 1918 Spanish flu.

Most of the experts who spoke with STAT echoed a version of Barry’s remarks: In
some respects, the pandemic is over when people stop taking measures to protect
themselves, when they stop following advice about how to lower their risk, when
they resume pre-pandemic behavior.

Michael Osterholm, director of the University of Minnesota’s Center for
Infectious Disease Research and Policy, said there are actually a couple of ways
to think about when a pandemic ends: by looking at what the disease is doing to
humans physically and psychologically.

By the latter yardstick, the pandemic is done like dinner.

“Everyone right now is fairly focused on the psyche. They want to move on.
They’re done with the pandemic. And I think that [Biden’s] comment reflects
that,” Osterholm said.

Using the former yardstick, however, Osterholm would disagree — noting pandemic
deaths have risen in recent weeks and the disease is still the fourth-leading
cause of death in the country.

“We’ve been in this high-plains plateau for 12 weeks. I don’t know how anyone
can say the pandemic is over for that reason,” he said. “In addition, we don’t
yet know what the next shoe to drop is.”


RELATED: A THIRD COVID AUTUMN IS UPON US. HERE’S A LOOK AT WHERE WE STAND

Osterholm suggested there was no science bolstering the president’s statement,
calling it “an unfortunate unforced error” coming as it did while the
administration is trying to drive up acceptance of the new updated Covid
vaccines.

“The last thing you want to do is discourage people from getting their boosters.
If I hear the president of the United States say the pandemic is over, why in
hell would you want to get a booster?” he asked.

Some people might assume the WHO will issue a decree of sorts, an all-clear
declaration. But in reality that’s not something the global health agency does,
said Alexandra Phelan, an assistant professor at Georgetown University’s Center
for Global Health Science and Security. The WHO didn’t declare the start of the
pandemic and it won’t declare an end to it, she said.

At some point, however, the WHO will announce the lifting of the state of
emergency it declared in late January of 2020 when Tedros declared the new
disease constituted a public health emergency of international concern, or
PHEIC, as the instrument is known in public health circles. The director-general
seeks advice from a committee of outside experts on issues related to the PHEIC;
that committee must meet at least every three months, though it could meet
sooner if Tedros asked it to.

The Covid emergency committee last met on July 8, which means an early October
meeting must be held. Phelan doesn’t think the committee will advise calling off
the PHEIC at that point, though she thinks conditions may allow for it toward
the end of the year.

The U.S. government also has an emergency declaration in effect, a tool that
gives it powers that have eased its ability to enact policies, allocate funding,
and fast-track the authorization of Covid vaccines, drugs, and tests. At some
point it will be declared at an end, but that is not what Biden was signaling in
the “60 Minutes” interview.

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The Department of Health and Human Services has said it will give a 60-day
notice to states before it terminates the public health emergency, or allows it
to expire. The next date for extending the emergency declaration is in October.

J. Alexander Navarro, assistant director of the University of Michigan’s Center
for the History of Medicine, said many of the terms the public has gotten
accustomed to hearing over the past couple of years — outbreak, epidemic,
pandemic, endemic — are not well-defined.

The reality is pandemics are rare events, and each is distinct. The 1918
pandemic was characterized by three waves — though Barry now believes there was
actually a fourth in the United States, in 1920, with some cities experiencing
more deaths than during the fall wave of 1918. The 2009 H1N1 pandemic, which was
mild by pandemic standards, had a single wave.

Typically it has taken the passage of time to see that another wave didn’t
crest, that disease activity had returned to a normal pattern. That’s easier to
see in retrospect than in real time.

It’s especially hard this time, Navarro said, because of our lack of recorded
experience with pandemics caused by coronaviruses. There are four coronaviruses
that cause common colds; they too at one point made their way from an animal
source into people. But it’s not known when that happened. And if they triggered
what we would consider a pandemic when they did so, the events were likely
mistaken for influenza.


RELATED: ‘I’M DEEPLY CONCERNED’: FRANCIS COLLINS ON TRUST IN SCIENCE, HOW COVID
COMMUNICATIONS FAILED, AND HIS CURRENT OBSESSION

With flu pandemics, the transition into the post-pandemic period is deemed to
have occurred when flu activity resumes its normal cadence. Summer waves
disappear; activity — at least in temperate zones — peaks during the winter
months. Deaths decline. Unusual behavior gives way to usual behavior.

There’s a problem here: We don’t yet know what endemic Covid-19 is going to look
like.

“What is normal going to look like with Covid? How many cases are we going to
expect daily, seasonally, yearly?” Navarro asked.

Osterholm said there should be some ground rules established for when and how to
declare the pandemic over, noting that if things take a turn for the worse,
public trust will take another beating.

“You can’t make a pandemic go away by a policy decision,” said Osterholm. “It
doesn’t work.”

Get your daily dose of health and medicine every weekday with STAT’s free
newsletter Morning Rounds. Sign up here.


 * 5 Comments
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ABOUT THE AUTHOR REPRINTS


HELEN BRANSWELL

Senior Writer, Infectious Diseases

Helen covers issues broadly related to infectious diseases, including outbreaks,
preparedness, research, and vaccine development.


@HelenBranswell


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