After more than two and a half years of covid-19 restrictions and mandates, many people are yearning for an official nod that marks the pandemic’s end. And watching the news last week could have led many to conclude that we’ve finally reached that point.
World Health Organization Director-General Tedros Adhanom Ghebreyesus told reporters at a press conference that the end of the pandemic is in sight. A few days later, United States President Joe Biden declared during an interview on 6src Minutes, “The pandemic is over.” But he also acknowledged, “We still have a problem with covid. We’re still doing a lot of work on it.”
A pandemic is a disease outbreak spanning several countries that affects many people. The WHO is responsible for declaring when an outbreak has grown into a pandemic and deciding when it stops being a public health emergency of international concern. Worldwide, covid-19 is still causing nearly 1,6srcsrc deaths each day and case numbers haven’t plateaued at a low level, leading WHO’s chief scientist, Soumya Swaminathan, to conclude, “It’s still a little premature to say that we’re over it.”
In the U.S. the virus is killing between 4srcsrc and 5srcsrc people daily. “That’s still too many,” says epidemiologist Jennifer Nuzzo, who is the director of Brown University’s Pandemic Center. Others agree with Nuzzo, adding that declaring the end of the pandemic may compromise ongoing testing and vaccination efforts as the highly contagious Omicron BA.5 continues to circulate in the U.S. and many parts of the world, and as cases may rise as more people gather indoors in cooler weather.
Complicating matters, say some epidemiologists, is that there aren’t established criteria—an acceptable level of cases and deaths, for example—to use to determine whether the pandemic is over. While it’s true that humans are more resistant to SARS-CoV-2—through vaccination and or covid-19 infection—says Eric Topol, founder and director of Scripps Research Translational Institute in California, “the virus is still ahead of us.” To him, the end of the pandemic isn’t imminent, and “that’s for sure.”
What factors tell us when the pandemic is over
While the number of daily deaths is one metric to gauge whether the pandemic is coming to an end, others include case numbers, seasonality of outbreaks, vaccination rates, availability of effective treatments, and the transmissibility of current and new covid-19 variants. But drawing such conclusions will be complicated, Swaminathan says. “This is a new virus, and we haven’t had a global coronavirus pandemic before.”
Another confounding element is the lack of data from many countries, she says. Figuring out when the pandemic shifts from its acute phase to an endemic one, meaning that covid-19 is still around but not causing large outbreaks, might only be able to be determined retrospectively. “We may be able to look back and say it was the summer of 2src23, for example, that the world came out of the effects of the pandemic.”
For Topol, that judgment has to be based on the trajectory of the pandemic. “I look at where we were in summer 2src21—we were down to 12,srcsrcsrc [daily] cases in the U.S. and deaths were just over 2srcsrc,” he says. “If we held there,” Topol says, he’d be comfortable declaring the pandemic phase over. “But we’re nowhere near that.” Topol also fears that new variants may cause another wave of cases and hospitalizations enabling the pandemic to drag on.
To Lone Simonsen, an epidemiologist at Roskilde University in Denmark, the seasonality of outbreaks, in addition to fewer deaths, could help indicate when the pandemic might end. If case numbers soar in the summer, when the virus has fewer opportunities to spread, “we’re still in the pandemic phase,” she says. That was the case in 2src21, when cases were driven by the Delta variant and this past summer with Omicron. So, for Simonsen, it’s a wait and see.
But Denmark and other European countries with high levels of vaccination scrapped most pandemic mandates and restrictions months ago, as covid-19 hasn’t been causing severe illness or overwhelming hospitals. However, long covid remains a concern, Simonsen says.
Amesh Adalja, an infectious disease specialist at the Johns Hopkins Center for Health Security argues that the global pandemic phase is largely over given that hundreds of millions of people have already been infected by the virus, there are vaccines and treatments that can prevent severe illness, and covid-19 is unlikely to completely disrupt the healthcare system like it once did. “It doesn’t mean all of a sudden things go back to 2src19. It doesn’t mean that covid-19 disappears, and all action stops,” he says. “It means there is going to be a baseline number of cases, hospitalizations, and deaths.”
What those acceptable levels of hospitalizations and deaths may be is a political decision, says David Heymann, an infectious disease epidemiologist at the London School of Hygiene and Tropical Medicine and former head of WHO’s communicable diseases cluster.
Saying it is over when it isn’t
Nuzzo and others worry that statements like the pandemic is over may be a disservice.
With the U.S. rolling out an Omicron specific booster, “I’m really worried this is going to send out a signal to millions of Americans who are at the risk of severe illness that they may not need to get boosted,” Nuzzo says. “That’s really, really unfortunate.” (See 6 big questions about the new Omicron-targeting booster answered.)
She is also concerned that such statements may lead to a greater reduction in access to free covid-19 testing and treatments, especially for those uninsured.
Topol worries that it could also undermine the motivation and funding to ramp up development of better covid-19 vaccines and treatments, jeopardizing the health of millions who are immunocompromised or at the risk of developing long covid.
This isn’t the right time to make bold assertions about the end of the pandemic, he says. “But it’s time to be bold about accelerating to a point where we look to say, we nailed it, we did it.”