Well, it depends on who you ask.
President Biden set off a minor firestorm when he said on “60 Minutes” that “the pandemic is over.” Opinions to the contrary exploded all over. World Health Organization (WHO) Director-General Tedros said more cautiously (and more globally than President Biden) that, “We’re not there yet, but the end is in sight.”
On the other hand, millions of Americans suffering from severe pandemic fatigue have returned to normal activities – eating in restaurants, attending concerts and sports events, shopping – and dispensing with their masks. Millions have been slow to get recommended boosters.
How do pandemics end? First, some definitions.
A disease outbreak is the sudden appearance or increase in the number of cases in a limited area or group. An outbreak may be localized, as when a group of children get diarrhea at a daycare center, or it may be more widespread, like the current Ebola outbreak in Uganda.
An epidemic is the sudden appearance of a disease unusual for an area or with a higher number of cases than normal that quickly spreads to a wider region. An epidemic that rapidly spreads to a large number of people in numerous countries is a pandemic. A disease that is always present at a steady level in an area or a population is said to be endemic.
These terms only relate to the prevalence of a disease, not how severe it is. Epidemiologist Rebecca Fischer explains the first three perfectly when she says that an outbreak is “small but unusual,” an epidemic is “bigger and spreading,” and pandemics are “international and out of control.”
Notice how imprecise this is. There is no exact scale for determining whether an outbreak has become an epidemic, no set number of cases or affected countries to trigger the declaration of an epidemic.
The World Health Organization is responsible for declaring a global pandemic under the terms of the 2005 International Health Regulations (IHR), a legally binding agreement among 196 countries. The official declaration is for a Public Health Emergency of International Concern (PHEIC). Although WHO prefers the official designation, Director-General Tedros declared the coronavirus epidemic a pandemic in March 2020 to underscore the extent, severity, and disastrous potential of COVID-19 with the better-known term.
We are close to three full years in this pandemic. Many of us thought it would be over before this, but the Delta and Omicron variants had different ideas. It has been a wild roller coaster ride. The development and deployment of vaccines, boosters, and tests, and public health measures such as school and business closures, social distancing, masking, and ventilation improvements have been effective.
Sadly, factors including the virus’s ability to mutate quickly, widespread misinformation, vaccine hesitancy, and economic, social, and political pressures to “get back to normal” have extended this pandemic and cost many lives.
When a pandemic ends is just as imprecise as its beginning; both become clear in retrospect. Pandemics don’t move on like tornados or hurricanes; there is no automatic “all clear.” Pandemics can end in several ways, depending on many factors, including those noted above. “Herd immunity” through natural exposure and/or vaccination is one way. Only one infectious disease – smallpox – has been eliminated by vaccination.
Others, such as measles and polio, can be well-controlled but can surge when vaccination levels fall. Endemic diseases remain present in one or more regions or populations, normally causing a low number of infections, but they have epidemic or pandemic potential if circumstances such as viral mutation or climate change make them more dangerous or more transmissible.
It’s unlikely that COVID-19 will ever go away completely. Experts disagree on when it will become endemic like the common cold and the flu. Some think we are getting close while others think it may still be a year or two away. Some believe that COVID will never become endemic because the virus mutates so easily, infections spread so quickly, and we haven’t found a way so far to make immunity total or permanent.
“Endemic” doesn’t mean “harmless.” COVID numbers are falling, but they have fallen before and risen again. Two- to three times more Americans may die from COVID in 2022 than die from flu in a bad year. Between 300 and 400 die from COVID every day.
What if that’s endemic? How many daily deaths are acceptable? 300? 200?
When will this pandemic end? No one knows for sure. But it won’t end because a politician says it’s over. It won’t be over just because we think it’s over. We can’t wish it away.
But every one of us who gets vaccinated and boosted, tests ourselves before visiting someone, and wears a mask around vulnerable people and in crowds, will give it a shove toward the door.
Let’s do it!
Michael Heyd, a retired medical librarian from Fairfield Township who spent more than forty years searching the literature for professional hospital staff, is a member of Let’s end COVID!