COVID continues to rise, but life is returning to normal everywhere. When is the pandemic really over?

COVID never goes away. But the pandemic will inevitably end at some point. Right?

For many, with masks, social distancing and frequent hand washing, it has already been relegated to a traumatic past that they don’t want to go back to.

This week, the Biden administration extended the US public health emergency for another 90 days, even though officials from the US Department of Health and Human Services recently warned states that the emergency could end soon. World Health Organization officials also remain optimistic that the global health crisis will end this year. A committee meeting on the matter is scheduled for January 27.

Are we – or not – still in a pandemic, three years from now? There are no consensus definitions for the terms “pandemic” and “endemic,” which loosely refer to a disease outbreak that affects the world and a particular area such as a country, respectively. Given the lack of agreement, it is impossible to say conclusively whether the pandemic is on. Personal opinions differ and shades of gray abound.

When will we all agree? Will we ever?

“Unfortunately, ‘pandemic’ is actually more of a political and sociological term than a scientific term,” Dr. Jay Varma, chief medical advisor at New York-based think tank Kroll Institute. Fortune. Varma, a 20-year veteran of the U.S. Centers for Disease Control and Prevention, was the chief architect for New York City’s COVID-19 pandemic response before joining the institute in March.

A pandemic tends to turn into an epidemic — at least in the court of public opinion — “when society or government reaches a point where it’s willing to accept a certain number of deaths every day,” Varma said.

“It is certainly not scientists who decide that. Public health people would say that is not acceptable.”

Dr. Michael Merson, a visiting professor at New York University’s School of Global Public Health, echoed Varma’s comments, telling Fortune that the general public has accepted that the pandemic is over – at the cost of massive casualties.

Conditions are better than in the early days of 2020, he admits. However, COVID “is still causing – to me – an unacceptable number of deaths,” he said, adding that society’s acceptance of the number of deaths – hundreds of thousands a year in the US alone – is “disturbing”.

Not now, all the time

Of all times to declare the pandemic over, now is not, many public health experts claim. The reason: China’s recent disconnection from years of “zero COVID” restrictions. The reopening appears to have happened without much or any planning, leaving the majority of China’s 1.4 billion people vulnerable to illness, hospitalization, death and long-term COVID – all at the same time.

The reopening also serves as a wildcard for the world, 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 January 22 are likely to promote transmission. In addition, the Chinese government is once again allowing residents to travel internationally.

Apart from China, levels of potentially terrifying COVID variant XBB.1.5, dubbed “Kraken”, are rising in the US. They played a role in a recent increase in hospitalizations in the Northeast – a trend that could play out in the rest of the country as the virus spreads westward. Other countries could eventually find themselves in a similar situation.

The emergence of XBB.1.5 “is just a reminder that as much as he would like this pandemic to be over, it isn’t,” Varma said. “The virus is not acting like it wants this pandemic to be over.”

Still, it may be time to end the emergency declarations, said Dr. Georges Benjamin, head of the American Public Health Association, a 150-year-old organization of public health professionals dedicated to promoting health and health equity in the US. Fortune.

“It has to go away at some point,” he said of the US federal health emergency on Tuesday. “And I think we’re quickly approaching that point.”

“The policymakers don’t want to fund it anymore; people don’t want to pay attention to it anymore,” he said. “It is a matter of human behavior. When everything is an emergency, nothing is.”

But ending the emergency doesn’t mean the pandemic is over, Benjamin warned.

“It means nothing,” he said. “We are not in a public health emergency and we still have an HIV/AIDS pandemic.”

How to exit the pandemic

There are a few accepted ways 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. Fortune.

One of them: when the level of COVID infections worldwide drops enough. The virus could settle into a pattern of true seasonality, similar to what is seen with RSV and the flu, with cases virtually absent in summer and peaks in winter. Or COVID levels could fall – somewhat – to a prolonged “high plateau,” with a relatively high number of cases occurring throughout the year.

A transition to the later scenario could be underway now, Lee argues. Spikes in cases are not as high as in the early pandemic days. Also, the troughs between peaks are not as low as they were, painting a potential picture of an endemic COVID future with consistently elevated levels of viral transmission.

A seasonal pattern would be preferable, says Lee.

“We don’t want higher than high plateaus or constant levels throughout the year,” he said. “That’s much harder to manage than anything seasonal.”

A glorified cold or flu?

With the US still in the throes of a “triple illness” of COVID, RSV and flu, public health officials are warning those with symptoms such as fever and malaise not to assume they have the flu and to test for COVID. It’s virtually impossible to tell the two apart based on symptoms at this point, experts say.

It’s a reality fueling debates over office water coolers about the ongoing legitimacy of the pandemic. How can COVID still have pandemic status if it is indistinguishable from the flu or, for some, the common cold?

It’s a fair question, but one with a simple answer: Cold viruses rarely kill — and the flu doesn’t kill nearly as often as COVID.

“Psychologically, I worry that the public will accept our current situation when the pandemic is over, despite the fact that we have 250,000 to 300,000 deaths a year — far more than the flu,” said Merson of New York University. .

The flu killed an estimated 5,000 Americans last season, according to the Centers for Disease Control and Prevention. It was certainly a mild flu year, thanks to pandemic precautions. But the annual flu death toll routinely runs in the tens of thousands — not hundreds of thousands, like COVID deaths. Since the start of the pandemic, COVID has killed nearly 1.1 million Americans. The flu has killed less than 50,000 people.

While the public and many public health experts continue to disagree on the status of the pandemic, Lee says things are looking good at the moment.

In 2020, many public health experts predicted the pandemic would last about 2.5 to 3 years, he says — about the length of the 1918 flu pandemic and other outbreaks such as Japan’s smallpox epidemic of 735-737, the Black Death and the Italian Plague of 1629-1631.

“We’re about on track, plus or minus — more plus — compared to what we originally anticipated,” Lee said. “This suggests that 2023 could be the big year of transition. We see the right trends.”

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