Fast Company The World Health Organization declared COVID-19 a pandemic three years ago today, but experts disagree about how and when pandemics end.
It’s been three years since the World Health Organization declared COVID-19 a pandemic. So we know when the pandemic officially began. But what must happen for it to officially end? Who even makes the call?
That’s where things get a bit mushy. The WHO made its declaration on March 11, 2020, after 118,000 cases in 114 countries and 4,291 deaths. A pandemic is a sort of “epidemic plus,” an infectious disease that spreads over a really large region. It could be worldwide or just a continent. The last time we saw a major global pandemic was the 1918 Spanish flu, which killed 50 million people, although there have been other pandemics since, including the 1968 flu pandemic and the 2009 H1N1 flu pandemic. Some experts would consider HIV and tuberculosis to be pandemics, too, but it depends on whom you’re asking.
Marking the end of a pandemic is complex, says Marion Dorsey, an associate professor of history at the University of New Hampshire who studies pandemics. It’s political, social, and scientific, and each is influencing the other.
“There’s no one body who is going to say definitively that this is over,” Dorsey says. “It’s not like a war where you can say, at 11:11 a.m. on November 11, that is the armistice and we all agree. It’s not going to be that clean.”
If you ask John M. Barry, author of The Great Influenza: The Story of the Deadliest Pandemic in History, a pandemic ends when people stop paying attention to it. He says it looks like society is willing to accept between 125,000 and 150,000 deaths a year as long as they’re almost all among the elderly or the frail. By comparison, influenza deaths range from 10,000 to 50,000.
“It has almost nothing to do with the virus or the death toll,” Barry says. “It’s over when people decide it’s over and return to normal patterns of living, which we seem to have done.”
Americans are split when asked whether the pandemic is over: 49% say it’s over, while 51% say it isn’t, according to a March Gallup Poll. Much of the mindset in the public arena has centered on where you fall politically. The White House has also oscillated over whether we still call COVID-19 a pandemic, and earlier this year, Republicans introduced a “Pandemic Is Over” Act, claiming that President Joe Biden’s extension of $10 billion in COVID funding was unwarranted.
FOLLOWING THE SCIENCE BUT LOSING THE PLOT
The discussion in the scientific community has been far more nuanced, albeit equally divided. The WHO’s emergency committee meets every three months to assess the situation. In January, it acknowledged that the COVID-19 pandemic may be approaching an inflection point, but noted that the virus “retains an ability to evolve into new variants with unpredictable characteristics.”
The next meeting is in April, and that expert committee would be the one to make a decision whether to declare the public health emergency over. But it’s highly unlikely it will end then, says WHO spokesman Daniel Epstein. At least 10,000 people die each week, and a few weeks ago, that number was 40,000.
“We are still in a public health emergency of international concern and a pandemic,” says Maria Van Kerkhove, WHO’s lead on COVID-19. “The virus has not settled into a predictable pattern. We do not have seasonality. As governments, we cannot let down our guard.”
This week, noted epidemiologist Eric Topol suggested that the pandemic was over in his March 4 blog post, which lays out evidence that COVID-19 has entered the “endemic” stage, indicating it will always be with us.
“We’ve been dealing with Omicron since November 2021,” writes Topol, who is founder and director of the Scripps Research Translational Institute and a professor of molecular medicine at the Scripps Research Institute. It’s hard to imagine how further mutations to Omicron will pose a major threat, he says, because we have three years of infections, vaccination, and boosters that combined can fight off major waves of the virus.
The U.S. may not see big surges of cases and adverse outcomes, Topol writes, unless there is a hyper-accelerated evolution of the virus within an immunocompromised host, or it’s a new family of viruses antigenically distant from our immune recognition.
Fellow scientists viewed his post as a declaration that the pandemic is indeed dead and turned to news organizations and Twitter to share the news. The virus, they say, has reached the endemic phase, which means it sticks around and acts more like the flu. But currently, there’s no “COVID season” as there is a flu season.
Luke O’Neill, a biochemistry professor at Trinity College Dublin, told Ireland’s NewsTalk radio station that many scientists already felt the pandemic was over. “In the old days, say with the 1918 pandemic, it’s over when you say it’s over.”
Not everyone is ready to call it just yet. “I’d say the pandemic is in a new phase but it’s not over,” says Dr. David Dowdy, an infectious disease epidemiologist at Johns Hopkins Bloomberg School of Public Health.
Fewer people report cases with home testing, we’re seeing fewer surges, and in healthy people the cases are milder than three years ago. Still, 300 people still die in the U.S. each day from COVID-19. “It’s not a small number,” Dowdy says. “It is still a very big problem, maybe not the No. 1 health problem in our country now, but it’s still in the top 10.”