Is the pandemic over?
President Biden gave an interview to 60 Minutes on Sunday evening that caught the attention of pandemic-watchers. The President told interviewer Scott Pelley:
"The pandemic is over. We still have a problem with COVID. We're still doing a lot of work on it. But the pandemic is over. If you notice, no one's wearing masks. Everybody seems to be in pretty good shape, and so I think it's changing, and I think [the reopening of the Detroit auto show] is a perfect example of it."
Could this be? Is the pandemic really over?
Unlike with monkeypox, where the “end” of the epidemic will be marked by a period of no new cases, the SARS-CoV-2 virus will be with us indefinitely. “The end” of the pandemic is not a single moment in time, but a transition from emergency to routine management of an ongoing public health threat.
And how will we know when we’ve made the transition? I think it’s helpful to consider three dimensions:
Has transmission eased?
This is a clear no. The good news is the United States is coming out of the BA.5 wave, and case counts have fallen from an average of over 120,000 per day in July to around half that now—but 60,000 cases per day is not a small number. It’s difficult to compare case counts year over year because more people are using at-home testing, the results of which are not reported to public health officials. Still, I think it’s safe to say that the wave this summer was just as widespread as previous summers.
Transmission has also not settled into a clear pattern like winter flu season. For Covid-19, the last two years have brought large waves in the summer and winter and a smaller wave in the spring, but I don’t have confidence that we can expect the same going forward. Waves are the product of some combination of new variants and waning immunity, and I think those factors produce dynamics that are too complex to result in a simple seasonal cycle, at least for the foreseeable future. (If the emergence of new variants slows or stops, that would change my opinion.)
So on this point, the pandemic is not over, but I’m also not sure it will be if we’re waiting for caseloads to ease.
Is the burden of severe illness lower?
Yes. For someone up to date on vaccines (now including the bivalent booster), the risk of progressing to severe illness is low. This is made truer by the availability of Paxlovid and Evusheld, both of which can reduce the chance that someone who is infected ends up in the hospital.
There’s a “but…” Less than half of people have received the booster dose that first became available last fall, and only a third of eligible adults (people ages 50+) got the second booster this spring. It’s too early to know how many people will get the updated bivalent booster (I did!), but whatever the number is, it’s probably not as high as we want it to be. Data on non-vaccine options is not much better. Evusheld, a combination of two long-acting monoclonal antibodies, can help to prevent severe illness in people who are immunocompromised if it is given before they are infected. Yet according to CDC, only 5.3% of people eligible are protected by Evusheld.
So despite the (theoretical) availability of tools that can keep people out of the hospital, we are still losing between 400-500 people each day to COVID-19. If I had been asked what the end of the pandemic would look like back in 2020, I would not have described a world where we lose thousands of people each week.
Is the pandemic still influencing daily life?
Yes, actually. A recent poll by Ipsos found that 37% of Americans report wearing a mask at least sometimes, and 57% are at least somewhat concerned about Covid-19. About half of respondents report that they have returned to their pre-Covid lives (though it’s not clear what that means, exactly). Yet many people are still working from home, and the grocery pickup line is as busy as ever at my local store.
Still, schools and businesses are open, quarantine is over, and air travel has returned to pre-pandemic volume. I interpret this to mean that residual markers of the pandemic like masking and telework are permanent changes, not direct responses to an ongoing emergency. In this regard, I think the President has a point that the pandemic is over. Society does not look exactly like it did in 2019, but I think we’re settling into a new way of life.
The bottom line
COVID-19 remains a serious cause of morbidity and mortality, and for that reason I think it must remain a top national priority. Too many people are undervaccinated and not benefiting from the resources that can help stave off severe illness. We cannot accept this level of preventable death.
But from an epidemiological perspective, I think we can expect things to continue more or less as they are. We will continue to face new waves and new variants. Vaccines and therapeutics will continue to save lives, but only those of people who are willing and able to access them. A minority of people will wear masks and conveniences like telework will continue, but not necessarily because of the virus.
The weight of the pandemic has not lifted, but I do think we are learning to navigate our new normal.
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Thanks. This, overall, parallels my views. The end of the pandemic, and the entry into endemicity, will be judged retrospectively, and shouldn't be declared in an interview or press briefing.
I'd much prefer to allow what's left of our public health infrastructure to lead on this, with cogent explanations (thank you, again) and reflection of well-designed and adequately powered research with decent reporting of results, rather than off-the-cuff, or even deep-held ideological beliefs about when we're going to be "done" with this virus.
I'm still waiting for the next VOC to rear its head, but others with loud public voice are declaring we're done. I noted the opinion piece in today's Washington Post by, theoretically, a trained PH doc, who was more than willing to declare the pandemic over. Personally, I prefer to continue to do the work on the public health arena and let history decide the ending date of the pandemic rather than trying to either wish it away, or bow to pressure from a public whose trust in the work the PH community has tried to diligently perform has been undermined by misplaced official and public statements.