Don’t expect President Biden or the World Health Organization to tell you when the COVID-19 pandemic is over. They’re not sure themselves.
While European nations and U.S. governors declare an end to the COVID-19 emergency and lift restrictions, the WHO says the pandemic is “nowhere near finished” and there is no formal mechanism for declaring the beginning or end of one.
The ambiguity leaves a fragmented and uncertain route to an endemic phase, in which a virus is generally present and managed like other diseases.
“There is no formal declaration of moving from a pandemic to endemic phase that I am aware of,” said Timothy Brewer, a professor of epidemiology at the University of California, Los Angeles’ Fielding School of Public Health. “For example, the human immunodeficiency virus pandemic has been going on for 40 years. HIV is endemic in some populations but has never been declared as such. Nor are there metrics that I am aware of.”
WHO Director-General Tedros Adhanom Ghebreyesus made a splash when he labeled the coronavirus crisis a pandemic on March 11, 2020. He said it was a characterization and didn’t change the U.N. agency’s threat assessment or strategy.
Still, the weighty label has been affixed to the crisis for nearly two years, and it’s not clear how and when it will be peeled off.
When the worldwide spread of any disease is brought under control to a local area, it is no longer a pandemic but an epidemic, according to WHO. If a disease is globally present but at expected or normal levels, it is not considered a pandemic but endemic — for instance, chickenpox or malaria.
“A pandemic is a characterization of disease in view of its geographical spread,” according to a WHO statement to The Washington Times. “The term carries no recognition under international law and there is no general, formal mechanism for declaring the beginning or end of a pandemic.”
Rather, the highest level of alarm under international law is the declaration of a Public Health Emergency of International Concern, which the WHO emergency committee revisits every three months. After its meeting in mid-January, it said COVID-19 remains an emergency of international concern.
“Unlike the first SARS outbreak, where it was very clear there was an ending because there were no cases, this isn’t going to go away,” Dr. Brewer said. “It’s going to circulate for a while. At some point, some people will just stop mentioning the word ‘pandemic.’”
For now, the U.S. and other nations are battling a fast-moving omicron variant that is causing record rates of infection, though it appears to cause milder disease. Vaccines are plentiful in the U.S., and other Western nations are maxing out who will take them to guard against severe disease, though the virus is expected to cause some level of infection in perpetuity.
Some say the pandemic label will be removed once hospitalization and death rates drop and teacher shortages and other societal disruptions from the disease disappear. However, those metrics need to be sustained to consider an end to the pandemic phase.
Temporary improvement in those metrics is “not sufficient alone because if you did it based on that, in June we were endemic,” said Julie Swann, a health systems expert who leads a team of pandemic modelers at North Carolina State University, referring to mild case levels last summer. “I look for not just a day or a week. I’m looking at over weeks to months.”
Experts said the closest thing to a formal declaration will be the WHO’s lifting of its public health emergency designation, though various countries and luminaries might start using the “endemic” lingo.
“Countries that have very high levels of population immunity from vaccines and prior infections will be first to move to an endemic phase. But leaders will also make different decisions in different countries, so we won’t see a single moment when the pandemic is over,” said Lawrence O. Gostin, a global health law professor at Georgetown University.
Some places have already declared an end to the emergency phase, no matter what it is called.
“The emergency is over. Public health [officials] don’t get to tell people what to wear; that’s just not their job,” Colorado Gov. Jared Polis, a Democrat, told Colorado Public Radio in December, explaining why he will not order another mask mandate.
Denmark this week became the first European country to lift all of its restrictions, including mask mandates and vaccine passes for bars. It cited the lower level of critical hospitalizations, despite rampant infection.
Norway is dropping restrictions on bars’ operating hours and said people don’t have to work from home anymore. France dropped an outdoor mask mandate, and Austria is making vaccines mandatory instead of trying to confine people in lockdown.
The Philippines will welcome tourists again on Feb. 10, and Hong Kong and South Korea are reducing quarantine times for international travelers.
As of Tuesday, people in San Francisco could go to gyms and offices without masks if they are fully vaccinated and boosted, or if they are unvaccinated and produce a negative test. Baltimore and Anne Arundel counties in Maryland lifted their mask mandates this week, citing declining positivity rates.
“From a societywide perspective, after two years on this hellish highway, it appears our country is finally arriving at the off-ramp,” Senate Minority Leader Mitch McConnell, Kentucky Republican, said in a floor speech Wednesday. “The virus appears to be heading endemic. Seventy percent of Americans agree with the statement, ‘It’s time we accept that COVID is here to stay and we just need to get on with our lives.’ It is time for the state of emergency to wind down.”
The get-on-with-it approach is making the WHO skittish. Officials cite the shape-shifting nature of the virus and ongoing crises in most parts of the world.
“Despite national, regional, and global efforts, the COVID-19 pandemic is nowhere near finished,” the WHO said. “Factors driving the current situation include variants of concern, inconsistent application of [public health and social measures], increased social mobility, and highly susceptible populations due to lack of equitable vaccine distribution. The pandemic continues to evolve with many variants of concern dominating global epidemiology. There is a strong likelihood for the emergence and global spread of new and possibly more dangerous variants of concern that may be even more challenging to control.”
Scientists point to the potential for new and dangerous variants that evade existing vaccines and treatments.
The wily nature of this pathogen sets it apart from Ebola, a virus that caused high-profile outbreaks in Africa over the past decade but had a clear beginning and endpoint and never reached a pandemic level of threat. WHO considers Ebola outbreaks to be over if two incubation periods of the virus, or a total of 42 days, have elapsed after the last confirmed patient was discharged from care.
On the coronavirus, the health agency said it is dangerous to assume omicron will be the latest variant or that the world has entered the endgame of the crisis. However, it said the world can inch closer to ending the pandemic by vaccinating 70% of the population of every country and ensuring equal distribution of lifesaving tools and essential care.
“Each country is in a unique situation and must chart its way out of the acute phase of the pandemic with a careful, stepwise approach,” Dr. Tedros said on Jan. 24. “It’s difficult, and there are no easy answers, but WHO continues to work nationally, regionally and globally to provide the evidence, the strategies, the tools and the technical and operational support countries need.”
He said, “If countries use all of these strategies and tools in a comprehensive way, we can end the acute phase of the pandemic this year. We can end COVID-19 as a global health emergency, and we can do it this year.”
The White House has said the U.S. has the tools to enter a new phase in dealing with the virus but hasn’t detailed when that might be.
“The president’s view is that we’re not going to live like this forever. We don’t want to live like this forever,” press secretary Jen Psaki said Wednesday. “Our objective and our goal is on ending this pandemic as we end it today so it’s not something that is disrupting our daily lives. We’ll do more and more to protect people and accelerate the path out of this pandemic.”
Health, The New York Today