One of the many things that disheartens me about the COVID-19 pandemic is how a public health emergency fractured our world when it should have united it. The reality of a novel virus ravaging the global population, leaving millions of bodies in its wake, is something that, at least in my view, should have been viewed as a matter of fact, not of opinion. But very early on in the strange journey of the past two-plus years, people seemed to choose conceptual and behavioral sides: lab leak vs. zoonotic origin, masks vs. bare faces, broadly accepted evidence vs. conspiracy theory. This division reached fever pitch with the authorization of a handful of COVID-19 vaccines in this country and around the world. Indeed, the pandemic has proven to be fertile ground not only for widely disparate opinions about the nature of the situation but for misinformation and aggression. That said, no matter what your political stripe or the tactics you employ to help cope with our new reality, one question still draws us together: When will this be over?
As we prepared to mark today (March 11) as the two-year mark since the World Health Organization (WHO) officially declared the rising tide of COVID-19 cases a global pandemic, I set out to write a piece answering this question by seeking out a list of established statistical breakpoints that could be met and checked off so that someone could stand at a podium and declare the global nightmare “over.” The WHO threw cold water on that prospect with a single email. “A pandemic is a characterization of a disease in view of its geographical spread,” one of its press officers wrote to me this week. “The term carries no recognition under international law and there is no general, formal mechanism for declaring the beginning or end of a pandemic.”
What I found as I poked around was that ending this pandemic and previous ones really has more to do with human behavior, as informed by scientific realities, than it does with wrestling a slippery pathogen into numerical submission and declaring it conquered.
The first step in envisioning an end to the COVID-19 pandemic is to disabuse ourselves of a view of the future where humans have completely vanquished SARS-CoV-2. “‘The pandemic is over,’ does not mean that the COVID-19 virus is eradicated like smallpox,” says Peter Pitts, president and cofounder of the Center for Medicine in the Public Interest. “It means it’s moved from a deadly phase to a phase where people are going to get infected and not suffer serious manifestations and not be hospitalized and not be intubated.”
There is no general, formal mechanism for declaring the beginning or end of a pandemic.—World Health Organization spokesperson
According to Pitts, who served as associate commissioner of the US Food and Drug Administration from 2003 to 2004, transitioning from a pandemic into an endemic scenario will happen when “we’ve moved from mitigating the virus, where the virus is in control, to containing the virus, where we are in control.”
Many experts agree that this shift toward endemicity is the most likely path out of the acute phase of the COVID-19 pandemic. “The ‘over’ suggestion—we’re going to get rid of COVID—that’s just not happening,” says Ezekiel Emanuel, oncologist and vice provost of global initiatives at the University of Pennsylvania. “But COVID being not a major emergency, and we get back to a life where COVID is like flu, like RSV [respiratory syncytial virus]. . . . Yes, we can, in that sense, get ‘over’ it and have it diminished into what I like to think of as background risk of everyday life.”
But experts agree we’re not quite there yet, even as infections, hospitalizations, and deaths trend downward in the US and many places around the world. There are many missing ingredients for this shift that vary by locale. In some places, such as much of Africa, vaccination rates lag far behind the rest of the world. This makes robust population-level immunity to the virus hard to accomplish. A fulsome understanding of the biology behind COVID-19’s health effects and how public health measures mitigate those effects is also lacking, according to Emanuel. For example, while there are data that strongly suggest triple vaccinated people are more likely to avoid serious health complications, hospitalizations, and death, data regarding the development and treatment of long COVID are seriously lacking, he says. “We’ve known about long COVID for 20 months, and effectively we don’t have a good handle on the frequency,” he says. “How frequent is it? How much does the vaccine protect? How much does having a mild case protect or not protect? The fact that we don’t have those answers is really a failure of the research organizations.”
Emanuel adds that he’s been involved in briefing agencies, including the National Institutes of Health and the US Centers for Disease Control and Prevention, to help gather and analyze that data so that it can be used to help understand long COVID. Conducting these analyses can not only help scientists understand the risk of long COVID, but may point the way to treating the condition or designing new vaccines that lower that risk.
Pitts agrees, adding that the world needs an enhanced way to gather scientific information about the intricacies of any pathogens that threaten humanity. “I think we need some type of international mechanism to collect, analyze, share, cogitate, and act on public health issues,” he says.
I am cautiously optimistic that we may soon be reporting on an end of sorts to the COVID-19 pandemic, even if this doesn’t involve a “mission accomplished” moment. The evolution to endemicity will likely be gradual and may, unfortunately, be delayed by outbreaks of new variants that spur the return of mitigation measures and continued hardship. But I echo Emanuel’s assertion that however this pandemic plays out, we mustn’t squander lessons learned about COVID-19 and previous disease outbreaks, including the benefits of enhanced pathogen surveillance and surgically applied mitigation measures. “If you look at the countries that took SARS in 2003 seriously,” he says, “[that] beefed up their epidemiologists and their public health departments, beefed up their infectious disease experts, created surveillance and good data infrastructures, they did much better in terms of fewer cases, fewer mortalities. . . . Being able to go out and identify your vulnerable people, protect them, get them vaccine . . . those are important measures to minimize the impact.”
These measures will be important for the near future, as COVID-19 transforms into a persistent but less-deadly presence, and further down the line, when the next pandemic comes knocking. “We can’t say, ‘Oh. Well that’s done. Now we can go back to the way we’ve always done things.’ That’s not acceptable,” Pitts says. “Because we have to figure out how to prepare, right now, for the next pandemic. . . . We need to learn from our victories and mistakes.”