Yyesterday on 60 minutesin an interview at the auto show in Detroit, Michigan, President Biden stated: “The pandemic is over. We still have a problem with COVID. We are still working on it a lot. But the pandemic is over.” His speech caught public health in the US and even some employees of the administration, unprepared. In the hours that followed, scientific commentators struggled to understand the basis for his conclusion that there was no longer a pandemic.
To be fair, as Boguma Kabisen Titanji, an infectious disease physician at Emory, said, “epidemiology and public health textbooks don’t really say how one determines when a pandemic is over.” The end of a pandemic is not like turning off a switch. It is not a discrete moment in time, but rather a process – one that can be messy and very contested. What President Biden’s declaration implies is that the “end” of the pandemic is not determined solely by science or public health data, but involves social and political considerations.
The classic one definition of Pandemic, by John Last’s Dictionary of Epidemiology, perhaps the “Bible” of public health terminology, is: “an epidemic occurring worldwide or over a very wide area, crossing international borders and usually affecting large numbers of people.” By this definition, it would be very difficult to conclude that the COVID-19 pandemic is over.
Yesterday there were 481,326 new cases and 1,789 deaths reported worldwide. The World Health Organization still categorizes COVID-19 as a pandemic, even though its director-general, Tedros Adhanom Ghebreyesus, said last week that “the end is in sight”, noting that daily deaths worldwide are at their lowest level since the start of the pandemic.
Perhaps President Biden was referring specifically to the United States? Anyway analysis last week from CBS News found that US COVID-19 deaths averaged 478 per day, “higher than in July 2021, when the average was 168 deaths per day, and also higher than in June 2022.” , when the average was 258 deaths per day’.
Average about 400-500 deaths per day no indicate the end of the pandemic phase in the US. Me too argued before that, the US cannot eliminate COVID-19 (elimination means there will be no new cases of the disease within our borders). We also cannot reduce deaths to zero, given that there will always be vulnerable people, especially among older Americans, and although our scientific tools to prevent death—vaccines, antivirals, and monoclonal antibodies—are very effective, they are not 100% effective. But we certainly do i can achieving “low endemic rates” – where there are low rates of severe disease, hospitalization and death, perhaps with seasonal peaks. This scenario is similar to influenza, which we strive to keep at low endemic levels, including through influenza vaccination. (CDC grades (this flu killed 12,000-52,000 people a year between 2010 and 2020, which we could reduce further by expanding access to annual flu shots.)
Determining when America has moved from the pandemic phase of COVID-19 to the “low endemicity” phase would ideally be done through an inclusive participatory process. Ole Norheim and colleagues from the University of Bergen, Norway argued that such a process — involving, for example, hearings, town halls and citizen panels — “could contribute to more credible and legitimate solutions to difficult ethical questions and policy trade-offs during the pandemic and beyond.” There would be less horror for President Biden’s 60 minutes interview if he had brought scientists and the general public into his deliberations. It is unclear whether President Biden was even consulted his own colleagues from the administrationnot to mention the wider community, in its determination that the pandemic is over.
But the main problem with the president saying the pandemic is “over” is that it could hinder our efforts to reach low endemic rates. For example, Congress is less likely to renew funding for COVID-19 measures if the pandemic is “over.” And the public may hear the message that COVID-19 is “over” and less likely to receive the new bivalent booster, the first vaccine tailored to current variants of the virus. The current US burden of disease, hospitalizations, deaths and Long Covid it can and should be taken down before the “job is done” is declared. There is many ways in which we can achieve this, including addressing stark inequities in the US and around the world in access to vaccines, boosters and antiviral therapies such as Paxlovid and the Evuscheld. Getting boosters for older Americans is an extremely high priority for preventing preventable deaths.
We are not yet at low endemic levels, but they are within our range. Only then can we declare that the pandemic is over. Until then, there is a lot of work to do.
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