Is the pandemic really over?

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We start today with some good news: “The pandemic is over. If you notice, no one’s wearing masks. Everybody seems to be in pretty good shape.”

That’s US President Joe Biden yesterday, and with midterm elections looming, you don’t have to be a political scientist to see it’s in his political interests to make such a proclamation. His comments follow the World Health Organisation (WHO) declaring last week: “the end is in sight”.

US President Joe Biden, says the pandemic is overCredit:AP

Of course, the virus is going nowhere, and does not particularly care what you call it. People will continue to get sick and die with COVID-19 for the foreseeable future.

Who is right? Or is everyone wrong? How should we think about the end of the pandemic?

“There’s no such thing”

Let’s start with the most surprising fact: there’s no hard international legal framework to declare a pandemic.

“There is no official pandemic title, as far as I am aware,” says Professor John Mackenzie, a member of the WHO’s COVID-19 International Health Regulations Emergency Committee. “It is what it is. You can announce something is a pandemic, but there’s not really anything particular about that.”

Nor is there a “X number of cases = pandemic” formula. The textbook definition of a pandemic is “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people” – which is so vague it could describe many diseases, including the flu. Indeed, it has been applied to obesity, lung disease, even car crashes.

The WHO’s highest alarm is to declare a “public health emergency of international concern”, or PHEIC. It did this in January 2020. Unfortunately, just about everyone ignored it, so in March the WHO then had to unofficially “declare a pandemic” so people would sit up and pay attention.

This is an example of the term pandemic being used politically rather than scientifically. And that should instantly make us sceptical about those who seek to declare it finished or unfinished.

If declaring a pandemic over is as much a political act as anything, we should ask: who wins and who loses?

The pandemic being over is very good for people who own vacant office blocks or cruise ships. It’s very good for political leaders facing elections – like President Biden.

It’s not so good for vaccine manufacturers (whose stock prices dropped on Biden’s declaration) or scientists or journalists.

Most importantly, it’s not good for people in insecure work who don’t get paid sick leave and suddenly find themselves cut off from government isolation payments.

vaccine manufacturers’ stock dropped on Biden’s declaration.Credit:AP

To extend this, consider all the globally-circulating viruses society does not think of as pandemics, such as HIV or hepatitis C. “Every scientist in the world would tell you they are pandemics,” says Professor Peter White, an expert on the history of pandemics at the University of NSW.

These viruses most affect marginalised minorities – gay men and drug users – people who White points out are often portrayed as “marginalised populations, doing naughty things” who “don’t deserve to be given any respite”.

It is society that ends pandemics, not biology. “The ‘end’ arrives when daily life is no longer majorly disrupted by the disease, rather than when the disease disappears,” says Tiarne Barratt, who has been studying responses to pandemics throughout history at the University of NSW.

Nineteenth-century England used to celebrate a general decline in cholera epidemics – and a return to life as normal – with a day of thanksgiving. Modern England celebrated Freedom Day in mid-2021 when the government dropped COVID restrictions.

“From this perspective, therefore, we could consider the COVID-19 pandemic over now, as the disruption to daily life and state of emergency has passed,” says Barratt.

Let’s recall Biden’s quote: “If you notice, no one’s wearing masks. Everybody seems to be in pretty good shape.”

One way of reading this is that Biden is saying the pandemic is over because we are treating it as though it is. This makes some sense. In Australia, our lives have returned to something close to what they were before 2020, with a bit of extra virus-hygiene. Media monitoring data from Streem somewhat backs this up, suggesting COVID media coverage remains high – but other things capture our attention too now, such as the war in Ukraine, politics and the death of the Queen.

Give me the numbers

Globally, the rolling average of confirmed COVID-19 deaths is as low as it has been since early 2020.

Globally, new cases hover at around half a million a day. Exclude the Omicron spike of early 2022 and that’s about where we’ve been since the virus became established in the population. The below graph is really telling us the virus is here to stay.

But the global view obscures what’s happening locally. Look at Australia’s death rate – in isolation, you could see these numbers and conclude our pandemic is just starting.

“We’ve had a particularly unusual pandemic trajectory,” says Professor Jodie McVernon, director of epidemiology at the Doherty Institute. “We’ve gone from nothing to worse. Most people have gone from horrendous to less. And that’s a difficult headspace for many Australians.”

What is to come? Best case, says University of Melbourne epidemiologist Professor Tony Blakely, our current variant BA.5 is “as evolutionarily as good-as-it-gets”. We will get waves of infection caused by waning immunity, “but each time it comes back, the effect on us will be less severe”. (I tend to think this unlikely – virologists don’t believe the virus has explored all its possible mutations; BA2.75.2 is already making scientists nervous.)

Mid-case scenario: the virus continues to spit out increasingly antibody-evasive variants. Each one causes a new wave of infections. “That’s not too bad,” says Blakely, as those infections coupled with vaccination should provide good ongoing protection against serious illness. This has been our experience so far – a new variant means a new wave of sickness but not necessarily a higher rate of deaths.

Worst-case scenario: a black-swan. The virus throws a variant that is more antibody evasive and more lethal. We’re all back to working from home and wearing masks. “We need to accept as a society that we can’t rule that out,” says Blakely. “We need to know that’s there in case we need it.”

Declaring something a pandemic spurs people to action. Some fear that if we say the pandemic is over, complacency will set in. People might be less likely to mask up and vaccinate in general.

“If ‘the pandemic is over’ means we just go back to the way everything was, I think we’ve lost an opportunity,” says McVernon.

The important commonality between Blakely’s three scenarios is that the virus will always be with us, and there will always be some level of suffering, long after we as a society have moved on.

As with most things in society, the harms will probably accrue most to the most-disadvantaged.

In declaring an end to a pandemic, we should be careful about the people we leave behind.

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