The Covid-19 emergency may be over, but there is no rule to say when the pandemic is over



CNN

President Joe Biden sparked controversy this week when he said in an interview that the “pandemic is over”: Is it really over? How do we know? Who decides?

Pandemics have no hard edges. Knowing where they start or stop is a judgment call, and there is no clear authority that comes to that decision.

Epidemiologists recognize a pandemic as a disease outbreak that occurs simultaneously in many countries and affects more people than an epidemic. Pandemics are caused by new viruses or a virus that has not circulated among humans for a long time. These events are impactful and often result in deaths, social disruption and economic hardship.

“I think we were all a little surprised when President Biden said what he said ’60 Minutes,’ but I think in many ways it was reflecting what many Americans were already thinking and feeling,” said J. Alex Navarro, assistant director of the Center for the History of Medicine at the University of Michigan Medical School.

But because the pandemic is a global event, not a single country or leader he can decide it’s over, he said.

“Declaring the end of a pandemic is a little different than declaring the end of a local epidemic,” Navarro said. “To call a pandemic over, you have to have different regions of the world with epidemics over. So it looks a little different, I think.”

The world will probably have to come to a consensus, which is a kind of recognition by the World Health Organization. – or maybe not.

“There is no official designation,” said Dr. Amesh Adalja, a senior expert at the Johns Hopkins Center for Global Health Security. “Who will admit that we are in a pandemic, but it is not as if someone called a pandemic and then said that the pandemic is over.”

Biden’s comment does not change how the US or other countries respond to Covid-19. For now, it remains a public health emergency in the United States, according to the US Department of Health and Human Services, and is still a public health emergency of international concern, or PHEIC, according to the WHO.

A PHEIC creates an agreement between countries to comply with WHO recommendations for emergency management. Each country declares its own public health emergency, statements that carry legal weight. Countries use them to pool resources and waive rules to ease the crisis.

When these designations are removed, there will be changes that reverberate through governments and reach individuals and families.. In the United States, for example, the end of the public health emergency will have implications for health coverage and cost-sharing for Covid-19 testing and treatment.

Saying the pandemic is over may affect public perception, but it doesn’t materially change how the federal or state governments respond.

“It’s distinguishing between what is a formal legal definition, ‘hey, we think this is over now, and hey, let’s move on,’ versus what’s a popular debate, and there are implications for both,” Rebecca said. Katz, who directs the Center for Health Science and Global Security at Georgetown University.

The term “pandemic” carries a lot of weight. After the new coronavirus was recognized as a PHEIC in January 2020, it took more than a month for WHO leaders to start calling the situation a pandemic.

In March 2020, WHO Director-General Tedros Adhanom Ghebreyesus said he was finally using the term because of the severity of the disease, how quickly it was spreading and the “alarming level of inaction”.

“Who has been assessing this outbreak around the clock,” Tedros said. “So we have assessed that Covid-19 can be characterized as a pandemic.”

was one language change that put the world on alert, but it was long after many public health experts had reached the same conclusion, and it was not changed by the WHO, the US Centers for Disease Control and Prevention. or other international health agencies were doing in response.

At this time, the WHO is not saying whether it will recognize the end of the Covid-19 pandemic.

“The WHO has no mechanism to declare or end a ‘pandemic,'” spokesman Tarik Jasarevi said in an email to CNN. Instead, he said WHO will continue to assess the need for a public health emergency, and an expert committee meets quarterly to do so.

Last week, Tedros said the end of the pandemic was “in sight”, but added that “we are not there yet”.

And it is not clear what “there” will be like.

“That’s one of the challenges we have is that we don’t have a good definition of when a pandemic starts or when it ends,” said Michael Osterholm, who directs the Center for Infectious Disease Research and Policy at the University of Minnesota.

In the modern era, there is no real precedent for closing the curtains on a pandemic.

“We’re really in new territory here,” said the University of Michigan’s Navarro.

The last pandemic to approach this scale was the 1918 flu pandemic. Back then, there was no federal response. President Woodrow Wilson “didn’t say anything about the flu as far as we know,” Navarro said, and it wasn’t expected.

“The response to the pandemic was very much state and local at the time, so people turned to state and local health officials for guidance,” Navarro said. This guidance was usually conveyed through local newspapers, which were widely read.

During that pandemic, life mostly returned to normal after the devastating wave of disease in the fall of 1918.

With few exceptions, most mask orders, lockdowns, and social distancing orders were lifted in early 1919.

But the flu wave continued until 1920, according to Navarro. The United States continued to see cases and deaths, but “didn’t think it was an epidemic level.”

Pandemics can end when viruses become less lethal and people develop immunity to them, Navarro said.

“Ultimately, we reach an equilibrium where we live with these microbes,” he said.

Whether the world is over with Covid-19 remains to be seen. Vaccines and treatments now offer some protection from serious illness and death, and cases are declining in most parts of the world.

But in the United States alone, about 65,000 new cases are still reported every day, according to data from Johns Hopkins University, and an average of about 400 people die from Covid-19 every day.