Is the Covid-19 pandemic over? That depends on who you are

According to US president Joe Biden, the pandemic is over. World Health Organisation (WHO) Director-General Tedros Adhanom Ghebreyesus didn’t go quite that far, telling a recent news briefing in Geneva: “We are not there yet, but the end is in sight.”

So how will we know the 2½-year health crisis is over?

And when it’s “officially” over, will it be over for everyone?

It’s far from straightforward. Experts say there are no accepted metrics or defined international rules that tell us when we can call time on a pandemic. In fact, for an issue with a scientific basis, it’s unusually ephemeral.

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According to the WHO, there were 3.1 million new Covid infections reported globally between September 5th and 11th, a 28 per cent reduction from the previous week. Weekly reported deaths from Covid-19 (week to September 26th) have dropped significantly to just over 8,000.

Some experts say it’s best to think of the pandemic’s end by looking at what the disease is doing to humans physically and psychologically.

We are going to have a couple of quiet months, but then we are going to cycle back up again

John Barry, author of The Great Influenza, a history of the 1918 Spanish flu, says “it’s over when people decide that it’s over ... and most people seem to have decided that it’s over”.

So at a psychological level, it could be argued that a pandemic is over when people stop taking measures to protect themselves, when they stop following advice about how to lower their risk, and when they resume pre-pandemic behaviour.

From a physical perspective, case numbers, deaths and hospitalisations represent a statistical certainty that cannot be denied. Using this yardstick, the Covid-19 pandemic certainly continues.

“How can one country say the pandemic is over?” asks Dr Eric Topol, executive vice-president of Scripps Research and editor-in-chief of Medscape. In his view the pandemic is far from over, and there has to be a balance between protecting public health and allowing individuals to decide how to run their lives based on risk tolerance.

But he does see some hope, tempered by the likelihood of new variants. “We are on the way down, in terms of circulating virus,” he says. “We are going to have a couple of quiet months, but then we are going to cycle back up again.”

For vulnerable populations - such as those with pre-existing chronic health conditions and older people - the pandemic is far from over. While hospitals are seeing fewer Covid-19 patients that require high flow oxygenation or intubation now, they are seeing more cases in which Covid impacts a patient’s long-term health. For example, if Covid exacerbates one of their underlying medical conditions, such as chronic lung disease or a heart rhythm problem such as atrial fibrillation, it then becomes a life-altering condition.

So while younger, healthier people may be able to safely unshackle their safeguards, they need to be aware of the people around them who carry more risk. Small steps to collectively reduce viral transmission and protect the vulnerable would be helpful: putting on a mask before you enter a high-risk setting, and carrying out an antigen test before going to visit someone in a nursing home are just some examples of how we can make a difference.

Has Covid-19 become endemic?

The WHO defines pandemics, epidemics, and endemic diseases based on a disease’s rate of spread. The difference between an epidemic and a pandemic isn’t in the severity of the disease, but the degree to which it has spread. A disease outbreak is endemic when it is consistently present but limited to a particular region. This makes the disease spread and rates predictable.

By this definition, we are not there yet. In fact, because we have never experienced a coronavirus pandemic, we do not yet know what endemic Covid-19 will look like.

The WHO will not announce an all-clear for Covid-19 anytime soon.

mhouston@irishtimes.com