Is the Pandemic Over? Not Quite

By Marie Rosenthal, MS

Updated on Sept. 21.

The president walked back his "60 Minutes" at a New York fundraiser, saying that it is "basically not where it was." Xavier Becerra, the secretary of the Department of Health and human Services added the COVID-19 health emergency was still in effect. Both urged Americans to receive their COVID-19 vaccines, including the new boosters.

Although cases, hospitalizations and deaths are down remarkably since the height of the COVID-19 pandemic, is it time to declare the pandemic over? 

“The pandemic is over,” President Joe Biden told Scott Pelley on “60 Minutes.” “We still have a problem with COVID. We are still doing a lot of work on it, but the pandemic is over. 

“As you notice, no one is wearing masks, everybody seems to be in pretty good shape, so I think it is changing, and I think this is a perfect example of it.” (The president and Mr. Pelley were walking the exhibition hall of the 2022 North American International Auto Show, in Detroit.)

Director General Tedros Adhanom Ghebreyesus, MD, of the World Health Organization (WHO), shares the president’s assessment that the pandemic is slowing, but stops short of saying the pandemic is over. In fact, he said it was not the time to become complacent.

“Last week, the number of weekly reported deaths from COVID-19 was the lowest since March 2020. We have never been in a better position to end the pandemic,” Dr. Tedros said at a media briefing on Sept. 14. “We are not there, yet, but the end is in sight.”

The cumulative COVID-19 numbers are staggering. 

In the United States, there have been more than 65 million cases and 1.047 million deaths since the beginning of the pandemic—more deaths than any other country in the world.  

But they are at all-time lows today. New cases averaged about 60,831 per day; new hospitalizations averaged about 4,311 per day; and deaths averaged 391 per day between August and Sept. 16, according to the CDC.

Internationally, there have been more than 609 million cases and more than 6.5 million COVID-19 deaths reported to the WHO as of Sept. 19. New deaths at about 640 per day are also at an all-time low around the world, according to the WHO.

We asked our editorial advisory board whether they agreed with the president's assessment. Although everyone is tired of COVID-19 and the worst is probably over, it’s hard to determine if the pandemic is actually finished, they said, but they suspect it is not.

“I agree that it is likely that the worst of pandemic has passed, but it is a rather strange claim to say it is over given we do not know what variants are still to come,” said Mark H. Wilcox, MD, FRCPath, the Sir Edward Brotherton Chair of Bacteriology, and a professor of medical microbiology at the University of Leeds, School of Medicine, in the United Kingdom. "Natural immunity—plus/minus vaccination—is the main protection against COVID-19 now, but while these reduce the chance of infection, virus transmission still occurs to a disturbingly high extent.  

“Also, we have yet to see what happens when a surge of influenza occurs with a new variant of SARS-CoV-2 prevalent (in a modestly immune population). We know that severe outcomes are more likely for those infected by two viruses rather than just SARS-CoV-2,” said Dr. Wilcox, who is also a consultant/the head of microbiology research & development and the infection lead of the NIHR Leeds Diagnostic Technologies Medical Technology and In Vitro Diagnostics Co-operative, Leeds Teaching Hospitals National Health Service Trust.

Worst Is Behind Us

“We are never going back to those awful dark days of 2020-2021,” said Shmuel Shoham, MD, a professor of clinical medicine, Division of Infectious Diseases, at the John Hopkins University School of Medicine, in Baltimore, but he wasn’t sure he would call the pandemic over.

“I don’t know what to call the current period, but it’s not the pandemic we used to have,” he said, pointing to the changes in end points for outpatient studies as an example of how much things have changed. Because admissions are down considerably, they would not be a good outcome measure anymore.

“More and more, we are seeing outpatient studies shift away from hospitalization as an end point. COVID-19 hospitalizations in clinical trial patients are just not common enough,” Dr. Shoham said.

“We're all tired of this pandemic state we've been living [in],” agreed Stuart C. Ray, MD, a professor of medicine, Division of Infectious Diseases and the departmental vice chair for data integrity and analytics at Johns Hopkins. But he agreed that it is too early to say the pandemic is over. 

“I don't think we'll know the correct answer regarding the current status of COVID-19 except in retrospect, because we haven't been good at predicting, a year in advance, the degree to which this virus will disrupt our daily lives,” Dr. Ray said.

What makes an infectious disease a pandemic versus an endemic disease, such as malaria and tuberculosis, is not the global suffering and death, but its scale and the unpredictable disruption the infection causes, according to Dr. Ray. For instance, influenza is not usually a pandemic because it follows a fairly predictable pattern with seasonal fluctuations, but it can become one when a highly virulent pandemic strain emerges, infecting a large number of people and causing considerable disruptions to healthcare centers, workplaces and schools. 

“Using my trusty crystal ball, I don't think we've reached predictability yet,” he joked. 

“SARS-CoV-2 evolution continues to generate new variants with reduced susceptibility to immune responses generated by earlier variants; immunity from prior infections and vaccinations is waning (naturally and due to that evolution); and vaccine uptake is low (reducing our ability to counteract safely that loss of immunity). The tremendous delta and omicron surges generated a lot of immunity that blunted recent surge impact somewhat, but that immunity is probably waning faster than it's being replaced for the reasons I've listed,” Dr. Ray explained.

“I am hopeful and pretty confident that the worst is behind us, but this virus has surprised us before and the best way to protect against disruption while infection rates are high is to maintain significant vaccination rates and use of nonpharmacological interventions (like masking, improved ventilation where people tend to congregate indoors, and effective rapid testing to reduce risk of meeting with people),” Dr. Ray said.
Although the end is in sight, this is not the time to become complacent and to stop mitigation, according to Dr. Tedros, who compared the response to a marathon runner who does not stop until they get to the finish line.

“Now is the time to run harder and make sure we cross the line and reap the rewards of all our hard work,” Dr. Tedros said. “If we don’t take this opportunity now, we run the risk of more variants, more deaths, more disruption and more uncertainty.”