September 21, 2022 – President Joe Biden says the pandemic is over. The World Health Organization says the end is in sight. Many of us would rather talk about almost anything else, and even New York City has dropped most of its COVID protocols.
Biden’s claim (made to reporter Scott Pelley on Sunday on 60 Minutes) has caused the debate over COVID-19 to explode yet again, even though he’s twice now tried to soften it. It has roiled the already divided public, fueled extensive coverage on television news, and led pundits to take sides.
But to many, a pandemic can’t be declared “over” when the US alone is averaging more than 71,000 new cases and more than 400 deaths a day, and there are 500,000 cases and nearly 2,000 deaths each day around the world.
Biden’s comment has split experts in medicine and public health. Some adamantly disagree that the pandemic is over, pointing out that COVID-19 remains a public health emergency in the United States, the World Health Organization still considers it a global pandemic, and most significantly, the virus is still killing over 400 people a day in the US
Others point out that most of the country is protected by vaccination, infection, or a combination, at least for now. They say the time is right to declare the pandemic’s end and recognize what much of society has already decided. The sentiment is perhaps best captured in a controversial new COVID health slogan in New York: “You Do You.”
In fact, a new poll from media site Axios and its partner, Ipsos, released Sept. 13, found that 46% of Americans say they’ve returned to their pre-pandemic lives – the highest percentage since the pandemic began. Meanwhile, 57% say they’re still at least somewhat concerned about the virus.
A Balancing Act
“How can one country say the pandemic is over?” asked Eric Topol, MD, executive vice president of Scripps Research and editor-in-chief of Medscape (WebMD’s sister site for medical professionals).
It’s far from over, in Topol’s view, 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.
“You can’t just abandon the public and say, ‘It’s all up to you.'” He sees that approach as giving up responsibility, potentially causing an already reluctant public to forget about getting the latest booster, the bivalent vaccine that became available earlier this month.
Topol coined the phrase “COVID capitulation” back in May when the US was in the middle of a wave of infections from the BA.2 variant of the coronavirus. He used the phrase again this month after the White House said COVID-19 vaccines would soon become a once-a-year need, like the annual flu shot.
Topol now sees hope, tempered by recurring realities. “We are on the way down, in terms of circulating viruses,” he says. “We are going to have a couple of quiet months, but then we are going to cycle back up again.” He and others are watching emerging variants, including the subvariant BA.2.75.2, which is more transmissible than BA.5.
The White House acknowledged as much back in May when it warned of up to 100 million infections this fall and the chance of a major increase in deaths. The Institute for Health Metrics and Evaluation at the University of Washington projects that about 760,000 people are now infected with COVID-19 in the US That number will rise to more than 2.48 million by the end of the year, the group warns.
A New Phase?
“From a public health perspective, we are clearly still in a pandemic,” says Katelyn Jetelina, PhD, a health policy expert who publishes Your Local Epidemiologist, a newsletter on science for consumers. “The question is, ‘What phase of a pandemic are we in?’ It’s not an emergency, where the Navy is rolling in the ships [as it did to help hospitals cope with the volume of COVID patients in 2020.]”
“The biggest problem with that comment [by Biden] is, are we normalizing all those deaths? Are we comfortable leaving SARS-CoV-2 as the third leading cause of death? I was disappointed by that comment,” she says.
Even if people shift to an individual decision-making mode from a public health perspective, Jetelina says, most people still need to consider others when determining their COVID-19 precautions. In her personal life, she is constantly taking into account how her activities affect those around her. For instance, she says, “we are going to see my grandfather, and everyone is doing antigen testing before.”
While younger, healthier people may be able to safely loosen up their safeguards, they should still be aware of the people around them who have more risk, Jetelina says. “We cannot just put the onus entirely on the vulnerable. Our layers of protection are not perfect.”
Like Topol, Jetelina suggests taking circumstances into account. She recommends small steps to collectively reduce transmission and protect the vulnerable. “Grab the mask” before you enter a high-risk setting, and “get the antigen test before going to the nursing home.”
Worst Behind Us?
“It’s not mission accomplished yet,” says William Schaffner, MD, an infectious disease expert and professor of preventive medicine at Vanderbilt University in Nashville. If he could rewrite Biden’s comments, he says, “He could have said something like ‘The worst is behind us,'” while mentioning the new vaccine to increase enthusiasm for that and pledging to continue to make progress.
Schaffner, too, concedes that much of society has at some level decided the pandemic is over. “The vast majority of people have taken off their masks, are going to concerts and restaurants again, and they want to function in society,” he says.
He understands that, but suggests one public health message should be to remind those people who are especially vulnerable, such as adults over age 65 and those with certain illness, to continue to take the extra steps, masking and distancing, especially as flu season gears up.
And public health messages should remind others of the vulnerable members of the population, Schaffner says, so those who continue to wear masks won’t be given a hard time by those who have given them up.
A Focus on the Most Vulnerable
Biden’s statement “could have been phrased better,” says Paul Offit, MD, an infectious disease expert and director of the Vaccine Education Center at Children’s Hospital of Philadelphia. But, he says, things are different now than in early 2020.
“We are in a different place. Now most of the population is protected against severe diseases [either by vaccination, infection, or a combination].”
The effect of that protection is already playing out in requirements, or the lack of them, Offit says. At the pandemic’s start, “we mandated the COVID vaccine at our hospital [for employees]”Now, the hospital won’t mandate the new bivalent vaccine.
The focus moving forward, he agrees, should be on the most vulnerable. Beyond that, he says people should be making their own decisions based on individual circumstances and their risk tolerance.
One important and looming question, Offit says, is for scientists to find out how long people are protected by vaccination and/or previous infection. Protection against hospitalization and severe disease is the goal of vaccination, he says, and is the only reasonable goal, in his view, not elimination of the virus.
Biden ‘Is Right’
Taking the opposing view is Leana Wen, MD, an emergency medicine doctor, health policy professor at George Washington University, and frequent media commentator, who says Biden should not be walking back his comment that the pandemic is over. “He is right.”
She says the US has entered an endemic phase, as evidenced by social measures – many people are back to school, work, and travel – as well as political measures, with many locations relaxing or eliminating mandates and other requirements.
There is disagreement, she says, on the scientific measures. Some say that over 400 deaths a day is still too high to call a pandemic endemic. “We are not going to eradicate the coronavirus; we need to live with it, just like HIV, hepatitis, and influenza. Just because it’s not a pandemic [in her view] doesn’t mean the level of disease is acceptable or that COVID is no longer with us.”
Wen doesn’t see taking a public health perspective versus a personal one as an either-or health choice. “Just because something is no longer a pandemic doesn’t mean we stop caring about it,” she says. But “I think [many] people live in the real world. They are seeing family and friends have returned to play dates, going to restaurants, not wearing a mask. COVID has become a risk just like many other risks they encounter in their lives.”
The tension between public health and individual health is ongoing and won’t go away, Wen says. And it applies to all health issues. The shift from the broad public health concern to individual decisions “is what we expect to happen and should happen.”
She noted, too, the cost of measures to fight COVID, including closed schools and businesses and their effect on mental health and economics, plus another less-discussed cost: The effect on trust in public health
Continuing to demand measures against COVID-19 when cases are declining, she says, may weaken trust in public health authorities even further. With New York state recently declaring a public health emergency after finding the polio virus in sewage samples, Wen wondered: “What happens when we say, ‘Get your kid immunized against polio?'”