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 suspended most of its COVID protocols.
Biden’s claim (to reporter Scott Pelley on Sunday on 60 minutes) has reignited the debate about COVID-19, although he has now tried twice to mitigate it. It has stirred up an already divided public, fueled extensive TV news coverage and prompted pundits to take sides.
But for many, a pandemic cannot be declared “over” when the US alone is averaging more than 71,000 new cases and more than 400 deaths per day and there are 500,000 cases and nearly 2,000 deaths per day worldwide.
Biden’s comment has divided medical and public health experts. Some strongly disagree that the pandemic is over, noting that COVID-19 remains a public health emergency in the United States, the World Health Organization still considers it a global pandemic, and most importantly, that the virus is still killing over 400 people a day in the US
Others point out that most of the country is protected, at least for now, by vaccination, infection, or a combination of these. They say it is time to declare the end of the pandemic and to acknowledge 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 by 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 are still at least somewhat concerned about the virus.
A balancing act
“How can a 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).
Topol believes it’s far from over and there needs to be a balance between protecting public health and allowing individuals to choose how they want to live their lives based on risk tolerance.
“You can’t just let the public down and say, ‘It’s up to you.'” He sees this approach as abandoning responsibility, potentially resulting in an already reluctant public accepting the latest boost, the bivalent vaccine, which became available, forget earlier this month.
Topol coined the phrase “COVID surrender” back in May, when the US was in the midst 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 requirement, like the annual flu shot.
Topol sees hope now, tempered by recurring realities. “In terms of the circulating virus, we’re on the way down,” he says. “We’ll have a quiet few months, but then we’ll cycle back up.” He and others are observing emerging variants, including subvariant BA.2.75.2, which is more easily transferrable than BA.5.
The White House confirmed this back in May, when it warned of up to 100 million infections this fall and the possibility of a sharp spike in deaths. The Institute for Health Metrics and Evaluation at the University of Washington estimates that around 760,000 people in the United States are currently infected with COVID-19. That number will rise to more than 2.48 million by the end of the year, the group warns.
A new phase?
“Clearly from a public health perspective, we’re still in a pandemic,” says Katelyn Jetelina, PhD, a public health policy expert who edits Your Local Epidemiologist, a scientific consumer newsletter. “The question is, ‘What stage 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 this comment [by Biden] are we normalizing all these deaths? Can we leave SARS-CoV-2 as the third leading cause of death? I was disappointed by that comment,” she says.
Even as people shift to an individual mode of decision-making from a public health perspective, most people still need to consider others when determining their COVID-19 precautions, Jetelina says. In her personal life, she constantly considers how her activities affect those around her. For example, she says, “We’re going to visit my grandpa, and everyone’s doing antigen tests beforehand.”
While younger, healthier people may be able to safely relax their safety precautions, they should still be aware of those around them who are at higher risk, Jetelina says. “We cannot only put the responsibility on the weak. Our protective layers are not perfect.”
Like Topol, Jetelina suggests considering the circumstances. She recommends taking small steps to collectively reduce transmission and protect the vulnerable. “Grab the mask” before entering a high-risk environment and “take the antigen test before going to the nursing home.”
The worst behind us?
“The mission is not yet accomplished,” says Dr. William Schaffner, an infectious disease expert and professor of preventive medicine at Vanderbilt University in Nashville. If he could paraphrase 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 it and promise to keep making progress.
Schaffner also acknowledges that much of society has declared the pandemic over at some level. “The vast majority of people have taken off their masks, go back to concerts and restaurants and want to function in society,” he says.
He understands this, but suggests that a public health message should be to remind those who are particularly vulnerable, such as adults over 65 and those with certain medical conditions, to continue to take the extra steps, to mask and to distance themselves , especially as a remedy for flu season.
And public health messages should remind others of vulnerable members of the population, Schaffner says, so those who continue to wear masks don’t face trouble from those who have given up.
A focus on the most vulnerable
Biden’s statement “could have been worded better,” says Dr. Paul Offit, infectious disease expert and director of the Vaccine Education Center at Children’s Hospital of Philadelphia. But, he says, things are different now than they were in early 2020.
“We are in a different place. Now most of the population is protected from serious diseases [either by vaccination, infection, or a combination].”
The effect of this protection is already playing out in requirements or lack thereof, says Offit. At the start of the pandemic, “we mandated the COVID vaccine in our hospital [for employees]“Now the hospital will not prescribe the new bivalent vaccine.
He agrees that the focus should be on the most vulnerable going forward. In addition, he says that people should make their own decisions based on individual circumstances and their willingness to take risks.
An important and emerging question, Offit says, is for scientists to find out how long people are protected by vaccination and/or previous infections. Protection against hospitalization and serious illness is the goal of vaccination, he says, and in his view the only reasonable goal, not elimination of the virus.
Biden “is right”
Leana Wen, MD, an emergency medicine physician, professor of health policy at George Washington University and frequent media commentator, takes the opposite view and says Biden shouldn’t retract his comment that the pandemic is over. “He’s right.”
She says the US has entered an endemic phase, evidenced by social measures – many people are going back to school, working and traveling – and political measures, with many locations relaxing or eliminating mandates and other requirements.
There is disagreement about the scientific measures, she says. Some say over 400 deaths a day is still too high to call an endemic pandemic. “We will not eradicate the coronavirus; we have to live with it, just like HIV, hepatitis and influenza. Just because it’s not a pandemic [in her view] does not mean that the extent of the disease is acceptable or that COVID is no longer with us.”
Wen doesn’t see it as an either-or health choice to choose a public health perspective over a personal one. “Just because something is no longer a pandemic doesn’t mean we don’t care about it anymore,” she says. But I think [many] Humans live in the real world. You see family and friends have returned to game dates, going out to restaurants and not wearing a mask. COVID has become a risk, just like many other risks they face in their lives.”
The tension between public health and individual health continues and will not go away, Wen says. And it applies to all health issues. The shift from broad public health concern to individual decision-making “is what we expect and should be happening”.
She also pointed to the costs of measures to combat COVID, including closed schools and businesses, and their impact on mental health and the economy, as well as another less discussed cost: the impact on public health trust
Calling for action against COVID-19 as cases fall could further undermine confidence in public health officials, she says. When New York state recently declared a public health emergency after finding polio virus in sewage samples, Wen wondered, “What happens if we say, ‘Do you vaccinate your child against polio?'”