As a well being journalist, I’ve written the phrase “the COVID-19 pandemic” extra instances than I care to rely within the 4 years for the reason that World Well being Group (WHO) first used that term on March 11, 2020. However recently, the phrase “pandemic” has given me pause.
Possibly you’ve observed it too: lately, lots of people seek advice from the pandemic prior to now tense. “Throughout COVID,” they are saying, or, “after we have been within the pandemic.” The implication is that the virus is gone and the pandemic is over.
The previous is clearly unfaithful. The SARS-CoV-2 virus nonetheless kills thousands of people around the world every month, saddles nonetheless extra with power signs known as Long COVID, and continues to evolve, with the extremely transmissible JN.1 variant just lately inflicting waves of an infection throughout the globe.
However are we nonetheless a pandemic? Nobody appears to know for certain.
After I requested Dr. Mandy Cohen, director of the U.S. Facilities for Illness Management and Prevention (CDC), she didn’t give a direct reply. “Reasonably than getting caught up within the semantics of it,” she says, individuals ought to really feel assured that “we’re outdoors of the emergency [phase]. However I don’t need people to overlook that COVID remains to be right here and nonetheless poses a threat.”
Even Maria Van Kerkhove, director of epidemic and pandemic prevention and preparedness on the WHO, admitted that the problem is a “complicated” one. The WHO continues to describe COVID-19 as a pandemic on its website. Van Kerkhove says that’s cheap given the virus’ continued world presence, despite the fact that we’re not within the disaster state we have been in 2020—however, she says, there’s no definitive, yes-or-no conclusion about whether or not that’s the suitable time period to make use of.
“There isn’t any common, agreed definition of what a pandemic is,” Van Kerkhove says. “If you happen to requested 100 epidemiologists to outline what a pandemic is, or, ‘Are we presently in a pandemic?’, you’d get a variety of completely different solutions.”
What’s a pandemic, anyway?
Epidemiologists think about a illness “endemic” when it spreads in a constant means, because the flu does every winter within the Northern Hemisphere. An endemic degree of illness is the baseline quantity for a selected space, which could not be zero however is no less than predictable. If a illness immediately causes a higher-than-average variety of circumstances in a set space, the scenario turns into an “epidemic.”
The definition for a “pandemic”—when an epidemic crosses borders, infecting a number of individuals throughout a number of nations or continents—is probably the squishiest of all.
Calling one thing a pandemic is actually a “judgment name,” as a result of “there isn’t a exact quantity” of circumstances, hospitalizations, deaths, or affected nations that definitively denotes one, says Dr. Jonathan Fast, an adjunct professor on the Duke World Well being Institute and writer of The Finish of Epidemics. “Anyone who offers you a exact quantity is simply pulling it out of their head.”
Utilizing that label is, in some methods, as a lot a political and public-relations determination as it’s an epidemiological one. “If you happen to’re making an attempt to essentially scale back the variety of deaths, you’ve acquired to be very strategic in what you do,” says Michael Osterholm, director of the Middle for Infectious Illness Analysis and Coverage on the College of Minnesota. Language is a part of the calculus, in that it may spur motion from officers and the general public alike.
However, technically talking, labeling one thing a pandemic has no quick coverage implications. Even the WHO does not formally declare pandemics. The company’s highest official degree of alert is a public well being emergency of worldwide concern (PHEIC), a designation meant to mobilize a worldwide, coordinated response. (The PHEIC associated to COVID-19 began in January 2020 and resulted in Could 2023, the identical month the U.S. government stopped calling the virus a public-health emergency.)
However, Van Kerkhove says, PHEIC is “not a superb acronym. It doesn’t evoke the form of motion just like the phrase ‘pandemic’ does.”
Representatives from WHO member nations around the globe are engaged on a proper definition of a pandemic—4 years after COVID-19 got here onto the scene—as a part of a wider effort to strengthen world pandemic preparedness. An alleged current draft, which was published in February by Well being Coverage Watch, is a mouthful: “the worldwide unfold of a pathogen or variant that infects human populations with restricted or no immunity by sustained and excessive transmissibility from individual to individual, overwhelming well being techniques with extreme morbidity and excessive mortality and inflicting social and financial disruptions, all of which requires efficient nationwide and world collaboration and coordination for its management.” (A WHO spokesperson declined to verify the legitimacy of that draft definition, however mentioned a brand new draft of the group’s work is about to be revealed this week.)
That reported definition doesn’t embrace numbers, but it surely does lay out extra exact floor guidelines for what constitutes a pandemic. The pathogen in query have to be contagious, novel—since people don’t have important preexisting immunity to it—and virulent sufficient to trigger a number of demise and illness, overwhelming well being techniques and disrupting society within the course of.
Is COVID-19 nonetheless a pandemic, or is it endemic?
Beneath these phrases, SARS-CoV-2 nonetheless has some pandemic-y options. It’s nonetheless extremely transmissible and circulating extensively in nations around the globe, and it stays a significant reason for death and incapacity globally.
Nevertheless it isn’t novel anymore, says Katherine Xue, a postdoctoral fellow at Stanford College who has studied viral evolution. Nearly all of the world’s population now has some immunity to the virus by vaccination, prior an infection, or each, which signifies that “even a brand new viral variant might be not going to have the ability to infect everyone” in the way in which the unique pressure might in 2020, she says.
COVID-19’s unfold isn’t completely predictable—new variants are rising on a regular basis, inflicting spikes in infections all 12 months spherical rather than seasonally—however it’s persistently circulating around the globe. To Xue, which means it’s truthful to name it endemic. “The image of COVID that we now have now might be going to be similar to what we now have 4 years from now, [whereas] the way in which we handled COVID was very completely different 4 years in the past,” she says. “The speed of change is completely different.”
COVID-19 additionally doesn’t overwhelm well being techniques in the way in which it as soon as did. In the present day, with masks, exams, vaccines, and coverings obtainable to some extent around the globe, fewer individuals develop extreme illness, and it’s simpler to care for many who do. The virus continues to kill individuals and trigger Lengthy COVID, however world demise charges are way down from their peaks.
Dr. Robert Wachter, chair of medication on the College of California, San Francisco, has stopped utilizing the phrase “pandemic,” which he says was a “shorthand option to convey to the general public” that COVID-19 constituted a worldwide emergency that required a worldwide shift in habits. However calling it a pandemic now “simply doesn’t really feel proper,” he says. In his opinion, we’ve been out of the pandemic part for a few 12 months, given the widespread availability of exams, therapies, and vaccines.
So what’s the phrase to make use of now? Specialists interviewed for this story have been hesitant to select one. “We actually don’t have the language for issues which are someplace between flus and chilly viruses and pandemics,” Fast says.
Does the label matter?
It could appear purely semantic, however ambiguity over the p-word has political and public-health implications. Whereas many nations use different labels, like emergency declarations, to unlock funding and set off coordinated governmental responses to a disaster, calling one thing a pandemic—even informally—has gravitas. And saying one has ended implies, rightfully or not, that the menace is gone, which can have trickle-down results on analysis funding, disease-prevention efforts, and insurance policies round sick go away and public providers.
Which may be why public-health consultants are so loath to take a agency stance. “I might be apprehensive if the headline of your story is, ‘WHO Says We’re No Longer In a Pandemic,’” Van Kerkhove informed me. “That will have a unique degree of that means from a political standpoint.”
Saying a pandemic is over additionally sends a message to the general public that they’ll transfer on—assuming, after all, that they haven’t already. Solely about 20% of U.S. adults acquired the newest vaccine, and a equally small share mentioned they have been apprehensive about COVID-19 going into this previous vacation season, according to KFF data from late 2023. A number of individuals stopped paying consideration lengthy earlier than COVID-19’s four-year anniversary, and “the pandemic is over for them” no matter how a lot consultants debate the suitable vocabulary to make use of, Osterholm says.
Distinction that with the daily lives of people who remain especially vulnerable to the illness— together with those that are aged, immunocompromised, or dealing with Lengthy COVID—and it may really feel like we’re dwelling in separate timelines, Osterholm says. “Is the pandemic over for some individuals sooner than it’s for others?” Osterholm says. “That doesn’t appear to make sense. That’s form of like saying that there’s two completely different temperatures in Minneapolis in a single evening.”
Nonetheless, even Osterholm wouldn’t say which view is the suitable one, or when a pandemic is definitively over. “I couldn’t reply it for you,” he says.
Reconciling these completely different realities is unlikely at this level. And to Fast, that’s okay. “The important thing messaging isn’t about terminology, however about what behaviors are acceptable,” he says.
For individuals who nonetheless observe the pandemic, these behaviors gained’t be in any respect shocking. Specialists suggest getting vaccinated, staying home when you’re actively sick, getting examined and treated if necessary, and contemplating further precautions like sporting a masks and bettering air flow. However with emergency declarations expired, mandates gone, and public steerage stress-free, whether or not you select to do these issues is now largely as much as you. “We’re in a unique place with COVID,” CDC director Cohen says.
Is that place a pandemic? It appears that evidently’s additionally as much as you.
