Is the COVID pandemic over? Too soon to say, experts insist

“The pandemic is over.”

It’s a statement we’ve heard numerous times in the more than 2½ years since the World Health Organization declared COVID-19 a pandemic.

As California enters the fall with the coronavirus sharply in decline, some once again declare victory. But health experts say that despite the significant advances, it’s less about turning the page than understanding that COVID-19 remains fairly unpredictable.

The long-simmering question heated up recently when President Biden declared “the pandemic is over” in an interview with 60 Minutes. Days later, Biden acknowledged the criticism he received for his testimony, but added that the pandemic “basically isn’t where it was.”

It wasn’t the first time the president tried to project the end of the pandemic. On July 4, 2021 – nearly seven months after the vaccine rolled out nationwide – Biden said, “We are closer than ever to declaring our independence from a deadly virus.”

But that declaration, which came as the US death toll from COVID-19 was just over 605,000, proved premature. Since then, nearly 450,000 COVID-19 deaths have been reported, fueled by last summer’s Delta variant and the two-pronged Omicron waves that first struck after Thanksgiving.

Officials across the country recognize the significant progress that has been made in the fight against COVID-19. The US is awash with vaccines and effective therapeutics, and new boosters targeting the dominant circulating strain of coronavirus are now available.

And even after the arrival of the Omicron variant — which spurred cases to unprecedented levels — California didn’t come close to reinstating the shutdowns or other severe restrictions typical of earlier phases of the pandemic.

Still, public health experts remain concerned about the significant number of daily deaths. And there is concern that too few Americans have received a single booster shot, which is important to protect against serious illnesses.

“We’re much better off now,” said Dr. Anthony Fauci, Biden’s senior medical adviser for the pandemic, during a recent virtual presentation by the Center for Strategic and International Studies. “But we’re not where we need to be if we’re going to, quote, ‘live with the virus’.”

There is no doubt that conditions have improved since the pandemic’s darkest days, when more than 3,000 Americans were dying each day. Since August, the US has been reporting 350 to 500 COVID-19 deaths every day. That’s above the low of about 200 before last year’s delta rise and is “unacceptably high,” Fauci said.

Over a year, that would result in 125,000 to 180,000 COVID-19 deaths — four to five times the average annual flu death toll, which is around 35,000.

“Four to five hundred deaths a day is simply unacceptable,” said Dr. Ashish Jha, the White House COVID-19 response coordinator, on Tuesday at another forum hosted by the Center for Strategic and International Studies. “It’s a level of suffering and death that we don’t accept as ‘living with COVID’.”

While there is no shortage of pundits, politicians and other forecasters clamoring to declare the end of the pandemic, the final call rests with the WHO.

And that’s a decision likely based on a scientific committee’s review of the data, not personal feelings.

“The definition of a pandemic is an outbreak of a disease that has then spread beyond a country or two to become global,” said Dr. Robert Kim-Farley, epidemiologist and infectious disease expert at UCLA Fielding School of Public Health.

A challenge in defining the end of a pandemic is figuring out when we’ve returned to some kind of baseline for coronavirus cases and deaths. Right now, “we don’t have the baseline for COVID because we’ve never had it before,” Kim-Farley said.

Before the coronavirus, the last time the WHO declared a global pandemic was H1N1 swine flu in 2009. However, that pandemic was less deadly than initially feared, and the agency declared its end the following year.

A previous system outlined by the WHO divided the course of a pandemic influenza into several phases – including a “post-peak” period during which “pandemic activity appears to be declining; however, it is uncertain whether further waves will occur,” followed by a “post-pandemic phase.”

But COVID-19 is the first pandemic known to be caused by a coronavirus.

A man in a mask sits next to a microphone

The Director-General of the World Health Organization, Tedros Adhanom Ghebreyesus, spoke at the agency’s Geneva headquarters last year.

(Laurent Gillieron/Keystone/Associated Press)

WHO Director-General Tedros Adhanom Ghebreyesus has tried to reconcile the unequivocal data showing the pandemic is improving while stressing that it is not over yet. He noted in early September that the number of weekly reported COVID-19 deaths had fallen to its lowest level since the pandemic began.

“We have never been in a better position to end the pandemic. We’re not there yet, but the end is in sight,” said Tedros.

He also compared the fight against COVID-19 to running a marathon who has not yet finished the race.

“Now is the worst time to stop running,” he said. “If we don’t seize this opportunity now, we risk more variants, more deaths, more disruption and more uncertainty.”

Scientists must experience many months of stability before it is certain that the pandemic is over. Declaring the end too early could be like giving the all-clear after a major earthquake when the potential for significant aftershocks still exists.

There are also additional practical consequences.

“I always worry that when you hear the pandemic is over, we’ll run out of resources to do the things we desperately need to keep each other safe,” said Barbara Ferrer, Los Angeles County Public Health Director . “We need money for vaccines so that they are still free. We need free trials. We need free access to the therapeutics to get us through the next few months. So I hope nobody thinks that we don’t need these resources to continue the hard work that we are doing.”

Also, to say, “we’re not in a pandemic phase anymore, metaphorically, federal agencies aren’t really willing to support some of these efforts to reduce these deaths,” said Dr. Peter Chin-Hong, a UC San Francisco infectious disease expert.

Chin-Hong said his definition of the end of a pandemic is when there is some level of predictability and a lower number of deaths — and neither of those criteria are met.

“It’s odd to say the pandemic is over now based on a point in time. It’s really more of a longitudinal assessment,” or examining trends over time, Chin-Hong said. “It’s like saying the pandemic was over before Omicron struck.”

COVID-19 was the third leading cause of death in the US in 2021, behind only heart disease and cancer. And during the first four months of this year, the per capita death rate from the disease in LA County was higher than the rates for diabetes, car accidents and flu/pneumonia.

Elderly residents continue to die at an increased rate. LA County’s COVID-19 death rate between May and July 2022 for persons age 65 and older was significantly higher than the same period in 2021. The pandemic also continues to disproportionately affect poorer residents and people of color.

It’s clear that “we’re in such a better place this year than we’ve ever been during the pandemic,” Ferrer said. “But we still have a lot to do before the end.”

Unvaccinated individuals also remain at greater risk – of both infection and the worst health consequences of COVID-19.

“That’s why everyone thinks that the end of this year will be another surge because [a number of] People who had a natural infection, say in January, with the onset of Omicron, would have had their immunity shriveled … where they might be more susceptible to reinfection,” Chin-Hong said.

In July, unvaccinated Californians were 2.5 times more likely to contract COVID-19 and 3.6 times more likely to die from the disease than those who had completed their primary immunization series, the researchers said latest available data from the State Department of Health.

When someone, especially someone who isn’t vaccinated, gets infected a second time, “it’s like playing COVID roulette. You don’t know if you’ll get very sick at that point,” Chin-Hong said. “For example, if someone has received three doses of a vaccine, I know I can be more confident that that person will not be seriously ill.”

Many experts expect that COVID-19 will eventually calm down enough to cause about 100,000 deaths annually in the US, which is still well above the typical annual mortality from the flu.

“Is that acceptable? Maybe it’s for society, but it’s something we didn’t have in 2019,” Chin-Hong said.

The ultimate joker is whether another problematic new variant gains traction.

“The ultimate goal would be… [to] achieve a level of control low enough not to disrupt our social order and essentially dominate what’s happening in society,” Fauci said. “We’re moving in that direction, but we have to be aware … that as we get into the coming late fall and winter, we’ll likely see another variant emerge.”

There is already a relatively new subvariant of Omicron, BA.2.75.2, which is being watched closely by the authorities.

Another Omicron subvariant, BA.5, remains the dominant version of the nation’s circulating coronavirus – accounting for an estimated 83.1% of cases in the week ending Saturday, according to data from the US Centers for Disease Control and Prevention. However, its grip has slipped recently, coinciding with small gains from newer subvariants like BA.4.6 and BF.7.

Right now, the only certainty about the coronavirus is uncertainty.

“Who knows when the next stage will come? Who knows what variants there will be? And what will happen in 2023 after this potential winter flood?” asked Chin-Hong.

As Ferrer put it Tuesday, “It would be foolish not to be prepared for uncertainty because we’ve just seen so much uncertainty.

“We are very optimistic. We have great tools. For the first time, we’re going to go into winter with a booster dose that’s actually aligned with what’s out there right now, which will give us a lot of protection,” she said during an update from the LA County Board of Supervisors. “But people need to get vaccinated and it’s difficult to motivate people to get vaccinated when they feel like the pandemic is over.

“So I think we have to be realistic to say we’re in a much better place than we’ve been in a long time, we have a great tool for this fall. But we still have to be aware that the pandemic is not over yet.”

https://www.latimes.com/california/story/2022-10-03/new-declarations-that-the-pandemic-is-over-once-again-miss-the-larger-point-experts-say Is the COVID pandemic over? Too soon to say, experts insist

Alley Einstein

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