Opinion | Why I Hope the COVID Pandemic Isn’t Over – Medpage Today

Sandman is a risk communication consultant.

On December 31, 2023, the World Health Organization's Maria Van Kerkhove, PhD, MS, tweeted that COVID-19 is "still a pandemic." Her long thread went on to detail the paradox of COVID's continued threat to health, the variety of ways to reduce the risk, and the high level of public complacency.

She is surely right about the complacency. As far as the U.S. media and general public are concerned, the COVID pandemic is over. Anyone who argues to the contrary is shrugged off as a doomsayer (if not a shill for Big Pharma).

It's been that way for a while. President Joe Biden said the pandemic was over in September 2022. A March 2023 WebMD headline read: "It's (Finally) Time to Stop Calling It a Pandemic: Experts." By June 2023, 64% of Americans had reached the same conclusion, according to a Gallup Poll.

Now, in January 2024, news articles about COVID are much less common -- and the few remaining articles, if they use the word "pandemic" at all, mostly do so in the past tense. Even articles urging people to take COVID precautions seldom resort to the "p" word. Just because the pandemic is over, they seem to be saying, that's no reason to throw caution to the wind.

An ever-growing majority of Americans desperately want to throw caution to the wind. To justify doing so, they are deeply committed to insisting that the pandemic is over.

This gets things exactly backwards. If we're lucky, the pandemic is not over. Here's why.

Deadliness Comparisons

According to CDC, COVID killed 42,670 people in the U.S. in the first half of 2023. (All COVID statistics are squishy and debatable -- consider the debate between died "of" COVID and died "with" COVID -- but the CDC statistics will do for comparison purposes.) In the first half of 2021, according to the same CDC spreadsheet, COVID killed 219,222 people in the U.S. By this measure, COVID was a little over five times deadlier to Americans 2 years ago than it is today. That's a big piece of why people feel entitled to claim the pandemic is over.

But consider a different comparator: flu. That same CDC spreadsheet says flu killed 23,613 people in the U.S. in the first half of 2023 -- making COVID 1.8 times as deadly as flu.

Okay, so COVID today is about five times less deadly than it was 2 years ago, and still almost twice as deadly as flu.

The big question is what's going to happen to COVID's deadliness in the years ahead. The experts are pretty sure the virus is not going to die out. But that's about all they're sure of. Given the COVID mutation lottery, they won't be terribly surprised if COVID gets deadlier again. Nor will they be very surprised if it stays pretty much as deadly as it is right now, or if it starts oscillating between parameters we will eventually come to understand and expect, the way flu does, with good years and bad years.

The other possibility, the happiest one and some people think the likeliest one, is that COVID keeps killing fewer and fewer Americans in the next several years before settling into a pattern significantly less deadly than it is now. Maybe similar to flu. Maybe less deadly than flu.

Why is that a reasonable expectation? Our immunity keeps improving. Thanks to repeated vaccination, repeated infection, or both, our bodies (our antibodies, really) are getting better at fighting off SARS-CoV-2. We still get infected but we don't get as sick. New and improved antivirals and other treatments contribute to the rosy prognosis. Yes, the virus might mutate in a way that makes it deadlier. But there's a good chance, maybe better-than-even chance, that COVID will be a lesser health threat in the 2030s than it was in the 2020s.

The chronic disease picture isn't so rosy. We don't know yet how bad or how "long" long COVID will be. But it's almost certainly going to be worse and longer than long flu.

Even so, the toll of acute COVID deaths (and COVID hospitalizations) has declined precipitously in the past 2 years, and there's a pretty good chance that it will keep declining in the next few years.

What does that mean for the question of whether the pandemic is over?

Hope for Dwindling, Not "Over"

There's no universally accepted definition of the term "pandemic," but there are some universally accepted components. Most definitions include some combination of these variables. Disease outbreaks are called "pandemic" when:

Seasonal flu is serious, transmissible, and widespread, but it has been around for centuries and we know what to expect. So it's not pandemic. From time to time a new flu strain starts circulating. Precisely because it's new, it's unpredictable. If it is also serious, transmissible, and widespread, we've got ourselves a flu epidemic -- or pandemic if it spreads globally. A year or two later, when the new strain becomes predictable, part of the new normal, the experts declare the flu pandemic over.

Once COVID settles into a predictable pattern, the experts will declare the COVID pandemic over. If 2024 and 2025 and 2026 turn out pretty much like 2023, we will know in hindsight that the COVID pandemic of 2020-2022 ended in 2023. If so, we'll have to face a new normal with a brand new disease nearly twice as deadly as flu...on top of flu and all the other diseases we face.

I'm hoping for better. I'm hoping that 2024 sees fewer COVID deaths than 2023, and 2025 sees fewer than 2024. I'm hoping that by 2030 COVID will have settled into a newly familiar pattern significantly less deadly than it was in 2023. I'm hoping the COVID pandemic dwindles for a few more years before it ends.

And that's why I hope the COVID pandemic isn't over.

Peter M. Sandman, PhD, MA, is a mostly retired risk communication consultant. His writing on pandemics and other risk communication topics can be found at http://www.psandman.com.

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Opinion | Why I Hope the COVID Pandemic Isn't Over - Medpage Today