Three years later, the COVID pandemic may never end, but the public health impact is becoming more manageable

Three years ago, on March 11, 2020, the Director General of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, officially described COVID-19 as a pandemic for the first time.

The impact of the pandemic on all aspects of society has been enormous, but we have come a long way since March 2020. The toll of this novel coronavirus has been mitigated thanks to responses from science, healthcare and public health.

At this point, it’s not unreasonable to wonder when the pandemic will be over. But the WHO continues to consider COVID a pandemic. Let’s take a look back at how we got here and explore where we might be heading.

First, what is a pandemic?

The term “pandemic” may have slightly different definitions depending on where you look. However, perhaps the most common use of the term applies to an emerging threat that is spreading across multiple countries: “an outbreak that occurs around the world.”

Essentially, a pandemic is one level above a public health emergency of international concern (USPPI). The WHO declared COVID a PHEIC (pronounced “false”) on January 30, 2020.

A USPPI, as defined in the International Health Regulations, is “an extraordinary event” where there is a risk of international spread of disease and which may require a coordinated international response. Previous examples include the Ebola outbreak in West Africa in 2014, the emergence of the Zika virus in 2016, and the mpox (monkey pox) outbreak in 2022.

Interestingly though, unlike a USPPI, the WHO does not have the authority to officially declare the start or end of a pandemic. Indeed, the term is not a category in the International Health Regulations, an important legal instrument. However, the WHO’s labeling of COVID as a pandemic carries a lot of weight and it has become widely seen as such.

Emergency committees can decide what constitutes a pandemic versus a USPPI based on factors such as the severity of the disease, its mode of transmission and its impact on nations.

A transition point

On January 30, 2023, exactly three years after the USPPI statement, the WHO issued a new statement stating that COVID should still be considered a USPPI, but noting that “the COVID-19 pandemic is likely at a transition point”. This acknowledges the fact that high levels of immunity to COVID are now limiting its impact.

The transition point refers to the de-escalation of COVID as PHEIC, which some have speculated could happen in April. Indeed, Adhanom Ghebreyesus said in December 2022 that the WHO hoped that “we can say that COVID-19 is no longer a global health emergency” at some point in 2023.

This change would reduce available funding and international coordination. This must be balanced with appropriate action that takes into account the continued burden of COVID, recognizing that each country will be at a different stage in their handling of the pandemic.

In this statement, there is a continuous reference to an ongoing “pandemic”. It’s not unreasonable, because COVID really does continue to meet any commonly used definition. There is, and will be for the foreseeable future, sustained transmission in several countries, alongside a significant burden of hospitalizations and deaths. Therefore, we may find ourselves in a situation where there is technically an ongoing pandemic despite the declared end of the USPPI. Such are the difficulties in defining the different stages of a global crisis.

There are still around 150,000 confirmed cases worldwide every day, with many more going unrecorded as real-time data management is relaxed in most countries.

Countries like China reported numerous epidemics in late 2022 and early 2023, with a significant impact on their health services. For a long time, COVID will continue to affect millions of people.

Widespread misinformation from influential anti-vaccination campaigners continues to be a problem, with the WHO citing the need to “tackle the infodemic”.

So, despite the incredible success of COVID vaccines and other public health efforts to bring outbreaks under broad control, the pandemic is not yet in the past. However, we are coming out of the emergency response phase.

How did other pandemics end?

Declared and final end of the 2009-2010 swine flu pandemic. It was a little easier due to seasonal flu patterns, something we don’t see with COVID.

Although real-time surveillance would have been limited, the influenza pandemics of 1918-19 and 1957-1958 also ended relatively clearly.

The precise endings of pandemics older in history, such as the Black Death in the 14th century and the large-scale smallpox epidemic in the 16th century, are unclear, but are ultimately defined from retrospective reports in the books. of history, rather than by scientific committees.

Declaring a new USPPI or defining the start of a pandemic is a little easier than the end. If the outbreak just isn’t ending, then declaring a time when “it’s over” is understandably tricky.

As the WHO indicates in its recent statement, the focus on COVID must continue beyond any defined end of the public health emergency. This goal must remain even as countries consider how to integrate their fight against the disease into a more routine public health and health service infrastructure.

The COVID pandemic may never be over. However, the public health threat from this virus is expected to continue to decline. The need to learn the lessons of this pandemic before the inevitable next time is essential. History has shown us that infectious diseases have the ability to evolve and emerge in unpredictable ways. The next pandemic may be imminent – ​​and we don’t know at what corner.

This article is republished from The Conversation under a Creative Commons license. Read the original article.