COVID continues to rise, but life is returning to normal everywhere you look. When will the epidemic really end?

COVID will never go away. But the pandemic will inevitably end at some point. right?

For many, it has already been done, with masks, social distancing, and frequent hand-washing to a painful past they don’t want to return to.

This week, the Biden administration Extended the state of public health emergency in the United States for another 90 days, though US Department of Health and Human Services officials recently warned states that the state of emergency may end soon. WHO officials also continue to express optimism that The global health emergency may be coming to an end this year. Committee meeting on this issue set on January 27.

Are we still — or not — in a pandemic, three years later? There is no consensus on the definitions of the terms “epidemic” and “endemic,” which loosely refer to an outbreak of a disease affecting the world, and a specific area such as a country, respectively. Since there is no agreement, it is impossible to say whether the epidemic is ongoing. Personal opinions vary, and shades of gray abound.

At what point do we all agree? Will we ever do that?

“Unfortunately, the term ‘pandemic’ is really more of a political and social term than a scientific one,” said Dr. Jay Varma, chief medical advisor at the Kroll Institute think tank in New York. luck. Varma, a 20-year veteran of the US Centers for Disease Control and Prevention, was the lead architect of the response to the COVID-19 pandemic in New York City before joining the institute in March.

An epidemic, at least in the court of public opinion, tends to turn into a pandemic, Varma said, “when a society or government reaches a point where it is willing to accept a certain number of deaths each day.”

Certainly not scientists who decide that. Public health workers may say this is unacceptable.”

Dr. Michael Merson, a visiting professor at New York University’s School of Global Public Health, echoed Pharma’s comments, saying: luck That the general public has accepted that the pandemic is over – at the cost of collective toll.

He acknowledges that conditions are better than they were in the early days of 2020. Still, he said, COVID “still causes – for me – an unacceptable number of deaths,” adding that society’s acceptance of the body count — hundreds of thousands a year in the US alone — It is “worrying”.

Not now, of all times

Many public health experts maintain that at all times to declare a pandemic over, it is not the case now. The reason: China’s recent deregulation from years of “zero COVID” restrictions. The reopening appears to have taken place without much planning, or any planning, leaving the majority of China’s 1.4 billion people vulnerable to illness, hospitalization, death, and COVID for a long time — one at a time.

Reopening is a wildcard for the world as well, putting it at risk of potentially dangerous new variants that are statistically more likely to occur there, given the very high levels of transmission. Chinese New Year gatherings on January 22nd are likely to increase fuel transmission. What’s more, the Chinese government Allowing residents to travel internationally again.

Aside from China, potentially frightening COVID-19 variant XBB.1.5 levels, It’s called “Kraken” We are rising in the United States They played a role in A recent rise in hospitalizations in the Northeast— a trend that could happen in the rest of the country, as the virus spreads westward. Other countries may eventually find themselves in a similar situation.

The rise of XBB.1.5, Varma said, “is just a reminder that as much as he would like this pandemic to end, it is not.”. “The virus is not acting as if it wants the epidemic to end.”

However, it may be time to end the emergency declarations, said Dr. George Benjamin, president of the American Public Health Association, a 150-year-old organization of public health professionals that seeks to advance health and health equality in the United States, luck.

“It has to go away at some point,” he said Tuesday of the US federal health emergency. “And I think we’re rapidly approaching that point.”

“Policy makers don’t want to fund it anymore; people don’t want to pay attention to it anymore.” It’s human behavior. If everything is emergency, then nothing is.

Benjamin warned that declaring an end to the state of emergency does not mean the end of the pandemic.

He said, “It doesn’t mean anything.” “We are not in a public health emergency and we still have an HIV/AIDS pandemic.”

How to get out of a pandemic

There are a few generally accepted paths out of a pandemic situation, says Dr. Bruce Y. Lee, professor of health policy and management at the City University of New York School of Public Health, Tell luck.

One of them: when the level of COVID infection has decreased sufficiently across the world. The virus can settle into a true seasonal pattern, similar to what we see with RSV and influenza, where cases are virtually non-existent in the summer and spike in the winter. Or COVID levels could drop – somewhat – to a “high plateau” for prolonged periods, with a relatively high level of cases occurring throughout the year.

He assures me that the transition to the latter scenario could be in the works now. Peaks in cases are not as high as they were in the early days of the pandemic. And the valleys between the elevations aren’t as low as they used to be — painting a possible picture of a future endemic COVID with ever-high levels of virus transmission.

Lee says the seasonal style would be preferable.

“We don’t want to have plateaus over the highs or flat levels throughout the year,” he said. “This is much more difficult than managing something seasonal.”

Glorifying a cold or the flu?

With the United States still in the grip of a “triple pandemic” of COVID, RSV, and influenza, public health officials are warning those with symptoms such as fever and malaise not to assume they have the flu, and get tested for COVID. Experts say it’s virtually impossible to tell the two apart based on symptoms at the moment.

It’s a fact that is fueling discussions about office water coolers over the ongoing pandemic’s legality. How can COVID remain in a pandemic if it is indistinguishable from the flu or, for some, a common cold?

It’s a fair question, but its answer is simple: Cold viruses rarely kill — and the flu doesn’t kill nearly as well as COVID.

“Psychologically, I fear the public will accept our current situation with the pandemic over, despite the fact that we have 250,000, 300,000 deaths a year — much more than we have with the flu,” said Merson, of New York University. .

Last season, the flu killed me Estimated 5,000 AmericansAccording to the US Centers for Disease Control and Prevention. It was a mild flu year, sure, thanks to pandemic precautions. But the annual death toll from influenza They routinely number in the tens of thousands-Not Hundreds of thousands, such as COVID deaths. Since the epidemic began, COVID has killed nearly 1.1 million Americans. I killed the flu less than 50,000.

While the public and many public health experts remain at odds about the state of the pandemic, Lee says things are getting better — for now.

In 2020, many public health experts projected the pandemic would last about 2.5 to 3 years, he says — about the length of the 1918 influenza pandemic and other disease outbreaks, such as the Japanese smallpox epidemic of 735-737, the Black Death, and the Italian plague of 1629-1631. .

He told me, “We’re working roughly on schedule, plus or minus—plus more—than we originally projected. And that suggests 2023 could be the big transition year. We’re seeing the right trends.”

This story originally appeared on Fortune.com

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